Fracture of the vomero-premaxillary junction in a repaired bilateral cleft lip and palate patient

Abstract

Although dental trauma is common in bilateral cleft lip and palate (BCLP), patients' reports on bony fractures of the vomero-premaxillary junction cannot be found. The aimof this report is to illustrate clinical findings and the technique of fracture fixation in a child suffering from a fractured vomero-premaxillary junction as well as subsequent columella lengthening. A 4-year-old girlwith a repaired BCLP presented with an open mucosal laceration and fractured vomeropremaxillary junction.Open reduction and fixation of the dislocated premaxilla was performed under general anesthesia. Fractured bone pieces of the vomero-premaxillary junction were removed and sharp bone edges at the vomer and the premaxilla were grinded. The repositioned premaxilla was fixed to the lateral alveolar arches with two mucoperiosteal sutures on each side. Additional columella lengthening was performed 2 years later. All family memberswere very happy about the new aesthetics of the girl. Although rare, fractures of the vomero-premaxillary junction present several challenges to clinicians related to anatomical, physiological, and psychological issues. Immediate and minimal invasive treatment strategies are recommended when managing such cases.