Orthognathic surgery in cleft lip and palate patents

Abstract

Maxillary hypoplasia is unavoidable for some patients with cleft lip and palate despite various surgical modifications and orthodontic efforts. Maxillary hypoplasia is observed three-dimensionally in cleft lip and palate patients. Retrusion, vertical deficiency, and asymmetry accompanied by maxillary hypopla-sia can be treated with Le Fort I osteotomy. However, vertical maxillary deficiency is overlooked in a few patients, close relationship of plastic surgeons and orthodontists is recommended. Disadvantages of maxillary osteotomy in cleft patients are intraoperative bleeding, circulatory disturbance of the maxillary segment, postoperative relapse, and deterioration of speech and velopharyngeal incompetence, Alveolar bone grafting prior to the maxillary osteotomy is necessary to prevent those complications. In order to prevent postoperative relapse, maxillomandibular osteotomies are recommended over maxillary osteotomy alone in the case of moderate or severe maxillary hypoplasia, and maxillary distraction is preferred in severe hypoplasia cases. However, while maxillary distraction is not always necessary in cleft patients, it should be performed in severe cases. The purpose of maxillary osteotomy is achievement of normal occlusion and better facial appearance. Definitive correction of the lip and nose after maxillary osteotomies provides better facial appearance.