Modification of the maxillary Le Fort I osteotomy in cleft-orthognathic surgery: the bilateral cleft lip and palate deformity.
The adolescent with bilateral cleft lip and palate (BCLP) undergoing orthognathic surgery may have multiple residual clefting problems, including a mobile, dysplastic premaxilla and hypoplastic lateral maxillary segments, with each segment misaligned in three dimensions. These problems are commonly compounded by residual oronasal fistulas, bony defects, soft-tissue scarring from previous surgery, and the congenital absence of the maxillary lateral incisor teeth with resulting cleft-dental gaps. This article describes modifications of the Le Fort I osteotomy that allow for the simultaneous routine and safe management of these deformities. Results of this operation on 22 consecutive patients are reported, with findings of follow-up ranging from 1 to 5 years. The long-term parameters reviewed include closure of residual oronasal fistulas, stabilization of the premaxilla, cleft-dental gap closure, maintenance of attached gingiva at the cleft site, maintenance of a positive overjet and overbite, the need for prosthetics to complete dental rehabilitation, and surgical morbidity.
Posnick
J C
JC
Division of Plastic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Tompson
B
B
D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation; D002971:Cleft Lip / Q000150:complications / Q000534:rehabilitation / Q000601:surgery*; D002972:Cleft Palate / Q000150:complications / Q000534:rehabilitation / Q000601:surgery*; D003830:Denture, Partial, Fixed; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery; D006801:Humans; D007180:Incisor / Q000002:abnormalities; D008297:Male; D008310:Malocclusion / Q000209:etiology / Q000628:therapy; D009059:Mouth Diseases / Q000209:etiology / Q000601:surgery; D009668:Nose Diseases / Q000209:etiology / Q000601:surgery; D009971:Orthodontics, Corrective; D010027:Osteotomy / Q000379:methods*