title: Surgical repositioning of the premaxilla with bone graft in 50 bilateral cleft lip and palate patients.
abstract: OBJECTIVE
  The aim of this study was to evaluate a modified surgical technique for premaxilla repositioning with concomitant autogenous bone grafting in bilateral trans-foramen cleft lip and palate patients.
  
  
  METHODS
  The study included 50 bilateral trans-foramen cleft lip and palate patients. Bone graft was harvested from the mandibular symphysis in 24 patients. Whenever more grafting was necessary, the iliac crest bone was used as the donor site (26 patients). The premaxilla was displaced by rupturing the bone and the palatine mucosa, and repositioned in a more adequate position using a surgical guide. The premaxilla and the grafts were fixed with miniplates and screws or screws only. The surgical guide was kept in place for 2 months, whereas the miniplates and screws were removed after 6 months, together with the complete bilateral lip and nose repair. Follow-up examinations were performed at 3, 6, and 12 months by means of periapical and occlusal radiographs, and by clinical examination. Thereafter, the patients were referred for completion of the orthodontic treatment.
  
  
  RESULTS
  Overall, in 48 cases (96%) the treatment achieved total graft integration, with complete closure of the bucconasal and palatal fistulas, and premaxilla stability (either at first surgery or after reoperation). In the remaining 2 patients (4%), the treatment failed, due to necrosis of the premaxilla.
  
  
  CONCLUSIONS
  The procedure is complex and involves risk. However, the patient's social inclusion, especially at the addressed age group, is the best benefit achieved.
authors.affiliation: Oral and Maxillofacial Surgery, Center for Integral Assistance of Cleft Lip and Palate Patients, Curitiba, Paraná, Brazil.
authors.forename: João L
authors.initials: JL
authors.lastname: Carlini
authors.forename: Cassia
authors.initials: C
authors.lastname: Biron
authors.forename: Kelston Ulbricht
authors.initials: KU
authors.lastname: Gomes
authors.forename: Rafael M
authors.initials: RM
authors.lastname: Da Silva
mesh_terms: D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D009296:Nasal Cavity / Q000601:surgery; D009336:Necrosis; D009666:Nose / Q000601:surgery; D009668:Nose Diseases / Q000601:surgery; D016155:Oral Fistula / Q000601:surgery; D010027:Osteotomy / Q000379:methods; D010159:Palate / Q000601:surgery; D010521:Periosteum / Q000601:surgery; D011183:Postoperative Complications; D016156:Respiratory Tract Fistula / Q000601:surgery; D013524:Surgical Flaps