title: [Orthognathic surgery for patients with cleft lip and palate].
abstract: Patients with cleft lip and palate frequently develop dento-facial deformity requiring orthognatic surgery. The origin of this deformity is therapeutic and surgeons are currently trying to prevent this iatrogenicity. The maxillary dento-facial deformity in these patients is a retrognathia with infragnathia, associated with endognathia, obliquity of the occlusal plane, with deviation of the superior incisive midline in case of unilateral clefts. The difficulties in the treatment of these skeletal deformities are due to the palatal, labial, and pterygomaxillary scar tissue. Orthognathic surgery is most of the time bimaxillary with a 3-dimensional movement of the jaws including maxillary advancement. The aims of surgery are occlusal, esthetic, and functional improvement. The first step is gingivoperiosteoplasty (ideally performed during childhood), orthodontic treatment including, if necessary, transversal maxillary distraction to obtain enough space to replace the lateral incisor; extraction of premolars should be avoided if possible. Planning and performing the treatment are difficult for the orthodontist and for the surgeon. Maxillary advancement by distraction may be an interesting alternative to prevent partial relapse. Obtaining normal oro-facial functions are required for a stable result. These should be monitored after the primary treatment by the whole staff, surgeons, speech therapist, and orthodontists. Performing Le Fort 1 osteotomy is more difficult than in other patients because of scar fibrosis than needs to be released.
authors.affiliation: 5, rue Chambovet, 69003 Lyon, France. Electronic address: docteurpaulus@paulus-richard.com.
authors.forename: C
authors.initials: C
authors.lastname: Paulus
mesh_terms: D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D019465:Craniofacial Abnormalities / Q000145:classification / Q000601:surgery; D006801:Humans; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D012008:Recurrence; D000267:Tissue Adhesions / Q000601:surgery
keywords: Chirurgie orthognathique; Cleft lip; Cleft palate; Fente labiale; Fente palatine; Orthognatic surgery