title: Management of the premaxilla in the treatment of bilateral cleft of lip and palate: what can the literature tell us?
abstract: OBJECTIVE
  In the treatment of bilateral cleft lip and palate (BCLP) patients, there is discussion about the management of the position of the premaxilla. This literature analysis summarises the literature on managing this condition.
  
  
  METHODS
  A PubMed, Embase and Cochrane Library search was conducted resulting in 4465 articles which were screened on title and abstract.
  
  
  RESULTS
  Seventy-one articles were available in full text, 16 of which were included in this literature analysis. We searched on keywords timing and technique, complications, growth of the maxilla and results after bone grafting the alveolar process. This literature analysis has shown that there are various ways to correct the position of the premaxilla. These can be divided into primary, early, late secondary and tertiary intervention before the age of 8 years, between the ages of 8 and 12 years and older than 12 years. Correction is done with surgery, orthodontics or a combination, with or without bone grafting.
  
  
  CONCLUSIONS
  An osteotomy of the premaxilla in combination with secondary alveolar bone grafting appears to be the most successful technique. Combining early secondary alveolar bone grafting with osteotomy creates more room to ensure a watertight closure of the nasal mucosa resulting in fewer postoperative complications. Before surgery, the orthodontist should try to optimise the position of the premaxilla for its surgical correction prior to bone grafting.
  
  
  CONCLUSIONS
  The treatment of BCLP patients is still based on experience and expert opinions. This literature analysis tries to give a summery on how to handle the protruded and displaced premaxilla.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands. koen.bittermann@me.com.
authors.forename: Gerhard K P
authors.initials: GK
authors.lastname: Bittermann
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands.
authors.forename: Ad P
authors.initials: AP
authors.lastname: de Ruiter
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands.
authors.forename: Nard G
authors.initials: NG
authors.lastname: Janssen
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Arnold J N
authors.initials: AJ
authors.lastname: Bittermann
authors.affiliation: Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Aebele M
authors.initials: AM
authors.lastname: van der Molen
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands.
authors.forename: Robert J J
authors.initials: RJ
authors.lastname: van Es
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands.
authors.forename: Antoine J W P
authors.initials: AJ
authors.lastname: Rosenberg
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Koole
mesh_terms: D000293:Adolescent; D016025:Bone Transplantation; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery* / Q000628:therapy; D002972:Cleft Palate / Q000601:surgery* / Q000628:therapy; D006801:Humans; D007223:Infant; D008437:Maxilla / Q000002:abnormalities* / Q000254:growth & development / Q000601:surgery*; D009970:Orthodontics
keywords: Alveolar bone grafting; BCLP; Osteotomy; Premaxilla