Orthognathic surgical treatment of secondary maxillary deformities following the cleft lip and palate repair
10.3760/cma.j.issn.1009-4598.2019.01.003
- VernacularTitle: 唇腭裂术后继发上颌骨畸形的正颌外科治疗
- Author:
Xiaofeng BAI
1
;
Bin ZHANG
1
;
Yulou TIAN
2
;
Li LU
1
;
Zengjian LI
1
;
Zhenzhen ZHANG
1
;
Yang LU
1
;
Qiang LIU
1
Author Information
1. Department of Oral-Maxillofacial Surgery and Plastic Surgery, School of Stomatology, China Medical University, Shenyang 110002, China
2. Department of Orthodontics, School of Stomatology, China Medical University, Shenyang 110002, China
- Publication Type:Clinical Trail
- Keywords:
Cleft lip and palate;
Orthognathic surgery;
Maxillary deformity
- From:
Chinese Journal of Plastic Surgery
2019;35(1):12-16
- CountryChina
- Language:Chinese
-
Abstract:
Objective:The aim of this study is to summarize the experience of the orthognathic surgical treatment forsecondary maxillary deformities following the cleft lip and palate repair.
Methods:Twenty-two patients with secondary maxillary deformities following the cleft lip and palate repairment(orthognathic approach), were retrospectively analyzed.All the cases were treated in the Hospital of Stomatology, China Medical University from January 2007 to December 2016. There were 9 males and 13 females, ranging from 18 to 24 years in age. Only 3 of those cases were not undergone preoperative and postoperative orthodontic treatments. The anteroposterior maxilla and mandible discrepancy was 6-11 mm preoperatively. The modified surgical procedures are as follows: One-stage alveolar bone graftand maxillary osteotomy were performed for unilateral cleft patients; Internal fixation with micro-plate at the alveolar cleft region was performed to stabilize the maxillary dental arch intraoperatively; Intermolar wire ligation and palatal arch were used to control the width of maxilla intraoperatively and 1 month after operation; 2-3 mm overcorrection for the Le Fort Ⅰ advancement was produced to reduce relapse in sagittal direction. Mandibular set back was performed using bilateral sagittal split osteotomy at the same time. Rigid internal fixation with titanium palates and screws was applied for all the cases. All patients had been followed up for 1 to 2 years postoperatively.
Results:Most of the patients had satisfactory facial proportion, and good and stable occlusion relationship, with only one patient developed severely uncontrollable relapse to class Ⅲ malocclusion, and 3 patients experienced relapse resulted in edge to edge incisor relationship.
Conclusions:Le Fort Ⅰ osteotomy combined with bilateral sagittal split osteotomy was effective to correct the secondary maxillary deformities following the cleft lip and palate repair. The treatment plan should be individualized, depending on the patients′ occlusion relationship, skeletal deformity, and facial appearance as well. It is necessary to modify the surgical techniques of Le Fort Ⅰ osteotomy for the cleft patients.
