Advertisement

Cleft-Orthognathic Surgery

  • Jeffrey C. Posnick
  • Paul S. Tiwana

26.7 Conclusions

For the cleft patient presenting in adolescence with a jaw discrepancy and malocclusion, misinformation and limited available surgical and dental expertise often prevents a favorable facial reconstruction and dental rehabilitation. A major advantage of the modified Le Fort I osteotomy is its ability to simultaneously: close cleft dental gap(s), resolve oro-nasal fistulas, manage skeletal defects, stabilize dentoalveolar segments, and correct jaw deformities. When a thoughtful staging of reconstruction is undertaken, individuals born with cleft lip and palate can reach adolescence after undergoing only a limited number of operations and interventions, without negative attention being drawn to their original malformation.

Keywords

Cleft Palate Distraction Osteogenesis Orthognathic Surgery Alveolar Cleft Palate Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Canady JW, Thompson SA, Colburn A. Craniofacial growth after iatrogenic cleft palate repair in a fetal bovine model. Cleft Palate Craniofac J 1997; 34:69.PubMedCrossRefGoogle Scholar
  2. 2.
    Correa Normando AD, da Silva Filho OG, Capelozza Filho L. Influence of surgery on maxillary growth in cleft lip and/or palate patients. J Craniomaxillofac Surg 1992; 20:111.Google Scholar
  3. 3.
    Daskalogiannakis J, Ross RB. Effect of alveolar bone grafting in the mixed dentition on maxillary growth in complete unilateral cleft lip and palate patients. Cleft Palate Craniofac J 1997; 34:455.PubMedCrossRefGoogle Scholar
  4. 4.
    DeLuke DM, Marchand A, Robles EC, et al. Facial growth and the need for orthognathic surgery after cleft palate repair: Literature review and report of 28 cases. J Oral Maxillofac Surg 1997; 56:604.Google Scholar
  5. 5.
    Gnoinski W. Early identification of candidates for corrective maxillary osteotomy in cleft lip and palate group. Scand J Plast Reconstr Surg 1987; 21:39.Google Scholar
  6. 6.
    Laspos CP, Kyrkanides S, Moss ME, et al. Mandibular and maxillary asymmetry in individuals with unilateral cleft lip and palate. Cleft Palate Craniofacial J 1997; 34:232.CrossRefGoogle Scholar
  7. 7.
    Laspos CP, Kyrkanides S, Tallents RH, et al. Mandibular asymmetry in noncleft and unilateral cleft lip and palate individuals. Cleft Palate Craniofac J 1997; 34:410.PubMedCrossRefGoogle Scholar
  8. 8.
    Motohashi N, Kuroda T, Filho LC, et al. P-A cephalometric analysis of a nonoperated adult cleft lip and palate. Cleft Palate Craniofac J 1994; 31:193.PubMedCrossRefGoogle Scholar
  9. 9.
    Posnick JC. Discussion of: Rosenstein SW. Facial growth and the need for orthognathic surgery after cleft palate repair: Literature review and report of 28 cases. J Oral Maxillofac Surg 1997; 55:698.CrossRefGoogle Scholar
  10. 10.
    Filho LC. Isolated influences of lip and palate surgery on facial growth: Comparison of operated and unoperated male adults. Cleft Palate Craniofac J 1996; 33:5.Google Scholar
  11. 11.
    Posnick JC. Cleft-Orthognathic Surgery: The unilateral cleft lip and palate deformity. In: Posnick JC, (ed.) Craniofacial and maxillofacial surgery in children and young adults. Philadelphia: W.B. Saunders; 2000, p. 860–907.Google Scholar
  12. 12.
    Adams GR. The effects of physical attractiveness on the socialization process. In: Lucker GW, Ribbens KA, McNamara JA, (eds.) Psychological aspects of facial form. Craniofacial growth series monograph No. 11. Ann Arbor: University of Michigan Press; 1981, p 25–47.Google Scholar
  13. 13.
    Bull R, Rumsey N. The social psychology of facial appearance. New York: Springer-Verlag; 1988.Google Scholar
  14. 14.
    Harper DC. Children’s attitudes to physical differences among youth from western and non-western cultures. Cleft Palate Craniofac J 1995; 32:114.PubMedCrossRefGoogle Scholar
  15. 15.
    Kapp-Simon KA: Psychological interventions for the adolescent with cleft lip and palate. Cleft Palate Craniofac J 1995; 32:104.PubMedCrossRefGoogle Scholar
  16. 16.
    Leonard BJ, Brust JD, Abrahams G, et al. Self-concept of children and adolescents with cleft lip and/or palate. Cleft Palate Craniofac J 1991; 28:347.PubMedCrossRefGoogle Scholar
  17. 17.
    Posnick JC. The Staging of cleft lip and palate reconstruction: Infancy through adolescence. In: Posnick JC, (ed.) Craniofacial and maxillofacial surgery in children and young adults. Philadelphia: W. B. Saunders; 2000, p. 785–826.Google Scholar
  18. 18.
    Posnick JC. Cleft lip and palate: Bone grafting and management of residual oro-nasal fistula. In: Posnick JC, (ed.) Craniofacial and maxillofacial surgery in children and young adults. Philadelphia: W.B. Saunders; 2000, p. 827–859.Google Scholar
  19. 19.
    Posnick JC. Cleft-Orthognathic Surgery: The bilateral cleft lip and palate deformity. In: Posnick JC, (ed.) Craniofacial and maxillofacial surgery in children and young adults. Philadelphia: W.B. Saunders; 2000, p. 908–950.Google Scholar
  20. 20.
    Posnick JC. Cleft-Orthognathic Surgery: The isolated cleft palate deformity. In: Posnick JC, (ed.) Craniofacial and maxillofacial surgery in children and young adults. Philadelphia: W.B. Saunders; 2000, p. 951–978.Google Scholar
  21. 21.
    Posnick JC, Ruiz RL. The staging of cleft lip and palate reconstruction: Infancy through adolescence. In: Wysynski DF, (ed.) Cleft lip and palate: From origin to treatment. London: Oxford University Press; 2002, p. 319–354.Google Scholar
  22. 22.
    Proffit WR. Orthodontic treatment of clefts: Yesterday, today, and tomorrow. In: Proceedings of the 48th Annual Meeting, American Cleft Palate-Craniofacial Association. Hilton Head: 1991, p 32.Google Scholar
  23. 23.
    Posnick JC. LeFort I, sagittal splits, and genioplasty: Historical perspective and step-by-step approach. In: Posnick JC, (ed.) Craniofacial and maxillofacial surgery in children and young adults. Philadelphia: W.B. Saunders; 2000, p. 1081–1102.Google Scholar
  24. 24.
    Posnick JC. Orthognathic surgery: General considerations; complications; and patient educational material. In: Posnick JC, (ed.) Craniofacial and maxillofacial surgery in children and young adults. Philadelphia: W.B. Saunders; 2000, p. 1103–1112.Google Scholar
  25. 25.
    Posnick JC. Cleft-Orthognathic Surgery. Plastic Surgery: Indications, Operations and Outcomes. In: Vander Kolk CA, (ed.) Philadelphia: Mosby; 2000. p. 851–867.Google Scholar
  26. 26.
    Siegel-Sadewitz VL, Shprintzen RJ. Nasopharyngoscopy of the normal velopharyngeal sphincter: an experiment of biofeedback. Cleft Palate J 1982; 19:194.PubMedGoogle Scholar
  27. 27.
    Vallino LD, Tompson D. Perceptual characteristics of consonant errors associated with malocclusion. J Oral Maxillofac Surg 1993; 51:850.PubMedGoogle Scholar
  28. 28.
    Warren DW. Perceptual characteristics of consonant errors associated with malocclusion (discussion). J Oral Maxillofac Surg 1993; 51:856.Google Scholar
  29. 29.
    Sandham A, Murray JAM. Nasal septal deformity in unilateral cleft lip and palate. Cleft Palate Craniofac J 1993; 30:222.PubMedCrossRefGoogle Scholar
  30. 30.
    Kolbenstvedt A, Aalokken TM, Arctander K, Johannessen S. CT appearances of unilateral cleft palate 20 years after bone graft surgery. Acta Radiol 2002; 43(6):567–70.PubMedCrossRefGoogle Scholar
  31. 31.
    Trinade IE, Yamashita RP, Suguimoto RM, Mazzottini R, Trindade AS Jr. Effects of orthognathic surgery on speech and breathing of subjects with cleft lip and palate: acoustic and aerodynamic assessment. Cleft Palate Craniofac J 2003; 40(1):54–64.CrossRefGoogle Scholar
  32. 32.
    Jorgenson RJ, Shapiro SD, Odiner KL. Studies of facial growth and arch size in cleft lip and palate. J Craniofac Genet Dev Biol 1984; 2:33.Google Scholar
  33. 33.
    McCance AM, Moss JP, Fright WR, et al. Three-dimensional analysis techniques-Part 1: Three-dimensional soft-tissue analysis of 24 adult cleft palate patients following Le Fort I maxillary advancement: A preliminary report. Cleft Palate Craniofac J 1997; 34:36.PubMedCrossRefGoogle Scholar
  34. 34.
    Wolford LM. Effects of orthognathic surgery on nasal form and function in the cleft patient. Cleft Palate Craniofac J 1992; 29:546.PubMedCrossRefGoogle Scholar
  35. 35.
    Posnick JC, Dagys AP. Skeletal stability and relapse patterns after Le Fort I maxillary osteotomy fixed with miniplates: The unilateral cleft lip and palate deformity. Plast Reconstr Surg 1994; 94(7):924–932.PubMedGoogle Scholar
  36. 36.
    Stoelinga PJ, Haers PE, Lennen RJ, et al. Late management of secondarily grafted clefts. Int J Oral Maxillofac Surg 1990; 19:91.Google Scholar
  37. 37.
    Suzuki A, Takahama Y. Maxillary lateral incisor of subjects with cleft lip and/ or palate: Part 1. Cleft Palate Craniofac J 1992; 29:376.PubMedCrossRefGoogle Scholar
  38. 38.
    Bell WH. Le Fort I osteotomy for correction of maxillary deformities. J Oral Surg 1975; 33:412.PubMedGoogle Scholar
  39. 39.
    Bell WH, Fonseca RJ, Kennedy JW III, et al. Bone healing and revascularization after total maxillary osteotomy. J Oral Surg 1975; 33:253.PubMedGoogle Scholar
  40. 40.
    Bell WH, Levy BM. Revascularization and bone healing after posterior maxillary osteotomy. J Oral Surg 1971; 29:313.PubMedGoogle Scholar
  41. 41.
    Bell WH, You ZH, Finn RA, et al. Wound healing after multisegmental Le Fort I osteotomy and transection of the descending palating vessels. J Oral Maxillofac Surg 1995; 53:1425.PubMedCrossRefGoogle Scholar
  42. 42.
    Bloomquist DS. Intraoperative assessment of maxillary perfusion during Le Fort I osteotomy (discussion). J Oral Maxillofac Surg 1994; 52:831.Google Scholar
  43. 43.
    Dodson TB, Neuenschwander MC, Bays RA. Intraoperative assessment of maxillary perfusion during Le Fort I osteotomy. J Oral Maxillofac Surg 1994; 52:827PubMedGoogle Scholar
  44. 44.
    Dodson TB, Neuenschwander MC. Maxillary perfusion during Le Fort I osteotomy after ligation of the descending palatine artery. J Oral Maxillofac Surg 1997; 55:51.PubMedCrossRefGoogle Scholar
  45. 45.
    Gillies H, Rowe NL. L’osteotomie du maxillaire superieur envisagee essentiellement dans les cas de bec-de-lieve total. Rev Stomatol Chir Maxillofac 1954; 55:545.Google Scholar
  46. 46.
    Lanigan DT. Wound healing after multisegmental Le Fort I osteotomy and transection of the descending palatine vessels (discussion). J Oral Maxillofac Surg 1995; 53:1433.CrossRefGoogle Scholar
  47. 47.
    Smabel Z. Treatment effects on facial development in patients with unilateral cleft lip and palate. Cleft Palate Craniofac J 1994; 31:437.CrossRefGoogle Scholar
  48. 48.
    Willmar K: On Le Fort I osteotomy. A follow-up study of 106 operated patients with maxillo-facial deformity. Scand J Plast Reconstr Surg 1974; 12(suppl):1.PubMedGoogle Scholar
  49. 49.
    Georgiade NG. Mandibular osteotomy for the correction of facial disproportion in the cleft lip and palate patient. Symposium on management of cleft lip and palate and associated deformities. Am Plast Reconstr Surg 1974; 8:238.Google Scholar
  50. 50.
    Kiehn CL, DesPrez JD, Brown F. Maxillary osteotomy for late correction of occlusion and appearance in cleft lip and palate patients. Plast Reconstr Surg 1968; 42:203.PubMedGoogle Scholar
  51. 51.
    Des Prez JD, Kiehn CL. Surgical positioning of the maxilla. Symposium on management of cleft lip and palate and associated deformities. Ann Plas Reconstr Surg 1974; 8:222.Google Scholar
  52. 52.
    Henderson D, Jackson IT. Combined cleft lip revision, anterior fistula closure and maxillary osteotomy: A one-stage procedure. Br J Oral Surg 1975; 13:33.PubMedCrossRefGoogle Scholar
  53. 53.
    Jackson IT. Cleft and jaw deformities. In: Symposium on reconstruction of jaw deformities; 1978. p 113.Google Scholar
  54. 54.
    Tideman H, Stoelinga P, Gallia L. Le Fort I advancement with segmental palatal osteotomies in patients with cleft palates. J Oral Surg 1980; 38:196.PubMedGoogle Scholar
  55. 55.
    Sinn DP. Simultaneous maxillary expansion and advancement, repair of oronasal fistula, and bone grafting of the alveolar cleft. In: Bell WH, Proffit WR, White RP, (eds.) Surgical correction of dentofacial deformities. Philadelphia: WB Saunders; 1980.Google Scholar
  56. 56.
    Ward-Booth RP, Bhatia SN, Moos KF. A cephalometric analysis of the Le Fort II osteotomy in the adult cleft patient. J Maxillofac Surg 1984; 12:208.PubMedCrossRefGoogle Scholar
  57. 57.
    James D, Brook K. Maxillary hypoplasia in patients with cleft lip and palate deformity-the alternative surgical approach. Eur J Orthop 1985; 7:231.Google Scholar
  58. 58.
    Poole MD, Robinson PP, Nunn ME. Maxillary advancement in cleft lip and palate patients: A modification of the Le Fort I osteotomy and preliminary results. J Maxillofac Surg 1986; 14:123.PubMedCrossRefGoogle Scholar
  59. 59.
    Posnick JC. Orthognathic surgery in the cleft patient. In: Instructional courses, Plastic Surgery Education Foundation (Vol. 4). St Louis: Mosby-Year Book; 1991. p 129–157.Google Scholar
  60. 60.
    Posnick JC. Orthognathic surgery for the cleft lip and palate patient. Semin Ortho 1996; 2:205.CrossRefGoogle Scholar
  61. 61.
    Posnick JC, Ewing M. Skeletal stability after Le Fort I maxillary advancement in patients with unilateral cleft lip and palate. Plast Reconstr Surg 1990; 85:706.PubMedGoogle Scholar
  62. 62.
    Posnick JC, Tompson B. Cleft-orthognathic surgery: Complications and long-term results. Plast Reconstr Surg 1995; 96:255.PubMedCrossRefGoogle Scholar
  63. 63.
    Posnick JC, Tompson B. Modification of the maxillary Le Fort I osteotomy in cleft-orthognathic surgery: The unilateral cleft lip and palate deformity. J Oral Maxillofac Surg 1992; 50:666.PubMedCrossRefGoogle Scholar
  64. 64.
    Posnick JC. Orthognathic surgery in cleft patients treated by early bone grafting (discussion). Plast Reconstr Surg 1991; 87:840.Google Scholar
  65. 65.
    Posnick JC, Tompson B. Modification of the maxillary Le Fort I osteotomy in cleft-orthognathic surgery: The bilateral cleft lip and palate deformity. J Oral Maxillofac Surg 1993; 51:2.PubMedGoogle Scholar
  66. 66.
    Abyholm F, Bergland O, Semb G. Secondary bone grafting of alveolar clefts. Scand J Plast Reconstr Surg 1981; 15:127.PubMedGoogle Scholar
  67. 67.
    Boyne PJ, Sands NR. Secondary bone grafting of residual alveolar and palatal clefts. J Oral Surg 1972; 30:87.PubMedGoogle Scholar
  68. 68.
    Hall HD, Posnick JC. Early results of secondary bone grafts in 106 alveolar clefts. J Oral Maxillofac Surg 1984; 41:289.Google Scholar
  69. 69.
    Proffit WR. Stability of Le Fort I osteotomy with maxillary advancement: A comparison of combined wire fixation and rigid fixation (discussion). J Oral Maxillofac Surg 1995; 53:248.CrossRefGoogle Scholar
  70. 70.
    Braun TW. Modification of the maxillary Le Fort I osteotomy in cleft-orthognathic surgery: The unilateral cleft lip and palate deformity (discussion). J Oral Maxillofac Surg 1992; 50:675.Google Scholar
  71. 71.
    Braun TW, Sotereanos GC. Orthognathic and secondary cleft reconstruction of adolescent patients with cleft palate. J Oral Surg 1980; 38:425.PubMedGoogle Scholar
  72. 72.
    Braun TW, Sotereanos GC. Orthognathic surgical reconstruction of cleft palate deformities in adolescents. J Oral Surg 1981; 39:255.PubMedGoogle Scholar
  73. 73.
    Braun TW, Sotereanos GC. Long-term results with maxillary advancement in cleft palate patients in oral and maxillofacial surgery. In: Proceedings of the Eighth International Conference on Maxillofacial Surgery. Amador City, CA: Quintessence; 1985. p. 265.Google Scholar
  74. 74.
    Harrison JW. Dental implants to rehabilitate a patient with an unrepaired complete cleft. Cleft Palate Craniofac J 1992; 29:485.PubMedCrossRefGoogle Scholar
  75. 75.
    Lund TW, Wade M. Use of osseointegrated implants to support a maxillary denture for a patient with repaired cleft lip and palate. Cleft Palate Craniofac J 1993; 30:418.PubMedCrossRefGoogle Scholar
  76. 76.
    Obwegeser HL. Surgical correction of small or retrodisplaced maxillae: The “dish-face” deformity. Plast Reconstr Surg 1969; 43:351.PubMedGoogle Scholar
  77. 77.
    Parel SM, Branemark PI, Jansson T. Osseointegration in maxillofacial prosthetics: Part I: intraoral applications. J Prosthet Dent 1986; 55:490.PubMedGoogle Scholar
  78. 78.
    Ronchi P, Chiapasco M, Frattini D. Endosseous implants for prosthetic rehabilitation in bone grafted alveolar clefts. J Craniomaxillofac Surg 1995; 23:382.PubMedGoogle Scholar
  79. 79.
    Suzuki A, Takahama Y. Maxillary lateral incisor of subjects with cleft lip and/or palate: Part 2. Cleft Palate Craniofac J 1992; 29:380.PubMedCrossRefGoogle Scholar
  80. 80.
    Takahashi T, Fukuda M, Yamaguchi T, et al. Use of endosseous implants for dental reconstruction of patients with grafting alveolar clefts. J Oral Maxillofac Surg 1997; 55:576.PubMedCrossRefGoogle Scholar
  81. 81.
    Tulloch JFC. A six-center international study of treatment outcome in patients with clefts of the lip and palate: Evaluation of maxillary asymmetry (commentary). Cleft Palate Craniofac J 1993; 30:22.CrossRefGoogle Scholar
  82. 82.
    Turvey T. Use of the Branemark implant in the cleft palate patient. Cleft Palate Craniofac J 1991; 28:304.Google Scholar
  83. 83.
    Verdi FJ Jr, Shanzi GL, Cohen SR, et al. Use of the Branemark implant in the cleft palate patient. Cleft Palate Craniofac J 1991; 28:301.PubMedCrossRefGoogle Scholar
  84. 84.
    Cohen SR, Burnstein FD, Stewart MB, et al. Maxillary-midface distraction in children with cleft lip and palate: a preliminary report. Plast Reconstr Surg 1997; 99:5.Google Scholar
  85. 85.
    Polley J. Management of secondary orofacial cleft deformities. In: Goldwyn RM, Cohen MN, (eds.) The unfavorable result in plastic surgery: avoidance and treatment. Philadelphia: Lippincott, Williams and Wilkins; 2001. p. 344–349.Google Scholar
  86. 86.
    Posnick JC, Ruiz R. Discussion of: management of secondary orofacial cleft deformities. In: Goldwyn RM, Cohen MN, (eds.) The unfavorable result in plastic surgery: avoidance and treatment. Philadelphia: Lippincott, Williams and Wilkins; 2001. p. 349.Google Scholar
  87. 87.
    Lo LJ, Hung KF, Chen YR. Blindness as a complication of Le Fort I osteotomy for maxillary distraction. Plast Reconstr Surg 2002; 109(2):688–698.PubMedCrossRefGoogle Scholar
  88. 88.
    Shaw WC, Mandall NA, Mattick CR. Ethical and scientific decision making in distraction osteogenesis. Cleft Palate-Craniofac J 2002; 39(6):641–645.PubMedCrossRefGoogle Scholar
  89. 89.
    Van Strijen PJ, Breuning KH, Becking AG, Perdijk FBT, Tuinzing DB. Cost, operation and hospitalization times in distraction osteogenesis versus sagittal split osteotomy. J Craniomaxillofac Surg 2002; 30:42–45.Google Scholar
  90. 90.
    Precious DS. Symposium on distraction osteogenesis — point/counterpoint. J Oral Maxillofac Surg (Suppl.) 2003; 61(8):5.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2006

Authors and Affiliations

  • Jeffrey C. Posnick
  • Paul S. Tiwana

There are no affiliations available

Personalised recommendations