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Complete Bilateral Cleft Lip and Palate

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Abstract

Management of the prominent premaxilla in bilateral cleft lip and palate remains challenging, and consequently, many different approaches have been tried. Surgical setback at time of lip repair is one approach that provides immediate resolution of the excessive midfacial prominence. However, follow-up studies have demonstrated severe deleterious effects on midface growth resulting from this treatment (see Chap. 7).

This chapter shows that surgical premaxillary manipulation has not succeeded in reducing the premaxillary prominence. Any approach that results in retraction of the entire premaxilla, including the anterior nasal spine area, has the potential to contribute to maxillary growth inhibition. The currently advocated nasoalveolar molding therapy (NAM) may also succeed in bringing the entire premaxilla back to a position between the lateral segments. This will facilitate a tension-free lip repair and may also allow periosteoplasty to replace missing bone. These procedures contribute to maxillary growth inhibition and interfere with later expansion to correct anterior crossbites.

This chapter shows that lip repair without presurgical orthopedics causes, in most cases, tipping of the premaxilla which reduces the prominence with growth enough to allow a good surgical outcome. The repaired lip will further mold the alveolar process of the premaxilla. Bodily premaxillary retraction will cause an eruption into an anterior crossbite.

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References

  • Aduss H, Friede H, Pruzansky S (1974) Management of the protruding premaxilla. In: Georgiade NG, Hagerty RF (eds) Symposium on management of cleft lip and palate and associated deformities. April 12–14, Duke University, Durham, NC, 1973. CV Mosby, St Louis, pp 111–117

    Google Scholar 

  • Atherton JD (1967) Morphology of facial bones in skulls with unoperated unilateral cleft palate. Cleft Palate J 4:18–30

    PubMed  CAS  Google Scholar 

  • Atherton JD (1974) The natural history of bilateral cleft. Angle Orthod 44:269–274

    PubMed  CAS  Google Scholar 

  • Bergland O, Borchgrevink H (1974) The role of the nasal septum in mid-facial growth in man elucidated by maxillary development in certain types of facial clefts. Scand J Plast Reconstr Surg 8:42–48

    Article  PubMed  CAS  Google Scholar 

  • Bergland O, Semb G, Abyholm F, Borchgrevink H, Eskeland G (1986) Secondary bone grafting and orthodontic treatment on patients with bilateral complete clefts of the lip and palate. Am J Plast Surg 17:460–471

    Article  CAS  Google Scholar 

  • Berkowitz S (1959) Growth of the face with bilateral cleft lip from 1 month to 8 years of age. University of Illinois School of Dentistry, Chicago

    Google Scholar 

  • Berkowitz S (1982) Some questions, a few answers in maxilla-mandibular surgery. Clin Plast Surg 9:603–633

    PubMed  CAS  Google Scholar 

  • Bishara SE, Olin WH (1972) Surgical repositioning of the premaxilla in complete bilateral cleft lip and palate. Angle Orthod 42:139–147

    PubMed  CAS  Google Scholar 

  • Blocksma R, Leuz CA, Mellerstig KE (1975) A conservative program for managing cleft palates without the use of mucoperiosteal flaps. Plast Reconstr Surg 55:160–169

    Article  PubMed  CAS  Google Scholar 

  • Boyne PJ (1974) The use of marrow cancellous bone grafts in maxillary alveolar and palatal clefts. J Dent Res 14:821–824

    Google Scholar 

  • Browne D (1969) Hare-lip. Am R Coll Surg 5:1949

    Google Scholar 

  • Burston WR (1960) The pre-surgical orthopaedic correction of the maxillary deformity in clefts of both primary and secondary palate. In: Wallace AB (ed) Trans-actions of the international society of plastic surgeons, second congress, London, 1959. E&S Livingston Ltd, Edinburgh, London, pp 28–36

    Google Scholar 

  • Burston WR (1967) Treatment of the cleft palate. Ann R Coll Surg Engl 25:225

    Google Scholar 

  • Coup TB, Subtelny JD (1960) Cleft palate deficiency or displacement of tissue. Plast Reconstr Surg 26:600

    Article  Google Scholar 

  • Dahl E (1970) Craniofacial morphology in congenital clefts of the lip and palate – an x-ray cephalometric study of young adult males. Acta Odontol Scand 28(Suppl):57

    Google Scholar 

  • Delaire J, Precious D (1985) Avoidance of the use of vomerine mucosa in primary surgical management of velopalatine clefts. Oral Surg Oral Med Oral Pathol 60:589–597

    Article  PubMed  CAS  Google Scholar 

  • Delaire J, Precious D (1986) Influence of the nasal septum on maxillonasal growth in patients with congenital labiomaxillary cleft. Cleft Palate J 23:270–277

    PubMed  CAS  Google Scholar 

  • Enlow DH (1982) Handbook of facial growth. WB Saunders, Philadelphia

    Google Scholar 

  • Enmark H, Bolund S, Jorgensen I (1990) Evaluation of unilateral cleft lip and palate treatment: long term results. Cleft Palate J 27:354–361

    Article  Google Scholar 

  • Friede H (1973) Histology of the premaxillary-vomerine suture in bilateral cleft case. Cleft Palate J 10:14–22

    PubMed  CAS  Google Scholar 

  • Friede H (1977) Studies on facial morphology and growth in bilateral cleft lip and palate. University of Goteborg. Thesis, Goteborg

    Google Scholar 

  • Friede H (1978) The vomero-premaxillary suture – a neglected growth site in mid-facial development of unilateral cleft lip and palate patients. Cleft Palate J 15(4):398

    PubMed  CAS  Google Scholar 

  • Friede H, Johanson B (1977) A follow-up study of cleft children treated with vomer flap as part of a three-stage soft tissue surgical procedure: facial morphology and dental occlusion. Scand J Plast Reconstr Surg 11:45–57

    Article  PubMed  CAS  Google Scholar 

  • Friede H, Morgan P (1976) Growth of the vomero-premaxillary suture in children with bilateral cleft lip and palate: a histological and roentgenocephalometric study. Scand J Plast Reconstr Surg 10:45–55

    PubMed  CAS  Google Scholar 

  • Friede H, Pruzansky S (1972) Longitudinal study of growth in bilateral cleft lip and palate from infancy to adolescence. Plast Reconstr Surg 49:392–403

    Article  PubMed  CAS  Google Scholar 

  • Friede H, Moller M, Lilia J, Lauritzen C, Johanson B (1987) Facial morphology and occlusion at the stage of early mixed dentition in cleft lip and palate patients treated with delayed closure of the hard palate. Scand J Plast Reconstr Surg 21:65–71

    Article  CAS  Google Scholar 

  • Hanada K, Krogman W (1975) A longitudinal study of postoperative changes in the soft-tissue profile in bilateral cleft lip and palate from birth to 6 years. Am J Orthod 67:363–376

    Article  PubMed  CAS  Google Scholar 

  • Handelman C, Pruzansky S (1968) Occlusion and dental profile with complete bilateral cleft lip and palate. Angle Orthod 38:185–198

    PubMed  CAS  Google Scholar 

  • Harvold E (1954) Cleft lip and palate: morphologic studies of the facial skeleton. Am J Orthod 40:493

    Article  Google Scholar 

  • Hellquist R, Svardstrom K, Ponten B (1983) A longitudinal study of delayed periosteoplasty to the cleft alveolus. Cleft Palate J 20:277–288

    PubMed  CAS  Google Scholar 

  • Latham RA (1969) The septopremaxillary ligament and maxillary development. J Anat 104:584

    PubMed  CAS  Google Scholar 

  • Latham RA (1973) Development and structure of the premaxillary deformity in bilateral cleft lip and palate. Br J Plast Surg 26:1–11

    Article  PubMed  CAS  Google Scholar 

  • Mazaheri M, Harding RL, Cooper JA, Meier JA, Jones TS (1971) Changes in arch form and dimensions of cleft patients. Am J Orthod 60:19–32

    Article  PubMed  CAS  Google Scholar 

  • McNeil CK (1950) Orthodontic procedures in the treatment of congenital cleft palate. Dent Rec 70:126–132

    Google Scholar 

  • Millard DR Jr (1978a) The forked flap. In: Millard Dr JR (ed) Cleft craft, 3rd edn. Little, Brown, Boston

    Google Scholar 

  • Millard DR Jr (1978b) The lip-switch flap. In: Millard DR Jr (ed) Cleft craft, 3rd edn. Little, Brown, Boston

    Google Scholar 

  • Millard DR Jr (1980) Cleft craft. Little, Brown, Boston, p 3

    Google Scholar 

  • Molsted K (1987) Kraniofacial morfologi hos born med komplet unilatral laebe-og ganespalte. University of Copenhagen, Copenhagen

    Google Scholar 

  • Narula JK, Ross RB (1970) Facial growth in children with complete bilateral cleft lip and palate. Cleft Palate J 7:239–248

    PubMed  CAS  Google Scholar 

  • Posnick JC, Tompson B (1993) Modification of the maxillary Lefort I osteotomy in cleft-orthognathic surgery: the bilateral cleft lip and palate deformity. J Oral Maxillofac Surg 51:2–11

    Article  PubMed  CAS  Google Scholar 

  • Pruzansky S (1953) Description, classification, and analysis of unoperated clefts of the lip and palate. Am J Orthod 39:590

    Article  Google Scholar 

  • Pruzansky S (1971) The growth of the premaxillary-vomerine complex in complete bilateral cleft lip and palate. Tandlaegebladet 75:1157–1169

    PubMed  CAS  Google Scholar 

  • Pruzansky S, Aduss H (1967) Prevalence of arch collapse and malocclusion in complete unilateral cleft lip and palate. Trans Europ Orthod Soc 1–18

    Google Scholar 

  • Pruzansky S, Friede H (1975) Two sisters with unoperated bilateral cleft lip and palate: age 6 and 4 years. Br J Plast Surg 28:251–258

    Article  PubMed  CAS  Google Scholar 

  • Prysdo V, Holm PC, Dahl E, Fogh-Andersen P (1974) Bone formation in palatal clefts subsequent to palato-vomer plasty: influence on transverse maxillary growth. Scand J Plast Reconstr Surg 8:73–78

    Article  Google Scholar 

  • Ross RB (1987) Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J 24:05–77

    CAS  Google Scholar 

  • Scott JH (1956a) The analysis of facial growth, part I: the anteroposterior and vertical dimensions. Am J Orthod 44:507

    Article  Google Scholar 

  • Scott JH (1956b) The analysis of facial growth, part II: the horizontal and vertical dimensions. Am J Orthod 44:585

    Article  Google Scholar 

  • Semb G (1991) A study of facial growth in patients with bilateral cleft lip and palate treated by the Oslo CLP team. Cleft Palate Craniofac J 28:22–39

    Article  PubMed  CAS  Google Scholar 

  • Smahel Z (1984) Variation in craniofacial morphology with severity of isolated cleft palate. Cleft Palate J 21:140–158

    PubMed  CAS  Google Scholar 

  • Vargervik K (1983) Growth characteristics of the premaxilla and orthodontic treatment principles in bilateral cleft lip and palate. Cleft Palate J 20:289

    PubMed  CAS  Google Scholar 

  • Veau V (1934) Le sequalette du bec-de-lievre. Ann Anat Pathol 11:873

    Google Scholar 

  • Veau V, Borel S (1931) Division palatine. Masson & Cie, Paris, p 35

    Google Scholar 

  • Wolfe SA, Berkowitz S (1983) The use of cranial bone grafts in the closure of alveolar and anterior palatal clefts. Plast Reconstr Surg 72:659–666

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Orthodontics, College of Dentistry, University of Illinois, Chicago, IL, USA

    Samuel Berkowitz DDS, M.S., FICD (Adjunct Professor)

  2. South Florida Cleft Palate Clinic, University of Miami School of Medicine, Miami, FL, USA

    Samuel Berkowitz DDS, M.S., FICD (Clinical Professor of Surgery and Pediatrics (Ret), Director of Research (Ret)

  3. Craniofacial Anomalies Program, Miami Children’s Hospital, Miami, FL, USA

    Samuel Berkowitz DDS, M.S., FICD (Consultant (Ret)

Authors
  1. Samuel Berkowitz DDS, M.S., FICD
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Correspondence to Samuel Berkowitz DDS, M.S., FICD .

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Editors and Affiliations

  1. Paradela Street 11035, Coral Gables, 33156, Florida, USA

    Samuel Berkowitz

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Berkowitz, S., Berkowitz, S., Berkowitz, S. (2013). Complete Bilateral Cleft Lip and Palate. In: Berkowitz, S. (eds) Cleft Lip and Palate. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-30770-6_7

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  • DOI: https://doi.org/10.1007/978-3-642-30770-6_7

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-30769-0

  • Online ISBN: 978-3-642-30770-6

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