Cleft Orthognathic Surgery

Abstract

Surgical correction of unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and isolated cleft palate exerts a deleterious effect on maxillary growth.Therefore, adolescent cleft lip and palate patients usually present with maxillary hypoplasia and mandibular protrusion. This compromises the airway, speech, aesthetics, and mastication, thus, more than half of all cleft patients require orthognathic surgery.Although essential, cleft orthognathic surgery is generally neglected as it is deemed difficult to perform with tangible risks of the blood supply of mobilized segments.In our clinical practice, orthognathic surgery (OGS) has evolved to become an essential component in addressing the cleft stigmata after lip and palate repair.This chapter outlines and depicts our approach and methodology in preparation and execution of orthognathic surgery with the use of adjunct techniques such as fat grafting to obtain a harmonious surgical outcome. Although the single-splint technique of orthognathic surgery has a steep learning curve, intraoperative freehand adjustments permit the movement of the maxilla-mandibular complex (MMC) to a position where the soft tissues can be redraped in the most ideal fashion.Concomitant fat grafting in the same surgical setting followed by rhinoplasty and lip revision would provide the finishing touches for the patients who have underwent OGS treatment for the best cosmetic outcomes.KeywordsOrthognathic surgeryLeFort I maxillary osteotomyBilateral sagital split osteotomyMalocclusion and cleft lip/palate