Premaxillary repositioning by means of a minimally invasive endonasal approach in a bilateral cleft patient: Report of two cases.

Abstract

The premaxillary malposition (MP) can develop in patients with cleft lip and palate and with bilateral alveolus (BCLP+A), impacting esthetics, function, and the quality of life of these patients. A 9-year-old child and a 29-year-old adult with BCLP+A and MP complained of a severe inferior positioning of the premaxilla to the upper lip, making it difficult to chew, speak, and swallow. Surgical planning of clinical cases was performed using virtual software (Dolphin Imaging). Minimal endonasal access, with exposure of the upper premaxilla, was observed. Using a reciprocating saw, osteotomy was performed in the posterosuperior aspect of the premaxilla. The premaxilla was repositioned through an occlusal splint, and the patients kept the splint fixed with steel wire postoperatively for 8 weeks. After 12 months of post-op, the patients present good maxillary positioning and a reestablished function. The premaxillary malposition (MP) can develop in patients with cleft lip and palate and with bilateral alveolus (BCLP+A), impacting esthetics, function, and the quality of life of these patients. A 9-year-old child and a 29-year-old adult with BCLP+A and MP complained of a severe inferior positioning of the premaxilla to the upper lip, making it difficult to chew, speak, and swallow. Surgical planning of clinical cases was performed using virtual software (Dolphin Imaging). Minimal endonasal access, with exposure of the upper premaxilla, was observed. Using a reciprocating saw, osteotomy was performed in the posterosuperior aspect of the premaxilla. The premaxilla was repositioned through an occlusal splint, and the patients kept the splint fixed with steel wire postoperatively for 8 weeks. After 12 months of post-op, the patients present good maxillary positioning and a reestablished function.