Primary vomerine osteotomy with gingivoperiosteoplasty for bilateral cleft lip and palate patients with protrusion and/or torsion of the premaxilla

Abstract

In patients with bilateral cleft lip and palate (BCLP) with protrusion and/or torsion of the premaxilla, achieving a good outcome with adequate facial and maxillary development remains a challenge. In the present study, we report a retrospective cohort of patients with complete BCLP treated between 2017 and 2020 at a single center in Japan. We investigated the effect and complications of primary vomerine osteotomy (PVO) with gingivoperiosteoplasty (GPP) after presurgical orthodontics (PSO) for premaxillary protrusion and/or torsion. For patients with residual premaxillary protrusion and/or torsion after PSO, PVO, and GPP were performed. The distances and angles of the premaxilla were measured on dental casts before PSO, on the day of PVO, after PVO, and on the day of palatoplasty after cheiloplasty. We further assessed postoperative complications.From a total of 36 patients with complete BCLP after PSO, seven patients underwent PVO with GPP. Proper positioning of the premaxilla was achieved in all seven patients. The distance between the anterior edge of the premaxilla and the anterior edge of the lateral segment and the length of the premaxillary-lateral segment on both sides continued to decrease over time. Loosening of GPP sutures occurred in two cases, although no major complications such as necrosis of the premaxilla or fistula formation occurred.VO with GPP before primary cheiloplasty is a potential treatment option in BCLP when premaxilla still protrudes despite PSO or because PSO could not be applied.