Segmental osteotomy of maxilla and secondary bone grafting simultaneously for a patient with unilateral cleft lip and palate: A case report

Abstract

Patients with cleft lip and palate often shows vertical and horizontal malocclusion because of maxillary hypoplasia and alveolar collapse. They need to repair it by orthognathic treatment in adults. It is essential to make a corrective and certain surgery to get satisfied occlusion. We performed left segmental osteotomy and secondary bone grafting simultaneously to a man with left cleft lip and palate presenting maxillary hypoplasia, left alveolar cleft and vertical displacement of major and minor segments. 11 months after left segmental osteotomy and secondary bone grafting, we performed Le Fort I osteotomy and bilateral sagittal splitting ramus osteotomy. First, we could improve the vertical displacement of major and minor segments by segmental osteotomy and align the dental arch. Moreover, the forward movement of segmental osteotomy reduces the alveolar cleft space. Owing to it, we could perform secondary bone grafting by minimum autologous cancellous bone from ilium. At the second surgery, we could perform Le Fort I osteotomy easily and simply because the maxilla had been made of a mass by first operation, that is loss of alveolar cleft. It should be an effective approach to perform segmental osteotomy and secondary bone grafting simultaneously as a first stage for orthognathic treatment for unilateral cleft lip and palate patients with vertical alveolar collapse and cleft.