Complete Bilateral Cleft Lip and Palate
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.
KeywordsMixed Dentition Deciduous Dentition Facial Convexity Bilateral Cleft Buccal Tooth
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