Cleft lip and palate patients often exhibit severe dentofacial deformities that necessitate orthognathic surgery. Orthognathic surgery in these patients generally includes not only maxillary advancement, but also sagittal, horizontal, and vertical movement of both jaws. Surgical planning and execution presents many difficulties, caused by the presence of extensive scar tissues from previous surgeries, tissue deficiencies, the difficulty of aligning multiple segments of bone and soft tissues. Other challenges in cleft patients are complications related to post-surgical airway, speech, velopharyngeal insufficiency, nerve damage, and infections. This review is focused on orthognathic surgery in cleft lip and palate patients, management, techniques, success, and complications.

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Orthognathic Surgery in Cleft Lip and Palate Patients

Current Treatment of Cleft Lip and Palate

The treatment of secondary and residual dentofacial deformities in the cleft patient: Surgical and orthodontic therapy

Cleft lip lower-lip deformity is a secondary deformity in patients who underwent primary cheiloplasty of the upper lip, characterized by an enlarged and anteriorly rotated lower lip. In these cases, soft-tissue imbalances remain even after skeletal correction with orthognathic surgery, and additional soft tissue treatment is required for lip harmony and esthetic facial balance in CLP (cleft lip palate) patients. This study describes three cases of transverse myomucosal excision of the lower lip for correction of cleft lip lower-lip deformity to restore facial esthetic balance. Each patient underwent orthognathic surgery, rhinoplasty, or upper lip revision cheiloplasty according to condition. Postoperatively, volume of the lower lip decreased and lip harmony was improved in all three patients. The surgeon should fully understand the anatomical structure around the lips and be able to evaluate overall harmony of the soft tissue. When a lower lip deformity is present, careful surgical planning and execution are important for each patient.

https://www.jkaoms.org/journal/download_pdf.php?doi=10.5125/jkaoms.2022.48.6.390

Surgical correction of cleft lip lower-lip deformity: a report of three cases

Study Design Case Report. Objective To present a case of a previous complicated mandibular orthognathic surgery that aimed to setback the mandible in a female cleft lip and palate (CLP) patient, which led to bone necrosis on one side with subsequent severe mandibular deviation and facial asymmetry. We additionally reviewed the previous reports of similar complications, the pathophysiology and the factors that could lead to this dreadful result. Method A 27-year-old female patient presented with a severe dentofacial deformity secondary to a complicated bilateral sagittal split ramus osteotomy performed five years earlier, which resulted in aseptic bone necrosis on the right side. The patient had marked mandibular deviation, chin and midface retrusion and a pronounced occlusal discrepancy. Imaging demonstrated a bony defect at the right mandibular angle with a superiorly displaced proximal segment. Deviation of the mandible was corrected first by performing vertical ramus subsigmoid osteotomy (RSO) on the left side. The right bone defect was then reconstructed with a reconstruction plate and bone grafting. Maxillary and chin advancement was performed at a second stage. Results On follow-up, the patient shows a significant improvement in facial esthetics and mandibular symmetry and is currently under orthodontic management to enhance the occlusal relationship. Conclusion Bone necrosis is a rare but dreaded problem in orthognathic surgery. Minimizing the musculo-periosteal dissection and competent execution of the bone osteotomy is substantially effective in reducing the risk of bone ischemia and necrosis.

https://doi.org/10.1177/27528464221078461

Partial Bone Necrosis Following Sagittal Split Ramus Osteotomy: Report of a Complicated Orthognathic Jaw Surgery

Dudak Damak Yarığında Ortognatik Cerrahi

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Orthognathic Surgery in Cleft Lip and Palate Patients

Dudak Damak Yarığında Ortognatik Cerrahi