Surgical Orthodontic Treatment for Cleft Lip/Palate Patients

摘要

Cleft lip and/or palate (CLP) is one of the most common congenital anomalies of the orofacial complex, with an incidence rate of approximately 1 in 500 live births in the Japanese population. In a course of the treatment for patients with CLP, an orthodontist should be a co-planner for surgical interventions such as orthognathic surgery for the correction of jaw deformities, secondary bone grafting into the alveolar cleft, and lip/nose revision. In such patients, various dentoskeletal features including maxillofacial disharmony, bony defect of alveolar clefts and dentoalveolar problems, occasionally involve dynamic procedures. Maxillary distraction osteogenesis (DOG) has replaced conventional Le Fort I surgery as a treatment for patients with severe crossbite1). Since 1999, we have treated 75 patients with DOG (Fig. 1). This technique allows substantial advancement of the maxillary bone segment, thereby facilitating the comprehensive orthodontic treatment in patients with CLP associated with severe maxillary retardation. Moreover, in patients showing maxillary deficiency combined with mandibular prognathism, the treatment strategy has included not only a two-stage procedure comprising DOG for maxillary advancement followed by mandibular setback surgery, but also simultaneous two-jaw surgery with maxillary DOG. The incorporation of Le Fort I segmental osteotomy, at times achieved by dentoalveolar distraction, may also increase the viable options for occlusal reconstruction in CLP patients.