Osteotomy of the Pre- Maxilla in Bilateral Cleft Lip: A Useful Technique Following Failure of Primary Lip Closure, Mid Term Follow Up

Objectives: Successful aesthetic repair of the bilateral cleft lip defect is one of the most challenging cases encountered by a surgeon. This challenge is heightened when the premaxilla is anteriorly protruded in relation to the lateral maxillary segments. Our aim is to demonstrate a method for reducing the premaxilla prior to secondary lip repair. We use a premaxillary osteotomy to posteriorly reposition the premaxilla between the lateral segments

Methods: Six patients with bilateral cleft lip and palate underwent repositioning of the protruded premaxilla. Five patients had previous primary lip closure procedures with unsatisfactory results and in one patient late primary closure. In five cases patient`s premaxilla protruded through a naris or above the lip. In all cases, the cleft size was reduced by premaxillary osteotomy with ostectomy from nasal septum and partial removal of the vertical vomer. The osteotomized premaxilla was then repositioned, fixed with a custom-made orthodontic appliance and secured for three months. Following this procedure, the lip was closed in a traditional fashion.

Results: All patients demonstrated satisfying lip closure without tension. In each case, the premaxilla was vital and exhibited partial stabilization during follow-up until secondary bone graft procedure have done later on. Aesthetic results were markedly improved in all patients.

Conclusions: In this study we demonstrate the usefulness of a premaxillary segment setback as an adjunct to improved function and aesthetics in bilateral lip repair. This method serves as an excellent solution for closure of the bilateral cleft lip with significant anterior position of the premaxilla.