Premaxillary excision: reasons and effects.

Case reports of five bilateral cleft lip and palate patients subjected to premaxillectomy at ages from 5 to 11 years are presented and the reasons for the procedure noted in each instance. Followed into adolescence, an abnormal peaked configuration of the maxillary arches termed "church steeple" defect developed in four of the five patients. Midfacial growth arrest with pseudoprognathism did not occur in any. Details of the surgical technique used are specified. Features of prosthetic and soft-tissue reconstruction are noted. The history and rationale of primary and secondary premaxillectomy are reviewed. Secondary excision of the premaxilla can be a valid treatment option in a few specifically selected cases.