Modification of the maxillary Le Fort I osteotomy in cleft-orthognathic surgery: the bilateral cleft lip and palate deformity.

The adolescent with bilateral cleft lip and palate (BCLP) undergoing orthognathic surgery may have multiple residual clefting problems, including a mobile, dysplastic premaxilla and hypoplastic lateral maxillary segments, with each segment misaligned in three dimensions. These problems are commonly compounded by residual oronasal fistulas, bony defects, soft-tissue scarring from previous surgery, and the congenital absence of the maxillary lateral incisor teeth with resulting cleft-dental gaps. This article describes modifications of the Le Fort I osteotomy that allow for the simultaneous routine and safe management of these deformities. Results of this operation on 22 consecutive patients are reported, with findings of follow-up ranging from 1 to 5 years. The long-term parameters reviewed include closure of residual oronasal fistulas, stabilization of the premaxilla, cleft-dental gap closure, maintenance of attached gingiva at the cleft site, maintenance of a positive overjet and overbite, the need for prosthetics to complete dental rehabilitation, and surgical morbidity.