CLEFT-ORTHOGNATHIC SURGERY - COMPLICATIONS AND LONG-TERM RESULTS

We reviewed the complications and long-term results of a consecutive s eries of adolescents (67 males, 49 females; age range 15 to 25 years; mean 18 years) born with a cleft who underwent primary repair in child hood and later developed a jaw deformity and malocclusion that require d orthognathic surgery. Between 1986 and 1992, 116 adolescents with ei ther unilateral cleft lip and palate (n = 66), bilateral cleft lip and palate (n = 33), or isolated cleft palate (n = 17) underwent an ortho gnathic procedure that included a Le Fort I osteotomy; 32 also underwe nt simultaneous sagittal split osteotomies of the mandible; and 87 und erwent osteoplastic genioplasty. Clinical follow-up ranged from 1 to 7 years (mean 40 months) at the close of the study. The preoperative cl inical examination varied according to cleft type and individual varia tion, but all patients had maxillary hypoplasia. Additional cleft-rela ted deformities included residual oronasal fistula and bony defects, c lefted alveolar ridges that retained dental gaps, and mobile premaxill a that lacked union to the lateral segments. Overall, 89 percent of re sidual fistulas underwent successful closure as part of the orthognath ic procedure. Surgical cleft dental gap closure was achieved and maint ained to the extent planned at 92 percent of the cleft sites. A fixed (prosthetic) bridge was used successfully for dental rehabilitation to close the gap in all other patients at each cleft site (n = 9). All p atients with alveolar clefts (n = 99) maintained keratinized mucosa al ong the labial surface of tire cleft-adjacent teeth (n = 264 teeth). C omplications were few and generally not serious. There was no segmenta l bone loss or loss of teeth because of aseptic necrosis or infection. Only 5 percent of cleft adjacent teeth underwent a degree of gingival recession and root exposure as a result of the maxillary osteotomy pr ocedure; all were retained long term. The long-term maintenance of ove rjet and overbite measured directly from the late (> 1 year) postopera tive lateral cephalometric radiograph indicated that 97 percent of pat ients maintained a positive overjet and 89 percent maintained a positi ve overbite; 5 percent shifted to a neutral overbite. The methods used to manage jaw deformity, malocclusion, residual oronasal fistula, and bony defects in adolescents born with a cleft are safe and reliable a nd offer the patient an enhanced quality of life. They also provide a stable foundation in which final soft-tissue lip and nose revisions ma y be carried out.