Orthognathic Surgery and Definitive Revision of the Lip and Nose in Patients with Cleft Lip and Palate

In patients with cleft lip and palate, a series of treatments have been performed to achieve a normal facial appearance and a good oronasal function. Decisions on timing and the procedure to be performed should always be based on the patient's growth. Despite successful, well-timed surgery and adequate orthodontic treatment, maxillary hypoplasia appears to be unavoidable in some patients with cleft lip and palate. Class III malocclusion and the accompanying facial deformity are treated with Le Fort I maxillary osteotomy after facial skeletal growth is completed. Maxillary osteotomy provides dramatic improvement in patient's facial appearance and occlusion; however, there is a possibility of relapse after surgery. In our retrospective evaluation, there are significant correlations between the amount of surgical movement and relapse in all directions. Because the lip and nose cover the maxilla, the movement of the maxilla influences the appearance of the lip and nose. Therefore, definitive revision of the lip and nose in cleft patients should be performed after maxillary osteotomy. At this stage, all procedures that were not done because of their effects on growth can be performed. For definitive management of the nose and lip, all strategies of reconstructive, plastic, and aesthetic surgery should be considered. A series of treatments as the patient grows after the birth is completed by these revisions