Surgical approach for 2nd skeletal Deformity of Cleft lip/Palate
Ting-Chen Lu, Philip Kuo-Ting Chen
In this speech, the cleft orthognathic surgery focus on:
- Differences between the cleft/non-cleft orthognathic surgery
- Our preferences in single splint other than double splint
- Surgical pitfalls in the cleft orthognathic surgery
- Relapse in the cleft orthognathic surgery
Cleft orthognathic surgery is different from the others mainly on the maxilla. It is more adhesion on nasal floor, more difficult for maxilla advancement or expansion, and more technical difficulty in bilateral clefts. The surgery pitfalls will be explained in this speech. In Chang Gung Memorial hospital, we use single splint technique other than double splint. There persists a double error in double splint. The maxilla was more under-advanced and over-impacted anteriorly than predicted by model surgery. The amount of mandibular setback was more than that predicted by model surgery. And sometimes, there is difficulty in fitting the maxilla into the intermediate splint, and during the surgery, it needs to shift to dingle splint technique. Check lists in single splint technique include midline, occlusal plane, facial profile, teeth show and paranasal symmetry. The relapse in cleft orthognathic surgery is about 10-20%. The complications are similar in non-cleft orthognathic surgery. Simultaneous alveolar bone grafting possible when the two segments are approximated during OGS.