Orthognathic surgery in cleft patients.

Orthognathic surgery has become a standard procedure in cranio-maxillo-facial surgery during the past five decades. Based upon the elementary works by Obwegeser who introduced sagittal split ramus osteotomy in the early 1950s, this procedure has become the worldwide gold standard in mandibular orthognathic procedures by now. When devices for ensuring the centric condylar position throughout the entire surgery were introduced by Luhr in the early 1980s, modern understanding of complete functional rehabilitation in orthognathic surgery was further enhanced. Even though Le Fort I osteotomy was performed by Wassmund already in the 1920s, it took almost another 50 years until this procedure became accepted in surgery, mainly due to concerns for severe haemorrhage that may occur during surgery. Application of a compound condylar positioning device which was established to ensure and keep the exact condylar position throughout maxillary, mandibular, as well as during bimaxillary osteotomies, and to permit the targeted use of distraction devices. Among those, cleft patients also sometimes need orthognathic correction of typical micrognathia and pseudoprogenia in late adolescence or at early adult age as secondary cleft surgery procedures. In this overview, special emphasis will be placed on orthodontic treatment as well as on the technical prerequisites for the surgical procedure.