Maxillofacial osteotomies for patients with cleft lip and palate.

A variety of dental malocclusions may be found in the patient with cleft lip and palate. These range from trivial dental rotation to major dentoskeletal disharmonies. Some of these deformities are intrinsic to the cleft malformation whereas others are secondary deformations resultant from specific management options taken in childhood. In most cases, a combination of orthodontics and orthognathic surgery is necessary to correct the deformity, that is, normalize the dentition, the facial skeleton, and the facial appearance. The timing of intervention, dependent upon the specific problem, is chosen to minimize negative secondary effects. Stability of mobilized and repositioned maxillary segments remains a problem in spite of the use of rigid internal fixation miniplates. The role of bone grafting when miniplates are used is unclear. While it is clear that movement of the maxilla, segmentally or in toto, can correct major dentoskeletal deformities in cleft patients, much remains to be learned regarding the best means of executing such operations.