Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.
J Craniofac Surg. 2021;32(2):472-476. doi: 10.1097/SCS.0000000000006911.
Successful aesthetic repair of the bilateral cleft lip and palate (BCLP) is one of the most challenging cases encountered by a surgeon. This challenge is heightened when the premaxilla is anteriorly protruded in relation lateral maxillary segments. Our aim is to demonstrate a useful technique for reducing the cleft size before secondary lip repair. We use a premaxillary osteotomy to posteriorly reposition the premaxilla between the lateral segments.
Six patients with BCLP underwent repositioning of the protruded premaxilla. Five patients had previous primary lip closure procedures with unsatisfactory results. The cleft size was reduced by premaxillary osteotomy from nasal septum and partial removal of the vertical vomer. The osteotomized premaxilla was then repositioned, fixed with a custom-made orthodontic appliance. Following this procedure, the lip was closed in a traditional fashion.
All patients demonstrated satisfying lip closure without tension. In each case, the premaxilla was vital and exhibited partial stabilization during follow-up.
In this study the authors demonstrate the usefulness of a premaxillary segment setback as an adjunct to improved function and aesthetics in bilateral lip repair. This method serves as useful technique for previously unsuccessful closure of BCLP.
成功修复双侧唇腭裂（BCLP）是外科医生面临的最具挑战性的病例之一。当上颌前突与外侧上颌段相关时，这种挑战更加严峻。我们的目的是展示一种在二次唇修复前缩小裂隙大小的有用技术。我们使用前颌骨切开术将前颌骨向后重新定位到外侧段之间。
6 例 BCLP 患者接受了突出前颌骨的复位。5 例患者曾行初次唇闭合术，但效果不理想。通过鼻中隔和垂直犁骨的部分切除从前颌骨切开术缩小裂隙大小。然后将切开的前颌骨重新定位，用定制的正畸器械固定。在这个过程之后，传统的方式关闭嘴唇。
所有患者均表现出满意的无张力唇闭合。在每个病例中，前颌骨均有活力，并在随访中表现出部分稳定。
在本研究中，作者展示了前颌骨后退作为双侧唇修复改善功能和美学的辅助手段的有用性。该方法为以前不成功的 BCLP 闭合提供了一种有用的技术。
