Secondary management of the premaxilla in bilateral cleft lip and palate patients.

Bilateral clefts of the palate pose difficult and unique problems in surgical rehabilitation. The premaxilla traditionally has been a controversial subject with a historic lack of uniformity in treatment protocol. Based on a review of facial growth and the evolution of premaxillary cleft surgery, principles of management and secondary reconstruction of the premaxilla are discussed. Timely surgical intervention combining osteotomies and bone grafting in conjunction with closure of soft tissue defects is shown to result in satisfactory functional and aesthetic results.