Treatment of maxillary arch collapse in an adult cleft palate patient: report of case.

The combined orthodontic, orthognathic surgical, and prosthodontic reconstruction of the previously treated bilateral cleft lip and cleft palate of a 20-year-old white man is reviewed. Maxillary arch collapse and severe malocclusion occurred after palatal closure in early childhood with alveolar bone grafting and premaxillectomy. A modified Le Fort I osteotomy, using a jackscrew with a modified posterior hinge, was employed to achieve rapid palatal expansion. In addition, mandibular subapical osteotomy was performed, in conjunction with postoperative orthodontic realignment. Fixed prosthodontic restorations were then used to achieve stability and a more esthetic appearance.