Cleft Orthognathic Surgeries

Patients with cleft lip and palate tend to have facial deformities especially of the maxilla ( upper jaw). The upper jaw tends to be smaller and underdeveloped. The teeth especially the front ones also tend to be mal aligned. Correction of these deformities requires both Orthodontic and Surgical management. The teeth are aligned and the narrowed jaw is expanded by Orthodontic treatment while the jaw alignment is corrected (brought forward) by surgery.

The surgical correction may be done in one stage as in Le Fort Osteotomy of the Maxilla or gradually over a few days as in Distraction Osteogenesis of the Maxilla. In a growing skeleton and or when the deformity is severe the distraction is the preferred modality, while in late teens and well aligned arches maxillary osteotomy will be beneficial.

Distraction osteogenesis is a technique of gradually growing ( Lengthening) a jaw over a few days with the help of specialised screw like apparatus. This technique is relatively recent and is technique sensitive. The technique involves placement of the device in the desired position and direction in the first stage followed by a period of consolidation and then the device is activated every day to gradually lengthen the bone. Once the desired lengthening has been achieved, the device is left in position for further 8-10 weeks to allow the bone to heal in the new position. Once healing is confirmed the device needs to be removed.