Surgical management of severely protruding premaxilla in bilateral clefts

Abstract

Background: In the cases of severe premaxillary protrusion where nasoalveolar moulding could not be delivered, we have opted for primary osteotomy of premaxilla/vomer to achieve tensionless closure of lip. The aim of present study is to document our experience with both kinds of osteotomies; premaxillary and vomerine.

Methods: In last seven years, 104 patients of bilateral cleft lip with severely protruding premaxilla reported to our unit. Out of these patients, 26 underwent primary osteotomy of premaxilla/vomer. Follow up period ranged from 4 to 72 months.

Results: In both types of osteotomies, we did not observe any issues with vascularity of premaxilla, eruption and vitality of maxillary incisors. Manipulation of osteotomised segment and closure of lip were more convenient in premaxillary osteotomy. Healing was satisfactory in all the patients except two. Aesthetic outcome was acceptable in all except five patients of premaxillary and three cases of vomerine osteotomy.

Conclusion: Primary setback osteotomy of premaxilla/vomer is a safe procedure to manage bilateral cleft lip with excessive protrusion of premaxilla. Regular follow-up should be done in such cases to assess the growth of midface and if required corrective orthodontic and/or surgical treatment should be carried out.

Keywords: Bilateral clefts; Osteotomy; Premaxilla; Premaxillary; Protruding; Vomerine.