Comprehensive treatment approach for bilateral cleft lip and palate in an adult with premaxillary osteotomy, tooth autotransplantation, and 2-jaw surgery

We report the successful treatment of a woman aged 25 years 3 months with bilateral cleft lip and palate. She had a protruded premaxilla, collapsed posterior segments, wide alveolar defects with oronasal fistulae, a congenital missing tooth, and severe facial asymmetry with a transverse occlusal can...

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Bibliographic Details
Published in:American journal of orthodontics and dentofacial orthopedics 2015, Vol.147 (1), p.114-126
Main Authors: Kokai, Satoshi, Fukuyama, Eiji, Sato, Yutaka, Hsu, Jui-Chin, Takahashi, Yuzo, Harada, Kiyoshi, Ono, Takashi
Format: Article
Language:English
Subjects:
Adult
Alveolar Bone Grafting - methods
Anodontia - surgery
Autografts - transplantation
Bicuspid - transplantation
Cephalometry - methods
Cleft Lip - surgery
Cleft Palate - surgery
Dentistry
Facial Asymmetry - surgery
Female
Follow-Up Studies
Humans
Incisor - abnormalities
Malocclusion, Angle Class III - surgery
Malocclusion, Angle Class III - therapy
Maxillary Osteotomy - methods
Nose Diseases - surgery
Oral Fistula - surgery
Orthognathic Surgical Procedures - methods
Osteotomy, Le Fort - methods
Osteotomy, Sagittal Split Ramus - methods
Palatal Expansion Technique
Patient Care Planning
Respiratory Tract Fistula - surgery
Tomography, X-Ray Computed - methods
Treatment Outcome
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Summary:We report the successful treatment of a woman aged 25 years 3 months with bilateral cleft lip and palate. She had a protruded premaxilla, collapsed posterior segments, wide alveolar defects with oronasal fistulae, a congenital missing tooth, and severe facial asymmetry with a transverse occlusal cant. The comprehensive treatment approach included (1) premaxillary osteotomy combined with alveolar bone grafting to reposition the premaxilla and minimize the wide alveolar defects, (2) autotransplantation of a tooth with complete root formation to the grafted bone region to restore the missing tooth without a prosthesis such as a dental implant or bridge, and (3) 2-jaw surgery to improve facial asymmetry. The premaxillary osteotomy was managed orthodontically, in combination with bone grafting. The results suggest that surgical orthodontic treatment with tooth autotransplantation might be useful to improve the occlusion and facial esthetics without prosthetics.
ISSN:0889-5406
1097-6752
DOI:10.1016/j.ajodo.2013.12.031