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

• 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
• ISSN: 0889-5406; 1097-6752
• DOI: 10.1016/j.ajodo.2013.12.031

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.