Abstract
We perform palatal closure in two stages to prevent growth disturbances in the bony maxillary bone structures. In this study, among 164 patients with unilateral cleft lip and palate who received continuous treatment from the period immediately after birth in the Department of Oral Surgery of our college, 68 patients whose long-term follow-up was possible during the treatment period in our orthodontic department were selected; 4 of these patients, in whom orthognathic surgery was finally required, were evaluated.
Regarding the evaluation method, we investigated 16 angle measurement items in lateral roentgenographic cephalograms at the time of the first examination in our orthodontic department, initiation of orthodontic treatment after completion of permanent dentition, and orthognathic surgery. Furthermore, facial prophilograms were produced, and patterns of facial profiles were classified.
Case 1: A male patient who had macroglossia and a tongue-thrusting habit, and had already presented with open bite at the time of the first examination in our orthodontic department. Le Fort type I osteotomy, sagittal split ramus osteotomy, and tongue-reducing surgery were performed at 18 years of age.
Case 2: A female patient who presented with slight maxillary retrusion at the time of the first examination in our orthodontic department. Although the values of items in the maxilla were almost within the normal range after entering adolescence, mandibular hyper-growth became marked. Sagittal split ramus osteotomy was performed at 16 years of age.
Case 3: A male patient who presented with slight maxillary retrusion at the time of the first examination in our orthodontic department and initiation of orthodontic treatment after completion of permanent dentition. Although only orthodontic treatment was planned at first, since the patient requested a shorter treatment period, sagittal split ramus osteotomy was performed at 18 years of age.
Case 4: A male patient who presented with maxillary retrusion and marked mandibular protrusion at the time of the first examination in our orthodontic department. The hyper-growth of the mandible progressed at the time of initiation of orthodontic treatment after completion of permanent dentition, and Le Fort type I osteotomy and sagittal split ramus osteotomy were performed at 19 years of age.
In all of these 4 cases, the reasons for orthognathic surgery were considered to be more closely related to factors other than the influence of palatoplasty.
