Abstract
We report a case of bilateral cleft lip and palate, which is associated with absence of both premaxilla and maxillary bilateral central incisors, in an 8-year-old female who presented with reversed occlusion. Preoperative maxillary dental arch coordination was performed, followed by interdental distraction osteogenesis at the age of 10 years and 9 months, in order to narrow the gap of the defective alveolar bone. Subsequently, the premaxilla was reconstructed by bone grafting on the remaining defective section of the alveolar bone at the age of 11 years and 3 months. Le Fort I distraction osteogenesis was performed with preoperative orthodontic treatment at the age of 12 years and 9 months; however, anterior cross bite, projected lower lip, and large mobility of both maxillary lateral incisors occurred during postoperative orthodontic treatment. Consequently, the occlusion was reevaluated at the age of 14 years and 8 months and was adjusted by bilateral extraction of maxillary lateral incisors, bilateral medialization of maxillary canines, and bilateral transplantation of extracted mandibular first premolars to the mesial side of the maxillary first premolars. Finally, nose deformities were repaired using costochondral graft, and the facial profile was remarkably improved. Although the treatment took 9 years and 10 months, the occlusion has been stable for 2 years and 6 months since the completion of treatment.
