Abstract
The postoperative stability of the inferior movement of the maxilla is poor after orthognathic surgery. This case report describes the orthognathic treatment of a unilateral cleft lip palate patient with severely retruded maxilla and crossbite. The maxillary segment was moved downward after Le Fort Ⅰ osteotomy and fixed rigidly with mesh-type plates.
The patient was a 21-year and 4-month-old female with left unilateral cleft lip palate who presented to Meikai University Hospital. Her chief complaint was anterior crossbite and nasal deformity. She had a short face and concave profile due to the underdeveloped maxilla. SNA and ANB were 66.5 and －10.5 degrees, respectively, showing a skeletal Class Ⅲ intermaxillary relationship. An unclosed alveolar cleft was seen on the left.
Secondary bone graft was performed at 22 years and 4 months old. After presurgical orthodontics, the maxilla was moved inferiorly （5.0mm） and anteriorly （5.0mm and 2.0mm on the left and right, respectively） by Le Fort Ⅰ osteotomy. To obtain rigid fixation between maxillary segments having spaces, titanium mesh-type plates were placed. Satisfactory postoperative stability was obtained up to 1 year and 9 months after the surgery. Finally, she underwent nasal reconstruction by transplantation of auricular cartilage and nasolabial flap at 25 years and 9 months old, and showed the anteriorly moved nasal tip and correction of nasal deformity.
