Abstract
Patients with cleft lip and palate often present with an anterior crossbite, molar crossbite, and sloping of the occlusal plane due to three-dimensional inferior growth of the maxillary bone. In the present case, a patient with cleft lip and palate with a narrowed maxillary dental arch was treated consistently in our clinic, resulting in a harmonious facial appearance and a good occlusal relationship.
The patient was a 6-year 1-month-old male with a left-sided cleft lip and palate. He had no skeletal problems and a narrowed maxillary dental arch, with an anterior crossbite and bilateral molar crossbite. Phase Ⅰ treatment included lateral expansion of the maxilla and cleft jaw bone grafting. Thereafter, growth was observed, but with anterior growth of the mandible, the patient was skeletal Class Ⅲ due to the posterior position of the maxilla and anterior position of the mandible at the age of 16 years 3 months. He exhibited a concave soft tissue facial profile with midfacial deficiency, and his lip was prognathic. Intraoral examination demonstrated a small overjet of －4.2mm, an overbite of 3.7mm, and a palatal transposition of the upper left lateral incisor. The midline of the upper and lower dentition was discordant. In addition, the length of the soft palate was short and there was dysfunction of nasopharyngeal closure. In the Phase Ⅱ treatment, the patient underwent upper and lower dentition alignment with a multi-bracket appliance, extraction of the maxillary left lateral incisor, and maxillary and mandibular osteotomies. The maxilla was moved anteriorly and the molars were moved upward by Le Fort Ⅰ osteotomy. The mandible was moved anteriorly using a sagittal split ramus osteotomy （SSRO）. The patient underwent postoperative orthodontic treatment to tighten the occlusion, genioplasty, lip and external nasal modification, and pharyngeal valvuloplasty. A good facial profile, occlusal status, and improvement of nasopharyngeal closure function were achieved.
