Rotating a Segmental Maxilla to Close a Serious Vertically Displaced Alveolar Cleft

In recent years, alveolar bone grafting has emerged as the first treatment choice for space closure in the secondary dentition. Despite this, a high possibility of failure still exists for patients with a vertical discrepancy of cleft segments. This is attributed to the absence of valid contact between the grafted bone and the surfaces of bone segments in the cleft region. In cases of minor discrepancies, the vertical distance can be reduced orthodontically, allowing for subsequent alveolar bone grafting.¹ However, in severe cases, isolated orthodontic treatment is not viable due to a high risk of periodontal problems and increased tooth mobility. Under the circumstances, surgical intervention is essential. Herein, we report a case in which the alveolar segment is aligned using a novel application of segmental maxillary osteotomy to rotate the segment with a subperiosteal tunnel. Rigid fixation of the segment in the desired position is then performed with concurrent bone grafting. Therefore, performing segmental maxillary osteotomy before bone grafting could be an alternative to correcting the vertical discrepancy encountered in cleft patients.