Evaluating Two-Piece Le Fort I Osteotomy for Residual Alveolar Clefts: Case Series Highlighting Occlusal Outcomes and...

ObjectivesTo assess the clinical and radiographic outcomes of segmental two-piece Le Fort I osteotomy in patients with cleft lip and palate (CLP) with residual alveolar clefts.DesignThis retrospective case series assessed the occlusal outcomes after Le Fort I osteotomy, and radiographic alveolar continuity using cone-beam computed tomography (CBCT).SettingTertiary cleft and craniofacial center within an academic institution.Patients/ParticipantsPatients aged ≥12 years with unilateral cleft lip and palate (UCLP) who presented with an anterior crossbite and residual alveolar defect and underwent orthodontic treatment and Le Fort I osteotomy between 2019 and 2025.InterventionsFour patients with UCLP underwent pre-surgical orthodontic treatment to prepare for orthognathic surgery. Extractions were performed to correct crowding and/or dental impactions. Patients then underwent Le Fort I osteotomies to correct the anterior crossbite and close the cleft gap.Main Outcome MeasuresCorrection of dental malocclusion and assessment of alveolar bone support of the residual alveolar cleft following segmental two-piece Le Fort I osteotomy.ResultsIn all cases, anterior crossbite was corrected to positive overjet with normal overbite. Results were well accepted by all patients. Size of cleft defects was reduced with radiographic evidence of osseous continuity. The need for prosthodontic replacement teeth was eliminated in each case.ConclusionsAll four patients who underwent orthodontic treatment and segmental two-piece Le Fort I osteotomy resulted in corrected the anterior crossbite and closure of the cleft gap. Patients underwent several extractions to ensure that the remaining teeth were centered in alveolar bone, and their final occlusion was functional and stable.