Late definitive correction of the orofacial cleft. Report of a case

This article presents the results obtained through staged secondary reconstruction of a unilateral complete cleft of the lip and palates in a young male patient. In the case report the principles of orofacial cleft management are addressed, with specific reference to those points of immediate importance to the orthodontist and the surgeon, around whose synergistic efforts the final rehabilitation often must pivot. Orthopedic and surgical expansion of the scarred, constricted maxilla, orthodontic preparation and completion, maxillary advancement and alveolar cleft bone grafting, and the stabilizing roles of palatal scar release and bone grafts for the translated maxillary complex are discussed as the treatment plan is executed. Completing the rehabilitation are the integral considerations of speech and audiology, otologic surgical intervention, and soft-tissue revision of the lip and nose. The genesis of the secondary deformity is also explored relative to the primary congenital anomaly, the techniques and temporal sequence of its repair, and subsequent growth disturbance. A review of the pertinent literature is included.