Le Fort type III osteotomy for midface deficiency in selected cleft palate patients

The comprehensive treatment of cleft lip and palate continues to evolve as understanding of the pathogenesis of this malformation and refinement of surgical techniques for its treatment have improved. The malformation, although varying in severity from individual to individual, is now considered an abnormality of the entire maxilla. Our experience indicates that a finite minority of cleft patients exists with significant malar and midfacial projection deficiency in addition to class III malocclusion who will benefit from a more extensive midfacial advancement. We have treated 10 patients with a diagnosis of cleft lip and palate as well as malar and midfacial retrusion with a Le Fort type III advancement. In this group of patients, there were two early postoperative complications. Two patients (20%) experienced late occlusal changes; 4 patients underwent orthodontic correction; and the other required a Le Fort type I osteotomy. Three patients (30%) experienced predicted velopharyngeal insufficiency requiring a pharyngeal flap for correction. All patients demonstrated both subjective and objective improvement in facial aesthetics and Angle's class I occlusion after surgery. In patients with cleft lip and palate who also have midfacial retrusion, the Le Fort type III advancement provides a more complete correction of the facial deformity as well as the malocclusion. This approach should be integrated into the comprehensive management of this deformity by individuals trained in craniofacial techniques.