Cleft-Related Orthognathic Surgery Based On Maxillary Vertical Lengthening Of the Anterior Facial Height

Background: The conventional approach during orthognathic surgery for cleft-related deformities has largely focused on restoration of maxilla retrusion, using the maxillary advancement as a standard treatment objective. However, we thought the maxillary vertical shortening and deficient incisor show could be the additional key elements of cleft-related deformities. Although slight vertical lengthening can be obtained with only maxillary advancement, it would not be enough to obtain satisfactory aesthetical results in terms of the anterior facial height. We hypothesized that vertical deficiency as well as anteroposterior maxillary retrusion exists in cleft-related deformities. Therefore, orthognathic surgery including intentional vertical lengthening and advancement would be better than the conventional simple advancement. Methods: A new approach was used to treat consecutive patients with dentofacial deformities between December 2007 and December 2016. The inclusion criterion was patients with cleft-related deformities. Results: Forty-one patients with cleft-related dentofacial deformities were included. The distance from the nasion to the incisor tip was 76.70 mm, angle of the lines connecting the sella, nasion, and point A was 74.03∘, and the incisor show was 1.02 mm. Corresponding measurements in forty patients without clefts were 81.57 mm, 80.08∘, and 3.38 mm, respectively. Postoperatively, the average vertical lengthening achieved was 0.88 mm in simple maxillary advancement group and 7.65 mm in intentional vertical lengthening accompanied by the maxillary advancement group. Conclusions: Our results suggest that simultaneous maxillary vertical lengthening with horizontal advancement is a viable approach to orthognathic surgery for cleft-related deformities given the long-term stability of outcomes demonstrated in this study. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Acknowledgment: This article was presented at 2016 EACMFS in London, England. Corresponding author: Jong Woo Choi, M.D., Ph.D., MMM, Associate Professor, Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, 388-1 PungNap-2Dong, SongPa-Gu, Seoul 138-736, Korea, Phone: 82-2-3010-3604; Fax: 82-2-476-7471, E-mail: pschoi@amc.seoul.kr ©2017American Society of Plastic Surgeons