Synchronous Palatal Closure and Premaxillary Setback in Older Children with Bilateral Complete Cleft of Lip and Palate

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Achieving good results after primary repair in older children with complete bilateral cleft lip and palate is a Herculean task, particularly when the premaxilla is protruding and twisted. The authors faced the problems of protruding premaxilla in children older than 5 years of age with bilateral complete cleft lip and palate who presented late for primary repairs. Due to financial constraints and the distances traveled, these patients prefer to come for fewer procedures with maximum benefits. These factors encouraged the authors to carry out synchronous palatal closure and premaxillary setback in older children with bilateral complete cleft of the lip and palate.


Synchronous palatal repair and premaxillary setback were carried out in 14 patients. During palate repair, good exposure of the vomer made premaxillary setback easy without compromising the blood supply to it. The premaxilla, after osteotomy, was immobilized in all patients using the simple technique of Kirschner wire fixation; an additional gingivoperioplasty was performed in a few patients. Palatal closure was achieved with two flap techniques with intravelar veloplasty.


Proper positioning of the premaxilla was achieved in all patients, with good labial repair 6 months after the primary palate closure. There were no major complications, such as loss of the premaxilla or vascular compromise. Two patients had an anterior open bite and one patient had a postalveolar fistula.


This technique had a few minor complications, but the overall surgical outcome was satisfactory. This protocol proved advantageous in achieving good results with fewer procedures and in reducing the total expenditures and the length of the patient's hospital stay.

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