engleski

Orthognathic, microvascular and implant-prosthetic therapy of untreated cleft lip and palate in adult person

This paper presents a case report of an untreated cleft lip and a palate in the adult patient. Multidisciplinary team composed of maxillofacial surgeons, prosthetic and orthodontic specialist was involved in the planning and treatment. The 44 year old women came to maxillofacial surgery office due to difficulties with feeding, swallowing, speech and appearance which worsened after the loss of teeth. Diagnostic procedure determined a cleft of the primary and secondary palate with severe bone deficiency in the alveolar ridge, a cleft lip badly treated in the childhood, oronasal fistulas, deformity of the nasal pyramid, unilateral choanal atresia and severe skeletal malocclusion. In the first surgery the narrow cleft maxilla required surgical expansion and the Le Fort I osteotomy with advancement and repositioning of the maxilla was done with prior orthodontic planning. The gaps of resected maxilla were filled with bone chips of corticocancellous iliac crest grafts. Microsurgical reconstruction of the alveolar ridge bone defect with the composite radial forearm free flap was done, together with closure of the oronasal fistula. Six months after the maxillar continuity was maintained, the grafts were stable and the oronasal fistula was closed, so in the second surgery the osteosynthethic material was removed and the osseointegrated implants were inserted in the upper jaw. The last, third surgery was done 3 months after the implant placement. The rhinoplasty was done and the sulcus formers were placed. Finally the good prosthetic rehabilitation with satisfying speech, good mastication and cosmetic appearance was achieved.

cleft lip and palate in adult person

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