Hourglass Maxillary Collapse in Repaired Postalveolar Clefts of the Palate

Abstract

The patient with a repaired complete cleft lip and palate routinely exhibits some degree of alveolar arch asymmetry and maxillary deform— ity. It is not usually recognized, however, that the patient with only a postalveolar palate cleft may also present a maxillary abnormality. The purpose of this paper is to draw attention to this defect in View of its characteristic appearance, its clear association with surgery, and the possibility that it may be avoided by simple surgical caution. Material and Cases The postalveolar cleft palates operated upon at the Columbia-Presbyterian Medical Center from 1958 to 1968 were reviewed. Two patients demonstrated a significant deformity of the alveolar arch. Case 1. This 17 month old child was operated upon for the closure of a post-alveolar cleft palate. No cleft of the primary palate was present. The edges of the cleft were pared, releasing incisions were made around the alveolar rim laterally, and mucoperiosteal flaps were elevated (von Langenbeck technique). The hamular processes were fractured at their bases, the greater palantine neurovascular bundles were preserved, and the palate was sutured in layers medialy leaving the relaxing incisions open. Healing was uneventful. Speech development was good. How— ever, at age 10, dental models demonstrated an " hourglass " maxillary collapse without apparent anterior—posterior shortening (Figure 1 A). Fig. 2. This child was operated upon at age 4 at which time a push—back procedure was done closing the anterior portion of a wide horseshoe type postalveolar palate defect. At age 6 a von Langenbeck procedure closed the posterior palate. Small turnover palate flaps were used at ages 8 and 9 to close a palato—nasal fis-tula. Dental models at age 21 showed severe " hourglass " deformity (Figure 1 B). Discussion Maxillary deformities in the repaired cleft lip and palate patient occur in four main categories (Figure 2). One is medial collapse of the cleft segment of the alveolus. This is ultimately manifest as a maxillary cross— "