Long-Term Effects of Premaxillary Setback on Facial Skeletal Profile in Complete Bilateral Cleft Lip and Palate

Abstract

The purpose of this study was to analyze the long-term effects of premaxillary setback in the surgical treatment of complete bilateral cleft lip and palate (C-BCLP). Roentgencephalograms at adolescence or early adulthood were available for 13 of our longitudinal C-BCLP patients who were treated with premaxillary setback and followed up with serial films since infancy. Six individuals had been subjected to early premaxillary setback to facilitate lip repair. Seven of the patients had had their premaxillae setback at a later age to correct a severe midfacial protrusion in the preschool years. Fourteen other C-BCLP patients, followed up and treated similarly except for the pre-maxillary setback, served as controls. The average long-term outcome of the setback surgery in both the early and late subgroups was retrusion of the midface and a slightly concave facial skeletal profile. Premaxillary protrusion, a characteristic of infants with complete bilateral cleft lip and palate (C-BCLP), has always consti— tuted a major problem in the surgical re— habilitation of this type of cleft. Millard's (1977) historical review of treatment of the projecting premaxilla is an interesting account of the efforts to achieve ideal results as early as possible, at a time when so little was understood about the spectrum of severity of the defect and its natural history.