Early Bone Grafting in Complete Cleft Lip and Palate Cases Following Maxillofacial Orthopedics: II.The Soft Tissue Development from Seven to Thirteen Years of Age

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Abstract
The subsequent effect of preoperative maxillofacial orthopedics and early bone grafting on the development of the soft tissue profile of the face was studied with roentgenocephalometric analysis on cleft patients between 7-13 yr of age. They were divided into 2 unilateral and 1 bilateral complete-cleft group, all having been bone grafted early with the 4-flap technique. The 2 unilateral groups were 1 group of 39 children operated on between 1960-1972 after premaxillary retropositioning pressure, combined when necessary, with outward rotation of the lateral maxillary segments. Comparisons of facial growth were made with U.S. nongrafted clefts and with nonclefts. The effect of the preoperative orthopedic management facilitated the subsequent surgical procedure by a narrowing of the cleft and replacement of the deviated maxillary and nasal structures. The results were within limits of the nongrafted cases, with the exception of the soft tissue overlying the subnasal region. The reduced prominence of that region was explained by the primary surgical procedure, which made the lip adherent to the alveolar crest. In comparison with nonclefts, all parameters indicated a reduced growth capacity.