Challenges in the Successful Reconstruction of Cleft Lip and Palate: Managing the Naso-Maxillary Deformity in Adolescence

The surgical techniques and execution of primary cleft lip and palate repair are no longer the biggest challenge to achieving successful rehabilitation for those born with facial clefting (i.e. bilateral cleft lip and palate [BCLP] and unilateral cleft lip and palate [UCLP]). Despite a surgeon's best efforts, when cleft palate repair is carried out during infancy, by the mixed dentition a majority will demonstrate naso-maxillary deficiency.The cleft team's commitment to a family under their care is to ensure that the newborn reaches adulthood reconstructed without need for special regard to their original birth malformation. Guiding principles are provided for the accurate diagnosis and the reliable reconstruction of the UCLP and BCLP adolescent/adult who presents with naso-maxillary deficiency and any residual oro-nasal fistula, bony defects, cleft dental gap(s), nasal obstructions, and associated facial dysmorphology. Successful orthognathic surgery provides a stable foundation on which any remaining soft tissue cleft lip or cleft nasal deformities can be accurately assessed and then reconstructed.