**7.1 Prevalence**

*Current Treatment of Cleft Lip and Palate*

carried out on Rhesus monkeys [38].

surgery methods for these.

*6.3.1 Standard Le fort I osteotomy*

the segmental Le Fort I osteotomy technique that considers biological principles in BCLP patients with maxillomandibular deformities [17, 55, 56]. This method, for instance, emphasizes preservation of the labial soft tissue mucosal pedicle in the maxillary of patients. The significance of this flap circulation that is achieved by considering biological principles was confirmed in the study by Bell et al. that was

Mainly, in BCLP patients, clinicians encounter maxillary deformities including those that are intact on both sides (successfully grafted) with one alveolar ridge, those with two segments with one side intact (successfully grafted), and those with three segments that are failed/non-grafted, and they apply different orthognathic

Patients in cases of BCLP may have intact alveolar ridges on both sides, one intact alveolar ridge on only one side or alveolar clefts that have been successfully grafted during mixed dentition. In adolescents or adults with maxillomandibular deformity and intact alveolar ridges on both sides, a standard Le Fort I down-

In an individual with BCLP, a unilaterally intact alveolar ridge (with residual alveolar cleft and oronasal fistula on the other side) shows the same anatomy as those in a UCLP patient. The surgical approach for such a patient is the same as that which is applied for a UCLP patient with separated segments. For patients who are born with BCLP and non-grafted alveolar arches, the modified Le Fort I Osteotomy

Unfortunately, a big part of patients who have BCLP maxillomandibular deformities are still observed to have alveolar clefts, residual oronasal fistulae, and mobile premaxilla. While carrying out a Le Fort I osteotomy procedure on a BCLP patient with non-grafted alveolar arches, accurate incisions has a critical impor-

In the technique, on each side, a buccal (labiolateral) incision is made from the zygomatic buttresses (anterior and gingival levels of the parotid canal) in the depth of the vestibule extending toward the location of the residual oronasal fistula. Then, vertical incision continues according to mesial angle of the canine (or if the canine is missing, the most mesial tooth on each lateral segment). Without completely separating the premaxilla, an intermediate splint is placed to fix the lateral segments. The premaxilla is to be included to the vestibular incisions at the posterior with angular, vertical incisions in its labial direction, and to separate the oral and nasal mucosa of the fistulae even further, the incision continues downward along the distal line angle of the central incisor teeth on both sides. Attention should be paid to prevent deformation or incision of the mucosa in the premaxilla. Shavings are made from the segments to get the hard and soft tissues closer to each other. While doing this, one should be careful not to damage the lamina dura of the existing teeth. After completion of the premaxillary segment and other adjustments, the final splint is placed, and the segments are fixed with titanium plates and screws [17]. If there is grafting, an additional microplate is also needed to stabilize each cortico-cancellous (iliac) graft. To repair facial asymmetries, mandibular deformations, and secondary

tance for providing all three segments with blood circulation [17].

fracturing technique performs to advance maxillary hypoplasia.

*6.3.2 Modified Le fort I osteotomy (two-segment)*

(three-segment) procedure should be applied.

*6.3.3 Modified Le fort I osteotomy (three-segment)*

**70**

It was reported that 20% of Caucasians with ICP who receive repairs in the period of infancy would experience maxillary hypoplasia in a way that would lead to malocclusions that do not respond to a conventional or compensatory orthodontic approach by itself [36]. Chen et al. [57] reported on the horizontal maxillary growth of both children and adults with ethnic origins of Eastern China who were operated/not operated. Accordingly, as an interesting finding, the results of the individuals with ICP who were not operated in the mixed dentition period showed an almost normal horizontal growth. In the patients who were operated (repaired cleft palate) in the mixed dentition period, there was a decrease in the clockwise rotation of the maxillomandibular complex. In addition to this, it was stated that, for an individual born with ICP, the prevalence of maxillomandibular deficiency is dependent on a combination of factors such as the internal structure of the primary cleft defect, secondary hypoplasia due to surgical repair at infancy, and functional factors (e.g., muscle effects – mastication, respiratory pattern, and mandibular resting posture) [58].
