**6. Orthognathic approach on BCLP deformities**

#### **6.1 Prevalence**

In the study that was carried out at Boston Pediatrics Hospital, it was stated that there was a need for maxillary advancement by orthognathic surgery in 76.5% adolescents whose BCLP had been repaired [3]. Moreover, the authors explained

**69**

**6.3 Surgical approach**

*Orthognathic Surgery in Cleft Lip and Palate Patients DOI: http://dx.doi.org/10.5772/intechopen.89556*

**6.2 Orthodontic approach**

computerized tomography (CBCT) images.

supported the findings of the aforementioned ones [51, 52].

in the arch and moved to ideal position by the orthodontist.

ideal angle, extraction is usually not necessary on the mandibular arch.

Incomplete, insufficient definitions were presented by previous studies for surgical techniques used for the purpose of warning BCLP patients about possible complications regarding maxillary osteotomy and achieving reliable osteotomy operations [39, 53]. Hugo Obwegeser provided significant contributions which may be considered as milestones about cleft surgery on BCLP patients. However, at the early stages, very few clinicians adopted the methods of Obwegeser. This was because, as one of the eight patients he treated died of airway complications, and the results on the others were not reported in an appropriate manner, relevant studies criticized them [54]. In the mid-1980s, Posnick described a safe method of

that, in addition to the severity of the cleft type, the number of previous operations and extent of cleft area also affect the need for orthognathic surgery. Another study conducted at Toronto Pediatrics Hospital stated that there was a need for orthognathic surgery in 65.1% of their own BCLP patients, while this rate was 70% for patients who were referred by other centers [8]. From the Cleft Craniofacial Unit in Adelaide, Australia, David et al. [50] followed BCLP patient groups from birth to adulthood and determined the need for orthognathic surgery. Accordingly, orthognathic repair was needed in skeletal class III malocclusion among 17 of 19 patients (89.5%) and when they reached 18 years of age. Other previous studies also

Different degrees of dysplasia in the sagittal, vertical, and horizontal directions are observed on the maxilla of patients without an ideal bone graft in the mixed dentition period that is divided into three segments. Before surgical treatment of maxillary segments, each segment is separately treated by an orthodontist. Before orthodontic treatment, cephalometric and panoramic radiography images are taken, and the angles, positions, and morphologies of teeth to soft tissues and bones are examined. In these patients, the volumes of the bones in the cleft region and the detailed position of teeth may be analyzed by additionally taking cone beam

BCLP patients have a broad variation in terms of the amount of dentoalveolar bone and the number of permanent teeth. Teeth that resemble lateral incisors are usually observed along the sides of the lateral segments. Due to the usually underdeveloped root structure of these teeth and their deformed crowns, extracting them is reasonable. Because of the deformed crowns and root structures of also the erupted supernumerary teeth found in the premaxilla of BCLP patients, it is usually appropriate to extract these during orthodontic treatment. In addition to this, only 7% of BCLP patients have lateral teeth with regular structure [6], and these are kept

Decision to extract the premolar teeth is dependent on the width and height of the present alveolar bone, position of canines, and the degree of crowding on the segments. In cases where inadequate bone and periodontal support remains or this support is substantially weakened after leveling and aligning the canines adjacent to the cleft, decision to extract of premolar teeth may be taken by the orthodontist. Aligning and leveling of the second molar teeth in addition to other maxillary teeth will increase the success of orthognathic surgery by improving the arch form and occlusion [35]. While extractions in the mandibular arch may be required based on the need for space on the arch and during the process of moving the incisors to an

*Orthognathic Surgery in Cleft Lip and Palate Patients DOI: http://dx.doi.org/10.5772/intechopen.89556*

that, in addition to the severity of the cleft type, the number of previous operations and extent of cleft area also affect the need for orthognathic surgery. Another study conducted at Toronto Pediatrics Hospital stated that there was a need for orthognathic surgery in 65.1% of their own BCLP patients, while this rate was 70% for patients who were referred by other centers [8]. From the Cleft Craniofacial Unit in Adelaide, Australia, David et al. [50] followed BCLP patient groups from birth to adulthood and determined the need for orthognathic surgery. Accordingly, orthognathic repair was needed in skeletal class III malocclusion among 17 of 19 patients (89.5%) and when they reached 18 years of age. Other previous studies also supported the findings of the aforementioned ones [51, 52].
