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Background: Patients with cleft lip and palate have functional and esthetic impairment and typically require multiple interventions in their life. Long-term evaluation following a treatment protocol, especially for patients with complete bilateral cleft lip and palate (BCLP), is important but was rarely reported in the literature. Patients and methods: A retrospective review was conducted on all patients with complete BCLP born between 1995 and 2002 and treated at our center. Inclusion criteria were having adequate medical records and receiving continuous multidisciplinary team care at least until 20 years of age. Exclusion criteria were lack of regular follow-up and congenital syndromic abnormalities. The medical records and photos were reviewed, and facial bone development was evaluated using cephalometric analysis. Results: A total of 122 patients were included, with a mean age of 22.1 years at the final evaluation in this study. Primary one-stage cheiloplasty was performed in 91.0% of the patients, and 9.0% underwent two-stage repair with an initial adhesion cheiloplasty. All patients underwent two-flap palatoplasty at an average of 12.3 months. Surgical intervention for velopharyngeal insufficiency was required in 59.0% of patients. Revisional lip/nose surgery was performed in 31.1% during growing age and in 64.8% after skeletal maturity. Orthognathic surgery was applied in 60.7% of patients with retruded midface, of which 97.3% underwent two-jaw surgery. The average number of operations to complete the treatment was 5.9 per patient. Conclusion: Patients with complete BCLP remain the most challenging group to treat among the cleft. This review revealed certain suboptimal results, and modifications have been made to the treatment protocol. Longitudinal follow-up and periodic assessment help to establish an ideal therapeutic strategy and improve overall cleft care. [ABSTRACT FROM AUTHOR]

Background/purpose: The purpose of this systematic review is to update the available data for complications following orthognathic surgery in cleft lip and/or palate patients.Methods: Three electronic databases (Medline, Embase, and Cochrane) were searched for publications from 1990 to 2014.Results: A total of 26 articles were selected including 1003 patients (male: 391, female: 353, 259: not mentioned) who underwent maxillary osteotomies for cleft lip/palate. Mean age at surgery was 19.3 years (range: 8.5-60 years). Overall perioperative complications were reported in 126 cases (12.76%). The most common complication was closure failure of pre-existing palatal fistula (28.57%), followed by velopharyngeal impairment (16.79%), closure failure of pre-existing alveolar fistula (10.74%), gingival recession (4.55%), and failure of premaxilla stabilization in bilateral cases (4.55%). Severe vascular complications included one arteriovenous fistula (0.10%), one maxillary aneurysm (0.10%), and one cavernous sinus thrombosis (0.10%). Mean horizontal relapse rate was 17.9% (range: -20.0% to 37.2%), and mean vertical relapse rate was 35.4% (range: -25.9% to 162.5%). Reoperation rate was 12.2% (range: 0.0-64.0%). Prospective studies or randomized trials were rare.Conclusion: To obtain a dataset with higher evidence, a prospective multicenter study should be conducted with clearly defined criteria for each complication. [ABSTRACT FROM AUTHOR]

Summary: Background: Biomechanical stability in patients in whom mandibular prognathism was corrected with different fixation methods during bilateral sagittal split osteotomy (BSSO) surgery remains controversial and needs to be clarified. Methods: A three-dimensional (3D) finite element (FE) model of the mandible was developed to simulate the biomechanical responses of osteo-synthesis screws and the stability of different screw-placement arrangements in BSSO. Six types of fixation methods for the osseous segments were simulated with two or three screws in different placement arrangements to avoid injury to the inferior alveolar nerve. Results: A triangular configuration of the screw position across the nerve presented less stress loading than the linear configuration, and hence provided better stability as the preferred fixation method for BSSO of the mandible. When the screws were aligned in a linear setting, the stress values were 4 times higher, implying a less stable fixation. Neither two nor three screws applied at the superior border appeared to be better at exploiting the increased thickness of the cortical bone encountered in this region. Conclusions: According to the 3D-FE analysis, the configuration with three screws inserted in a triangular shape across the inferior alveolar nerve (Type 4) demonstrates the best rigidity among six screw-placement configurations. Three 2.3-mm diameter bi-cortical screws were considered a sufficient fixation tool after BSSO of the mandible. [Copyright &y& Elsevier]