Primary Premaxillary Ostectomy and Setback Dealing With the “Fly-away” PremaxillaFarhadi, Rana MBChB; Wallace, Robert D. MDAnnals of Plastic Surgery: May 14, 2018 - Volume Publish Ahead of Print - Issue - p doi: 10.1097/SAP.0000000000001423 Reconstructive Surgery: PDF Only Buy PAP Abstract Author InformationAuthors Article MetricsMetrics Objective This study aimed to analyze our outcomes of primary premaxillary ostectomy and setback combined with lip adhesion as the first stage in repair of the bilateral cleft lip with fly-away premaxilla. Methods This retrospective study included all patients who required primary premaxillary setback by a single surgeon to achieve successful lip repair between 2011 and 2017 at a tertiary children's hospital. All patients had bilateral cleft lip and complete cleft palate with significant premaxillary protrusion. All patients either had failed presurgical orthodontic manipulation or were thought to be poor candidates because of the rigidity of the premaxilla on clinical examination. Patient data were obtained from review of medical records and photographs. Surgical technique is described. Results Eleven patients with bilateral cleft lip, all of whom also had complete cleft palate, underwent primary premaxillary setback and lip adhesion at an average age of 8.2 months. The mean follow-up was 1.9 years (range, 139 days to 4.5 years). All patients subsequently completed formal lip repair, of which 10 have undergone palatoplasty. Serial photography documented stable premaxillary position and successful lip repair within the follow-up time frame. No patient had postoperative premaxillary instability or vascular compromise. One patient had dehiscence of the lip adhesion requiring reoperation. Conclusions Primary premaxillary ostectomy and setback allows for successful staged formal lip repair in patients with bilateral cleft lip and palate who have failed presurgical infant orthopedics. Further research is required regarding long-term follow-up with respect to midfacial growth. From the Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN. Received October 29, 2017, and accepted for publication, after revision January 2, 2018. Conflicts of interest and sources of funding: none declared. Reprints: Robert D. Wallace, MD, Department of Plastic Surgery, University of Tennessee Health Science Center, 1068 Cresthaven Rd, Suite 500, Memphis, TN 38119. E-mail: firstname.lastname@example.org. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.