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Orthognathic Surgery in Cleft Patients

Phillips, John H. F.R.C.S.C.; Nish, Iain F.R.C.D.(C.); Daskalogiannakis, John F.R.C.D.(C.)

Plastic and Reconstructive Surgery: March 2012 - Volume 129 - Issue 3 - p 535e–548e
doi: 10.1097/PRS.0b013e31824128e6
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Learning Objectives: After studying this article, the participant should be able to: 1. Identify the skeletal changes in the cleft patient that necessitate surgery. 2. Describe the orthodontic principles that precede surgical treatment. 3. Demonstrate the surgical principles involved in cleft orthognathic surgery and how to avoid common pitfalls particular to cleft orthognathic surgery. 4. Anticipate when dentoalveolar distraction can help in the treatment of problems not easily treated with conventional orthognathic techniques.

Summary: This CME article covers the basic multidisciplinary approach to the treatment of patients requiring a combined orthodontic orthognathic approach to their skeletally based malocclusion. The dentoskeletal abnormalities are described for these patients, as are the fundamental orthodontic principles in the presurgical treatment of these patients. The basic surgical principles are discussed in general, and the reader is provided with advice on avoiding common pitfalls. Specific attention is given to the more recent advances in dentoalveolar distraction in cases of large defects that would have been difficult to treat using conventional orthognathic surgery. Videos are provided to illustrate the general principles in treating the cleft orthognathic patient and to illustrate the treatment of large defects using dentoalveolar distraction.


Toronto, Ontario, Canada

From the Departments of Dentistry and Orthodontics, Hospital for Sick Children.

Received for publication February 8, 2011; accepted June 28, 2011.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Related Video content is available for this article. The videos can be found under the “Related Videos” section of the full-text article, or, for Ovid users, using the URL citations printed in the article.

John H. Phillips, F.R.C.S.C.; The Hospital for Sick Children, 555 University Avenue, Suite 5429, Toronto, Ontario M5G 1X8, Canada,

©2012American Society of Plastic Surgeons