The basic principles of a Le Fort I osteotomy in patients who have had previous repair of a cleft palate are the same as for a non-cleft patient. However there are some special considerations.
The posterior blood supply to the maxilla may be compromised in the cleft patient because of previous surgery and scar tissue formation, Furthermore, the maxilla tends to be small and access to it more limited. Consequently mobilization of the cleft maxilla may be more challenging.
Because of the scar tissue, relapse of the advanced maxilla has been commonly reported.
Transient velo-pharyngeal dysfunction (VPD) following maxillary advancements in cleft patients may occur. In some cases long term VPD may result.
The descriptions in this section are based on the assumption that the maxilla is in one piece and if necessary has received a good quality alveolar cleft bone graft. There will be occasional instances when a multi-piece maxillary le Fort I osteotomy has to be considered but our principal approach is to try to avoid this.
The maxillary vestibular approach is modified to improve the blood supply and to facilitate more radical mobilization.