This patient was born with an alveolar cleft lip and palate, the most common of cases treated through Beyond Faces. In the first year of life, conventional surgical treatment closed the gap in the lip and soft palate. Remaining in the deficiency were (1) separation of the right and left halves of the maxilla (upper jaw), (2) a hole through the palate (roof of the mouth) connecting the mouth with the nose, (3) missing section of the alveolar process (upper jaw) including some permanent teeth, and (4) hypoplasia (decreased growth) of the midface (upper jaw and nose).
Past treatment would involve many surgeries and an expected degree of compromise. In most craniofacial centers the child would undergo (1) bone grafting limited to the front of the upper jaw, (2) orthodontic treatment to widen the upper jaw for bite correction and to provide spaces for prosthetic tooth replacement, and (3) orthognathic surgery to enlarge the upper jaw. Since this approach has been followed for many years, we know the experience of surgery and the treatment compromises we will ask our patients and families to accept.
In most cleft palate patients, only the bone missing that will impair tooth development is replaced. This situation leaves the entire roof of the mouth gap unrepaired and only covered with soft tissue. Replacement of the full volume of missing bone of the upper jaw provides normal structural integrity which is important during maxillary enlargement surgery (called Le Fort I osteotomy) typically needed as a teenager to enlarge the growth deficient maxilla.
By replacing the missing bone of the upper jaw early, erupting permanent teeth develop better. The normal eruption of permanent teeth is important to the optimal growth of the upper jaw. In addition, this gives the body (or the orthodontist) the opportunity to modify the position of erupting teeth to compensate to a tooth that may be missing as part of the cleft disorder. This often avoids the need to place a prosthetic tooth to make up for the missing tooth.
After the child has reached the teenage years, it may be clear that the midface (upper jaw and base of the nose) is not optimally developed from a functional (occlusion) or an aesthetic standpoint. Maxillary advancement surgery (Le Fort I osteotomy) may be needed. To have the best results from Le Fort I surgery, the treatment steps described before are important. Having a fully grafted, structurally sound upper jaw is important during Le Fort I surgery, particularly in combination with distraction osteogenesis. The Beyond Faces surgeons have developed advanced methods to (1) perform Le Fort I osteotomies and (2) improve the results with distraction osteogenesis.
This patient's treatment involved placement of a BMP graft into the maxillary cleft. No bone was taken from this patient. The BMP material stimulates the body to grow natural, living bone. The teeth in the area respond by naturally erupting through the newly formed bone and become healthy, functional teeth. Conventional orthodontics then provides a good smile and bite. This patient is still growing and may someday need surgery of the upper jaw should it fail to keep up with the growth of the lower jaw.