Background and objectives: Bilateral cleft lip palate patients often present vertical and horizontal excess in the premaxilla, together with dental torque alterations, due to unrestrained premaxilla displacement and premaxillary-vomerine suture overgrowth. Access to premaxilla osteotomy is generally achieved through an oral intrasulcular incision. However, this approach can compromise the vascularization of the premaxilla.

Methods: Between November 2007 and February 2013, 16 premaxilla osteotomies have been accomplished in Sant Joan de Deu Hospital through an endonasal septoplasty approach. The main goal was to correct dental torque of the premaxilla, as well as the anteroposterior and vertical excess. The premaxilla was stabilized for 2 months with an acrylic splint. No alveolar bone grafts were performed simultaneously.

Results: The average age was 13.66 years old. The average torque correction was 19.33°. Complications included one lack of consolidation (6.25%) and one relapse of the premaxilla to the previous position (6.25%). An accurate orthodontic treatment is vital to achieve the desired results.

Conclusions: Endonasal approach is a valid and safe access to premaxilla osteotomy. It diminishes the risk of premaxilla necrosis because it keeps the oral mucosa attached to the premaxilla.

Key words : cleft lip palate; premaxilla; osteotomy