Purpose: Evaluate and promote a multidisciplinary management protocol for patients with post operative sequelae from previous cleft lip and palate repair. The protocol should include evaluation of sequelae, secondary labial revision, orthodontic management, secondary alveolar graft, possible vestibuloplasty, secondary nasal revision and audiologic and ENT evaluation.
Patients and methods: Case report of a 9 year old male patient, managed in a multidisciplinary process for post operative sequelae from previous cleft lip, palate repair (at another institution). Starting with his evaluation, surgical techniques commonly used for the correction of short lip, whistle defect and oral vestibule deficiency, such as z-plasty, re-operation with rotational and advancement flaps (Millard Technique) individualized to the defect for the severity of the sequelae. Treatment is continued by orthodontic management with leveling, alignment, and expansion prior to the nasoalveolar reconstruction. Vestibular depth management with V-Y technique and periodontal evaluation and management. Follow-up was immediate, 1, 3, 6, 12, 24, and 30 months and consisted of clinical, functional and radiographic.
Results: This sequential management resulted in improvement of the scar, defect, labial contour and symmetry. We obtained adequate maxillary arch continuity and alar base support. We also obtained adequate osseous support for the eruption of teeth relative to the cleft.
Conclusions: The management of postoperative sequalae of cleft lip, palate and alveolus is complex and sequential treatment should be directed by a multidisciplinary group to obtain better and more efficient results. Continuous evaluation and perfecting of treatment protocols are fundamental to offering patients the best care possible.
Conflict of interest: None declared.