Background and objectives : The delayed or inadequate treatments of cleft lip palate and alveolus patients always reveal challenging clinical outcomes. The modified surgical approaches would be needed to overcome these problems.

Methods : The patients requiring for revision surgeries and additional orthodontic treatment approaches evaluated. The surgical additional treatment techniques included distraction osteogenesis, osmotic tissue expanders, dermal fillers, rhinoplasty, and alveolus reconstructions with allografts, autografts, barrier membranes and orthognatic surgery.

Results : The distraction osteogenesis technique allowed gaining soft and hard tissue rehabilitation at the same time for extended cleft areas. Grafting with sandwich techniques including both allo–auto bone grafts showed acceptable results when used with barrier membranes and helped better environment for un-erupted teeth. Le Fort osteotomies were mostly required. Aesthetic, functional and cosmetic results were highly satisfactory.

Conclusions : Delayed treatment or inadequate treatment of cleft patients always a challenging problem both for aesthetic and functional aspects. Grafting, distraction osteogenesis, dermal fillers, osmotic expenders helped surgeons and to orthodontists to increase the hard and soft tissue volume at any anatomic part of the cleft region.

Key words: secondary clefts; osmotic expanders; distraction osteogenesis; augmentation