A comparison of treatment results in complete bilateral cleft lip and palate using a conservative approach versus Millard-Latham PSOT procedure.

Conservative non-presurgical orthopedic treatment in complete bilateral cleft lip and palate (CBCLP) cases were compared with those treated will the Millard-Latham (M-L) method, which involves the presurgical mechanical retraction of the protruding premaxilla using pinned palatal appliances. In conservatively treated cases, a head bonnet with an external elastic is sometimes used before surgical lip closure to ventroflex the premaxilla thereby reducing tension at the surgical sites. The M-L method involves premaxillary bodily retraction followed by a gingivo-periosteoplasty. In both series of cases the palatal cleft (hard and soft) is closed for patients aged 18 to 30 months using a modified von Langenbeck procedure. A secondary alveolar bone graft is only performed in the conservatively treated series for patients aged 7 to 9 years. Although the premaxilla in 2 of 29 conservatively treated cases were retruded and in anterior crossbite by 10 to 12 years of age, all M-L cases were retruded by 9 years of age requiring maxillary protraction. In the M-L cases 90% showed bony bridging of the alveolar cleft with frequent loss of the lateral incisor space; surgical closure of the nasal floor is facilitated, and early aesthetic improvement is followed by midfacial retrusion.