Reconstruction of the premaxilla: an option for mutilated bilateral clefts.

The loss of the maxilla is a severe mutilation resulting from inadequate surgery of bilateral clefts of the lip and palate. It is usually associated with palatal fistulae, collapse of the maxillary segments, and limited facial growth.Functional rehabilitation can be achieved by reconstruction of the premaxilla with osteomucosal fibula grafts. Mucosal grafts are fixed to the fibula in a preliminary stage. The composite graft is transplanted to the maxilla 10 to 12 weeks later. Osteointegrated implants are placed 3 months later.The procedure was used in 7 patients, 1 holoprosencephaly and 6 with sequelae of bilateral clefts; mean age, 17.28 years, with a follow-up of 14 to 70 months.The mucosal grafts integrated successfully to the fibula in all the patients. The osteocutaneous graft achieved a solid maxillary arch in all the patients. Normal mastication was achieved with a prosthesis fixed to the osteointegrated implants. Facial proportions were greatly improved.