Maxillary advancement in cleft palate patients. A modification of the Le Fort I osteotomy and preliminary results.

A technique for maxillary advancement at the Le Fort I level in cleft palate patients is described. A partial thickness palatal flap which leaves the greater palatine vessels in situ allows the maxilla to be repositioned anteriorly without displacing the soft palate. This leaves velopharyngeal function undisturbed whilst maintaining a good blood supply to the maxilla. This operation has been carried out on 7 patients and preliminary observations on the results have been made using speech assessment, nasendoscopy, Doppler flow studies and an assessment of skeletal relapse. Six of the patients had either no change or an improvement in speech and showed no significant change on nasendoscopy. One patient's speech deteriorated. Doppler studies, which were only possible in 3 patients, demonstrated blood flow in the greater palatine vessels when tested approximately 4 months postoperatively. The average skeletal relapse was 29% of the operative advancement.