Atlas of the Oral & Maxillofacial Surgery Clinics of North America RSS feed: Current Issue. Twice a year, Atlas of the Oral and Maxillofacial Surgery Clinics of North America provides comprehensive coverage of the latest procedures in oral and maxillofacial surgery using detailed line drawings, photographs, and radiographs. Each issue focuses on a single topic in the specialty and is presented under the direction of an experienced guest editor. Note that subscribers to the Oral and Maxillofacial Surgery Clinics can subscribe to this Atlas at a reduced rate. http://www.oralmaxsurgeryatlas.theclinics.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Atlas of the Oral & Maxillofacial Surgery Clinics of North America1061-3315172September 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.oralmaxsurgeryatlas.theclinics.com/article/PIIS1061331509000353/abstract?rss=yesContents10.1016/S1061-3315(09)00035-3Atlas of the Oral & Maxillofacial Surgery Clinics of North America 17, 2 (2009)2009-09-01Atlas of the Oral & Maxillofacial Surgery Clinics of North America2009-09-01172S1061-3315(09)X0003-Xvvhttp://www.oralmaxsurgeryatlas.theclinics.com/article/PIIS1061331509000365/abstract?rss=yesForthcoming Issues10.1016/S1061-3315(09)00036-5Atlas of the Oral & Maxillofacial Surgery Clinics of North America 17, 2 (2009)2009-09-01Atlas of the Oral & Maxillofacial Surgery Clinics of North America2009-09-01172S1061-3315(09)X0003-Xvivihttp://www.oralmaxsurgeryatlas.theclinics.com/article/PIIS1061331509000286/abstract?rss=yes Cleft lip and palate are congenital deformities, which, because of their frequency and localization to the orofacial region, are of great significance to the oral and maxillofacial surgeon. Although confined to a fairly small anatomic region, the typical cleft deformity requires significant specialized care by many disciplines. Nearly 15 years ago, the American Cleft Palate – Craniofacial Association (ACPCA) proposed parameters of care designed to help standardize the management of cleft patients. The goals of these cleft teams are to carry out periodic assessments and make suggestions regarding timing and sequencing of care. Although mainly a North American phenomenon, the ACPCA guidelines have been taken on a global front and interpreted differently by many countries. The result has been a vast array of management protocols without universal standardization.PrefaceG.E. Ghali10.1016/j.cxom.2009.06.001Atlas of the Oral & Maxillofacial Surgery Clinics of North America 17, 2 (2009)2009-09-01Atlas of the Oral & Maxillofacial Surgery Clinics of North America2009-09-01172S1061-3315(09)X0003-Xviiviihttp://www.oralmaxsurgeryatlas.theclinics.com/article/PIIS1061331509000298/abstract?rss=yesThe comprehensive treatment of cleft lip and palate deformities requires thoughtful consideration of the anatomic complexities of the deformity, and the delicate balance between intervention and growth. The surgical reconstruction of clefts requires that the surgeon maintain a cognitive understanding of the complex malformation itself, the varied operative techniques employed, facial growth considerations, and the psychosocial health of the patient and family. This article describes the overall reconstructive approach for repair of the unilateral cleft lip and nose deformity using the rotation-advancement repair technique modified from the original description by Millard, still the most common version of unilateral cleft lip and nose repair in the world. Several other techniques exist and are used in various forms by most surgeons. To date, no technique has definitively been proven to produce the best results.Unilateral Cleft Lip and Nasal Repair: The Rotation–Advancement Flap TechniqueBernard J. Costello, Ramon L. Ruiz10.1016/j.cxom.2009.07.001Atlas of the Oral & Maxillofacial Surgery Clinics of North America 17, 2 (2009)2009-09-01Atlas of the Oral & Maxillofacial Surgery Clinics of North America2009-09-01172S1061-3315(09)X0003-X103116http://www.oralmaxsurgeryatlas.theclinics.com/article/PIIS1061331509000237/abstract?rss=yesThe complexity of a bilateral cleft lip repair must be well understood by any surgeon performing this procedure. Multiple factors play a role in the difficulty that one must overcome to correct the obvious facial deformity. These include a widely displaced lateral lip segment, lack of developed lip tissue in the anterior segment, and a displaced premaxillary segment. All three need to be taken into consideration to obtain an optimal result.Primary Bilateral Cleft Lip/Nose Repair Using a Modified Millard TechniqueG.E. Ghali, Jason L. Ringeman10.1016/j.cxom.2009.05.002Atlas of the Oral & Maxillofacial Surgery Clinics of North America 17, 2 (2009)2009-09-01Atlas of the Oral & Maxillofacial Surgery Clinics of North America2009-09-01172S1061-3315(09)X0003-X117124http://www.oralmaxsurgeryatlas.theclinics.com/article/PIIS1061331509000250/abstract?rss=yesWith the exception of those special cases of clefts associated with holoprosencephaly, wherein there exists true tissue hypoplasia, the anomalies observed in labiomaxillary clefts result essentially from displacement, deformation, and functional hypotrophy of the dentoskeletal elements and the covering soft tissues. This is particularly true with the maxillary bony segments, the dentoalveolar elements that they support, and the nasal cartilages. It is also true for the nasolabial muscles, which are all present on the cleft side but whose absence of normal insertions and the resultant dysfunctions are directly responsible for supra- and subjacent anomalies. Displacement, deformation, and functional hypotrophy also affect the mucocutaneous structures that border the labial clefts. This fact is less well known, but it has, nevertheless, great importance in the selection of incision design in the primary closure of cleft lip. The goal of primary closure is not only to re-establish normal insertions of all the nasolabial muscles but to restore the normal position of all the other soft tissues, including the mucocutaneous elements.Primary Unilateral Cleft Lip/Nose Repair Using the “Delaire” TechniqueDavid S. Precious10.1016/j.cxom.2009.05.003Atlas of the Oral & Maxillofacial Surgery Clinics of North America 17, 2 (2009)2009-09-01Atlas of the Oral & Maxillofacial Surgery Clinics of North America2009-09-01172S1061-3315(09)X0003-X125135http://www.oralmaxsurgeryatlas.theclinics.com/article/PIIS1061331509000274/abstract?rss=yesOnce differentiation of the cells forming the future face has been initiated by one or more epithelial-mesenchymal interactions, other factors regulate subsequent development and growth of the maxillofacial complex. Individual elements or regions do not develop and grow at the same rate; there is a well-known phenomenon of relative growth. Such regional differences imply that development and growth are not regulated globally.Primary Bilateral Cleft Lip/Nose Repair Using the “Delaire” TechniqueDavid S. Precious10.1016/j.cxom.2009.05.006Atlas of the Oral & Maxillofacial Surgery Clinics of North America 17, 2 (2009)2009-09-01Atlas of the Oral & Maxillofacial Surgery Clinics of North America2009-09-01172S1061-3315(09)X0003-X137146http://www.oralmaxsurgeryatlas.theclinics.com/article/PIIS1061331509000262/abstract?rss=yesCleft lip and palate is considered to be the most common facial birth defect worldwide. Attempts to repair these deformities date back to the sixteenth century. In 1552, Jacques Houllier proposed that the cleft edges be sutured together, but his operation was unsuccessful. Nearly 200 years later, LeMonnier, a French dentist, successfully completed the repair of a cleft velum. It was not until 1816, however, that the first successful closure of a cleft palate was performed by Carl Ferdinand von Graefe in Germany. An interesting approach was attempted in 1826 by Johan Fredrick Dieffenbach, closing the hard palate and the soft palate. The technique consisted of passing wire through the medial aspect of the cleft, followed by lateral incisions to osteotomize the junction of the palatal bones and the alveolar process; finally, the wires were twisted to close the defect. Unfortunately, this technique had frequent wound breakdowns with subsequent fistula formation.Primary Palatoplasty Using Bipedicle Flaps (Modified Von Langenbeck Technique)Kevin S. Smith, Carlos M. Ugalde10.1016/j.cxom.2009.05.005Atlas of the Oral & Maxillofacial Surgery Clinics of North America 17, 2 (2009)2009-09-01Atlas of the Oral & Maxillofacial Surgery Clinics of North America2009-09-01172S1061-3315(09)X0003-X147156http://www.oralmaxsurgeryatlas.theclinics.com/article/PIIS1061331509000249/abstract?rss=yesThe Furlow double-opposing palatoplasty (FDOP) was first introduced by Leonard Furlow in 1978 and published formally in 1986 by the Children's Hospital of Pennsylvania cleft unit . It has gained acceptance by many surgeons as the preferred technique for cleft palate repair. Although conceptually and procedurally a challenge, the FDOP has the distinct advantage of lengthening the soft palate and restoring normal velar anatomy and function. Since its introduction, the FDOP has undergone several modifications, much like other named cleft lip and palate techniques.Primary Palatoplasty: Double-Opposing Z-Plasty (Furlow Technique)Bruce B. Horswell10.1016/j.cxom.2009.05.004Atlas of the Oral & Maxillofacial Surgery Clinics of North America 17, 2 (2009)2009-09-01Atlas of the Oral & Maxillofacial Surgery Clinics of North America2009-09-01172S1061-3315(09)X0003-X157165http://www.oralmaxsurgeryatlas.theclinics.com/article/PIIS1061331509000225/abstract?rss=yesThe standard of care in patients who have a complete cleft is to perform secondary bone grafting of the absent bone in the alveolus and anterior maxilla with autogenous cancellous bone somewhere between 6 and 9 years of age. Although other treatment regimens have been suggested, no regimen has proved to be equal, and certainly not superior, to this regimen. The exact timing of secondary bone reconstruction has been a source of contention for years, and there is currently good evidence that secondary bone reconstruction is best done somewhere between 6 and 9 years of age. This does not negate later secondary reconstruction; yet, the overall result in terms of toot eruption, orthodontic tooth movements into the grafted area, and periodontal health is superior when it is done at an earlier age. One of the major factors that the author has observed in delayed or late secondary reconstruction occurs when orthodontic treatment is performed in the area before bone grafting. This generally has an adverse effect on the adjacent (central or lateral incisor or cuspid) teeth in that they are moved inadvertently into an area of inadequate bone, and therefore lose significant periodontal support. Conversely, when no orthodontic treatment is performed in the older patient and adequate adjacent periodontal bone support exists, secondary bone grafting can be done with subsequent orthodontic treatment and a successful outcome can be achieved ().Alveolar-anterior Maxillary Cleft RepairBruce N. Epker10.1016/j.cxom.2009.05.001Atlas of the Oral & Maxillofacial Surgery Clinics of North America 17, 2 (2009)2009-09-01Atlas of the Oral & Maxillofacial Surgery Clinics of North America2009-09-01172S1061-3315(09)X0003-X167173