편측성 구순구개열 환자에서 소분절 재위치술을 포함한 구순구개열 악교정 수술과 심측두근막을 이용한 휘파람 변형의 교정

Cleft Orthognathic Surgery Involving Surgical Repositioning of Lesser Segment and Correction of Whistle Deformity Using Deep Temporal Fascia in a Patient with Unilateral Cleft

A 24-year-old male patient with a complete cleft lip and palate had secondary deformities, including maxillary deficiency. Preoperative photographs showed a deficient lip tubercle on the cleft side, facial asymmetry, maxillary canting, and a vertically elongated flat chin. Computed tomography also revealed an anterior cross-bite and maxillary discontinuity due to untreated alveolar cleft. Cleft orthognathic surgery was performed via circumvestibular and peri-fistular incisions. After an inferior turbinectomy, a modified LeFort I osteotomy was completed in two segments, which were then advanced. The alveolar gap was surgically closed through differential segmental repositioning of the lesser segment. The nasal mucosa was sutured water-tight, and iliac cancellous bone was placed along the cleft nasal floor. The final occlusion was achieved through BSSRO (Bilateral Sagittal Split Ramus Osteotomy) and mandibular set-back. An advancement genioplasty was performed for the desired chin morphology. Six months later, the whistle deformity was corrected using a deep temporal fascial graft, and the titanium osteofixation devices were removed. Postoperatively, the patient's anterior facial balance was objectively improved, and an esthetic facial profile was achieved.