Optimization of the protocol for premaxillary repositioning in patients with bilateral cleft lip and palate

Objective. To implement an optimized surgical protocol and evaluate the effectiveness of treatment in patients with bilateral cleft lip and palate and severe premaxillary displacement during the preparation stage for alveolar bone grafting of the maxilla. Materials and Methods. A standardized protocol for correcting significant premaxillary displacement was applied in 15 patients aged 7 to 15 years who underwent surgery at the Central Research Institute of Stomatology and Maxillofacial Surgery. The protocol included model surgery, the fabrication of an individual occlusal splint for fixation, and an atraumatic surgical approach. Inclusion criteria were significant premaxillary protrusion, vertical displacement, or rotation, as well as the impossibility of achieving proper alignment through orthodontic compensation alone to prepare for alveolar bone grafting of the maxilla. Effectiveness was assessed based on the following criteria: achieving the planned position of the premaxilla, preservation of maxillary blood supply, creation of conditions for two-stage alveolar bone grafting without the need for additional orthodontic or surgical correction. Results. The planned position of the premaxilla was achieved in 100% of cases. Vascularization of the premaxilla was preserved in all patients. One case of partial ischemia of the premaxilla was observed in the early postoperative period, likely due to multiple previous surgeries on the upper lip. Nevertheless, full rehabilitation was achieved. Anatomically correct positioning of the maxilla was ensured in all patients, enabling alveolar bone grafting without the need for additional correction. Conclusion. The proposed protocol for surgical repositioning of the premaxilla in patients with bilateral cleft lip and palate demonstrates high clinical effectiveness due to increased accuracy and standardization. The use of preoperative modeling, an individual occlusal splint for fixation, and well-defined inclusion criteria minimizes intraoperative risks, ensures stability of the premaxilla, and creates optimal conditions for subsequent bone grafting.