Staged Orthognathic Surgery Following Repeated Relapse After Maxillary Advancement in a Bilateral Cleft Lip and Palate Patient: A Case Report

Repeated relapse after maxillary advancement presents a major challenge in patients with cleft lip and palate (CLP). We report a bilateral CLP patient with recurrent relapse following distraction osteogenesis and Le Fort I advancement. Because postoperative maxillary stability was unpredictable, repeat Le Fort I advancement with interpositional iliac bone grafting was followed by a planned 5-month biologic verification period before bilateral sagittal split ramus osteotomy. Stable skeletal and occlusal outcomes were maintained for approximately 5 years after repeat Le Fort I advancement, with limited long-term skeletal change. This case illustrates a case-specific staged treatment strategy in which mandibular surgery was deferred to allow clinical and radiographic assessment of the reconstructed maxilla before definitive mandibular correction.