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It is a long time since I had any involvement with cleft surgery, but I do occasionally encounter cleft patients (presenting with other things), and trainees who will soon be asked to give a reasonable account of things that they will never see. For these two situations, this is a real gem of a review article from one of the leading authorities in Toronto. Wide ranging without trying to be comprehensive. Well structured, balanced, economically illustrated but most importantly readable. For non dental trained readers, internet access will probably help to understand some of the terms used (no? just me then).

A very brief context is given of the frequency of these interventions in cleft, comparison with the non-cleft equivalents, issues such as growth restriction and vascularity, influenced by the underlying condition, previous surgery, and the extreme movements occasionally required. Emphasising the team structure involved in these cases, the selection, investigation, and preparatory measures are covered (orthodontics, speech assessment, endoscopy, dental hygiene). Planning issues (imaging, computer modelling, 3D printing, concurrent extraction strategy, simultaneous mandibular procedure). The operative procedure of Le Fort 1 osteotomy is covered succinctly, seasoned with examples of issues that may be encountered peroperatively and how they may be addressed. Peri- and postoperative splint regime is summarised. Complications are covered, with outlines regarding avoidance and correction.

A final section on distraction osteogenesis and a discussion of its role in this patient group. All in all, a great read that I would heartily recommend, even though it may lead to our plastic trainees requesting leave to attend maxillofacial theatres more.

Orthognathic surgery for patients with cleft lip and palate.
Roy AA, Rtshiladze MA, Stevens K, Phillips J.
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Philip Geary

St John’s Hospital, Livingston, UK.

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