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Median clefts, which run through the midline of the upper lip, and alveolus are considered a type of craniofacial cleft. A Tessier number 0 median cleft lip is the rarest, and there are few reports concerning its surgical management. Here, we describe the case of a 6-year-old boy who presented at our hospital with a median cleft and alveolus of the upper lip with a shortened bifid frenulum. Inverted-V and Z-plasty incisions were performed for the median cleft and iliac bone grafting for the midline alveolus. At 1 year 5 months later, the postoperative course was uneventful, and proper approximation of the orbicularis oris muscle and vermilion were achieved, with a symmetrical Cupid's bow and labial tubercle and philtrum.

This case report describes the use of an osseointegrated implant to maximize anchorage in a 24-year-old female orthodontic patient with an Angle Class II, Division 1 malocclusion. Preadjusted edgewise appliance therapy was performed by extraction of only the maxillary first premolars. The osseointegrated implant was placed in the median-sagittal region of the hard palate for maximum orthodontic anchorage and connected to maxillary first molar bands via a transpalatal arch. Total treatment time was 2 years and 8 months. Cephalometric superimposition revealed the achievement of maximum molar anchorage in the maxilla, resulting in satisfactory occlusal and facial improvements. Histological analysis of the implant-bone interface demonstrated that the fixture was successfully osseointegrated. In conclusion, the osseointegrated implant placed in the median-sagittal palate was shown to be an effective orthodontic system that can be used clinically as a rigid intraoral anchorage.

The purpose of this study was to investigate the long-term stability of jaw relations and occlusion following surgical orthodontic treatment of mandibular prognathisms and skeletal openbites. Subjects consisted of fifteen adult patients. Ten patients underwent the sagittal split ramus osteotomy (SSRO) of the mandible and five patients underwent two jaw surgery (Le Fort I osteotomy of the maxilla and SSRO of the mandible). They were observed over five years after the end of active treatment, and lateral X-ray cephalograms were taken at each stage. In the SSRO group, pogonion was retrograded an average of 8.7mm due to the operation and it was further replaced 0.4mm backward after the end of active treatment. Although the vertical distance between nasion and menton decreased 2.9mm between the operative period, it increased 1.8mm after the end of active treatment. On the other hand, in the two jaw surgery group, point A was advanced 4.0mm forward and < SNA increased 3.1 degrees between the operative period. Pogonion was retrograded 11.4mm between the same period, but moved 0.7mm forward after the end of active treatment. A comparison of the osteosynthesis methods revealed that pogonion in the wiring group was retrograded 8.3mm backward between the operative period, but moved 2.1mm forward during the postsurgical orthodontic treatment. Pogonion in the rigid group was retrograded 12.6mm backward between the operative period, but moved 1.6mm forward during the postsurgical orthodontic treatment. However, both groups were stabilized completely after the end of active treatment. A comparison of the differences in the orthodontic treatment method revealed that < Ul-SN in the extraction group inclined 8.3 degrees lingually during presurgical orthodontic treatment, but it tipped 7.0 degrees labially during the postsurgical orthodontic treatment and inclined 3.4 degrees lingually after the end of active treatment. < Ul-SN in the non-extraction group inclined 5.5 degrees lingually during the presurgical orthodontic treatment, but it tipped 2.0 degrees labially during the postsurgical orthodontic treatment and inclined 1.9 degrees lingually after the end of active treatment.

The faces of fifteen adult patients who had undergone surgical orthodontic treatment were videotaped frontally and laterally in order to observe their oral circumferential behavior for function and their facial muscle posture at rest. As the ANB angle became 0.9 degrees from -3.5 degrees and the occlusal relationship improved to normal, facial morphology became harmoneous. In general observation, habits of facial muscle tensity at rest was reduced and lip sucking following forward tongue thrusting was decreased after treatment. Pronunciation of previously unclear sounds such as 'Ta' and 'Sa' improved and breath leakage decreased after treatment. The cooperative motions between lips and tongue improved significantly. Although a few subjects still had weak lip tensity and facial muscles, habits of tongue thrusting during swallowing were generally reduced and swallowing motions became more natural. As the movement of tongue tip became smoother, rhythmical chewing improved, and they became capable of chewing on both sides. Good relationships between morphology, oral function, and muscular behavior are very important in stabilization of the normal dentition after surgical orthodontic treatment. Normally maintained forces of balanced occlusion reduce the possibility of relapse.