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Patients with bilateral complete cleft lip and palate (BCLP) may present a vertical excess of the premaxilla in childhood. This is a severe functional and aesthetic problem, where bone grafting is more challenging. The aim of this study was to describe a simple and reproducible non-surgical orthopaedic treatment for vertical excess of the premaxilla in the deciduous/early mixed dentition phase in BCLP patients. Six growing patients with complete BCLP with a severe vertical excess of the premaxilla were included. An intrusion device associated with a bonded rapid palatal expander was applied to intrude the premaxilla. Radiographic and photographic records obtained before and at the end of the orthodontic intrusion, at short- and long-term follow-up, were available. A flattening of the occlusal plane was achieved in all patients. Normalization of the position of the maxillary incisors and gingival display in relation to the upper lip was obtained, and an improvement in anterior nasal spine position was also observed in all cases. The novel technique described might be of assistance in treating BCLP children with vertical excess of the premaxilla during the deciduous/early mixed dentition phase. This simplified, easily reproducible method may allow the burden of care of this rare but complex problem affecting BCLP patients to be reduced significantly.

Objectives: We evaluated the correlation between the skeletal facial advancement through Le Fort III osteotomy and the modification of polysomnographic values in syndromic patients with sleep respiratory disorders affected by craniofacial synostosis. Methods: We selected a sample of 17 patients affected bymild to severe OSAS. All patients underwent a Le Fort III osteotomy. In five cases we used the “classical technique” and in 12 cases distraction osteogenesis. Sleep respiratory disorders were evaluated by pre-op and post-op polysomnography. All patients had pre-op and post-op cephalometric records. Results: The average midface advancement was 16mm (10–28mm)measured at A point. The average pre-op polysomnographic records were: ODI 28.6 (8–75), AHI 23.2 (8–50). The average post-op polysomnographic records were: ODI 3.88 (0.3–7), AHI 4.14 (0.2–3). In one tracheostomized patient we removed the tracheostomy and one patient with CPAP stopped the treatment. Conclusions: The respiratory disorders in syndromic patients with midfacial hypoplasia have different clinical manifestation: from snoring to acute respiratory distress requiring tracheostomy. Our study demonstrates an improvement of polysomnographic values in all patients, with a shift from severe to mild OSAS or even a complete resolution.