Effect of Single-Stage Posterior Vomerine Ostectomy/Premaxillary Setback on Facial Growth in Bilateral Cleft Lip and Protuberant Premaxilla

Abstract

Objective

To evaluate the impact of single-stage posterior vomerine ostectomy with premaxillary setback (PVPS) on craniofacial development in children with bilateral cleft lip and palate (BCLP) and a protuberant premaxilla.

Design

Retrospective pilot study.

Setting

Resource-limited outreach setting.

Patients, Participants

Fifty-two children were included: 22 with BCLP who underwent PVPS before 8 years of age and 30 age-matched non-cleft controls.

Interventions

Single-stage PVPS with bilateral gingivoperiosteoplasties, bilateral cleft lip repair, and primary rhinoplasty.

Main Outcome Measure(s)

Twenty-two cephalometric parameters assessed post-operatively; intergroup comparisons made using the Mann–Whitney U-test with post-hoc power analysis.

Results

Of 22 cephalometric variables, 16 showed no statistically significant differences between PVPS-treated and control groups, indicating minimal overall impact of PVPS on craniofacial growth. Significant differences were noted in SNA (P = .05), ANB (P = .02), N-A-Pog (P < .01), A-Ptm (P < .01), (ANS-Ptm/M-Me)% (P = .03), and HSTA (P < .01). These differences reflected localized or subtle growth effects rather than global craniofacial alterations.

Conclusions

PVPS appears to preserve craniofacial growth in the preadolescent period in BCLP patients with a protruding premaxilla, with limited and localized impact on specific parameters. While not recommended when preoperative orthodontics is available, PVPS provides a valuable alternative in resource-limited settings by achieving adequate results, reducing psychosocial stigma, improving societal integration, and consolidating surgical interventions.