You'll find hundreds of files on cleft lip, cleft palate here on

This one is about: Maxillofacial Advancement Surgery - Adolescent/Adult Surgery 

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A parent asks:

>Hi all,
>My son had his cleft team visit again today and they finally cleared him 
>for surgery.

>I even got a better understanding of his jaw problems that would need 
>surgery in another year or two. The "maxillary deficiency" means that 
>his upper jaw bone is way too small for his lower jaw bone. I'm not 
>really sure if it means his lower jaw is acromegalic or congenitally 
>large or if his upper jaw is congenitally small. I'm not sure but I 
>think they're also talking about a lot of preparation prior to this 
>surgery like braces and something that pulls the jaw outward or 
>whatever. Does anyone have any ideas about what's going to be 
>happening here???

Dr Kirt Simmons responds:

As an orthodontist I have an "idea" about what's going on- I surmised your son is a teenager from his post about junior varsity sports? The "maxillary deficiency" does in fact mean that his upper jaw is deficient, generally this term would be used in the context of his whole head and face and if his bottom jaw was too large ("acromegalic"- actually refers to the large jaw which occurs due to too much growth hormone in ADULTHOOD) it would be described as "mandibular excess" or "mandibular prognathism". MOST CA individuals have a small top jaw and a normal size (although the shape may be "different") bottom jaw- which looks large compared to the top jaw. This is usually best treated by orthodontics (braces) to line the teeth up correctly over each jaw bone and then having a surgical procedure to line the jaws up correctly. Most cases of top jaw smallness can be corrected by just top jaw surgery, it DEPENDS ON THE INDIVIDUAL CASE (ALL this discussion is generalities of course). With more specific information I could address your question more specifically. It is generally best to delay the surgery until facial growth is complete, or nearly so. Otherwise the patient may "grow out of" the correction. Hope this is helpful.

Kirt Simmons DDS PhD
Wide Smiles Orthodontics Consultant

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