12G

MOST IMPORTANT
THE DENTAL OCCLUSION
CLEFT CLEFT

ASPECT

OF THE

CLEFT

DEFORMITY WHICH INFLUENCES

IS

AND MAXILLARY OF THE

DOES ALVEOLUS

PLATFORM FOR THE FACE EXTENDING

THE

THE

PRESENCE PALATE USUALLY

IF

OF
THE

THROUGH THE ALVEOLUS

ARCH TO

HARD
IS

NOT GO THROUGH
IN

THERE

ENOUGH

BUTTRESS

THE

ANTERIOR
RESIST

BONY

MAINTAIN
DIRECTLY

OCCLUSION

WITH THE MANDIBLE

OR SECONDARILY
IN

AND

DISTORTIONS

CAUSED

BY THE SURGER

BY POSTSURGICAL

CONTRACTURE SEGMENTS
IT
IS

THE

DISCREPANCIES

THE

MAXILLAR

AND PREMAXILLARY

ASSOCIATED THE NATURE

WITH CLEFTING PRESENT VARYING DEGREES OF DISTORTION OF SURGEON

TO

TAKE

UP

THE SCALPEL

OR CHISEL TO THE USE

TO CORRECT THE

DEFORMITY
PLESSION OF

AND

ALTHOUGH

MANY WETE CONTENT

CLOSURE TO TO

COM
ACTION

BANDAGES

OR LIP

MOLD

PREMAXILLAR

PROTRUSION

SOME WERE

STIMULATED

TAKE

MORE

RADICAL

EXCISION
IN

OF

PREMAXILLA
DESAULT HAD REMOVED THE
IN BILATERAL CLEFTS

1814

XAVIER

BICHAT NOTED THAT

PROJECTING

BONY PROMINENCE OF
ALL

THE PREMAXILLA

AND BY THREE MONTHS

BUT
THE

HAD HEALED

HE

ALSO OBSERVED

NANSVERSE DIAMCTER

OF THE DID

UPPER JAW

DIMINISHED

BY THE

WHOLE

IDRH
JAW

OF THE PLOJECRING
IS

BUTTON
IN

NOR CORRESPOND ANY MORE TO THE LOWEI

SETTING

ND AS

OFTEN OBSERVED

OLD PERSONS THERE SUPERVENED

FOT

OF THE

UPPER IN THE LOWER JAW WHICH WAS EXTREMELY INCONVENIENT THIS INCONVENIENCE
MAXILLARY

MASTICATION
IN

BEING

THE

OBVIOUS
THE

TESULT OF PRACTICE

LO

OF SUBSTANCE

THE

SUPERIOR

BONE CHANGED

OF DESAULT

ON THIS

POINT

HE

TURNED

TO EXTERNAL
VV

PRESSURE AGAINST CLOTH

THE PREMAXILLA

PRESURGICAL

ORTHOPEDICS

ITH

LINEN

BANDAGES

OSTECTOMY AND OSTEOTOMY

UNILATERAL
IN

IN

CLEFTS
OF CONTRAI WITH
LEFT

1864
IN

DAMBRE
PATIENT

CLOSED

THE

BREACH

IN

THE

ALVEOLAR
SPLIT

RIDGE

UNILATERAL INTO

LIPJAWPALATE
AFTER

BY
THE

PUSHING
RIGHT MAXILLA

THE PROJECTING MAXILLARY

PREMAXILLA INCISOR

PLACE

EXTRACTING

SECOND

TO PROMOTE
PLATE AND

HEALING

BETWEEN
NITRATE IN

AND PREMAXILLA
THE PARTS WITH

HE CAUTERIZED
AN IVORY

THE EDGES WITH SILVER

AND FIXED

TSHAPED ROD

1873

DUPLAY

CLOSED INTO RIGHT

UNILATERAL PLACE

ALVEOLAR CLEFT BY PUSHING SECTIONING THE THE

THE PROJECTING

PREMAXILLA

AFTER

BONES SUBPERIOSTEALLY

FROM
THE

THE

MAXILLA

HE DENUDED

EDGES

AND

AFTER

WIRING

BONE

SUTURED THE

MUCOPERIOSTEUM
STARK
IN PLASTIC

AS NOTED BY CONWAY AND HUNDRED

LATERAL

SURGERY

ONE

YEARS

AGO GURDON BUCK

LIP

DESCRIBED
IN

OSREOTOMY FOR UNI

CLEFTS

OF THE

AND PALATE

1876

THE BONY PROMINENCE

OF THE ALVEOLAR ARCH
APPLICARINN
XX

FORMED
AS
FIRST

THE ANTERIOR ENTLEMITY

OF THE RIGHT

SEGMENT
THE
IT XX

BROKEN DOWN AND REDUCED INTO POSITION

PLIERS

BUTCHERS
BRIDGED PARING OVER THE

BNNE AND

THE
THE
CLEFT

PRNMINENCE
IN

AFTER

AS

LE
REDUCED
TX

FILLED

UP

THE

ALVEOLAI

AICH

BY

CONFIONRING

EDGES

BONY

CONSOLIDATION THE

WAS SECUIED
OF THE

THE REMOVAL
HALS ES

OF THIS

PROMINENCE

ALSO FACILITARCD

APPROXIMATION

OF THE

LIP

IN

JUNE 1882
SECTION

IN

ST PAUL MINNESOTA
OF THE

AT

THE

DENTAL

AND ORAL
HIS
CLEFT

SURO ER

MEETING

AMA GOODWILHIE
IN

DESCRIBED
IN

METHOD
PALATE

FOR CORRECTING

DISCREPANCY

MAXILLAR

ALIGNMENT

BY MEANS OF
AS
II

SMALL

TEVOLVING THE

KNIFE

AND SURGICAL
PROCESS OF THE

ENGINE

SHAPED SECTION
JUST

ALVEOLAR

INRERMAXILLARY

IWIFL

ENOUGH WAS TAKEN

INRERMAXILLAR

AWAY BY THE

SHAPED SECTION

TO ALLOW THE ALVEOLUS

OF THE

TO RESUME ITS

NORMAL POSITION

AFTER WILLIE IN

THE

OSTECTOMY THE PREMAXILLA

WAS BENT AND WIRED HOUR

PASSED
AFTER

GOOD

OPERATED

AS

EARLY

AS

THE

TWELFTH

BIRTH
THROUGH

1892

VON ESMARCH AND KOWAIZIG

UNION
PRESSED

CHISEL

THE INTERMAXILLAR

SO THAT THE PREMAXILLA INTO THE

CLEFT

COULD BE TURNED OF THE

SOFT

ON

ITS

AXIS
AT

AND

WITH

CLOSURE

TISSUE

THE

SAME RIME

216

IN

1893

WYETH USED
RIDGE IN

AN OSTEOTOMY TO CORRECT THE CONTINUITY

OF UNILATERAL

OF

THE ALVEOLAR THE

CASES

LIPJAWPALATE
SIDE
DISTAL

CLEFTS

WHEN
FRAC

PREMAXILLARY

PORTION

ON

THE

CLEFT

WAS ABSENT
TO THE CLEFT FIXING
IT

HE

TURED THE

SEGMENT OF THE MAXILLARY FORWARD TO

FILL

BONE
THE

MOVING
WIRE

FRAGMENT
PASSED

GAP

AND

WITH

SUTURES IN

THROUGH THE

BONE
THAT
IN
CASES

1896

JULIUS

WOLFF EMPHASIZED

OF UNILATERAL
LIP

WYETH

PROJECTING
SUFFICED

PREMAXILLA

NORMAL PRESSURE OF THE SURGICALLY UNITED

THE ALVEOLAR RIDGE THIS THE

TO RESTORE THE BREACH IN BLAIR

IN

SAME VIEW

WAS CHAMPIONED BY

1930S ASYMMETRY
IN

YET OTHERS CONTINUED

THE
UIIILATCRAL

TO CORRECT THE PREMAXILLAR

CLEFT

ALVEOLAR

SURGICALLY PROJECTING

SCHOEMAKER REMOVED
PREMAXILLA
PERCY IN

HORIZONTAL

WEDGE BEHIND
THE GENTLE UNILATERAL

THE

1911
SUGGESTED
SCHOERNAKER

IN
THAT

1912

JAMES BERRY WITH

PROJECTION

LEGG

MINOR

COULD BE IGNORED
IN

AND

THE

LIP

CLOSED OVER IT

NEVERTHELESS

FOR CASES
AS TO

WHICH
LIP

THEY

RECOGNIZED

THAT THE PROJECTION THEY OFFERED

WAS SO GREAT
ALTERNATIVES

MAKE

CLOSURE IMPOSSIBLE

TWO

PRESSURE

BY
AS

STRAPPING

FOR LONG

PERIODS

WHICH

THEY

DIS

MISSED
PARTIAL

SLOW

AND NOT ALTOGETHER AND CRUSHING

SATISFACTORY

SEPARATION

WITH

PAIR

OF BONE

FOR

CEPS OF THE CONJOINED PREMAXILLARY

IN

BONES FROM THE MAILLA BONES BACK INTO

THE CLEFT

OIDER

TO PRESS THE

PREMAXILLAR

IN

PICAL

EXAMPLE
STATED

OF

HIS

SENSITIVE

APPROACH TO

THIS

KINDRED

DEFORMITY
IT
IS

BERRY

NOT DESIRABLE

TO EFFECT

COMPLETE REPOSITION
REPRESSED SUFFICIENTLY

OF TBC

PRERNAXILLARY THE HARELIP

BONES
TO BE

THEY SHOULD HOWEVER BE

CLOSED OVER THE MAXILLA

TO ENABLE

THEM

THE SUBSEQUENT
CORRECT THE

PRESSURE OF THE LIPS

AND THE GROWTH OF

OF THE ALVEOLAR

WILL EVENTUALL

REMAINING

DEFOIMIT

AA QJ

BORDEI

IN

1923

OMBRDANNE SECTIONED
CHISEL

THE

PREMAXILLA

WITH

BROAD
IN HIS

SHORTHANDLED

HE SHOWED SOME
LIFTED

SOPHISTICATION

PROCEDURE BY THE WAY HE

OF THE ALVEOLAR THE
CLEFT TO

THE

MUCOPERIOSTEUM OF
FOR APPOSITION

THE EDGES

PREPARE

THEM

AND HEALING WIRE SUTURE

HE

FIXED

NEW POSITION
BONE

OF THE

PREMAXILLA

WITH

PASSED

THROUGH THE

217

ALSO IN LIP

1923

TRUMAN BROPHY
MENTIONED

OF CHICAGO

IN

HIS

BOOK

CLEFT

AND PALATE

PATIENT

WHO
MAXILLARY

UNFORTUNATELY
EASILY

HAD REACHED

AN AGE WHERE THE PROPER RELATION

BONES COULD NOT BE

BENT AND BROUGHT INTO

AT

LEAST

THE

PATIENT WIRES SO

WAS THUS
OVER

SAVED

FROM SUFFERING TECHNIQUE

IN

THE

CRUSHING

TRANSMAXILLARY

SILVER

PLATES FORCE

INTO

WHICH
OF

BROPHY

DIRECTED

MUCH

ENERGETIC

MODIFICATION THE

METHOD BY
EXTERNAL INTERNAL PLATE

SHEARER BROPHY DIVIDED

OF THE BONE WITH
CHISEL NXITH

GREENSTICK

FRACTURE

OF THE

PLATE WITH THE OSTEOTOMIZED FRAGMENT REDUCED INTO PROPER POSITION

WITH

WIRES

OSTEOTORNE
TS

MODERN OSTEOTOMIES
UNILATERAL
DCSCNDING
PALATINE PALARAL
FLAP

IN

CLEFTS

FOIARNEN

JOHN GROCOTT
JOUIIIAL

OF STOKE

DI1S1ONS

OF

PLAITIC

SU

ON TRENT ENGLAND
REPORTED
IN

IN

THE

1973

BRITITH

25
CLEFTS

YEAIS

01

CXPCRICNCC PALATE
CLEFTS

WITH AN

PRIMARY

MAXILLARY

OSTEOTOMIES

OF THE

USING

OSREOTOME HE
PALAIUM
II

CUR THROUGH THE

BONE OF INCOMPLETE
AS

WITH THE AND

DESCENDING

PALATINE

FORAMEN

THE

APEXES

OF THE

TRIANGLE

REMOVED
OF THE
SOFT

THE FREE

BONE
ALSO

SHADED

THIS

MANEUCR
OF THE
IN

ALLOWED FREEING
SO THAT THE

ARTERIES

AND

UPWARD MOTION

FLAPS THE

PALATE
IT

REACHED

POSITION

MUCH

HIGHER

NASOPHARYNX

OSTEOTOMT
PIEMAXILLA

THAN

DID

WITH

THE

CONVENTIONAL

CLOSURE

GROCORT CLAIMED

FLEXIBLE

SOFT PALATES

WITH MINIMAL

FISTULAE

AND

NO NEED
ALVEOLUS

FOR LATER

PHARYNGEAL FLAPS
CLEFTS TO OBTAIN GREATER

IN

COMPLETE

UNILATERAL

SYMMETRY HE
AND
THE

USED AN OSREOTOMY TO DETACH BY

PRISING
IT

THE PREMAXILLA
IT

FROM THE MAXILLA MIDLINE PACKING

HE DISPLACED GAUZE SOAKED

IN

ACROSS

THE

DEFECTS WITH
PALAIXIL FLAP

WHIREHEADS VARNISH THE RAW BONY VON

ONLY TO

INCISIONS

EDGES

MADE CONTACT

AND THE ANTERIOR PALATE WAS CLOSED WITH TECHNIQUE

AFTER

PACK

LANGENBECK FEW PATIENTS

PROCEDURE THIS BUT THE

RESULTS

HAS BEEN

USED

IN

TWO YEARS SEEMED PROMISING

GROCOTR HE WAS

PLEASED

WITH

THE

SMMETRV

OF THE

PREMAXILLA

77
AIIVING
T2LINIV

ITH

THE

MAXILLA

ON THE

CLEFT SIDE

AND THE AREA OF THE OSTEOTOMY

HAS

SMOOTHED OUT

PRESENTING

GOOD

ALXEOLAR

ARCH

BLO0J

TO PIERNIXILLA

OSTECTOMY AND OSTEOTOMY

BILATERAL
CLEFTS

IN

SURGICAL

CORRECTION

OF THE PROJECTING
ITS

PREMAXILLA
SIMILAR

BY FRANCO IN
DRASTIC ACTION

THE

MIDDLE

AGES INVOLVED

TOTAL

EXCISION

WAS

ROSE AND OTHERS KILNER EMPLOYED BY DUPUYTREN SIMS

TO KEEP
IT IT

PREFERRED
IF

AS

RACK TO SUPPORT THE MIDDLE

THIRD

OF THE FACE AND

IT

REMAINED
FITTED

WOBBLY
WITH

AT

AGE

TO

YEARS HE EXCISED

AND HAD THE

CHILD

DENTURE FEW SURGEONS ON OCCASION

THERE
WILLING

HAVE BEEN
TO SCRAP THE

WHO

HAVE BEEN AND

TOOTH BUDS AND PART OF THE PREMAXILLA COVERED WITH SEGMENTS

TO

KEEP

ONE BONY PLATE

THE MAXILLARY

MUCOPERIOSTEUM
ACHIEVE
THIS

TO

WEDGE
OF THE

BETWEEN
ALVEOLAR

CONTINUITY

ARCH GILLIES
CHIPS

AND POTTER USED

THE

APPROACH AND MASTERS

ADDED

BONE

TO BOLSTER

ARCH PANCOAST

NUMEROUS
INNIS HAVE

SURGEONS

AMONG THEM GENSOUL

FRACTURES
LIP

AND
TO

CARRIED

OUT COMPRESSION BACK AND ALLOW MULTITUDE

OF THE

VOMER

FORCE THE

PREMAXILLA THETE

CLOSURE

THEN VOMER
ILLA

WERE THE
IN

OF SURGEONS

WHO

CARRIED

OUT

RESECTION

VARIOUS

WAYS TO ALLOW SETBACK

OF THE

PREMAX
THE

INTO

THE MAXILLARY

ARCH PRIOR TO LIP DIVIDED

CLOSURE BLANDIN
THE

RESECTED FORCED

PIE

WEDGE VON

BARDELEBEN

VOMER AND

ENDS TO OVERLAP VARIATIONS

BEDERSPIEL
REFR

OF THIS

APPROACH WERE USED BY PI CHLER DENIS

VAUGHAN AND SCHULTZ

AS THE

BROV NE

IESECTED

HAT HE

NED

BONY OVERGROWTH
HELD THE

BETWEEN THE PREMAXILLA BACK

IN

AND
ARCH

ILLANDIN

THE

VOMER AND

PREMAXILLA
INTO

THE

MAXILLARN

WITH

TOOTHED BAR

WIRED

POSITION

HE

CLAIMED
CLEFTS

HIGH

PERCENTAGE IN

OF BONY OR FIBROUS
TO THE

UNION

ACROSS THE

REFERENCE

BROWNETYPE

SETBACK
HIS

OF

PROJECTING

PTEMAXILLA
THIS

MATTHEWS OF LONDON
IF

JUSTIFIED

SMALL

CONCERN ABOUT

MANEUVER

BONE GRAFTS WERE ADDED

THE SURGEON CAN BE

LRRUALLN

REASSURED THE
IS

THAT

IN

THE
IS

VERY

SEVERE CASE WHEIC

THIS

THERE

IS

NO AIRERNARIVE

CND RESULT

NOR PRCJUDICED

RADICAL

OPERATION THIS OBSERVATION HAVE BEEN ACCOMPANIED

OPERATION
THIS
IS

ONH
HILIRERAL

PET TINENT
GI AFRS

HOWEVER
IT
IS

HEN THESE SETBACKS DOUBTFUL

SIMILAR
IS XX

BY

HCRHER RESULT IF

WITHOUT HONE GRAFTS WOULD PRODUCE

THAT
IF

RIUC

IT

FOL1OV

SETBACK

IS

DONE

BONE GRAFT

OBLIGATORY

21

SEPTAL CARTILAGE

BROWN MCDOWELL
PUSHED
THE PREMAXILLA
ALSO

AND

BYARS RESECTED
IT

PORTION

OF

VOMER
KEITH

BACK AND HELD

WITH
DIVIDED

TRANSFIXION THE

NEEDLE CRONIN
FIXED THE

RESECTED THE SETBACK

VOMER

SEPTUM AND
WIRE
FREEING

BONES IN

POSITION

WITH

KIRSCHNER

KERNAHAN AND BURSTON MODIFIED CRONINS PROCEDURE BY

THE
CRONIN LARY

SEPTUM
SETBACK
IS

ALONG THE

VOMERINE GROOVE

TO ACHIEVE

THE

PREMAXIL

THERE
SETBACK

AN ESTEEMED

SPANISH PREMAXILLA
IN

PLASTIC

SURGEON
THIS

WHO

FAVORS

OF THE PROJECTING
IN CLEFT

CONSIDERING VILAR

THE GREATEST ALTET

PROBLEM

SURGETY

1971

SANCHO

OF

MADRID WROTE

MY

OPINION
IS

IN

CONNECTION WITH SURGICAL

FOI

RERROPOSIRIONING CONSIDER

OF THE PROJECTING
THAT THOSE

PIEMAXILLA

THE

TIME

BEING

FAVOURABLE

WHO
OF

DETRACT THE IMPORTANCE THE ANOMALOUS CAUDAL

OF THESE TECHNIQUES
APOPHYSIS

OVERVALUE

THE SURGICAL

ACTION

OF THESE PROTRUDING PREMAXILLAE

OF THE RETRUSION OF THE MIDDLE

OVERLOOK

ING THE FACT THAT THE REAL CAUSE

HVPOPLASIA OF THE

THIRD IS DUE TO

MAXILLAC

MOST SURGEONS
SETBACK

TODAY

AVOID

VOMER

RESECTION
IT

FOR
IT

PREMAXILLARY
IS

WHEN POSSIBLE
CLARENCE

OR AT LEAST POSTPONE

UNTIL

ABSOLUTELY

NECESSARY AVOIDS
FEELS
IT

MONROE OF RUSH

MEDICAL

COLLEGE

CHICAGO

RESECTION
IS

WHEN POSSIBLE
IN

BUT HAS NO GREAT CONCERN 1971 HE WAS ACCOSTED

WITH

WHEN HE
WITH
PROJECT

INDICATED

OCTOBER

NO REMAIN ONE OF THE MOST RADICAL SOT GEONS WHCN DEALING

ING

PTET
WAS

IN

WHAT CASES DO WITH

SO MII

00
11

SET

IT

BACK

BY WHAT APPROACH AND FLYING

AT

HOW

DO YOU JOSTIH

THIS

DENTAL

FLACK

YOO

THIS

MONROES ANSWER
CASES

IN

THOSE
LIP

IARE

HAVENT
FAI

HAD

TO DO

ONE IN

LONG

TIMEWHEN

THE

LATERAL

ELEMENTS ARE SO WITH

BACK OF THE PROLABIUM

CANNOT BRING
THE

THEM
OF

TOGETHER

MY

FLNGEIS

THEN IN

MY
IS

CLINICAL IN

JUDGMENT

SUCCESS TO RESECT

BIINGING
TO 10

THEM

TOGETHER

WITH SORGEL
ORNET IN
STAY

DANGER

AM
REGION THE

WILLING

TOM
THE

OF SEPTUM ROOT

AND

THE

POSTERIOR

OF THE BULGE RIGHT

JUST

UP

TO

OF THE

NOSE

AWAY FROM
AS

AREA

BEHIND

THE

PIEMAXILLA

WHICH

DENIS

BIOWNE

TESECTED

AN

OVERGROWTH

MONROE WAS
EVEN
CERTAIN

THEN ASKED

PLU
CASES

AND BORSTON

SS

ILL

TOLETATE

LATER

PIEMAXILLATY

SETBACK

IN

WHEN DO

YOU EXECUTE

YOUR RESECTION

220

AND
IN
IS

REPLIED

THE IN FIN

FIRST

MONTHS OF AGE
POSITION

AT

THE SAME TIME TO OFTEN

AS

THE LIP

CLOSURE

THE
IS

SETBACK

UNDERCORRECTED
AS

BY
JR
IS

MM AND
TEMPTING

THE PREMAXILLA TO SET

FIXED

WITH BACK BUT

EPIPHYSEAL 1INE

BROWN

DESCRIBED THE

THE PREMAXILLA IN THE PAST

INTO

CNNRACR WITH

MAXILLARY

ELEMENTS
SETBACK

HAVE DONE THIS

AT

WAS SORRY WITH

HAS

THIS UNDERCORRECTED LOSSES

MONTHS

ONLY

ONE OUR OF 20
SETBACK CASES IN

SHOWN SIMILAR

THEN

TOO TWENTY CASES WITH PREMAXILLARY WITH

RWENRN

HAVE BEEN COMPARABLE IN WHICH

THE PREMAXILLA

GROWRH AND DEVELOPMENT

SET

WAS NOR

BACK

WILLIAM
HIS

OLIN

OF THE UNIVERSITY
SETBACK

OF

IOWA WROTE
PREMAXILLA

IN

1978

OF

KIRSCHNER WIRE

OPPOSITION

TO SURGICAL

OF THE

WHILE

READING

CLEFT

CRAFT II

CAME
IN

ACROSS YOUR REPORT OF THE THEY ROUTINELY

1949

PAPER BY REPOSI MONIOE

HUFFMAN AND
TIONED THE

LIERLE

PAGE 66
IN

WHICH

SURGICALLY

PREMAXILLA

INFANCY

OBSERVED

THESE

PATIENTS

WHILE RHEX GIEW

AND FOLLOWED THEM TO ADULT

SERIOUS CASES

HOOD AND WOULD LIKE

FACE GROWTH

TO REPORT THAT
AS

THEY ALL HAVE

IN

MIDTHIRD

OF THE AND
THEIR

PIOBLEM

DEMONSTRATED
SEVERE

THE

ENCLOSED LICILE AND CHANGED

HUFFMAN
TECHNIQUE

IECOGNIZED

THIS

UNDCIDEVELOPMCNR

OSTECTOMY AND OSTEOTOMY

SELDOM INDICATED
EARLY RESTRAIN

RUBBER

BAND

TRACTION

ATTACHED

TO

HEADCAP
SO THAT AFTER

WILL

USUALLY

PREMAXILLARY

PROJECTION

ENOUGH

FCW WEEKS

221

THE

LIP

CAN THE
LIP

BE CLOSED OVER
CLOSED OVER

THE THE

PREMAXILLA PREMAXILLA

IN
THE

FEW CASES
PROJECTION

EVEN
WILL

WITH

CONTINUE
AT

TO BE TOO YEARS RARELY

MUCH

NECESSITATING

RESECTION IN

OF THE VOMER UNDERCORRECTED

THAT THE

TO

FOR SETBACK WILL

OF THE

PREMAXILLA PROJECT

POSITION
LIP

THE PREMAXILLA OVER

IF

SO SEVERELY
EARLY

CANNOT BE CLOSED
IS

IT

IN

SUCH

CASE

CONSERVATIVE

SETBACK

JUSTIFIED

UNDERCORRECTED AND
CLOSURE

RETROPOSITIONED

ONLY

ENOUGH

TO ALLOW LIP

222