Orthodontic-Surgical Management Of Skeletal Class Iii With Cleft Palate

This study analyzes the interdisciplinary management of a 17-year-old skeletal Class III patient with cleft lip and palate. The treatment involved orthodontic preparation followed by orthognathic surgery. Extraction of undersized teeth #12 and #22, along with strategic utilization of the #12 space for segmental maxillary arch narrowing, effectively reduced treatment duration while achieving optimal occlusal and facial outcomes. A 17-year-old male presented with concave profile, Angle Class III malocclusion, anterior crossbite, and maxillary midline deviation. Clinical evaluation revealed maxillary crowding (5mm), microdontia (#12, #22), and lingually inclined incisors (U1-NA=18.7°, L1-NB=14.8°). Cephalometric analysis confirmed skeletal Class III (ANB=-4.4°) and normodivergent growth pattern (GoGn-SN=31.8°). Treatment included extraction of #12 and #22, reshaping #13 to replace #12, and surgical maxillary constriction using the residual 3mm space at #12 region. Total treatment duration was 21 months. Pre-surgical coordination of maxillary and mandibular widths is critical. The existing #12 space facilitated direct surgical reduction of maxillary width, eliminating prolonged orthodontic space closure and arch coordination. This approach optimized treatment efficiency while ensuring stable occlusal outcomes. Strategic integration of orthodontic preparation and surgical maxillary width adjustment can significantly reduce overall treatment duration in cleft-associated skeletal discrepancies. This case demonstrates the clinical efficacy of interdisciplinary planning for complex dentofacial deformities.