Surgical treatment of the nasal-maxillary complex in adolescents with cleft lip and palate.

Rather than treating nasal, maxillary, and soft tissue deformities as separate problems, the author has approached the deformities as a single aesthetic and functional unit, the nasal-maxillary complex. This complex includes the maxilla, nose, and overlying soft tissues, including the upper lip. Successful reconstruction is based on a thorough knowledge of the underlying anatomy and physiology of these structures. Treatment of nasal-maxillary complex deformities in adolescents represents the final stages in a lifetime of reconstructive procedures. A team approach is preferred that includes a craniofacial surgeon, orthodontist, dentist, prosthodontist, and speech and language pathologist. The author's personal philosophy is based on sequential reconstruction of the underlying nasal-maxillary bony base. This is followed by reconstruction of the internal/external nasal complex and final soft tissue reconstruction. These principles are presented along with case examples.