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CASE STUDY 15: NOAH LOGAN PATIENT: Noah Logan PREOPERATIVE DIAGNOSIS: Midface deficiency POSTOPERATIVE DIAGNOSIS: Cleft hard palate with cleft soft palate OPERATIVE PROCEDURE: LeFort I osteotomy with advancement ANESTHESIA: General via nasal intubation BLOOD LOSS: 200 FLUIDS: 600. URINE OUTPUT: 125. DRAINS: No drains. COMPLICATIONS: No complications. BRIEF HISTORY: The patient is an 8-month-old male who has been under the care of Dr. Grayson for his pre-surgical orthodontics in order to address a midface deficiency. He was also found to have a maxillary midline deficit of approximately 3 mm to his left side. It was determined that he would benefit from a maxillary advancement of approxi- mately 6 mm with rotation in order to set the midline straight. OPERATIVE PROCEDURE: He was seen in the preop area, brought to the operating room, placed in supine position. General anesthesia was induced. Head and neck were prepped and draped in normal fashion. Time-out was performed. An NG was placed The external reference marks were made using the right and left medial canthaltendon areas. The nasal width was also measured. Next, a vestibular incision was made between the right and left first molars in the maxilla. Subperiosteal dissection was performed, as well as dissection around the piriform rim into the nasal fossa. Next, using a reciprocating saw, a standard LeFort 1 osteotomy was made. The osteotomy was taken posteriorly into the pterygomaxillary Junction. Next, using a series of guarded chisels, the osteotomies were completed. The nasal septum was disarticulated as were the lateral nasal walls and finally pterygomaxil lary disfunction was completed with chisels. The maxilla was brought down quite easily without any bleeding. All bony interferences were removed. The maxilla was then mobi- lized appropriately. Next, the maxilla was placed into Intermaxillary fixation, and four 1.5 mm KLS plates were placed across the right and left piriform rims as well as the zygomaticomaxillary buttresses in order to plate the LeFort 1 osteotomy. Once this was done, the intermaxil- lary fixation was released and the occlusion was found to be stable and repeatable. This was approximately a 6-mm advancement move with about a 2-mm rotation to the left. At this point, a V-Y closure of the upper lip was performed. An alar cinch suture was also used to reestablish the alar width. The vestibular incision was then irrigated and closed. The throat pack was removed. NG was maintained. The patient was extubated and taken to the recovery room