FIGURE LEGENDS
Figure 1: Dental casts showing the maxillo-mandibular relationship (a) and arch form (b) of the patient and intraoral photograph showing the rotated anterior maxillary segment, anterior crowding and a centrally placed oro-nasal fistula (c) .
Figure 2: (a) Panoramic radiograph at the beginning of treatment showing anterior maxillary crowding with impacted teeth(green arrows) . (b) Axial section CT scan revealing a discontinuity of the maxillary alveolus accompanied by fistulae (yellow arrows). (c) 3D reconstruction showing the floating anterior maxillary segment.
Figure 3: Surgical exposure of 13 and orthodontic traction in order to align the tooth in occlusion (a) . Results by the end of phase one treatment (b).
Figure 4: Intraoperative photographs showing exposure of the cleft segment and soft tissue repair of the nasal floor (a) followed by packing of the bone graft to reconstruct the alveolus (b). This was followed by adequate soft tissue cover using a mucoperiosteal flap (c).
Figure 5: The anteriorly based, left dorsal tongue flap design(a). Suturing of flap to palate with adequate pedicle length while its base remained attached to the tongue, promoting vascularization and healing (b). Adequate closure of all oro-nasal fistulae was achieved with no futher complications