For a revision of cleft lip repair in an 18-year-old with maxillary hypoplasia, what is the first step?

In the context of revising cleft lip repair and addressing maxillary hypoplasia in an 18-year-old, establishing maxillary position is crucial as the first step. This approach is rooted in the understanding that maxillary hypoplasia can significantly impact both the aesthetic outcome and the functional aspects of oral and facial structures.

Determining the maxillary position is essential because it provides a reference for any subsequent interventions. If the maxilla is positioned inadequately, any repair or reconstruction performed on the lip or palate may not align correctly with the new maxillary position, leading to suboptimal functional and aesthetic results. By establishing the maxillary position first, the surgical team can ensure that any revisions to the lip or palate are performed in a manner that complements and supports the overall facial structure.

After establishing the appropriate position of the maxilla, it becomes possible to address the other structures effectively. This procedure would precede any revisions of the lip or speech assessments, as a well-placed maxilla serves as a foundation for any further surgical corrections needed in the region. Thus, establishing maxillary position is not just a preliminary step but a guiding factor for the entire surgical revision process.