This paper presents basic science information regarding the premaxilla (PMx), pathologic states of which are the cause of labiomaxillary clefts. PMx has 3 anatomic subunits and a blood supply which is distinct from surrounding structures. These concepts become important in clefts because they lead to a more rational dissection of the prolabium and premaxilla with an improved aesthetic and functional outcome. DFR surgery conceptualizes craniofacial development as a sequential series of interactions among biologic units of epithelium and mesenchyme, termed developmental fields. Fields are constructed upon one another like Lego~R pieces. When one is deficient or absent, the surrounding Lego pieces will collapse into the void. This model nicely explains how defects in PMx cause distortions in surrounding structures. DFR surgery seeks to reconstruct the premaxilla at the initial intervention to promote better long-term growth. Technical details of DFR are described in a recent CME review published in the Indian Journal of Plastic Surgery (January, 2007); this can be accessed online: www.ijps.org.
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