Bone-anchored maxillary protraction in patients with unilateral complete cleft lip and palate and Class III malocclusion

Objective The aim of the study was to assess the quality of life (QOL), oral health-related QOL (OHRQOL), temporomandibular disorders (TMDs), and psychological factors in patients with skeletal Class III malocclusion with cleft lip and palate (CLP) and without CLP. Design Case–control. Setting Primary care, institutional practice. Patients One hundred thirty-six patients with skeletal Class III malocclusion with CLP (n = 68) and without CLP (n = 68). Main outcome measures QOL and OHRQOL were assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire and the Oral Health Impact Profile-14 questionnaire, respectively. TMDs and psychological factors were assessed using the Research Diagnostic Criteria for TMD (RDC/TMD). Results No differences in QOL were found between the groups ( P > 0.05). Patients with CLP reported a better OHRQOL ( P = 0.025) in the physical pain, physical disability, and psychological disability domains ( P < 0.05). Patients with CLP presented with less myofascial pain (OR, 0.28; 95% CI, 0.11-0.71] and other articular conditions (OR 0.24; 95% CI 0.06-0.90]. More patients with CLP reported no chronic pain ( P = 0.012). The QOL of patients with CLP with no depression or with no nonspecific physical symptoms including pain (NSPSIP) was better than that of patients without CLP. The OHRQOL of patients with CLP without TMDs or no psychological factors was better than that of patients without CLP. Conclusions Patients with skeletal Class III malocclusion who require orthognathic surgery with CLP have better OHRQOL and present with fewer TMDs than those patients without CLP.

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Bone-anchored maxillary protraction in patients with unilateral cleft lip and palate:

The Angle Orthodontist ◽

10.2319/091919-598.1 ◽

2020 ◽

Vol 90 (4) ◽

pp. 539-547 ◽

Cited By ~ 1

Author(s):

Eman H. Elabbassy ◽

Noha E. Sabet ◽

Islam T. Hassan ◽

Dina H. Elghoul ◽

Marwa A. Elkassaby

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Three Dimensions ◽

Class Iii ◽

Maxillary Expansion ◽

Forward Movement ◽

Maxillary Protraction ◽

Computed Tomography Images ◽

Group I ◽

Effective Treatment Modality

ABSTRACT Objectives To assess the effectiveness of bone-anchored maxillary protraction (BAMP) in patients with unilateral cleft lip and palate (UCLP) and whether it was enhanced when preceded by maxillary expansion. Materials and Methods The sample consisted of 28 growing children (9–13 years old) with UCLP and Class III malocclusion. They were divided into two equal groups. In group I, patients were treated with BAMP not preceded by maxillary expansion. In group II, patients were treated with BAMP preceded by maxillary expansion. To assess treatment changes in three dimensions, Cone-beam computed tomography images were taken 1 week after surgical placement of the miniplates (T1) and after 9 months of treatment (T2). Results BAMP produced forward movement of the maxilla in both groups (3.17 mm) and (3.37 mm) respectively, without significant differences between the two groups except for clockwise rotation of the palatal plane in group I (1.60). Conclusions BAMP is an effective treatment modality for correcting midface deficiency in patients with UCLP whether or not maxillary expansion was carried out.

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An Oral Health-Related Quality of Life Comparison Between Adults With Unilateral Cleft Lip and Palate and Class III Malocclusion

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619854567 ◽

2019 ◽

Vol 56 (10) ◽

pp. 1359-1365

Author(s):

Leandro Almeida Nascimento Barros ◽

Flávia Aline Silva Jesuino ◽

João Batista de Paiva ◽

José Rino-Neto ◽

José Valladares-Neto

Keyword(s):

Oral Health ◽

Orthognathic Surgery ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Health Related Quality ◽

Class Iii ◽

Class Iii Malocclusion ◽

Related Quality ◽

Health Related

Objective: To compare oral health-related quality of life (OHRQoL) before treatment of adults with unilateral cleft lip and palate (UCLP) and surgical Class III malocclusion, and to consider if clefts needing different orthodontic treatment protocols could influence people’s self-perception. Design: Cross sectional. Setting: Cleft Lip and Palate Center and Clinic of Orthognathic Surgery from a School of Dentistry. Participants: A sample of adults with repaired nonsyndromic UCLP (n = 52) which was age- and sex-matched with a noncleft Class III malocclusion sample seeking orthognathic surgery (n = 51). In turn, the cleft group was subdivided according to treatment planning into nonsurgical orthodontic and surgical orthodontic approaches. Main Outcome Measure: The whole sample was assessed using the short-form oral health impact profile (OHIP-14), with higher scores indicating a poorer OHRQoL. Statistical comparisons were performed with Mann-Whitney U and Kruskal-Wallis tests, and effect size. Bonferroni adjustment was used for post hoc tests ( P < .017). Results: The OHIP-14 scores of the UCLP and Class III groups were significantly different ( P = .001, η2 = 0.108), and higher in Class III. The largest commitment was in the physical disability, physical pain, and psychological disability domains. In addition, no differences were found when the UCLP treatment planning was considered. Conclusion: Surgical Class III malocclusion have a poorer OHRQoL when compared to patients with UCLP, irrespective of whether they are treated surgically or orthodontically. Therefore, the greater commitment of OHRQoL appears to be influenced by the etiology of Class III, and not by treatment plan.

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Evaluation of Lefort I Osteotomy Line and Pterygomaxillary Junction Region in Patients With Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620969575 ◽

2020 ◽

pp. 105566562096957

Author(s):

Bahadır Sancar ◽

Şuayip Burak Duman

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Class Iii ◽

Class Iii Malocclusion ◽

Le Fort I Osteotomy ◽

Maxillary Hypoplasia ◽

Le Fort ◽

Osteotomy Line ◽

Le Fort I ◽

Pterygomaxillary Junction

Objective: This study aimed to evaluate the Le Fort I osteotomy line and pterygomaxillary junction via cone-beam computed tomography in individuals with cleft lip and palate (CLP). Design: Retrospective study. Patients and Methods: The study included individuals older than 16 years with CLP, who were scheduled for repositioning of the maxilla by Le Fort I osteotomy, and those with class III malocclusion with maxillary hypoplasia, who were scheduled for Le Fort I osteotomy. The measurements made in the area of the cleft of individuals with CLP were compared with both the side with no cleft and those with class III malocclusion with maxillary hypoplasia. A total of 11 measurements were made on the axial section parallel to the Frankfurt Horizontal plane, corresponding to the lower 1/5 of the distance between the infraorbital foramen and the anterior nasal spine. Results: There were significant differences both in the comparisons made between the individuals with CLP and those without CLP in terms of the canal-anterior alveolar crest (G) and sinus-anterior alveolar crest (L) measurements ( P < .05). The mean measurement values showed that the measurement results were higher in individuals with CLP in general. Conclusion: In conclusion, we believe that there might be difficulties both in osteotomy and down fracture stages during Le Fort I osteotomies performed in individuals with CLP.

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Early orthodontic intervention followed by fixed appliance therapy in a patient with a severe Class III malocclusion and cleft lip and palate

American Journal of Orthodontics and Dentofacial Orthopedics ◽

10.1016/j.ajodo.2012.11.028 ◽

2013 ◽

Vol 144 (5) ◽

pp. 726-736 ◽

Cited By ~ 4

Author(s):

He Zhang ◽

Feng Deng ◽

Huaqiao Wang ◽

Qianqian Huang ◽

Yi Zhang

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Class Iii ◽

Class Iii Malocclusion ◽

Fixed Appliance

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Tomographic Pharyngeal Dimensions in Individuals with Unilateral Cleft Lip/Palate and Class III Malocclusion are Reduced When Compared with Controls

The Cleft Palate-Craniofacial Journal ◽

10.1597/15-124 ◽

2017 ◽

Vol 54 (5) ◽

pp. 502-508 ◽

Cited By ~ 6

Author(s):

Trindade-Suedam Ivy Kiemle ◽

Freire Lima Thiago ◽

Dominguez Campos Letícia ◽

Faria Yaedú Renato Yassutaka ◽

Filho Hugo Nary ◽

...

Keyword(s):

Cleft Lip ◽

Outcome Measure ◽

Cleft Lip And Palate ◽

Cone Beam ◽

Control Group ◽

Craniofacial Anomalies ◽

Class Iii ◽

Class Iii Malocclusion ◽

Cross Sectional ◽

Cleft Lip Palate

Objective The objective of this study was to three-dimensionally evaluate the pharyngeal dimensions of individuals with complete nonsyndromic unilateral cleft lip and palate (UCLP) using cone beam computed tomography. Design This was a cross-sectional prospective study. Setting The study took place at the Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru-SP, Brazil. Patients and Participants The control group (CON) consisted of 23 noncleft adults with class III malocclusion, and the cleft group (UCLP) consisted of 22 individuals with UCLP and class III malocclusion. Two subgroups of individuals with class III malocclusion as a result of maxillary retrusion with (UCLP'; n = 19) and without (CON'; n = 8) clefts were also assessed. Interventions Pharyngeal volume, pharyngeal minimal cross-sectional area (CSA), location of CSA, pharyngeal length, sella-nasion-A point angle (SNA), sella-nasion-B point angle (SNB), and A point-nasion-B point angle (ANB), and body mass index were assessed using Dolphin software. Main Outcome Measure The pharyngeal dimensions of UCLP individuals are smaller when compared with controls. Results Mean pharyngeal volume (standard deviation) for the UCLP patients (20.8 [3.9] cm3) and the UCLP’ patients (20.3 [3.9] cm3) were significantly decreased when compared with the CON (28.2 [10.0] cm3) and CON’ patients (29.1 [10.2] cm3), respectively. No differences were found in the pharyngeal minimal CSA, ANB, or pharyngeal length values between groups (CON versus UCLP and CON’ versus UCLP'). CSAs were located mostly at the oropharynx, except in the UCLP’ patients, which were mainly at the hypopharynx. Mean SNA in the UCLP (76.4° [4.6°]) and UCLP’ groups (75.1 [3.1°]) were significantly smaller than those in the CON (82.8° [4.1°]) and CON’ groups (78.6° [1.2°]). SNB values were statistically smaller only for the comparison of CON versus UCLP patients. Conclusion The pharynx of individuals with UCLP and class III malocclusion is volumetrically smaller than that of individuals with class III malocclusion and no clefts.

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Immediate and late follow-up effects of class III early correction in cleft lip and palate patients treated with maxillary protraction

Revista de Odontologia da UNESP ◽

10.1590/1807-2577.04920 ◽

2020 ◽

Vol 49 ◽

Author(s):

Carolina Mazon MIRANDA ◽

Rodrigo Matos de SOUZA ◽

Giovana Cherubini VENEZIAN ◽

Cristina FRANZINI ◽

William CUSTODIO

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Class Iii ◽

Maxillary Expansion ◽

Maxillary Protraction ◽

Chi Squared ◽

Skeletal Pattern ◽

Pre Treatment ◽

The Stability

Abstract Introduction There is no consensus about the immediate and latte follow-up effects of maxillary protraction in cleft lip and palate patients. Objective To evaluate the stability of Class III early treatment in cleft lip and palate patients through maxillary expansion and protraction. Material and method The sample consists in three lateral cephalometric radiographs of 28 patients (mean pre-treatment age of 6.7±1.8 years) who presented cleft lip and palate and were treated with maxillary expansion and Petit facial mask. The angular (SNA, SNB, ANB, SN.GoGn, FMA, Z Angle) and linear (overjet, Co-A, Co-Gn, Nperp-A, Nperp-Pg, AO-BO) cephalometric measures were evaluated through the Dolphin® software, in three moments: T0 (initial), T1 (after treatment), and T2 (follow-up). Data were submitted to the analysis of variance (ANOVA) and Tukey-Kramer test. The correlation between cephalometric measures and patient’s age was determined by Pearson’s chi-squared test. Result The SNA, ANB, and AO-BO measures increased considerably (p<0.05), and they did not present any differences compared to the initial ones after the follow-up time. The overjet measure increased (p<0.05) after treatment and, even with its decrease at the follow-up time, it was still higher than at the beginning (p<0.05). The Z angle showed improvement with treatment and remained stable at the follow-up time. Conclusion After treatment (maxillary expansion associated with protraction), there was a skeletal pattern improvement. During the follow-up period, those alterations decreased to a measure close to the beginning. There was an improvement in the dental pattern and facial profile that continued in the follow-up period.

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Maxillary Protraction Therapy in Class III Patients With and Without Cleft Lip and Palate: An Interim Report of a Prospective Comparative Study

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620954058 ◽

2020 ◽

pp. 105566562095405

Author(s):

Yifan Lin ◽

Zhen Fu ◽

Runzhi Guo ◽

Lian Ma ◽

Weiran Li

Keyword(s):

Treatment Duration ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Controlled Clinical Trial ◽

Class Iii ◽

Lower Incisor ◽

Maxillary Protraction ◽

Average Treatment ◽

Significant Difference ◽

Before And After

Objective: To investigate and compare the effects of maxillary protraction therapy on Class III patients with unilateral cleft lip and palate (UCLP) and Class III patients with noncleft. Design: Prospective controlled clinical trial. Patients: Twenty-six Class III patients with UCLP (mean age: 10.32 ± 1.29 years) and 26 Class III patients with noncleft (mean age: 9.82 ± 1.03 years) were included and treated with maxillary protraction therapy. Interventions: Maxillary protraction therapy was performed with an intraoral Hyrax appliance and extraoral facemask. Cone beam computed tomography scans were taken before and after treatment. Pretreatment skeletal and dental characteristics and treatment changes were analyzed and compared. Results: The average treatment duration was 18.44 ± 4.16 months in the UCLP group, which was substantially longer than the 12.46 ± 4.03-month average treatment duration in the noncleft group ( P < .001). No significant difference was found in the maxillary changes (length, advancement of point A, and SNA angle) and improvement of intermaxillary relationship (ANB angle) between the 2 groups. The UCLP group had 1.40° more mandibular clockwise rotation ( P = .034). Regarding dental changes, the UCLP group had more upper incisor proclination ( P = .006) and less lower incisor retroclination ( P = .023). Conclusions: Approximately extended maxillary protraction therapy in patients with UCLP could be as effective as in patients with noncleft. Further study is required to follow patients until completion of growth to elucidate the long-term stability of the treatment.

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Dentocraniofacial Morphology of 12 Japanese Subjects with Unilateral Cleft Lip and Palate with a Severe Class III Malocclusion: A Cephalometric Study at the Pretreatment Stage of Surgical Orthodontic Treatment

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2001_038_0597_dmojsw_2.0.co_2 ◽

2001 ◽

Vol 38 (6) ◽

pp. 597-605 ◽

Cited By ~ 5

Author(s):

Chizu Tateishi ◽

Keiji Moriyama ◽

Teruko Takano-Yamamoto

Keyword(s):

Orthodontic Treatment ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Effective Length ◽

Maxillary Incisor ◽

Class Iii ◽

Class Iii Malocclusion ◽

Group 2 ◽

Japanese Male Subjects ◽

Male Subjects

Objective: The present study clarifies the dentocraniofacial morphology of patients with cleft lip and palate (CLP) with severe Class III malocclusion prior to surgical orthodontic treatment. Methods: The sample was 12 Japanese male subjects with repaired complete unilateral CLP (surgical CLP group; 21.2 ± 1.92 years in mean age). Two sets of patients without CLP Class III malocclusion, consisting of 19 male subjects treated by surgical orthodontic treatment (surgical Class III group; 23.4 ± 6.35 years in mean age) and 14 male subjects treated by nonsurgical orthodontic treatment (nonsurgical Class III group; 18.7 ± 3.49 years in mean age) were used as controls. Analyses were performed using lateral and posteroanterior (P-A) cephalograms. Results: (1) The surgical CLP group showed significantly smaller values for overjet, SNA angle, and inclination of the maxillary incisor as compared with those of the surgical and nonsurgical Class III controls. The values of SNB, mandibular effective length, and ramus height in the surgical CLP group were significantly smaller than those of the surgical Class III group but were similar to those of the nonsurgical Class III group. (2) The mandible and the upper and lower dental arches deviated laterally toward the cleft side. The displacement of the mandible was correlated with that of the maxilla. These results show that CLP patients who required surgical orthodontic treatment had a characteristic dentocraniofacial morphology, compared to controls without CLP with Class III malocclusion.

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