Cleft lip and palate management with maxillary expansion and space opening for a single tooth implant

This case report demonstrates the successful use of intraoral distractor/hygenic rapid expander (HYRAX) for rapid maxillary expansion in anteroposterior direction with an adjunctive use of face mask therapy for anterior orthopedic traction of maxillary complex in a cleft patient with concave profile. The patient was a 13-year-old girl who reported with a chief complaint of backwardly positioned upper jaw and a severely forward positioned lower jaw. Therefore, a treatment was chosen in which acrylic bonded rapid maxillary expansion was done with tooth tissue borne intraoral distractor/HYRAX having a different activation schedule along with Dr Henri Petit facemask to treat maxillary retrognathism. As a result, crossbite got corrected and attained a positive jet with no bone loss in cleft area over a period of 5 months which was followed by fixed mechanotherapy achieving a well settled occlusion in 1 year. After completion of expansion and fixed mechanotherapy, ANB became +1 post-treatment which was −4 pretreatment. The prognathic profile was markedly improved by expansion and taking advantage of the remaining growth potential, thus minimizing the chances of surgery later in life. This provided a viable alternative to orthognathic surgery with good long-term stability.

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Description of transverse maxillary expansion in patients with bilateral cleft lip and palate undergoing gingivoperiosteoplasty with alveolar bone graft. A preliminary study

Journal of Dentofacial Anomalies and Orthodontics ◽

10.1051/odfen/2014030 ◽

2015 ◽

Vol 18 (1) ◽

pp. 108

Author(s):

N. Niez ◽

K. Nham ◽

B. Vi-Fane

Keyword(s):

Bone Graft ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Maxillary Expansion ◽

Bilateral Cleft Lip ◽

Preliminary Study

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Effects of rapid maxillary expansion in cleft patients resulting from the use of two different expanders

Dental Press Journal of Orthodontics ◽

10.1590/2177-6709.2016-001.aop ◽

2016 ◽

Vol 21 (6) ◽

pp. 82-90 ◽

Cited By ~ 1

Author(s):

Daniel Santos Fonseca Figueiredo ◽

Lucas Cardinal ◽

Flávia Uchôa Costa Bartolomeo ◽

Juan Martin Palomo ◽

Martinho Campolina Rebello Horta ◽

...

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Rapid Maxillary Expansion ◽

Cone Beam ◽

Tomographic Image ◽

Maxillary Expansion ◽

Downward Movement ◽

Computed Tomographic ◽

Significant Difference ◽

Maxillary Region

ABSTRACT Objective: The aim of this study was to evaluate the skeletal and dental effects of rapid maxillary expansion (RME) in cleft patients using two types of expanders. Methods: Twenty unilateral cleft lip and palate patients were randomly divided into two groups, according to the type of expander used: (I) modified Hyrax and (II) inverted Mini-Hyrax. A pretreatment cone-beam computed tomographic image (T0) was taken as part of the initial orthodontic records and three months after RME, for bone graft planning (T1). Results: In general, there was no significant difference among groups (p > 0.05). Both showed a significant transverse maxillary expansion (p < 0.05) and no significant forward and/or downward movement of the maxilla (p > 0.05). There was greater dental crown than apical expansion. Maxillary posterior expansion tended to be larger than anterior opening (p < 0.05). Cleft and non-cleft sides were symmetrically expanded and there was no difference in dental tipping between both sides (p > 0.05). Conclusions: The appliances tested are effective in the transverse expansion of the maxilla. However, these appliances should be better indicated to cleft cases also presenting posterior transverse discrepancy, since there was greater expansion in the posterior maxillary region than in the anterior one.

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Transverse Expansion of Contracted Maxillary Dental Arch in Patients with Cleft Lip and Palate-Application of Surgically Assisted Maxillary Expansion-

The Japanese Journal of Jaw Deformities ◽

10.5927/jjjd1991.17.206 ◽

2007 ◽

Vol 17 (3) ◽

pp. 206-212

Author(s):

KAZUHIRO ONO ◽

TADAHARU KOBAYASHI ◽

CHIKARA SAITO ◽

JUN-ICHI FUKUDA ◽

RITSUO TAKAGI ◽

...

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Dental Arch ◽

Maxillary Expansion ◽

Transverse Expansion

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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 Alternative Clinical Approach to Achieve Greater Anterior Than Posterior Maxillary Expansion in Cleft Lip and Palate Patients

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000001037 ◽

2014 ◽

Vol 25 (6) ◽

pp. e523-e526 ◽

Cited By ~ 3

Author(s):

Dauro Douglas Oliveira ◽

Flávia Uchôa Costa Bartolomeo ◽

Lucas Cardinal ◽

Daniel Santos Fonseca Figueiredo ◽

Juan Martin Palomo ◽

...

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Clinical Approach ◽

Maxillary Expansion

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Orthodontic-Surgical Approach for Treating Skeletal Class III Malocclusion With Severe Maxillary Deficiency in Isolated Cleft Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665618777573 ◽

2018 ◽

Vol 56 (3) ◽

pp. 400-407 ◽

Cited By ~ 1

Author(s):

Kohei Nakatsugawa ◽

Hiroshi Kurosaka ◽

Kiyomi Mihara ◽

Susumu Tanaka ◽

Tomonao Aikawa ◽

...

Keyword(s):

Cleft Palate ◽

Surgical Approach ◽

Orthodontic Treatment ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Class Iii ◽

Maxillary Expansion ◽

Rapid Palatal Expansion ◽

Isolated Cleft Palate ◽

Maxillary Deficiency

Orthodontic treatment in patients with orofacial cleft such as cleft lip and palate or isolated cleft palate is challenging, especially when the patients exhibit severe maxillary growth retardation. To correct this deficiency, maxillary expansion and protraction can be performed in the first phase of orthodontic treatment. However, in some cases, the malocclusion cannot be corrected by these procedures, and thus, skeletal discrepancy remains when the patients are adolescents. These remaining problems occasionally require various orthognathic treatments according to the degree of the discrepancy. Here, we describe one case of a female with isolated cleft palate and hand malformation who exhibited severe maxillary deficiency until her adolescence and was treated with multiple orthognathic surgeries, including surgically assisted maxillary expansion (surgically assisted rapid palatal expansion), LeFort I osteotomy, and bilateral sagittal split osteotomy in order to correct severe skeletal discrepancy and malocclusion. The treatment resulted in balanced facial appearance and mutually protected occlusion with good stability. The purpose of this case report is to show the orthodontic treatment outcome of 1 patient who exhibited isolated cleft palate and subsequent severe skeletal deformities and malocclusion which was treated by an orthodontic-surgical approach.

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