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

Objective To verify the effects of rapid maxillary expansion performed after secondary alveolar bone graft in one patient. Setting Department of Orthodontics of the Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo. Patient(s) The patient had bilateral cleft lip and palate, had already had a bone graft, and showed a relapsing maxillary constriction in need of correction. Intervention A fixed dental-mucous-bone-supported expander corrected the maxillary constriction. Main Outcome Measure(s) Measurements were obtained from dental casts, including transverse dimensions (intercanine distance [IC], interfirst premolar distance [IP], and interfirst molar distance [IM]) and measurements of the grafted area (interfirst premolar/central incisors [IPI] and interfirst premolar/canine [IPC]) to observe the changes. Clinical and radiographic analyses were done through direct view. Results The occlusal radiograph of the maxilla after expansion showed opening of the intermaxillary suture in the premaxillary area, which was clinically confirmed by the diastema between the maxillary central incisors. No radiographic alteration was observed in the grafted area. The transverse measurements of the dental casts (IC, IP, and IM) showed a significant increase. The measurements of the teeth adjacent to the grafted area, IPI and IPC, increased. Conclusions The orthopedic effect of rapid maxillary expansion after bone graft was verified. Nevertheless, additional studies are necessary to define any side effects in patients submitted to bone graft.

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Secondary alveolar bone graft in patients with bilateral cleft lip and palate submitted to premaxilla repositioning: retrospective study

RSBO ◽

10.21726/rsbo.v14i1.630 ◽

2017 ◽

Vol 14 (1) ◽

pp. 05-10

Author(s):

Tuanny Carvalho de Lima do Nascimento ◽

Fernando Luiz Zanferrari ◽

Juliana Lucena Schussel ◽

José Luís Dissenha ◽

Laurindo Moacir Sassi ◽

...

Keyword(s):

Retrospective Study ◽

Bone Graft ◽

Medical Records ◽

Cleft Lip ◽

Statistical Data ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Care Center ◽

Facial Asymmetry ◽

Bilateral Cleft Lip

This study aimed to analyze the effectiveness of the closure of oronasal communication, to report the importance of secondary alveolar bone graft repositioning of the premaxilla in patients with bilateral complete cleft lip and palate. Material and methods: This retrospective study analyzed the medical records obtained from the Cleft Lip and Palate Integral Care Center/ Association of Rehabilitation and Social Development of Cleft Lip and Palate Patients (CAIF/AFISSUR), Curitiba – Paraná – Brazil, to obtain statistical data involving 26 records of patients who underwent this surgery in the period between January/2010 – January/2014. Results and Conclusion: The benefits observed were: premaxilla stability, aided by the union of pre-maxillary segments; integrity of oronasal structure; aesthetic improvement; better bone support for the teeth adjacent to the cleft; support for the bridge of the nose reducing facial asymmetry and facilitating future rhinoplasty; orthodontic treatment without the limitation of the bone defect; closure of oronasal communication in 88% of patients.

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Effects of Cleft Type, Facemask Anchorage Method, and Alveolar Bone Graft on Maxillary Protraction: A Three-Dimensional Finite Element Analysis

The Cleft Palate-Craniofacial Journal ◽

10.1597/10-265 ◽

2012 ◽

Vol 49 (2) ◽

pp. 221-229 ◽

Cited By ~ 11

Author(s):

Ii-Hyung Yang ◽

Young-Ii Chang ◽

Tae-Woo Kim ◽

Sug-Joon Ahn ◽

Won-Hee Lim ◽

...

Keyword(s):

Finite Element ◽

Stress Distribution ◽

Bone Graft ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Three Dimensional ◽

Bilateral Cleft Lip ◽

Dimensional Finite Element ◽

Three Dimensional Finite Element

Objective To investigate biomechanical effects of cleft type (unilateral/bilateral cleft lip and palate), facemask anchorage method (tooth-borne and miniplate anchorage), and alveolar bone graft on maxillary protraction. Design Three-dimensional finite element analysis with application of orthopedic force (30° downward and forward to the occlusal plane, 500 g per side). Model Computed tomography data from a 13.5-year-old girl with maxillary hypoplasia. Intervention Eight three-dimensional finite element models were fabricated according to cleft type, facemask anchorage method, and alveolar bone graft. Main Outcome Measure(s) Initial stress distribution and displacement after force application were analyzed. Results Unilateral cleft lip and palate showed an asymmetric pattern in stress distribution and displacement before alveolar bone graft and demonstrated a symmetric pattern after alveolar bone graft. However, bilateral cleft lip and palate showed symmetric patterns in stress distribution and displacement before and after alveolar bone graft. In both cleft types, the graft extended the stress distribution area laterally beyond the infraorbital foramen. For both unilateral and bilateral cleft lip and palate, a facemask with a tooth-borne anchorage showed a dentoalveolar effect with prominent stress distribution and displacement on the upper canine point. In contrast, a facemask with miniplate anchorage exhibited an orthopedic effect with more favorable stress distribution and displacement on the middle maxilla point. In addition, the facemask with a miniplate anchorage showed a larger stress distribution area and suturai stress values than did the facemask with a tooth-borne anchorage. The pterygopalatine and zygomatico-maxillary sutures showed the largest suturai stress values with a facemask with a miniplate anchorage and after alveolar bone grafting, respectively. Conclusion In this three-dimensional finite element analysis, it would be more advantageous to perform maxillary protraction using a facemask with a miniplate anchorage than a facemask with a tooth-borne anchorage and after alveolar bone graft rather than before alveolar bone graft, regardless of cleft type.

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Management of an adolescent with complete bilateral cleft lip and palate using fan-shaped expander and secondary alveolar bone graft: A case report

International Orthodontics ◽

10.1016/j.ortho.2020.04.002 ◽

2020 ◽

Vol 18 (3) ◽

pp. 593-602

Author(s):

Maheen Ahmed ◽

Mubassar Fida ◽

Waqar Jeelani

Keyword(s):

Case Report ◽

Bone Graft ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Bilateral Cleft Lip

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Orthognathic Surgery Combined with Orthodontic Treatment in a Patient with Bilateral Cleft Lip, Palate and Alveolus, Without Alveolar Bone Graft: A Case Report

Jurnal Rekonstruksi dan Estetik ◽

10.20473/jre.v3i1.24365 ◽

2021 ◽

Vol 3 (1) ◽

pp. 1

Author(s):

Yudi Siswanto ◽

Magda Rosalina Hutagalung ◽

Indri Lakhsmi Putri ◽

Jusuf Sjamsudin

Keyword(s):

Bone Graft ◽

Orthognathic Surgery ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Maxillary Hypoplasia ◽

Le Fort ◽

Alveolar Cleft ◽

Bilateral Cleft Lip ◽

Cleft Lip Palate

Background: The incidence of cleft lip and palate is 8 in every 10,000 live births. A patient with this condition experiences a deficiency in maxillary growth. Maxillary hypoplasia leads to malocclusion and skeletal disharmony. Orthognathic surgery at skeletal maturity is the standard procedure at the end of the protocol to correct maxillary hypoplasia resulting in malocclusion not correctable with orthodontics alone.Case Presentation and Operation Technique: We report the result of orthognathic surgery performed on a 23 year old male with complete bilateral cleft lip, palate, and alveolus. We proceeded with bimaxillary surgery despite the alveolar cleft. We also recorded a neglected alveolar cleft in which he should have had undergone alveolar bone graft prior to the current procedure. The pre-maxillary segment was stabilized with miniplate followed by Le Fort 1 advancement and mandibular setback guided by an occlusal wafer. Malar augmentation was done by onlay bone grafts. Mandibulo-maxillary fixation was maintained. Postoperatively, a good occlusion and better facial harmony were achieved. He was planned to undergo a septorhinoplasty in the near future.Discussion: Despite adequate treatments following the protocol recommended by many centres, some patients developed some degree of maxillary hypoplasia. A quarter of this population need osteotomies and Le Fort I maxillary osteotomy is the most common procedure to correct retrognathic maxilla.Conclusion: Orthognathic surgery combined with orthodontic treatment in a patient with bilateral cleft lip and palate provided good functional and aesthetic result. However, this procedure cannot replace the standard protocol of having an alveolar bone graft performed before permanent canine eruption to achieve optimal outcomes

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Secondary alveolar bone graft in patients with bilateral cleft lip and palate submitted to premaxilla repositioning: retrospective study

RSBO ◽

10.21726/rsbo.v1i1.379 ◽

2017 ◽

Vol 1 (1) ◽

pp. 5

Author(s):

Tuanny Carvalho de Lima Do Nascimento ◽

Fernando Luiz Zanferrari ◽

Juliana Lucena Schussel ◽

José Luís Dissenha ◽

Laurindo Moacir Sassi ◽

...

Keyword(s):

Retrospective Study ◽

Bone Graft ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Bilateral Cleft Lip

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Occlusal Relationship in Patients with Bilateral Cleft Lip and Palate during the Mixed Dentition Stage: Does Neonatal Maxillary Arch Configuration Predetermine Outcome?

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2002_039_0317_oripwb_2.0.co_2 ◽

2002 ◽

Vol 39 (3) ◽

pp. 317-321 ◽

Cited By ~ 2

Author(s):

Chad A. Perlyn ◽

Jeffrey N. Brownstein ◽

Donald V. Huebner ◽

Jeffrey L. Marsh ◽

Richard J. Nissen ◽

...

Keyword(s):

Bone Grafting ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Mixed Dentition ◽

Class Iii ◽

Maxillary Expansion ◽

Alveolar Bone Grafting ◽

Bilateral Cleft Lip ◽

Maxillary Arch

Objective: To determine whether there is any correlation between initial maxillary arch dysmorphology patterns in complete bilateral cleft lip/palate (BCLP) and the subsequent occlusal relationship in early mixed dentition. Design: This retrospective study evaluated 41 consecutive patients with complete BCLP who were managed by a single tertiary cleft team between 1983 and 1992. All patients had bilateral synchronous lip adhesions with placement of a passive alveolar molding appliance at 4 to 8 weeks of age; definitive modified Manchester lip repair at 6 to 8 months of age; and a one-stage “two-flap” palatoplasty at 14 months of age. Neither gingivoperiosteoplasty nor early alveolar bone grafting was performed. Four patients required early surgical premaxillary setback because of adverse social reactions to a very protrusive premaxilla. All patients (7 to 9 years) were assessed prior to initiation of first-phase orthodontics (maxillary expansion) in anticipation of alveolar bone grafting. Cleft team records were reviewed to determine initial maxillary arch dysmorphology, treatment, and occlusal relationships in early mixed dentition stage. The initial maxillary dysmorphology was classified using a new grouping based on orientation of the vomer, the intercanine distance, and its symmetry. Patterns of mixed dentition occlusion were then compared with group type, and predication tables were generated. Because midface retrusion is the major dentoskeletal morbidity in cleft patients, angle Class I and II occlusions were designated as “favorable” and Class III as “unfavorable.” Results: In early mixed dentition, approximately three-fourths of patients with complete BCLP had favorable occlusion and one-fourth unfavorable occlusion. The occlusal status seemed unrelated to the initial maxillary arch dysmorphology, the use of early passive alveolar molding appliance, or surgical premaxillary setback. Conclusion: Patterns of variation within the initial dysmorphology of the maxillary arch in infants with complete BCLP cannot be used to predetermine subsequent molar occlusal relationships in the mixed dentition.

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Stabilization of an Edentulous Premaxilla for an Alveolar Bone Graft: Case Report

The Cleft Palate-Craniofacial Journal ◽

10.1597/03-009 ◽

2004 ◽

Vol 41 (2) ◽

pp. 214-217 ◽

Cited By ~ 4

Author(s):

Paul Bohman ◽

Dennis Duke Yamashita ◽

Seung-Hak Baek ◽

Stephen L.-K. Yen

Keyword(s):

Case Report ◽

Bone Graft ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Orthodontic Appliances ◽

Bilateral Cleft Lip

Objective The patient with bilateral cleft lip and palate and an edentulous premaxilla poses several additional challenges to the surgeon and the orthodontist. The cleft segments are usually expanded and stabilized with tooth-supported orthodontic appliances prior to an alveolar bone graft. This report describes a technique for stabilizing an edentulous premaxilla using an orthodontic-surgical screw that is ligated to an orthodontic archwire.

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