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

2018 ◽  
Vol 56 (3) ◽  
pp. 400-407 ◽  
Author(s):  
Kohei Nakatsugawa ◽  
Hiroshi Kurosaka ◽  
Kiyomi Mihara ◽  
Susumu Tanaka ◽  
Tomonao Aikawa ◽  
...  

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.

2014 ◽  
Vol 51 (6) ◽  
pp. 651-657 ◽  
Author(s):  
S. Carpentier ◽  
J. Van Gastel ◽  
J. Schoenaers ◽  
C. Carels ◽  
V. Vander Poorten ◽  
...  

Objective The purpose of this longitudinal retrospective study was to evaluate transverse maxillary expansion after a Schuchardt or segmental posterior subapical maxillary osteotomy (SPSMO) in patients with cleft lip and palate (CLP). A second aim was to compare these data with data for adult patients without CLP who were receiving a surgical assisted rapid palatal expansion (SARPE). Method The study group comprised 19 patients with CLP and a severe transversally collapsed maxilla who were treated with SPSMO followed by hyrax expansion at the University Hospitals Leuven. Dental casts of the 19 patients were analyzed before treatment, at maximum expansion, during orthodontic treatment, at the completion of orthodontic treatment. and 2 years after orthodontic treatment and were measured at the canine, premolar, and molar levels. Adult patients without CLP who were enrolled in a prospective study served as the control group. Results Maxillary expansion within the study group was significantly greater ( P < .05) at all measured levels compared with the maxillary arch before treatment. No significant relapse was measured in the study group 2 years after orthodontic treatment. When comparing the study and control groups, the only statistical difference was that canine expansion was significantly greater in the study group. Conclusion SPSMO followed by maxillary expansion and orthodontic treatment is an appropriate treatment option to correct a severe transversally collapsed maxilla in patients with CLP. The overall treatment effect of SPSMO expansion is comparable with the effects of SARPE, although canine expansion was greater in the SPSMO group.


2021 ◽  
Vol 14 (54) ◽  
pp. 80-88
Author(s):  
Renata Mayumi Kato ◽  
Renato André de Souza Faco ◽  
Hilde Timmerman ◽  
Hugo De Clerck ◽  
Daniela Garib

The purpose of this study was to report a case with complete unilateral cleft lip and palate (CLP) treated with bone anchored maxillary protraction (BAMP) in miniplates followed up until the end of facial growth. A 7-year-old girl with complete left side CLP started the orthodontic treatment in a rehabilitation center. She presented a Class III skeletal pattern due to maxillary deficiency, a GOSLON 4 sagittal interarch relationship, a negative overjet of 1.5mm and agenesis of left upper lateral incisor. In the mixed dentition, the patient was submitted to rapid maxillary expansion followed by the secondary alveolar bone grafting procedure. At 12y 3m two miniplates were installed in the maxilla and two in the mandible with BAMP therapy. The patient was instructed to use full time Class III elastics with force of 250g/side together with a bite lifting plate in the upper arch. BAMP therapy duration was 19 months leading to a positive overjet and GOSLON 1 sagittal interarch relationship. The cephalometric analysis demonstrated a mild maxilla advancement. Class III elastics started to be used only at night as an active retention concomitantly with Phase II orthodontic treatment. Compensatory corrective orthodontic treatment established adequate occlusion between the dental arches with significant improvement of facial aesthetics after the intervention. Le Fort 1 surgery with maxillary advancement was not necessary.


2020 ◽  
Vol 90 (4) ◽  
pp. 539-547 ◽  
Author(s):  
Eman H. Elabbassy ◽  
Noha E. Sabet ◽  
Islam T. Hassan ◽  
Dina H. Elghoul ◽  
Marwa A. Elkassaby

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.


2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Noemí Leiva Villagra ◽  
Miguel Muñoz Domon ◽  
Sebastian Véliz Méndez

The aim of the paper is to present full orthodontic treatment of an operated cleft lip adult patient.Case Report. An 18-year-old patient consulted for severe crowded teeth. He comes from a poor family. At that time he already had four operations (velum, palate, lip, and myringotomy). Treatment included maxillary expansion, tooth extraction, and fixed orthodontic, as well as kinesiology and speech therapy treatment. A multidisciplinary approach allowed us to achieve successfully an excellent result for this patient and gave him a harmonic smile and an optimal function without orthognathic surgery. Two years after treatment, occlusion remains stable.


2008 ◽  
Vol 45 (6) ◽  
pp. 592-596 ◽  
Author(s):  
Aziza Aljohar ◽  
Kandasamy Ravichandran ◽  
Shazia Subhani

Objective: To report the patterns of cleft lip and/or cleft palate in Saudi Arabia from data collected at a tertiary care hospital. Design and Setting: King Faisal Specialist Hospital and Research Center, Riyadh. Patients: All the cleft lip and/or cleft palate patients registered in the Cleft Lip/Palate and Craniofacial Anomalies Registry from June 1999 to December 2005. Results: Retrospectively, 807 cases of cleft lip and/or palate were registered. There were 451 boys and 356 girls. Cleft lip and palate was more common (387) than isolated cleft palate (294) and isolated cleft lip (122). Boys predominated in cleft lip and palate and cleft lip; whereas, girls predominated in isolated cleft palate, with boy to girl ratios of 1.6:1, 1.2:1, and 0.9:1 for cleft lip and/or palate, isolated cleft lip, and isolated cleft palate, respectively. The Riyadh region had more cases (32.0%) than the Asir (15.6%) and Eastern (14.6%) regions. Parents of 439 individuals had consanguineous marriages. A positive family history of cleft was seen in 224 cases. Of 238 cases with associated anomalies, 91 had congenital heart disease. Of the children with isolated cleft palate, 40.5% had associated anomalies, whereas only 23.0% of the children with isolated cleft lip or cleft lip and palate had associated malformations. Conclusion: The pattern of cleft observed in this study does not differ significantly from those reported in the literature for Arab populations.


1982 ◽  
Vol 9 (3) ◽  
pp. 129-131 ◽  
Author(s):  
E. A. Devenish ◽  
T.D. Foster ◽  
D. Chinn

A system of differential rapid maxillary expansion is described. This method is particularly useful in patients with cleft lip and palate who have severe defects of lateral maxillary growth, since it enables the maxillary segments to be rotated so that intercanine width increases without a concomitant increase in the intermolar width.


UNICIÊNCIAS ◽  
2021 ◽  
Vol 24 (1) ◽  
pp. 112-117
Author(s):  
Andreza Maria Fábio Aranha ◽  
Amanda Alves de Oliveira ◽  
Alexandre Meireles Borba ◽  
Luiz Evaristo Ricci Volpato

As fissuras labiopalatinas (FLP) são as malformações congênitas mais comuns da região craniofacial e apresentam diferentes fenótipos e características clínicas, que diferem entre si de acordo com as estruturas anatômicas envolvidas: fissura de lábio, fissura de lábio e palato e fissura de palato isolada. A etiologia das FLP é multifatorial e inclui fatores genéticos e ambientais. O objetivo do presente estudo foi investigar o papel das fissuras labiopalatinas na prevalência de cárie dentária por meio de uma revisão na literatura. O defeito anatômico que envolve o rebordo alveolar e/ou o palato pode resultar em agenesias dentárias, dentes supranumerários, anomalias de forma e estrutura, bem como atresia maxilar, mordidas cruzadas posteriores e apinhamentos dentários. Também, a presença da FLP pode resultar aos indivíduos problemas durante alimentação, pronúncia de alguns fonemas, audição e integração social, o que poderia afetar a qualidade de vida do indivíduo e da dinâmica familiar. Quando a saúde bucal de crianças e adolescentes com FLP foi investigada, maior retenção do biofilme microbiano nas superfícies dentárias, de inflamação gengival e maior ocorrência de cárie dentária foram observados. Para um diagnóstico e tratamento adequados, é fundamental uma abordagem multidisciplinar, individualizada, para orientação e planejamento do tratamento dos indivíduos com a malformação, desde o nascimento até a fase adulta. O conhecimento dos efeitos da FLP na saúde bucal e no bem-estar dos indivíduos e das famílias afetadas é fundamental para mudanças nas políticas públicas das práticas de saúde e redução da sobrecarga da presença da malformação congênita.   Palavras-chave: Cárie Dentária. Fenda Labial. Fissura Palatina. Saúde Bucal   Abstract Cleft lip and palate (CLP) are the most common congenital malformations of the craniofacial region and they present different phenotypes and clinical characteristics, which differ according to the anatomical structures involved: cleft lip, cleft lip and palate and isolated cleft palate. The etiology of CLP is multifactorial and includes genetic and environmental factors. The aim of this study was to investigate the role of cleft lip and palate in the prevalence of dental caries through a literature review. The anatomical defect involving the alveolar ridge and / or the palate can result in dental agenesis, supernumerary teeth, anomalies in shape and structure, as well as maxillary atresia, posterior cross bites and dental crowding. Also, the presence of CLP can result in problems for individuals during feeding, pronunciation of some phonemes, hearing and social integration, which could affect the individual's quality of life and family dynamics. When the oral health of children and adolescents with CLP was investigated, greater retention of microbial biofilm on dental surfaces, gingival inflammation and the occurrence of dental caries were observed. For an adequate diagnosis and treatment, a multidisciplinary and individualized approach is essential to guide and plan the treatment of individuals with the malformation, from birth to adulthood. The knowledge of the effects of FLP on oral health and on the well-being of affected individuals and families is fundamental to changes in public health practice policies and to reduce the burden of the presence of the congenital malformation.   Keywords:  Cleft Lip. Cleft Palate. Dental Caries. Oral Health.


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