scholarly journals Maxillary distraction osteogenesis for correction of maxillary retrognathia in cleft lip and palate patients: a case series

2019 ◽  
Vol 5 (6) ◽  
pp. 154
Author(s):  
Burçak Kaya ◽  
Secil Cubuk ◽  
Sıdıka Akdeniz ◽  
Burak Bayram
Keyword(s):  
Distraction Osteogenesis ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Protocol ◽  
Case Series ◽  
Dental Arch ◽  
Maxillary Expansion ◽  
Oronasal Fistula ◽  
Alveolar Bone Grafting ◽  
Maxillary Distraction

<p class="abstract">The treatment protocol of patients having maxillary retrognatia is presented in this case series. Maxillary expansion, secondary alveolar bone grafting and/or oronasal fistula closure were performed in 6 cleft lip and palate patients. Preoperative simulation of Le Fort I osteotomy and adaptation of maxillary distractors were realized with stereolytographic cranium models. Intraoral maxillary distraction was applied under general anesthesia. A single unit acrylic occlusal splint was ligated to maxillary dental arch and worked as a guide during entire activation and consolidation period of distraction osteogenesis. Rigid internal fixation plates were placed in the osteotomy sites at the end of consolidation period. The amount of maxillary advancement was between 5-14 mm.  Satisfying occlusal and skeletal relationships were obtained in all patients. Advancement of maxilla by distraction osteogenesis resulted in gradual formation of bone at the osteotomy line and enhanced treatment outcome in patients with cleft lip and palate.</p>

Maxillary Distraction Osteogenesis in Cleft Lip and Palate Patients with Skeletal Anchorage

2007 ◽  
Vol 44 (2) ◽  
pp. 137-141 ◽  
Author(s):  
Katsuhiro Minami ◽  
Yoshihide Mori ◽  
Kwon Tae-Geon ◽  
Hidetaka Shimizu ◽  
Miyuki Ohtani ◽  
...  
Keyword(s):  
Distraction Osteogenesis ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Three Dimensional ◽  
Treatment Protocol ◽  
Skeletal Anchorage ◽  
Stereolithographic Model ◽  
Ct Data ◽  
Maxillary Distraction ◽  
Stereolithographic Models

Objective: Maxillary distraction osteogenesis with the rigid external distraction (RED) system has been used to treat cleft lip and palate (CLP) patients with severe maxillary hypoplasia. We introduce maxillary distraction osteogenesis for CLP patients with skeletal anchorage adapted on a stereolithographic model. Patients: Six maxillary deficiency CLP patients treated according to our CLP treatment protocol had undergone maxillary distraction osteogenesis. Method: In all patients, computed tomography (CT) images were recorded preoperatively, and the data were transferred to a workstation. Three-dimensional skeletal structures were reconstructed with CT data sets, and a stereolithographic model was produced. On the stereolithographic model, miniplates were adapted to the surface of maxilla beside aperture piriforms. The operation performed involved a high Le Fort I osteotomy with pterygomaxillary disjunction. Miniplates were fixed to the maxillary segment with three or four screws and used for anchorage of the RED system. Retraction of the maxillary segment was initiated after 1 week. Results: The accuracy of the stereolithographic models was enough to adapt the miniplates so that there was no need to readjust the plates during surgery. Postoperative cephalometric analysis showed that the direction of the retraction was almost parallel to the palatal plane, and dental compensation did not occur. Conclusions: We performed maxillary distraction osteogenesis with skeletal anchorage adapted on the stereolithographic models. Excellent esthetic outcome and skeletal advancement were achieved without dentoalveolar compensations.

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

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

Cleft Lip and Palate Care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 4: Outcome Comparisons, Training, and Conclusions

2001 ◽  
Vol 38 (1) ◽  
pp. 38-43 ◽  
Author(s):  
David Bearn ◽  
Sue Mildinhall ◽  
Terrie Murphy ◽  
John J. Murray ◽  
Debbie Sell ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Dental Health ◽  
Parent Satisfaction ◽  
Advisory Group ◽  
Dental Arch ◽  
The United Kingdom ◽  
Alveolar Bone Grafting

Objective A critical appraisal of cleft care in the United Kingdom. Design Retrospective comparative study. Setting All National Health Service cleft centers in the United Kingdom. Patients/Participants Children born with unilateral complete clefts of the lip and palate between April 1, 1982, and March 31, 1984 (12-year-olds), and April 1, 1989, and March 31, 1991 (5-year-olds). Newly appointed and senior cleft clinicians. Main Outcome Measures Skeletal pattern, dental arch relationship, success of alveolar bone grafting, dental health, facial appearance, oral health status, patient/parent satisfaction. Conclusions This paper highlights the poor outcomes for the fragmented cleft care in the United Kingdom, compared with European centers. There is an urgent need for a review of structure, organization, and training.

Assessment of Dental Arch Relationships in Japanese Patients with Unilateral Cleft Lip and Palate

2006 ◽  
Vol 43 (1) ◽  
pp. 96-102 ◽  
Author(s):  
Takafumi Susami ◽  
Yuji Ogihara ◽  
Masako Matsuzaki ◽  
Miyuki Sakiyama ◽  
Tsuyoshi Takato ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Good Practice ◽  
Weighted Kappa ◽  
Japanese Patients ◽  
Craniofacial Morphology ◽  
Dental Arch ◽  
Kappa Statistics ◽  
Consecutive Series ◽  
Alveolar Bone Grafting

Objective Evaluation of the dental arch relationships of Japanese patients with unilateral cleft lip and palate (UCLP) from the orthodontic clinic of the University of Tokyo Hospital (UTH) compared with patients treated by the Oslo Cleft Team, Norway. Design Retrospective study and comparison with previous reports. Materials Dental models of 24 patients with UCLP in UTH taken before orthodontic treatment and before alveolar bone grafting were included. Surgeons in many hospitals performed primary surgeries. These models were matched for age and gender with 24 models from a consecutive series of patients treated by the Oslo Cleft Team as part of the Eurocran Good Practice Archive. A total of 48 models were evaluated. Main Outcome Measure Dental arch relationship was rated with the Goslon Yardstick. The strength of agreement of rating was assessed with weighted kappa statistics. Results Intra- and interexaminer agreements evaluated by weighted kappa statistics were high, indicating good reproducibility. Almost 60% of the patients in UTH were classified into poor or very poor categories, and the mean Goslon score was 3.50. These results show a contrast to those in Oslo and were the poorest in comparison with previous reports. Conclusion Dental arch relationships in patients with UCLP in UTH were poor. This seemed to be attributable to surgical procedures, but a factor of racial difference in the craniofacial morphology was also considered. Further intercenter research is required to clarify this point.

scholarly journals Presurgical nasoalveolar moulding treatment in cleft lip and palate patients

2009 ◽  
Vol 42 (S 01) ◽  
pp. S56-S61 ◽  
Author(s):  
Barry H. Grayson ◽  
Pradip R. Shetye
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Clinical Skills ◽  
Vertical Plane ◽  
Nasal Cartilage ◽  
Oronasal Fistula ◽  
Alveolar Bone Grafting ◽  
Proper Training ◽  
Infant Orthopedics

ABSTRACTPresurgical infant orthopedics has been employed since 1950 as an adjunctive neonatal therapy for the correction of cleft lip and palate. Most of these therapies did not address deformity of the nasal cartilage in unilateral and bilateral cleft lip and palate as well as the deficiency of the columella tissue in infants with bilateral cleft. The nasolaveolar molding (NAM) technique a new approach to presurgical infant orthopedics developed by Grayson reduces the severity of the initial cleft alveolar and nasal deformity. This enables the surgeon and the patient to enjoy the benefits associated with repair of a cleft deformity that is minimal in severity. This paper will discuss the appliance design, clinical management and biomechanical principles of nasolaveolar molding therapy. Long term studies on NAM therapy indicate better lip and nasal form, reduced oronasal fistula and labial deformities, 60 % reduction in the need for secondary alveolar bone grafting. No effect on growth of midface in sagittal and vertical plane has been recorded up to the age of 18 yrs. With proper training and clinical skills NAM has demonstrated tremendous benefit to the cleft patients as well as to the surgeon performing the repair.

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