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

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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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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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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Rapid Maxillary Expansion after Secondary Alveolar Bone Graft in a Patient with Bilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/02-099.1 ◽

2004 ◽

Vol 41 (3) ◽

pp. 332-339 ◽

Cited By ~ 14

Author(s):

Arlete de Oliveira Cavassan ◽

Marcelo D'Albuquerque de Albuquerque ◽

Leopoldino Capelozza Filho

Keyword(s):

Bone Graft ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Rapid Maxillary Expansion ◽

Maxillary Expansion ◽

Bilateral Cleft Lip ◽

Maxillary Constriction ◽

Intercanine Distance ◽

Dental Casts

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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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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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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8 An investigation of variables associated with length of stay related to primary cleft lip and palate and alveolar bone graft operations

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/s0266-4356(10)60009-5 ◽

2010 ◽

Vol 48 ◽

pp. S2-S3

Author(s):

N. Izadi ◽

P. Haers

Keyword(s):

Length Of Stay ◽

Bone Graft ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone

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Craniofacial Morphology in Children with Complete Bilateral Cleft Lip and Palate: Does Infantile Size of the Premaxilla Predetermine Outcome?

The Cleft Palate-Craniofacial Journal ◽

10.1597/03-021.1 ◽

2004 ◽

Vol 41 (4) ◽

pp. 410-415 ◽

Cited By ~ 6

Author(s):

Yu-Fang Liao ◽

Chiung-Shing Huang ◽

Ya-Yu Tsai ◽

M. Samuel Noordhoff

Keyword(s):

Retrospective Study ◽

Outcome Measures ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Craniofacial Morphology ◽

University Hospital ◽

Cephalometric Analysis ◽

Bilateral Cleft Lip ◽

Dental Cast ◽

Craniofacial Characteristics

Objective To evaluate the possible association between the size of the premaxilla in infants and craniofacial morphology in children with complete bilateral cleft lip and palate (CBCLP) and identify the characteristics of craniofacial morphology in children with CBCLP with median facial dysplasia (MFD). Design Retrospective study. Setting A university hospital craniofacial center. Subjects Thirty-four patients with nonsyndromic CBCLP, 24 boys and 10 girls, had large premaxilla (LP group). Thirty-six patients with nonsyndromic CBCLP, 16 boys and 20 girls, had small premaxilla (SP group). Thirteen CBCLP patients with MFD, five boys and eight girls (MFD group). Main Outcome Measures Infant maxillary dental cast at the age of 1 year was used to measure the size of the premaxilla. Cephalometric analysis was used to determine craniofacial morphology in children at the age of 5 years. Results The size of the premaxilla in infants with CBCLP varied greatly. The LP group tended to have a longer maxilla and a more protruded maxilla, producing a better interjaw relation. The opposite phenomena were observed in the MFD group; the SP group yielded results between those of the LP and the MFD groups. Conclusion The size of the premaxilla in infants with CBCLP can be used to predetermine subsequent craniofacial morphology at the age of 5 years. Children with nonsyndromic CBCLP had craniofacial characteristics that differed significantly from those of children with CBCLP with median facial dysplasia.

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