Transverse Dento-skeletal Effects of Two Rapid Palatal Expansion Appliances in Cleft Lip and Palate Patients

2020 ◽  
Author(s):  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Palatal Expansion ◽  
Rapid Palatal Expansion ◽  
Skeletal Effects

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 ◽  
...  
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.

Evaluation of Transverse Maxillary Expansion after a Segmental Posterior Subapical Maxillary Osteotomy in Cleft Lip and Palate Patients with Severe Collapse of the Lateral Maxillary Segments

2014 ◽  
Vol 51 (6) ◽  
pp. 651-657 ◽  
Author(s):  
S. Carpentier ◽  
J. Van Gastel ◽  
J. Schoenaers ◽  
C. Carels ◽  
V. Vander Poorten ◽  
...  
Keyword(s):  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Adult Patients ◽  
Control Group ◽  
Study Group ◽  
Maxillary Expansion ◽  
University Hospitals ◽  
Rapid Palatal Expansion ◽  
Maxillary Osteotomy

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.

scholarly journals Miniscrew-assisted rapid palatal expander (MARPE): the quest for pure orthopedic movement

2016 ◽  
Vol 21 (4) ◽  
pp. 17-23 ◽  
Author(s):  
Hideo Suzuki ◽  
Won Moon ◽  
Luiz Henrique Previdente ◽  
Selly Sayuri Suzuki ◽  
Aguinaldo Silva Garcez ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Anterior Segment ◽  
Middle Segment ◽  
Palatal Expansion ◽  
Rapid Palatal Expansion ◽  
Pubertal Growth ◽  
Incisive Foramen ◽  
Skeletal Effects ◽  
Maxillary Constriction ◽  
Palatal Bone

ABSTRACT The midpalatal suture has bone margins with thick connective tissue interposed between them, and it does not represent the fusion of maxillary palatal processes only, but also the fusion of palatal processes of the jaws and horizontal osseous laminae of palatal bones. Changing it implies affecting neighboring areas. It has got three segments that should be considered by all clinical analyses, whether therapeutic or experimental: the anterior segment (before the incisive foramen, or intermaxillary segment), the middle segment (from the incisive foramen to the suture transversal to the palatal bone ) and the posterior segment (after the suture transversal to the palatal bone ). Rapid palatal expansion might be recommended for patients at the final pubertal growth stage, in addition to adult patients with maxillary constriction. It represents a treatment solution that can potentially avoid surgical intervention. When performed in association with rapid palatal expanders, it might enhance the skeletal effects of the latter. Of the various designs of expansion appliances, MARPE (miniscrew-assisted rapid palatal expander) has been modified in order to allow its operational advantages and outcomes to become familiar in the clinical practice.

Biomechanical Effects of Rapid Palatal Expansion on the Craniofacial Skeleton with Cleft Palate: A Three-Dimensional Finite Element Analysis

2007 ◽  
Vol 44 (2) ◽  
pp. 149-154 ◽  
Author(s):  
Xiaogang Pan ◽  
Yufen Qian ◽  
Jia Yu ◽  
Dongmei Wang ◽  
Yousheng Tang ◽  
...  
Keyword(s):  
Finite Element ◽  
Stress Distribution ◽  
Cleft Palate ◽  
Nasal Cavity ◽  
Cleft Lip And Palate ◽  
Three Dimensional ◽  
Dental Arch ◽  
Craniofacial Skeleton ◽  
Palatal Expansion ◽  
Rapid Palatal Expansion

Objective: To explore the biomechanical effects of rapid palatal expansion (RPE) on the craniofacial skeleton with cleft palate. Design: A finite element model of a patient's skull with cleft lip and palate (CLP) was generated using data from spiral computed tomographic (CT) scans. Finite elemental analysis (FEA) was performed to depict the physiological changes and stress distribution in craniofacial structures loaded with orthopedic forces that created 5 mm of displacement on the region of the maxillary first premolar and first molar crown. Patients, participants: A 14-year-old girl with left complete unilateral CLP was included in this study. Interventions: Spiral CT was carried out prior to any treatment. Main outcome measure(s): Three-dimensional (3D) features of displacement and stress distribution were analyzed following application of transverse orthopedic force. Results: Marked amount of displacement and deformation occurred in the dental region. Asymmetric displacement and deformation of UCLP under RPE were evident. The stress generated by RPE was dispersed around the cleft palate and nasal cavity, and was distributed at the buttress of the maxilla-inferior border of the nasal cavity, outboard of the orbit, and central frontal bone near the nasion. Conclusions: Application of RPE to UCLP patients induces a pyramid-like displacement of the nasomaxillary complex along with fan-like expansion of the upper dental arch. The uniqueness of RPE with UCLP, however, lies in the asymmetric expansion and dispersed stress distribution around the lateral maxilla buttress and outboard of orbit.

Excessive Rapid Palatal Expansion with Latham Appliance for Distal Repositioning of Protruded Premaxilla in Bilateral Cleft Lip and Alveolus

2006 ◽  
Vol 43 (6) ◽  
pp. 673-677 ◽  
Author(s):  
Eiji Fukuyama ◽  
Susumu Omura ◽  
Kiyohide Fujita ◽  
Kunimichi Soma ◽  
Katsuyuki Torikai
Keyword(s):  
Cleft Lip ◽  
Maxillary Expansion ◽  
Orthopedic Treatment ◽  
Primary Operation ◽  
Palatal Expansion ◽  
Rapid Palatal Expansion ◽  
Postoperative Changes ◽  
Bilateral Cleft Lip ◽  
Plaster Casts ◽  
The Ideal

Objective: This article reports a case of bilateral cleft lip and alveolus (BCLA) for which excessive rapid palatal expansion with a Latham appliance was performed for preoperative alignment of the protruded premaxilla. Postoperative changes of maxillary width were investigated with serial plaster casts. Patient and Results: A 3-month-old girl presented with complete BCLA in which the premaxilla was markedly protruded. Preoperative alignment of the protruded premaxilla with a Latham appliance was planned to facilitate primary lip repair. The appliance was placed when the patient was 4.5 months old. The necessary palatal expansion was estimated to be 7.0 mm in order to move the premaxilla backward into the ideal position. After palatal expansion and posterior repositioning of the protruded premaxilla, the primary operation, including cheiloplasty and gingivoperiosteoplasty, was performed when the patient was 7 months old. Excessive maxillary expansion might be a cause of transverse maxillomandibular discrepancy. Measurement with serial plaster casts demonstrated that maxillary widths increased from 42.3 mm pretreatment to 49.0 mm after orthopedic treatment but relapsed markedly to 43.5 mm at 3 months after the primary operation. Therefore, the net change of maxillary widths was only 1.2 mm. After alignment of the protruded premaxilla, tension-free soft tissue repairs were performed, and a harmonious alveolar arch was obtained without change in maxillary width. Conclusion: These results indicate that this method is useful for preoperative management of BCLA with protruded premaxilla.

Treatment of a Patient with Cleft Lip and Palate Using an Internal Distraction Device

2008 ◽  
Vol 45 (5) ◽  
pp. 552-560 ◽  
Author(s):  
Emel Sari ◽  
Cihan Ucar ◽  
Oytun Türk ◽  
Huseyin Kurtulmus ◽  
H. Ayberk Altug ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Latency Period ◽  
Open Bite ◽  
Maxillary Expansion ◽  
Anterior Open Bite ◽  
Automatic Speech Recognition System ◽  
Rapid Palatal Expansion ◽  
Maxillary Osteotomy ◽  
Maxillary Distraction

A 24-year-old man with a bilateral cleft lip and palate was treated by a multidisciplinary team composed of an orthodontist, plastic surgeon, and prosthodontist with assistance from an engineer. Before treatment, clinical photographs, dental casts, lateral and posteroanterior cephalograms, periapical and panoramic radiographs, and three-dimensional computed tomography (3D CT) images were obtained. He presented with a narrow and retrognathic maxilla with a 23-mm anterior open bite. Following maxillary expansion with rapid palatal expansion, a Le Fort I maxillary osteotomy was performed, and an internal distractor was placed. After a 5-day latency period, internal maxillary distraction was performed at a rate of 1 mm/day achieved by two activations per day. Cephalometric analysis showed a 7-mm maxillary advancement. Mandibular bilateral sagittal split osteotomy was also performed to close the open bite following maxillary distraction and a 3-month stabilization period. Finally, the treatment was completed with prosthetic rehabilitation. The changes in speech production were evaluated using an automatic speech recognition system.

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