Effects of the long-term use of maxillary protraction facemasks with skeletal anchorage on pharyngeal airway dimensions in growing patients with cleft lip and palate

Objective: The objective of this retrospective longitudinal study was to evaluate short- and long-term results of the application of the Liou Alt-RAMEC (alternate rapid maxillary expansion and constriction) technique, a late orthopedic maxillary protraction technique, with intraoral anchorage, in patients with cleft. Materials and Methods: Twenty-six patients with unilateral cleft lip and palate (UCLP) were consecutively treated with the Alt-RAMEC technique. The average age of the patients was 11.7 years (10.3-13.2 years) before protraction and 18.3 years (17.4-21.1 years) at long-term follow-up. A sample of nontreated patients with UCLP was used as a control group. It was matched for sex, skeletal class III, and age (11.3 years). The control sample had records at the end of growth (18.7 years). Results: The sagittal advancement of A-point, after the application of the technique, was 5.7 (2.17) mm. Some mandibular dentoalveolar and positional adaptation was noted. The position of the maxilla was stable in the long term. On the other hand, the UCLP control group showed hardly any growth at the maxillary level during the long-term follow-up period. Conclusion: Our results showed that the Alt-RAMEC technique, performed at the correct time, with a double-hinged expander, followed by class III spring or elastic traction, 24 hours per day, allows for satisfactory maxillary protraction, with, at this stage, apparently stable long-term results. Nevertheless, as only 50% of the patients had long-term follow-up data, we are still unable to predict the percentage of patients which will not eventually need orthognathic surgery.

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Three-dimensional assessment of airway volumes in patients with unilateral cleft lip and palate

Progress in Orthodontics ◽

10.1186/s40510-021-00382-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Bita Kiaee ◽

Ludovica Nucci ◽

Farzin Sarkarat ◽

Ahmad Reza Talaeipour ◽

Sara Eslami ◽

...

Keyword(s):

Respiratory Insufficiency ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Sagittal Plane ◽

Three Dimensional ◽

Control Group ◽

Historical Cohort ◽

Old Patients ◽

Pharyngeal Airway ◽

Airway Dimensions

Abstract Background Considering the adverse consequences of respiratory insufficiency in cleft lip and palate (CLP) patients, this study aimed to assess the pharyngeal airway dimensions in 9–12-year-old patients with unilateral CLP. This historical cohort evaluated the cone-beam computed tomography (CBCT) scans of 30 patients with non-syndromic unilateral CLP between 9 and 12 years and 30 age- and sex-matched non-cleft controls. Three-dimensional (3D) images were reconstructed by the Mimics software, and the nasopharyngeal, oropharyngeal, and total airway volumes, as well as the minimal cross-sectional area of the airway (minAx), and posterior airway length (PAL) were all measured in the sagittal plane. Data were analyzed by the Student’s t test. Results The oropharyngeal and the total airway volumes, as well as the minAx and PAL in CLP patients, were significantly smaller than the corresponding values in the control group (P < 0.05). Despite smaller nasopharyngeal airway volume in CLP patients than controls, this difference was not statistically significant (P > 0.05). Conclusions Nine- to twelve-year-old non-syndromic unilateral CLP patients have smaller pharyngeal airway dimensions than non-cleft controls, and are therefore at higher risk of respiratory insufficiency.

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Long-term stability of maxillary protraction therapy in Class III patients with complete unilateral cleft lip and palate

The Angle Orthodontist ◽

10.2319/070418-501.1 ◽

2018 ◽

Vol 89 (2) ◽

pp. 214-220

Author(s):

Yixin Zhang ◽

Zhen Fu ◽

Haichao Jia ◽

Yiping Huang ◽

Xiaobei Li ◽

...

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Growth Spurt ◽

Maxillary Incisor ◽

Class Iii ◽

Stable Group ◽

Maxillary Protraction ◽

Term Stability ◽

Long Term Stability

ABSTRACT Objectives: This study evaluated the long-term stability of maxillary protraction (MP) in patients with complete unilateral cleft lip and palate (UCLP) and identified factors influencing relapse and long-term outcomes. Materials and Methods: Twenty-three adolescents with UCLP who underwent MP therapy were recalled when craniofacial growth was close to completion. Subjects exhibiting reverse/positive overjets were assigned to unstable/stable groups. Lateral cephalometric measurements were made before treatment (T0), after active treatment (T1), and at the end of the growth spurt (T2). Results: About 63% of the subjects exhibited positive overjets during follow-up. The unstable group demonstrated higher B–x and Co–Gn distances than the stable group (both P < .05) at T0. More short-term (T0–T1) sagittal advancement of point A (A–y) was evident in the unstable group than in the stable group (P < .05), but no long-term difference was apparent between the two groups (P = .481). During the posttreatment period (T1–T2), the SNA angle and maxillary incisor protrusion (U1–SN angle) were considerably lower in the unstable group than in the stable group (both P < .05). Overall, the unstable group exhibited a lower increase in the vertical extent of point A (A–x) than the stable group from T0 to T2 (P < .05). Conclusions: In the long term, MP affords favorable maxillary advancement in patients with UCLP. A mandibular excess at T0 and vertical maxillary hypoplasia may contribute to the long-term relapse of a reverse overjet.

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Bone-anchored maxillary protraction long-term outcomes in UCLP:

The Angle Orthodontist ◽

10.2319/121219-795.1 ◽

2020 ◽

Vol 90 (5) ◽

pp. 734-741

Author(s):

Daniela Garib ◽

Fernando Pugliese ◽

Renata Mayumi Kato ◽

Renato Faco ◽

Marilia Yatabe ◽

...

Keyword(s):

Orthodontic Treatment ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Full Time ◽

Class Iii ◽

Maxillary Protraction ◽

Maxillary Advancement ◽

Facial Esthetics

ABSTRACT This case report presents a 12-year-old boy with unilateral complete cleft lip and palate and severe maxillary retrusion treated with bone-anchored maxillary protraction (BAMP) therapy followed by fixed appliances. The follow-up period extended until the end of growth. Initially, the patient demonstrated a Goslon 4 interarch relationship with an overjet of −3.5 mm and a Wits appraisal of −7.9 mm. Six months after the secondary alveolar bone graft, Bollard miniplates were fixed bilaterally at the infrazygomatic region in the maxilla and between the canines and lateral incisors in the mandible. Class III elastics were used bilaterally full time for 12 months. After treatment, the overjet increased 5.9 mm. Significant maxillary advancement (SNA +3.2°) and skeletal convexity improvement (NA-APo +12.4°) were observed. Retrusion of the anteroposterior position of the mandible was observed (SNB –2.1°). Comprehensive orthodontic treatment was performed after BAMP therapy with nighttime bone-anchored Class III elastics as active retention until the end of growth. Occlusion and facial esthetics were satisfactory at the end of orthodontic treatment and growth. Le Fort I surgery for maxillary advancement was not required. BAMP therapy demonstrated an adequate orthopedic outcome, preventing the need for orthognathic surgery in unilateral complete cleft lip and palate.

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