Individual appraisal of facial soft and hard tissues with the mesh diagram

The lateral cephalometric mesh diagram analysis presents advantages not readily available in conventional cephalometric methods. The face is oriented on the patient's natural head position, which provides comparability between cephalometric findings and the clinical facial examination. The patient's profile is not directly compared with the population norm but with an "individualized norm" derived from the application of the population norm to a grid scaled on the patient's facial shape namely, the upper face height [N-ANS] and facial depth [N-S]. Each landmark is assessed by its proportionate location in the mesh diagram grids. Thus, facial form is evaluated in one single display easily interpretable without computation of linear and angular measurements. These principles are illustrated for diagnosis of malocclusions and treatment with a combination of orthodontics and orthognathic surgery. The discrepancies between hard and soft tissues are readily ascertained and measured through the mesh display, and allow the formulation of conclusions on treatment and outcome. The mesh diagram is a flexible cephalometric analysis that should be incorporated in the routine dentofacial diagnosis and treatment planning

Sequencing cleft lip and palate treatment

Comprehensive treatment of cleft lip/palate involves a team approach [surgeon, orthodontist, prosthodontist, speech therapist, etc.] for long-term multidisciplinary planning, to achieve proper function and esthetics of facial structures, as well as optimal hearing and intelligible speech. Our aim is to review evidence-based treatment timing in relation to key growth events. Sequence: Within the first year of life, lip adhesion and/or closure are performed; soft palate closure is indicated with or without hard palate surgery, which is not delayed beyond the age of 2 years. Feeding appliances may be given to non-thriving infants. Before school begins [age 3-5 years], the lip and columella are lengthened and the alar base is repaired if indicated. In early to mid-childhood [6-12 years], orthodontics is initiated before secondary alveolar bone grafting [ABG]: expansion appliances are used to correct posterior/anterior crossbites; maxillary segments and teeth adjacent to the cleft are aligned. The optimal time for ABG is before the dental emergence age of 10 years, as research indicates the prevalence of ectopic tooth eruption if bone is provided later. A pharyngeal flap may be needed at the same time. In the adolescent years, final revisions of the lip and soft palate, and rhinoplasty, are performed. Orthodontic treatment is completed alone or with adjunctive orthognathic surgery. Permanent cosmetic and functional dental restorations are done last. Maxillofacial orthopedic treatment of cleft lip/palate is enhanced by proper sequencing, coordinated and implemented by a team of specialists from birth to adulthood