Correction of Maxillary Arch of Cleft Lip and Palate Patient using Active Stabilized Extraoral Apparatus

ABSTRACT

Presurgical maxillary orthodontics during neonatal period has been advocated to facilitate cleft lip and/or palate cases through correcting widened alveolar bone and twisting or bending protruded premaxilla. This may improve post-orthodontic surgical lip repair procedure. Premaxilla cannot be moved into the correct position by a passive acrylic appliance alone. Therefore active acrylic appliance may be necessary and force vector, amount and stability of appliance are mandatory. Because neonatal infant still doesn't have a fully grown face, there may be some limitations to apply proper active force to the patient. The authors devised a new active stabilized extraoral appliance which provided stable extraoral force in the cleft lip and/or palate patients. We applied our new device to 2 infants with unilateral and bilateral cleft lip and palate. Stability of extraoral part has been increased by elastic rubber band, and the intraoral part is firmly connected to extraoral part. By using this device, the gap has decreased from 11.5mm to 6.5mm between right and left alveolar ridge in 1-month infant with unilateral case after 7 weeks. In 2-month infant with bilateral cleft, the length between premaxilla and alveolar ridge decreased from 6.5mm to 2.0mm after 4 weeks. We think our intraoral active stabilized orthodontic appliance could be widly used in cleft patients to put their maxillary segments to desirable position. This procedure makes the cleft lip surgery easier, with less tension.