A case of cleft lip and palate with severe maxillary retrognathism treated by distraction osteogenesis and custom made intraoral rapid maxillary expansion appliance: A 2-year follow-up of retention.

Herewith, a case is reported of an adolescent female patient with maxillary retrognathism due to restricted growth arising out of the previous cheiloplasty and palatoplasty surgeries treated for cleft lip and palate. She also presented an oroantral fistula in the scarred tissues of the palatal region. There was anterior crossbite and distorted occlusion in the anterior segment with crowding and open bite. There is maxillomandibular discrepancy of 6 degrees°. The distraction osteogenesis was performed so as treat the maxillary hypoplasia. This allows undermanding adaptation of the soft-tissue structures to the modification in the skeletal structures as a result of surgical procedures and ensures long-term stability. A custom made intraoral rapid maxillary expansion device was prepared utilizing the hyrax screw for the distraction of the bony segments. At the end of the treatment and a retention period of 24 months, the patient exhibited improved facial profile and hence esthetics.

Comparison of the effect of labiolingual inclination and anteroposterior position of maxillary incisors on esthetic profile in three different facial patterns.

OBJECTIVE: To test the null hypothesis that there is no effect of esthetic perception of smiling profile in three different facial types by a change in the maxillary incisor inclination and position. MATERIALS AND METHODS: A smiling profile photograph with Class I skeletal and dental pattern, normal profile were taken in each of the three facial types dolichofacial, mesofacial, and brachyfacial. Based on the original digital image, 15 smiling profiles in each of the facial types were created using the FACAD software by altering the labiolingual inclination and anteroposterior position of the maxillary incisors. These photographs were rated on a visual analog scale by three panels of examiners consisting of orthodontists, dentists, and nonprofessionals with twenty members in each group. The responses were assessed by analysis of variance (ANOVA) test followed by post hoc Scheffe. RESULTS: Significant differences (P < 0.001) were detected when ratings of each photograph in each of the individual facial type was compared. In dolichofacial and mesofacial pattern, the position of the maxillary incisor must be limited to 2 mm from the goal anterior limit line. In brachyfacial pattern, any movement of facial axis point of maxillary incisors away from GALL is worsens the facial esthetics. The result of the ANOVA showed differences among the three groups for certain facial profiles. CONCLUSION: The hypothesis was rejected. The esthetic perception of labiolingual inclination and anteroposterior of maxillary incisors differ in different facial types, and this may effect in formulating treatment plans for different facial types.