ABSTRACT
BACKGROUND: Maxillary growth deficiency is still a problem in children with repaired cleft lip-cleft palate, and little progress has been made on research for its prevention. An increase in the early diagnosis of maxillary growth deficiency prompted this study to obtain an early indication of the efficacy of a new protocol for better dental and maxillary development. METHODS: A new method for repair of the hard palate in infants with bilateral cleft lip-cleft palate that made innovative use of mucosa of the nasal septum and involved less extensive surgery was coupled with the repair of the lip at 18 months instead of at 8 months. Twelve consecutive cases were compared with 12 cases treated by the previous method. Records of dental occlusion and lateral head radiographs at 5 years were obtained prospectively for the new treatment group and retrospectively for the previous group. RESULTS: In the previous group, there was a high incidence of dental crossbite. Incisor crossbite was present in 10 of the 12 (83 percent), and all 12 had one or both cuspids in crossbite. In the new treatment group, the incisor crossbite was reduced to four of 12 cases (33 percent), with cuspid crossbite at 50 percent. The new treatment group also showed greater values for cephalometric measures in maxillary length, maxillary prominence, and the ANB angle. CONCLUSION: At the age of 5 years, a definite improvement in dental and maxillary development was evident in the new treatment group.
Subject(s)
Cleft Lip/surgery , Cleft Palate/surgery , Maxilla/growth & development , Tooth/growth & development , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Prospective Studies , Plastic Surgery Procedures/methods , Retrospective StudiesABSTRACT
OBJECTIVE: It is proposed to test the practicality of septopalatal protraction in the unilateral cleft palate infant for purposes of straightening the nasal septum and thus relieving nasal airflow obstruction and its detrimental sequelae. METHODS: Alternate infants affected with complete unilateral palatal clefts had septopalatal protraction for a period of 6 to 8 weeks (protraction group; n = 4). Septal deviation was measured by a standardized technique that used computed tomography scans. The remaining infants had no protraction and served as controls (nonprotraction group; n = 5). Septal deviation was measured in the nonprotraction group from palatoseptal dental molds. RESULTS: A total of 9 patients were studied. All patients in the nonprotraction group had worsening of nasal septal deviation over a period of 8 weeks compared with the protraction group, which had complete nasal septal straightening. Differences in septal angle deviation between the protraction group and nonprotraction group at the end of the study were statistically significant (P < or = 0.01) as measured by the paired Student t test. CONCLUSIONS: Septopalatal protraction in the newborn appears to provide a means for correcting nasal septal deviation in complete unilateral cleft palate infants. Septopalatal protraction in the newborn is relatively easy and safe.
Subject(s)
Cleft Palate/therapy , Nasal Obstruction/therapy , Nasal Septum/abnormalities , Palatal Expansion Technique/instrumentation , Palate, Hard/abnormalities , Cleft Palate/complications , Cleft Palate/diagnostic imaging , Follow-Up Studies , Humans , Infant , Nasal Obstruction/diagnostic imaging , Nasal Obstruction/etiology , Nasal Septum/diagnostic imaging , Orthodontic Appliances , Palate, Hard/diagnostic imaging , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
OBJECTIVE: Cases of bilateral complete clefts of the primary palate and unaffected secondary palate are very rare. One of these cases as well as a new method of presurgical orthopedics to solve the protruding premaxilla protrusion is presented.
