Presurgical Orthopedic Treatment of a 3-Year-Old Child with Unoperated Complete Bilateral Cleft Lip and Palate and Protruding Premaxilla.

Unoperated patients with bilateral complete cleft lip and palate (BCCLP), who do not receive orthopedic treatment in infancy and present with significant sagittal excess of the premaxilla, are among the most difficult patients to treat. Delay in primary reconstruction reduces the elastic characteristics of the tissues. The resulting rigidity of bony structures accompanied by the wide alveolar and palatal clefts associated with sagittal excess of the premaxilla pose a great challenge for both surgeon and orthodontist. There is no unique protocol for treatment of these conditions. This paper describes the use of orthopedic treatment in an unoperated 3-year-old male child with BCCLP and a protrusive premaxilla whose appearance and function were both severely affected. A modified Meazzini technique, as described in operated BCCLP patients with a downward-displaced premaxilla, was used. The device itself consists of the 2 independent components mutually connected by a 17 × 25 steel arch. The first is an active fan-type expander. The second consists of an acrylic cap covering the premaxilla and 3 brackets used for the steel arch application. They are connected by a rectangular steel 17 × 25 archwire. Reduction of the premaxillary sagittal excess of is carried out with an elastic chain. The use of this orthopedic appliance is a reliable and valuable presurgical treatment in the therapy of children with BCCLP and protrusive premaxilla whose orthopedic and surgical treatment have been delayed.

Rare Disease: Lobar Holoprosencephaly With a Median Cleft Lip-Case Report.

Holoprosencephaly is a complex malformation of the brain associated with the median facial defects. Variability of the clinical picture is the characteristic of this anomaly. In most cases, the degree of severity of the facial anomaly correlates with the degree of damage to the brain. This article aims to present a rare case of child with a milder form of brain anomaly combined with a severe form of facial anomaly. The article also presents the application of a feeding stimulator to improve the child's quality of life. The anomaly was diagnosed by postnatal sonography of the brain, magnetic resonance imaging of the endocranium, and three-dimensional computed tomography of the craniofacial skeleton.

Index of orthodontic treatment need in children from the Nis region.

BACKGROUND/AIM: The Index of Orthodontic Treatment Need (IOTN) is a scoring system for malocclusion that con- sists of the two independent components: Denal Health Component (DHC) and Aesthetic-Component (AC). IOTNs are usually used in the countries with dental healthcare financed by the government through the national healthcare system or healthcare insurance. The aim of the study was to determine IOTN in primary school children from the town of Nis and to asses percent of children with any kind of orthodontic treatment. METHODS: The study involved 301 school children, 11-14 (12.4 ± 1.1) years old. The IOTN was used by the two examiners in order to evaluate the treatment need. RESULTS: The results of the study showed that 111 (37%) out of 301 examined children had orthodonic treat- ment (33.33% boys and 66.67% girls) and they were excluded from the study. Out of final sample of 190 school children, considering DHC of the IOTN, 27.4% of the children showed great (grades 4-5), 41.0% moderate (grade 3) and 31.6% slight or no treatment need (grade 1-2). Considering IOTN AC, 15.3% of the children showed great (grade 8-10), 24.3 % moderate (grade 5-7) and 60.4% slight or no treatment need (grade 1-4). CONCLUSION: The need for ortho- dontic treatment in school children in the town of Nis, Serbia, is similar to the need in most European countries, despite the fact that the number of children orthodontically treated is much higher compared to most of European countries.

Cephalometric analysis of the middle part of the face in patients with mandibular prognathism.

BACKGROUND/AIM: The middle part of the face, that is the maxilla, has always been mentioned as a possible etiologic factor of skeletal Class III. However, the importance of the relationship of maxillary retroposition towards the cranial base is still unclear, although it has been examined many times. The aim of this study was to conduct cephalometric analysis of the morphology of maxilla, including the whole middle part of the face in patients with divergent and convergent facial types of mandibular prognathism, as well as to determine differences betweeen them. METHODS: Lateral cephalometric teleradiograph images of 90 patients were analyzed at the Dental Clinic of the Military Medical Academy, Belgrade, Serbia. All the patients were male, aged 18-35 years, not previously treated orthodontically. On the basis of dentalskeletal relations of jaws and teeth, the patients were divided into three groups: the group P1 (patients with divergent facial type of mandibular prognathism), P2 (patients with convergent facial type of mandibular pragmathism) and the group E (control group or eugnathic patients). A total of 9 cephalometric parameters related to the middle face were measured and analyzed: the length of the hard palate--SnaSnp, the length of the maxillary corpus--AptmPP, the length of the soft palate, the angle between the hard and soft palate--SnaSnpUt, the angle of inclination of the maxillary alveolar process, the angle of inclination of the upper front teeth, the effective maxillary length--CoA, the posterior maxillary alveolar hyperplasia--U6PP and the angle of maxillary prognathism. RESULTS: The obtained results showed that the CoA, AptmPP and SnaSnp were significally shorter in patients with divergent facial type of mandibular prognathism compared to patients with convergent facial type of the mandibular prognathism and also in both experimental groups of patients compared to the control group. SnaSnp was significantly shorter in patients with divergent facial type of mandibular prognathism compared to the control group, whereas SnaSnp was significantly smaller in patients with convergent facial type of mandibular prognathism compared to the control group. Additionally, there was a pronounced incisor dentoalveolar compensation of skeletal discrepancy in both groups of patients with mandibular prognathism manifested in the form of a significant upper front teeth protrusion, but without significant differences among the groups, while the maxillary retrognathism was present in most patients of both experimental groups. A pronounced UGPP was found only in the patients with divergent type of mandibular prognathism. CONCLUSION: The maxilla is certainly one of the key factors which contributes to making the diagnosis, but primarily to making a plan for mandibular prognathism treatment Accurate assessment of the manifestation of abnormality, localization of skeletal problems and understanding of the biological potential are key factors of the stability of/the results of surgical-orthodontic treatment of this abnormality.

Presurgical orthodontic treatment of patients with complete bilateral cleft lip and palate.

INTRODUCTION: Cleft lips and palates are the most common congenital orofacial anomaly. This type of clefts is the most severe from the orthodontic-surgical therapy aspect. CASE REPORT: A female newborn with a complete cleft of the primary and the secondary palate was admitted to the clinic, where a multiple-role orthodontic device was specially designed and applied to primarily manage the closure of the existing cleft and help to improve the suckling ability of the baby. Besides the fact that it allows breastfeeding, it has a significant orthodontic effect, too. CONCLUSION: Specificity of this device is the lack of extraoral fixation. What can easily be observed is a progressive reduction of the cleft between the separated segments and the premaxilla retrusion. It, thus, allows the creation of much better conditions for further surgical management of the said defect.

A cephalometric analysis of the cranial base and frontal part of the face in patients with mandibular prognathism.

BACKGROUND/AIM: The literature suggests different views on the correlation between the cranial base morphology and size and saggital intermaxillary relationships. The aim of this study was to investigate the cranial base morphology, including the frontal facial part in patients with mandibular prognathism, to clarify a certain ambiguities, in opposing viewspoints in the literature. METHODS: Cephalometric radiographies of 60 patients were analyzed at the Dental Clinic of the Military Medical Academy, Belgrade, Serbia. All the patients were male, aged 18-35 years, with no previous orthodontic treatment. On the basis of dental and sceletal relations of jaws and teeth, the patients were divided into two groups: the group P (patients with mandibular prognathism) and the group E (the control group or eugnathic patients). A total of 15 cephalometric parametres related to the cranial base, frontal part of the face and sagittal intermaxillary relationships were measured and analyzed. RESULTS: The results show that cranial base dimensions and the angle do not play a significant role in the development of mandibular prognathism. Interrelationship analysis indicated a statistically significant negative correlation between the cranial base angle (NSAr) and the angles of maxillary (SNA) and mandibular (SNB) prognathism, as well as a positive correlation between the angle of inclination of the ramus to the cranial base (GoArNS) and the angle of sagittal intermaxillary relationships (ANB). Sella turcica dimensions, its width and depth, as well as the nasal bone length were significantly increased in the patients with mandibular prognathism, while the other analyzed frontal part dimensions of the face were not changed by the malocclusion in comparison with the eugnathic patients. CONCLUSION: This study shows that the impact of the cranial base and the frontal part of the face on the development of profile in patients with mandibular prognathism is much smaller, but certainly more complex, so that morphogenetic tests of the maxillomandibular complex should be included in further assessment of this impact.

[Application of palatal RB obturator in babies with isolated palatal cleft].

BACKGROUND: Isolated cleft of secondary palate has a specific clinical picture due to a wide communication between the mouth and nose cavity. As a consequence of that, babies born with this malformation are often subject to infections of the upper bronchial tubes, middle ear, speech disorders, and certainly the most difficult existential problem they face at the very beginning of their lives, the impossibility of suckling (breast feeding). Such babies have to be fed with gastric probe. The difficulties in their nutrition have often been described in literature, yet a singular attitude toward early orthodontic therapy has not been adopted still. The aim of the paper was to describe a design and application of obturator immediately after the birth of a baby with isolated palatal cleft, and the role in feeding. CASE REPORT: We presented a female neonate, born on 27th December 2007, with a wide fissure in the shape of the letter U over the entire secondary palate. The baby was referred to the Stomatology Clinic due to nutrition impossibility. To avoid feeding with gastric probe, the formation of RB obturator was performed (artificial palate). Hereby, the procedure of obturator making with an explanation of its function is presented. CONCLUSION: The application of RB obturator and the necessary education of parents have a major role in shortening the time of breast feeding and increasing the amount of food intake and, thus, for the normal growth and development of newborn infants with isolated palate cleft.