Long-term results of segmental repositioning of the maxilla in cleft palate patients without previously grafted alveolo-palatal clefts.

Eleven patients (9 UCLP, 2 BCLP) were treated with segmental osteotomies with or without osteotomies at the Le Fort I level and simultaneous bone grafting of the alveolo-palatal clefts at adult age. These patients were clinically and radiographically evaluated after a mean follow-up period of 59 months (range 39-110 months). One patient showed complete dentoalveolar relapse, whereas the skeletal stability after miniplate fixation proved to be adequate in all cases. Only one patient presented with a persisting oro-nasal fistula. In six cases, the alar base asymmetry had improved to such an extent that further nasal corrections were not necessary. The procedure described is a reliable technique to graft the alveolo-palatal cleft and reposition the dentoalveolar segments simultaneously in those adult cleft palate patients who had no previous alveolar bone grafting.

[Diagnosis of dento-skeletal deformities]. / Diagnostiek van dento-skelettale afwijkingen.

The diagnosis of dento-skeletal deformities is discussed. The suggestion has been made to use a simple classification, which leaves room for a descriptive diagnosis. The descriptive diagnosis should include aspects related to the maxillofacial skeleton, the soft tissues and the dentoalveolar part. A soft tissue analysis will help to assess the main deformity which is often a combination of factors, frequently located in both jaws. A recommendation is made to include a physical therapist, speech therapist and psychologist in the team.

Combined mandibular vertical ramus and body step osteotomies for correction of unusual skeletal and occlusal anomalies.

A technique is described involving the combined use of mandibular ramus osteotomies and body step osteotomies. The combined use of these osteotomies enables the surgeon to solve some of the most complicated skeletal and occlusal problems. The method has proved to be safe in that no complications have occurred in the 7 patients reported.

Surgical orthodontic treatment of anterior skeletal open bite using small plate internal fixation. One to five year follow-up.

Thirty-eight patients with skeletal open bite were studied retrospectively to assess stability of surgical-orthodontic treatment when small plate internal fixation was used. 86% of the sample population showed stable clinical results. Follow-up was from 1-5 years. Only 1 patient experienced skeletal relapse (3%) and 5 patients (13%) dento-alveolar relapse. Fifty percent of relapses were due to transverse relapse of orthodontically expanded maxillary arches. No relapse was seen with surgically assisted orthodontic expansion or surgical expansion at the time of osteotomy. Stable results can be achieved in treating skeletal open bite when small plate internal fixation is used and proper consideration given to the cause of skeletal open bite when planning treatment.

Late management of secondarily grafted clefts.

34 patients (40 sides) received alveolo-palatal bone grafts for closure of the residual cleft, thus guiding a lateral incisor or canine into the arch. Long-term follow-up shows that in 41% of the patients uninterrupted arches were achieved with a normal relationship by orthodontic treatment only. 38% needed segmental osteotomies to eliminate the edentulous space, and in only 20% were bridges made to restore the dental arch. 9 (25%) patients still required a Le Fort I advancement osteotomy, despite optimal orthodontic treatment. The use of segmental osteotomies for eliminating edentulous spaces in cleft palate patients is discussed, and their advantage in relation to nasal base support is emphasized. It should be the aim to achieve in every cleft palate patient a complete archform without the need for bridges or removable prostheses. A rational orthodontic-surgical approach to the cleft, lip and palate patient is suggested with respect to naso-maxillary growth and development.

The prevention of relapse after maxillary osteotomies in cleft palate patients.

The use of segmental osteotomies to treat surgically severe malocclusion in cleft patients is discussed. The coordinated approach by orthodontist and surgeon is advocated and the advantage of such an approach is stressed. The method allows for the simultaneous correction of the skeletal deformity and closure of residual oro-nasal perforation. The relapse tendency in both antero-posterior and transverse dimensions appeared to be minimal as found in this study of 18 patients.

The role of the intraosseous osteosynthesis wire in sagittal split osteotomies for mandibular advancement.

Two groups of 20 patients who were treated for mandibular hypoplasia by surgical lengthening of the mandible using the bilateral sagittal split ramus osteotomy were followed pre- and postoperatively using serial lateral cephalograms. One group of patients was treated without internal fixation and the second group, with superior border intraosseous osteosynthesis wiring. Both groups were evaluated for postoperative skeletal and occlusal changes and the results were compared. A notably greater amount of relapse was observed in the group of patients in whom no intraosseous wiring was used.

Class II anomalies: a coordinated approach to the management of skeletal, dental, and soft tissue problems.

Osteotomies to set back the anterior part of the maxilla or the whole maxilla (Le Fort I) can be done to reduce the anteroposterior discrepancy in class II anomalies. Predictable and stable results can be expected. Transverse discrepancies may be treated either by orthodontic means or by combined surgical-orthodontic means or by combined surgical-orthodontic methods, depending on the age of the patient, the axial inclination of the teeth, and the width of the apical base. Surgical expansion alone works well in the anterior maxillary osteotomy. Surgical expansion on the whole maxillary arch by additional palatal splitting in Le Fort I osteotomies gives excellent results, provided the gaps are filled with autogenous bone grafts. Mandibular segmental osteotomies or body osteotomies to advance portions of the mandible also provide stable results. Advancement procedures carried out in the rami show a tendency for relapse that can be compensated by overcorrection and orthodontic treatment.