Surgical Repositioning of the Premaxilla: Incidence, Indications and Growth Study About a 189 Bilateral Cleft Lip ± Palate Population.

OBJECTIVE: We aimed to evaluate the rate of patient requiring Surgical Repositioning of the Premaxilla in a population carrying BCL ± P, retrieve age and operative indication. Our secondary objective was to present further facial growth characteristics. SETTINGS: This was a retrospective, single-center cohort study conducted in Nantes University Hospital, Oral and Maxillofacial Surgery department, tertiary cleft center. PATIENTS: Patients with BCL ± P born between 1980 and 2019 treated at Nantes University Hospital were included. MAIN OUTCOME MEASURE: Our primary outcome measure was the rate of patient requiring SRP. RESULTS: Over the whole period, 189 patients with BCL ± P were identified. Three patients (1,58%) underwent SRP. Patients who underwent SRP all had BCLP. SRP was performed during their primary dentition period. The indication for surgical repositioning was always premaxilla vertical overgrowth with an overbite over 10 mm. Facial growth features in the three patients were mostly comparable with a population carrying BCLP who had no premaxillary surgery. CONCLUSION: Our results showed a low incidence of SRP. No SRP was necessary during early infancy (ie, before lip repair) or during adulthood. Surgical repositioning of the premaxilla is beneficial for patient with orthodontically uncorrectable vertical premaxillary excess, even more since facial development compared with other patients with BCLP appears comparable.

Impact of Orthodontic Gap Closure versus Prosthetic Replacement of Missing Maxillary Lateral Incisor on Dental Arch Relationships and Symmetry in 212 Patients with Cleft Palate: Retrospective Study.

BACKGROUND: Maxillary lateral incisors are frequently missing in patients with cleft lip and/or palate. The aim of this study was to assess how orthodontic gap closure or prosthetic rehabilitation of the missing maxillary lateral incisor affected dental arch relationships and symmetry at the end of treatment. The authors also aimed to determine the effect of the level of oral hygiene on the decision made to manage the missing maxillary lateral incisor gap. METHODS: A descriptive, retrospective cohort study including all patients with cleft lip and/or palate born between 1980 and 1999 and treated at Nantes Cleft Center was performed. Patients presenting unilateral or bilateral missing maxillary lateral incisors were reviewed. Data on management of the missing incisor gap, dental arch relationships, symmetry, and level of oral hygiene were collected. RESULTS: A total of 486 patients with cleft lip and/or palate were reviewed, including 212 patients with unilateral or bilateral missing maxillary lateral incisors. When compared with orthodontic gap closure, prosthetic replacement of the gap was associated with better final dental arch relationships (59.8 percent versus 10.3 percent; p < 0.01) and better dental arch symmetry (88.1 percent versus 44.0 percent; p < 0.01) for patients with unilateral missing incisors but not for patients with bilateral missing incisors. A higher level of oral hygiene was associated with more cases of prosthetic replacement for patients with unilateral missing incisors ( p = 0.03) but had no effect for patients with bilateral missing incisors. CONCLUSION: Prosthetic replacement of the missing maxillary lateral incisor gap provided better functional and aesthetic results for patients with cleft lip and/or palate presenting with unilateral missing maxillary lateral incisor.

Evaluation of vertical ramus osteotomy for the surgical correction of unilateral mandibular posterior vertical insufficiency: Long-term follow-up results.

PURPOSE: Unilateral posterior vertical insufficiency (PVI) is a growth defect of the mandibular condyle that results in a facial asymmetry. Various surgical procedures can be used to elongate the hypoplastic ramus. The aim of this study was to evaluate long-term aesthetic and architectural outcomes of vertical ramus osteotomy (VRO) in patients with unilateral PVI. MATERIALS AND METHODS: Patients operated on with unilateral VRO were included in this retrospective study. Aesthetic and architectural parameters were evaluated on frontal photographs as well as on frontal and lateral cephalograms preoperatively, postoperatively, at 1-year and at the end of the follow-up. RESULTS: A total of 48 patients were analyzed. The aesthetic assessment revealed significant correction of the chin deviation (CD) and of the lip commissural line tilt after VRO (p1 = 0.0038 and p2 = 0.0067, respectively) with stable results. The architectural analysis revealed significant improvement in the maxillary and mandibular occlusal planes, as well as the chin deviation (p < 0.0001). A tendency to relapse was noted for the mandibular canting and the CD during the follow-up. VRO allowed for a mean mandibular lengthening of 8.39 mm (ranging from 2.5 to 14 mm). CONCLUSION: VRO allows for immediate restoration of the symmetry of the lower third of the face in patients with unilateral PVI. A revisional procedure may be needed due to a tendency for the chin deviation to relapse.

[Proposal for a clinical diagnosis index in rapid palatal expansion (RPE) in childhood]. / Proposition d'un indice définissant les indications médicales d'une disjonction intermaxillaire chez un sujet en période de croissance.

INTRODUCTION:  Rapid palatal expansion (RPE) in childhood is indicated in children and teenagers with transverse maxillary deficiencies, often with skeletal antero-posterior and vertical anomalies, and functional abnormalities. The procedure consists of separating the right and left maxillae over two or three weeks. Curiously, orthodontists are using expansion appliances without any real indication; they use little RPE although it is the only effective treatment of true transverse maxillary deficiencies. MATERIALS AND METHODS:  Using clinical and radiological observations of many patients it was possible to devise a diagnostic index specifying the indications for semi-rapid palatal expansion. RESULTS:  This quick and easy index composed of 4 items takes into account all the information necessary to establish a medical indication for rapid palatal expansion. It also allows practitioners to evaluate the effectiveness of the index by comparing scores before and after treatment. DISCUSSION:  At present, there is no other comparable diagnostic tool. The objective of the index is to specify the medical indication of RPE and to reduce differences in the use of this therapy.

[Diagnostic and therapeutic interest of studying the nose in maxillo-dento-facial orthopedics]. / Intérêt diagnostique et thérapeutique de l'étude du nez en orthopédie dento-maxillo-faciale.

INTRODUCTION: Orthodontists have long tried to predict future growth. It is one of the most difficult goals to achieve precisely despite the different methods of growth forecasting. A simple technique based on clinical and radiological analyses of the nose and premaxilla makes it possible, using no measurements, to accurately predict future maxillary growth and to deduce the therapeutic indications. A morphologic study of the nose is also an important item in the diagnosis of cranio-facial syndromes. MATERIALS AND METHODS: Combining detailed semiologic and radiologic studies of the nasal and premaxillary structures, this article proposes a method for evaluating and predicting facial growth. RESULTS: Experience based on many observations and current embryological knowledg can detect growth abnormalities of the ethmoïdo-nasal-premaxillary unit and provide valuable therapeutic information. DISCUSSION: Combining clinical and radiologic analyses of nasal and premaxillary morphology is a good method to predict growth of the upper face. It is also an important feature in the diagnosis of cranio-facial syndromes. CONCLUSION: This technique should be included in the diagnosis of maxillo-dento-facial orthopedic cases.

[Normal and pathologic mandible development: practical deductions in maxillo-dento-facial orthopedics]. / Développement normal et pathologique de la mandibule. Déductions pratiques en orthopédie maxillo-dento-faciale.

INTRODUCTION: The mandible consists of different segments, each of which possess its own specific characteristics regarding emergence, ossification during growth and pathologies. Orthodontists need to be very familiar with these developmental anomalies if they are to avoid failure in their orthopedic or orthodontic treatments and in order to understand the reasons for the lack of success of "conventional" treatments. Each segment must develop correctly if the mandible is to achieve optimal development and occupy a normal position within the cranio-facial complex. The position of the mandible in the cranio-facial block is also conditioned by its attachment to the base of the skull. MATERIALS AND METHODS: Combining a detailed semiologic study and a three-dimensional architectural and structural radiologic analysis of clinical cases, this article investigates the various anomalies affecting the mandibular segments and their impact on the craniofacial structure as a whole. RESULTS: An understanding of these anomalies and this analytical method can enable clinicians to perform early diagnosis, avoid undertaking orthopedic and orthodontic treatments which are likely to fail, understand the reasons for unsuccessful "conventional" treatments, provide an orthopedic-surgical guide and make it possible to inform patients correctly. Anomalies affecting the growth of the mandible and its position on the cranial base and their impact on cranio-facial skeletal balance are clearly revealed by structural and architectural analysis, which pinpoints the different clinical elements in skeletal Class II et III cases. DISCUSSION: In maxilla-dento-facial orthopedics when confronted with a pathology of mandibular origin, it is essential to carefully study the radiographs of each segment of the mandible, to seek out the minor forms of the anomalies and to calculate the position of the mandible on the cranial base relative to the neighboring structures; the skull, the cervical vertebrae and the maxilla.

Los efectos de las tracciones de la máscara ortopédica de J. Delaire sobre el esqueleto facial: resultados, nuevas orientaciones terapéuticas (trad) / Effects of J. Delaire's orthopedic mask traction on facial skeleton: results, new therapeutic orientations

La finalidad de este trabajo es la de estudiar el centro de acción y la amplitud de la repercusión sobre el esqueleto facial de las tracciones posteroanteriores sobre la máscara ortopédica en el tratamiento de las clases III

Efectos de las radiaciones y de los quimioterápicos antimitóticos sobre la dentición; transcripciones / Impact of radiation and antimicotic chemothepraphy of the teeth. Apropos of 3 cases

Los autores muestran la desorganización del desarrollo dentario en tres niños que han recibido radiaciones y una quimioterapia antimitótica. Ellos piensan que, en esos casos, la quimioterapia induce anomaliasdentarias y, en un caso, un efecto acumulativo o de potenciación de radiaciones por la quimioterapia que no puede ser excluido(AU)

Los efectos de las tracciones de la máscara ortopédica de J. Delaire sobre el esqueleto facial: resultados, nuevas orientaciones terapéticas / Effects of J. Delaires orthopedic mark traction on facial skeleton: results, new therapeutic orientations

La finalidad de este trabajo es la de estudiar el centro de acción y la amplitud de la repercusión sobre el esqueleto facial de las tracciones posterioanteriores sobre la máscara ortopédica en el tratamiento de las Clases III(AU)

Los efectos de las tracciones de la máscara ortopédica de J. Delaire sobre el esqueleto facial: resultados, nuevas orientaciones terapéticas / Effects of J. Delaire’s orthopedic mark traction on facial skeleton: results, new therapeutic orientations

La finalidad de este trabajo es la de estudiar el centro de acción y la amplitud de la repercusión sobre el esqueleto facial de las tracciones posterioanteriores sobre la máscara ortopédica en el tratamiento de las Clases III

Efectos de las radiaciones y de los quimioterápicos antimitóticos sobre la dentición; transcripciones / Impact of radiation and antimicotic chemothepraphy of the teeth. Apropos of 3 cases

Los autores muestran la desorganización del desarrollo dentario en tres niños que han recibido radiaciones y una quimioterapia antimitótica. Ellos piensan que, en esos casos, la quimioterapia induce anomaliasdentarias y, en un caso, un efecto acumulativo o de potenciación de radiaciones por la quimioterapia que no puede ser excluido