RESUMEN
The aim of this retrospective, mixed longitudinal study was to assess the long-term outcome of early secondary closure and premaxilla osteotomy in 40 bilateral cleft lip and palate patients who underwent early secondary osteotomy of the premaxilla and bone grafting at the age of 8-12 years. Clinical and cephalometric evaluations of profile, lip relation, nasolabial angle and position of the maxilla preoperatively, postoperatively and at adolescence were compared to normal values of non-cleft individuals and the reported data of 90 bilateral cleft lip and palate patients treated in Oslo. In 68% of patients the profile was considered acceptable, but in 26 maxillary growth appeared to be impaired by cephalometric standards. In four patients a Le Fort I osteotomy was carried out and nine patients would have benefited from such a procedure. This study reveals a trend towards maxillary growth retardation partially compensated by orthodontic and dental treatment. Since the results are comparable to those reported for the Oslo group with regard to maxillary growth, the surgical protocol followed does not require revision. Considering the benefits, i.e. closure of alveolo-palatal cleft, continuity of dental arch, eruption of canine in the graft and closure of oro-nasal communications, this mode of treatment should be continued.
Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Maxilar/cirugía , Adolescente , Adulto , Factores de Edad , Trasplante Óseo , Estudios de Casos y Controles , Cefalometría , Niño , Preescolar , Labio Leporino/rehabilitación , Fisura del Paladar/rehabilitación , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Maxilar/anomalías , Maxilar/crecimiento & desarrollo , Ortodoncia Correctiva/métodos , Osteotomía/métodos , Valores de Referencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
In the Netherlands 15 centres provide multidisciplinary care for cleft lip and palate patients. Usually the following disciplines participate in such teams: paediatrics, plastic and reconstructive surgery, orthodontics, genetics, social work or nursing, ENT, speech therapy, maxillofacial surgery, prosthetic dentistry, psychology and oral hygiene. An overview is given of the treatment protocol from birth until 20 years of age for a child with a complete UCLP or BCLP. It is concluded that properly designed prospective clinical trials are rare, resulting in a lack of evidence based care in the field of cleft lip and palate. Furthermore it should be investigated whether it is preferable to centralise the cleft care in less centres than the present 15 ones.
Asunto(s)
Labio Leporino/terapia , Fisura del Paladar/terapia , Manejo de la Enfermedad , Relaciones Interprofesionales , Grupo de Atención al Paciente/organización & administración , Adolescente , Niño , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Protocolos Clínicos , Hospitales Especializados/organización & administración , Humanos , Lactante , Países BajosRESUMEN
A retrospective study of bone grafting of 296 clefts (165 unilateral and 131 bilateral was required) to answer questions about the most favourable timing and the most appropriate bone graft material. The results as such are not exceptional in comparison with earlier publications by the same or other authors, but it is of special interest that operations with different graft materials applied at different times in development, in (usually) a sufficient number of cases, can be compared together. The patients have been operated on during a period of 11 years, by the same surgeons, applying the same principles and techniques. It is shown that early secondary grafting, before the eruption of the canine, results in by far, the highest success rate. Similarly, chin bone is considerably better than any other type of transplant. Aspects of general planning, timing, technique and failures are extensively discussed. Besides the afore-mentioned most significant findings, it is also concluded that the results of grafting during osteotomies are better than they appear; that tertiary grafting is extremely difficult, and requires special surgical skill; that rib grafts score as high as iliac crest grafts and that materials other than these three types of bone should be avoided.