RESUMEN
The present investigation analyses longitudinally the effects of early orthopaedic and/or surgical treatment on maxillary alveolar arch development in 30 children with a complete bilateral cleft lip and palate (BCLP). Palatal arch dimensions were measured on dental casts and their growth velocities during different treatment periods were calculated. Differences in growth velocities between consecutive treatment periods were examined and tested statistically. Furthermore, growth velocities were compared with those of 80 non-cleft children. Before lip closure, growth of the intercanine width of children with a BCLP and non-cleft children was comparable. Only for arch length significantly was less growth observed in BCLP patients in comparison with the control group. After lip closure, intercanine width, arch length and segmental angle diminished. During the intersurgical period, arch form seemed to adapt to a new muscular balance. Immediately after soft palate surgery, growth of the intercanine width and intertuberosity width was restricted. This negative growth was compensated in the postsurgical period, where a catch-up growth of intertuberosity width was even observed.
Asunto(s)
Labio Leporino/terapia , Fisura del Paladar/terapia , Arco Dental/crecimiento & desarrollo , Maxilar/crecimiento & desarrollo , Modelos Dentales , Proceso Alveolar/anomalías , Proceso Alveolar/crecimiento & desarrollo , Cefalometría , Preescolar , Labio Leporino/fisiopatología , Labio Leporino/cirugía , Fisura del Paladar/fisiopatología , Fisura del Paladar/cirugía , Diente Canino , Femenino , Humanos , Lactante , Recién Nacido , Labio/cirugía , Estudios Longitudinales , Masculino , Obturadores Palatinos , Hueso Paladar/cirugía , Paladar Blando/cirugíaRESUMEN
OBJECTIVE: To describe the development of maxillary arch dimensions in children with bilateral cleft lip and palate (BCLP) during the first 4 years of life and to compare it with that in noncleft children. DESIGN: This was a retrospective, mixed-longitudinal study. SETTING: The study was conducted at the Cleft Palate Center of the University Hospital of Nijmegen. SUBJECTS: The sample consisted of 26 boys with BCLP who were born between 1976 and 1990 and treated at the University Hospital of Nijmegen. Data for a control group of 34 noncleft boys were collected at the University Hospital of Amsterdam. METHOD: Palatal arch dimensions were digitized on dental casts. A comparison between BCLP and noncleft dimensions was made at fixed time intervals. RESULTS: At birth, anterior and posterior arch widths as well as arch depths were significantly larger in children with BCLP. After 7 months (lip closure), anterior arch width and arch depth diminished considerably in the cleft group. After 12 months (palatoplasty), a slight decrease in posterior arch width was observed, and arch depths showed slight catch-up growth. At 4 years of age, anterior arch width was significantly narrower and anterior arch depth was shorter in children with BCLP than in control subjects. Posterior arch width was significantly wider. CONCLUSIONS: During the first 4 years of life, maxillary arch dimensions in children with BCLP show a unique development that is significantly different from that in noncleft children.
Asunto(s)
Labio Leporino/patología , Fisura del Paladar/patología , Arco Dental/patología , Maxilar/patología , Cefalometría , Preescolar , Labio Leporino/fisiopatología , Labio Leporino/cirugía , Fisura del Paladar/fisiopatología , Fisura del Paladar/cirugía , Arco Dental/crecimiento & desarrollo , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Maxilar/crecimiento & desarrollo , Modelos Dentales , Hueso Paladar/crecimiento & desarrollo , Hueso Paladar/patología , Estudios RetrospectivosRESUMEN
The aim of this study was to describe maxillary and mandibular dental-arch form and occlusion in bilateral cleft of the lip and palate (BCLP) from 3 to 17 years of age and to compare their characteristics with a normative sample. A sample of 22 patients with BCLP was investigated, with a noncleft control sample used for comparison. Dental-arch dimensions were studied on dental casts. A comparison between both groups was made at fixed time intervals. From 9 years of age, the cleft sample showed a significantly smaller maxillary depth. Maxillary dental-arch widths were also significantly smaller than in the control group over the whole age period. Mandibular dental-arch measurements were very similar in both groups, although smaller first-molar widths were noted in the BCLP group beginning at 12 years of age. A tendency for end-to-end occlusion was found, which became more clear with age and was most markedly in the canine region.
Asunto(s)
Envejecimiento/patología , Labio Leporino/patología , Fisura del Paladar/patología , Arco Dental/patología , Oclusión Dental , Mandíbula/patología , Maxilar/patología , Adolescente , Análisis de Varianza , Niño , Preescolar , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Diente Canino , Femenino , Humanos , Estudios Longitudinales , Masculino , Maloclusión/clasificación , Maloclusión/patología , Modelos Dentales , Diente MolarRESUMEN
In this study, sagittal facial growth of bilateral cleft lip and palate (BCLP) patients between 6 and 20 years of age is analyzed. The data of Nijmegen were derived from 131 lateral cephalograms taken in 21 BCLP patients who were treated in the Cleft Lip and Palate Center of the University Hospital of Nijmegen. Reported data of 90 BCLP patients treated at the Center of Oslo were used as a reference for comparison. Results of this investigation showed mandibular growth to be similar in both centers. In the premaxillary region some differences were found: The Nijmegen patients presented a more protrusive premaxilla than those at Oslo. The upper front teeth and hence, the premaxilla, were more retroclined in the Nijmegen sample. There were also statistically significant differences in the soft tissue profile. The mean z-score was positive for the nasolabial angle and negative for the angle N'-Sn-Pg'. At 18 years of age, these differences are still apparent. In comparison with Broadbent's values of normal individuals, the SNPg-angle was smaller and the mandibular angle greater in Nijmegen and Oslo. The profiles of the BCLP patients are more convex in Nijmegen and more concave in Oslo than in the noncleft group. Finally, the different treatment strategies of the Cleft Lip and Palate Centers of Nijmegen and Oslo are compared and discussed in terms of their long-term results.
Asunto(s)
Cefalometría , Labio Leporino/fisiopatología , Fisura del Paladar/fisiopatología , Desarrollo Maxilofacial , Adolescente , Adulto , Niño , Mentón/patología , Labio Leporino/patología , Labio Leporino/cirugía , Labio Leporino/terapia , Fisura del Paladar/patología , Fisura del Paladar/cirugía , Fisura del Paladar/terapia , Femenino , Humanos , Incisivo/patología , Labio/patología , Estudios Longitudinales , Masculino , Maxilar/patología , Países Bajos , Noruega , Nariz/patología , Dimensión VerticalRESUMEN
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.
Asunto(s)
Proceso Alveolar/anomalías , Alveoloplastia/métodos , Trasplante Óseo/métodos , Fisura del Paladar/cirugía , Estudios de Seguimiento , Humanos , Ilion , Mandíbula , Maxilar/cirugía , Osteotomía/métodos , Estudios Retrospectivos , Costillas , Factores de Tiempo , Resultado del TratamientoRESUMEN
The anatomical aberration of the premaxilla in bilateral cleft lip and palate (BCLP) gives rise to many problems. Orthodontic and orthopaedic treatment alone often fail to correct this deformity. In this study, the results of a combined surgical-orthodontic approach were analysed. 22 BCLP-patients, who had undergone an osteotomy of the premaxilla in combination with secondary or tertiary bone grafting, were involved in this study. Two cephalograms were analysed from each patient, one prior to and one after osteotomy. Dental casts were made prior to orthodontic treatment, prior and after osteotomy of the premaxilla and after final orthodontic treatment. As a control group, BCLP-patients treated by the cleft palate centre, Oslo were used. Treatment planning of these two teams is comparable, except for the fact that in Oslo surgical repositioning of the premaxilla is never performed. Cephalometric values before and after osteotomy of the premaxilla were calculated. These values were corrected for growth by means of the Oslo-data. Differences before and after osteotomy were tested statistically with a paired t-test. After osteotomy, good arch form was achieved, the premaxilla was positioned more superiorly and normal inclination of incisors was achieved. It was not possible, however, to lower a high-positioned premaxilla to a normal vertical relationship.
Asunto(s)
Fisura del Paladar/cirugía , Fisura del Paladar/terapia , Maxilar/cirugía , Ortodoncia Correctiva/métodos , Adolescente , Adulto , Trasplante Óseo , Cefalometría , Niño , Labio Leporino/cirugía , Labio Leporino/terapia , Femenino , Humanos , Masculino , Maxilar/anomalías , Osteotomía/métodos , Técnica de Expansión Palatina , Resultado del TratamientoRESUMEN
The literature over 10 years covering tissue expansion in cranio-maxillo-facial surgery is reviewed. Since 1981, an evolving set of indications for application of the soft-tissue expansion technique has been published. However, it seems to be based much more on clinical experience (empiricism) than on the results of thorough experimental research. The direction of future research should be aimed at effects on bone, cartilage and mucosa at a microscopical level, and at the influence on growth and development of cranio-maxillo-facial structures.
Asunto(s)
Cara/cirugía , Trasplante de Piel/métodos , Expansión de Tejido/métodos , Humanos , Piel/anatomía & histología , Trasplante de Piel/patologíaRESUMEN
Since 1981 in cleft lip and palate patients a combined surgical-orthodontic procedure has been performed to eliminate the residual alveolar cleft. For early secondary bone grafting (before the eruption of the canine tooth) initially the graft tissue of choice was rib. Since 1984 chin bone has also been used. Sixty one patients with complete unilateral clefts were reviewed (mean age 9.5 years). 15.7% of the rib graft cases showed resorption of the graft of 50% and more. Such resorption was not found in any of the chin graft cases. No complications such as wound dehiscence, sequestration, excessive resorption of bone or recurrence of an oro-nasal fistula were found in the chin graft group. This leads to the conclusion that if enough bone is available in the chin region to bridge the defect, this graft is preferable to a rib graft.