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      Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - Part 3: Oral and Maxillofacial Surgery

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          Abstract

          This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.

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          Secondary bone grafting of residual alveolar and palatal clefts.

          P Boyne, Fiona N. Sands (1972)
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            Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment.

            G Semb, F Abyholm, Alan O. Bergland (1986)
            A combined surgical/orthodontic procedure to eliminate the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment is described. The operations have been carried out on 378 patients: 240 males and 138 females. Seventy-two patients had bilateral clefts, making a total of 450 grafted clefts. The optimal age for this secondary bone grafting has been found to be 9 to 11 years. In 292 of the cases, the canine had reached its final position in the arch, which allowed a four-group semiquantitative assessment of the newly obtained interdental septum on dental radiographs. The best results have been achieved in cases where the bone graft was carried out prior to the eruption of the canine. In this group, a normal (category I) interdental septal height was achieved in 64 percent and a slightly lower (category II) interdental septum in 32 percent. Interdental septa classified as type I and II are considered to be acceptable. The cleft space was closed in 90 percent of the cases. No significant difference between unilateral and bilateral cases was found. When the same procedure was carried out after eruption of the canine, the results were less favorable.
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              Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 1: overall aspects

              José Alberto de Souza Freitas, Lucimara Teixeira das NEVES, Ana de Almeida … (2012)
              Cleft lip and palate is the most common among craniofacial malformations and causes several esthetic and functional implications that require rehabilitation. This paper aims to generally describe the several aspects related to this complex pathology and the treatment protocol used by the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP) along 40 years of experience in the treatment of individuals with cleft lip and palate.
              Article 0 comments Cited 52 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Appl Oral Sci
                Journal ID (iso-abbrev): J Appl Oral Sci
                Journal ID (publisher-id): J. Appl. Oral. Sci.
                Title: Journal of Applied Oral Science
                Publisher: Faculdade de Odontologia de Bauru da Universidade de São Paulo
                ISSN (Print): 1678-7757
                ISSN (Electronic): 1678-7765
                Publication date (Print): Nov-Dec 2012
                Volume: 20
                Issue: 6
                Pages: 673-679
                Affiliations
                [1 ] DDS, MSc, PhD, Superintendent, Hospital for Rehabilitation of Craniofacial Anomalies (HRAC); Full Professor, Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
                [2 ] DDS, MSc, PhD, Associate Professor of Orthodontics, Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry; Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo, Bauru, SP, Brazil.
                [3 ] DDS, MSc, PhD, Assistant Professor, Department of Biological Sciences, Bauru School of Dentistry and Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo, Bauru, SP, Brazil.
                [4 ] DDS, MSc, PhD, Maxillofacial Surgeon, Dental Division of the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo, Bauru, SP, Brazil.
                [5 ] DDS, MSc, PhD, Assistant Professor, Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry; Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo, Bauru, SP, Brazil.
                [6 ] DDS, MSc, Orthodontist, Dental Division of the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo, Bauru, SP, Brazil.
                [7 ] DDS, MSc, PhD, Assistant Professor, Department of Prosthodontics, Bauru School of Dentistry; Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo, Bauru, SP, Brazil.
                [8 ] DDS, MSc, PhD, Assistant Professor, Department of Biological Sciences, Bauru School of Dentistry; Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo, Bauru, SP, Brazil.
                [9 ] DDS, MSc, PhD, Assistant Professor, Department of Stomatology, Bauru School of Dentistry; Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo, Bauru, SP, Brazil.
                [10 ] DDS, MSc, PhD, Associate Professor, Department of Stomatology, Bauru School of Dentistry and Dental Division of the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo, Bauru, SP, Brazil.
                [11 ] DDS, MSc, PhD, Prosthodontist, Dental Division of the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo, Bauru, SP, Brazil.
                Author notes
                Corresponding address: Daniela Gamba Garib - Faculdade de Odontologia de Bauru - USP - Alameda Dr. Octávio Pinheiro Brizolla, 9-75 - Bauru - SP - 17012-901 - Brazil - Phone: 55-14-3235-8217 - e-mail: dgarib@ 123456uol.com.br
                Article
                DOI: 10.1590/S1678-77572012000600014
                PMC ID: 3881850
                PubMed ID: 23329251
                SO-VID: 994690eb-4267-4f6d-9d95-da144bc594f2
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 May 2012
                Date revision received : 27 June 2012
                Date accepted : 02 July 2012
                Categories
                Subject: Cases Reports

                Keywords: cleft palate,cleft lip,bone transplantation,orthognathic surgery
                Data availability:
                Keywords: cleft palate, cleft lip, bone transplantation, orthognathic surgery

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