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      The impact of cleft lip and palate repair on maxillofacial growth

      review-article
      1 , 2
      International Journal of Oral Science
      Nature Publishing Group
      cleft, growth, maxilla, surgical repair

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Surgical correction is central to current team-approached cleft treatment. Cleft surgeons are always concerned about the impact of their surgical maneuver on the growth of the maxilla. Hypoplastic maxilla, concaved mid-face and deformed dental arch have constantly been reported after cleft treatments. It is very hard to completely circumvent these postoperative complications by current surgical protocols. In this paper, we discussed the factors that inhibit the maxillofacial growth on cleft patients. These factors included pre-surgical intervention, the timing of cleft palate and alveolae repair, surgical design and treatment protocol. Also, we made a review about the influence on the maxillary growth in un-operated cleft patients. On the basis of previous researches, we can conclude that most of scholars express identity of views in these aspects: early palatoplasty lead to maxilla growth inhibition in all dimensions; secondary alveolar bone graft had no influence on maxilla sagittal growth; cleft lip repair inhibited maxilla sagittal length in patients with cleft lip and palate; Veau's pushback palatoplasty and Langenbeck's palatoplasty with relaxing incisions were most detrimental to growth; Furlow palatoplasty showed little detrimental effect on maxilla growth; timing of hard palate closure, instead of the sequence of hard or soft palate repair, determined the postoperative growth. Still, scholars hold controversial viewpoints in some issues, for example, un-operated clefts have normal growth potential or not, pre-surgical intervention and pharyngoplasty inhibited maxillofacial growth or not.

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          Most cited references55

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          Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment.

          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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            Presurgical nasoalveolar molding in infants with cleft lip and palate.

            Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. In this paper, we present a paradigm shift from the traditional methods of presurgical infant orthopedics. Some of the problems that the traditional approach failed to address include the deformity of the nasal cartilages in unilateral as well as bilateral clefts of the lip and palate and the deficiency of columella tissue in infants with bilateral clefts. The nasoalveolar molding (NAM) technique we describe uses acrylic nasal stents attached to the vestibular shield of an oral molding plate to mold the nasal alar cartilages into normal form and position during the neonatal period. This technique takes advantage of the malleability of immature cartilage and its ability to maintain a permanent correction of its form. In addition, we demonstrate the ability to nonsurgically construct the columella through the application of tissue expansion principles. This construction is performed by gradual elongation of the nasal stents and the application of tissue-expanding elastic forces that are applied to the prolabium. Use of the NAM technique has eliminated surgical columella reconstruction and the resultant scar tissue from the standard of care in this cleft palate center.
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              • Abstract: not found
              • Article: not found

              Treatment variables affecting facial growth in complete unilateral cleft lip and palate.

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                Author and article information

                Journal
                Int J Oral Sci
                Int J Oral Sci
                International Journal of Oral Science
                Nature Publishing Group
                1674-2818
                2049-3169
                March 2015
                14 November 2014
                1 March 2015
                : 7
                : 1
                : 14-17
                Affiliations
                [1 ]State Key Laboratory of Oral Diseases, Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University , Chengdu, China
                [2 ]University Cleft-Craniofacial Center, Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh , Pittsburgh, USA
                Author notes
                [* ]State Key Laboratory of Oral Diseases, Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, No.14, Section 3 , Renmin South Road, Chengdu 610041, China. E-mail: shibingcn@ 123456vip.sina.com
                Article
                ijos201459
                10.1038/ijos.2014.59
                4817536
                25394591
                e2d925b9-6eb5-4509-9a7d-efcb51f6bc43
                Copyright © 2014 West China School of Stomatology

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/3.0/

                History
                : 28 September 2014
                Categories
                Review

                Dentistry
                cleft,growth,maxilla,surgical repair
                Dentistry
                cleft, growth, maxilla, surgical repair

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