Maxillary arch control in infants with unilateral clefts of the lip and palate

Abstract

T he pros and cons of early treatment of infants with clefts have been debated at considerable length ever since 1950, when McNeil’ first advocated that “conditions approaching anatomical and physiological perfection should be attained at the earliest possible age.” Maxillary orthopedics came to the fore in 1954, when McNeil” described his technique for early treatment. Numerous authors have since reported on a variety of techniques and devices which have been used to achieve the anatomic and physiologic perfection that McNeil recommended. Naming them all would only result in a lengthy, boring, and essentially meaningless bibliography. Some of the strongest advocates of early maxillary orthopedics are Burston3-5 from Liverpool and Jacobson and Rosenstein’;-” from Chicago. Even though the literature on this subject is copious, many of the proponents of early orthopedic treatment have not seen the need to follow their cases through to the completion of palatal closure, and none has used anp controls. The interest in early orthopedics treatment can be attested to by the fact that, in 1964 an lnternat,ional Symposium on “Early Treatment of Cleft Lip and Palate” was held in Ziirich”’ and in the first volume of the Cleft Palate Journal the first four articles were “A Symposium : Early Expansion Prosthesis and Bone Grafting.““-I” The strong advocates of bone grafting in conjunction with early orthopedic treatment in infants are slowly fading from the scene, as the long-term results have proved to be less than satisfactory, especially when the risk and trauma to the patient are taken into consideration. Early maxillary orthopedic treatment and the use of passive applianecs to prevent postsurgical collapse, however, continue to he t&niques used by many pcdodontists, orthodontists, and plastic surgeons throughout the Irnited St,ates and especially in Europe. The strongest, and most vocal opponent of presurgical orthopedic treatment