Hotz Plate Research Articles

Cephalometric evaluation after two-stage palatoplasty combined with a Hotz plate: a comparative study between the modified Furlow and Widmaier–Perko methods

The effects on craniofacial growth of two different soft palate repair techniques in two-stage palatoplasty were investigated. This was a retrospective, cross-sectional cohort study of 68 children with non-syndromic, complete unilateral cleft lip and palate. Thirty-four patients were treated with the modified Furlow method (F-group) and the remaining 34 with the Widmaier–Perko method (P-group). Craniofacial growth was assessed by analyzing 12 angular and 12 linear measurements on lateral cephalograms. Composite facial diagrams from the two groups were compared with those of a control non-cleft group. Angular and linear measurements did not differ significantly between the two groups, implying that the craniofacial morphology was not affected by the difference in soft palate repair technique. However, small differences in anterior nasal spine and posterior nasal spine were found in cleft patients compared with controls. These findings suggest that the modified Furlow and Widmaier–Perko methods have a similar impact on craniofacial growth. Considering speech function, the modified Furlow method provides better craniofacial growth and speech function. However, the long-term effects of both methods on craniofacial growth after growth cessation remain to be determined.

The effects of palatoplasty and pre-surgical infant orthopedic treatment on occlusion in unilateral cleft lip and palate patients

PurposeThe aim of this study was to evaluate the effect of pre-surgical infant orthopedic treatment (Hotz plate) and type of palatoplasty on the dental arch relationship and the dental arch morphology of unilateral cleft lip and palate (UCLP) patients. Materials and methodsSeventy-four children with UCLP were divided into three groups. One group had undergone one-stage palatoplasty without Hotz plate (OSP w/o H), the second had undergone one-stage palatoplasty with Hotz plate (OSP w/H), and the third had undergone two-stage palatoplasty with Hotz plate (TSP w/H). We evaluated the dental models which were taken during initial examination at our orthodontic clinic, using the Goslon Yardstick, the 5-year-old index, and dental model analysis. ResultsRegarding both indices, there were no significant differences among the three groups. However, the dental arch width between maxillary deciduous canines in OSP w/H and TSP w/H was significantly greater than that of OSP w/o H. The dental arch width at the maxillary deciduous second molars in TSP w/H was significantly greater than in OSP w/H and OSP w/o H. ConclusionDental arch relationship in UCLP patients was not influenced by the type of palatoplasty and the use of pre-surgical infant orthopedic treatment. Our results suggest that pre-surgical infant orthopedic treatment results in the increase of anterior dental width, whereas two-stage palatoplasty is significantly effective for increasing posterior dental width in UCLP patients.

A novel pre-surgical maxillary orthodontic device using β-titanium wire for wide unilateral cleft lip and palate patients: Preliminary study of its efficacy and impact for the maxillary formation

For patients with a wide, complete, unilateral cleft lip and palate, pre-surgical maxillary orthodontic treatments have been used to reduce the alveolar gap before cheiloplasty. However, most of these treatments are complicated and laborious for patients and for medical professionals. Thus, we developed an original pre-surgical orthodontic device made with two separate acrylic resin plates connected with a spring-shaped β-titanium wire (β-TW). When the device was applied on the palate, each segment of the maxilla was automatically aligned for our target formation with the elastic force of β-titanium alloy. This study aimed to evaluate the efficacy of the new device and the size of the maxilla in comparison with the conventional Hotz procedures. A total of 47 patients with a wide unilateral cleft lip and palate were retrospectively evaluated; 33 patients were treated with our new device (β-TW plate group) and 14 were treated with a Hotz plate (HP group). We evaluated the alveolar gap reduction and the size of the maxilla between the two groups, obtaining intraoral maxillary impressions at birth, at 3 months and 1 year. The width of the alveolar gap in the β-TW plate group was significantly reduced compared with that in the HP group 1 month after the treatment (p < 0.001). The alveolar gap reduction continued until the age of 1 year (p = 0.02). By contrast, no significant difference in the maxillary size was observed between the two groups at any examination period. Our treatment protocol using the β-TW plate was not only easy and simple to apply but it was also cost-effective, with highly predictable outcomes. Moreover, it provided the ideal alveolar cleft reduction without detrimental collapse of the alveolar segments. Therefore, we consider our β-TW plate device to be useful for application in pre-surgical orthodontic treatments.

Presurgical Orthopedic Treatment Ameliorates Postoperative Nasal Deformity After Cheiloplasty

We assessed the postoperative nasal form and symmetry after presurgical use of a Hotz plate (HP) in patients with unilateral complete cleft lip and palate (UCLP). The subjects were 28 infants with UCLP who underwent cheiloplasty. Of these subjects, 14 underwent presurgical orthopedic treatment using the HP (HP group) and 14 underwent the same treatment without the HP (non-HP group). Photographic records were obtained 1 and 6 months after cheiloplasty, and the results of anthropometric analysis were compared between the 2 groups. The nasal inclination and the ratio of the width of the nasal base to the total width of the nose were significantly improved in the HP group compared with the non-HP group at both postoperative time points. Thus, presurgical use of the HP significantly improved the nasal asymmetry and deformity in UCLP patients after primary cheiloplasty and nasal repair.

Effects of Hotz's plate and lip adhesion on maxillary arch in patients with complete unilateral cleft lip and palate until 5 years of age

PurposeThe purpose of this study was to evaluate the effect of infant orthopedic treatment using Hotz's plate and lip adhesion (LA) on maxillary arch of the patients with complete unilateral cleft lip and palate (UCLP) until 5 years of age. Patients and methodsFifty patients with complete UCLP who were treated in Cleft Lip and Palate Center of Harapan Kita Children and Maternity Hospital, Indonesia, were divided into three groups. Hotz (+) group: 22 patients treated with Hotz's plate until palatoplasty. Hotz–LA group: 14 patients treated with LA at one or two months of age and with Hotz plate until palatoplasty. Hotz (−) group: 14 patients treated without Hotz's plate and LA. Serial dental casts were obtained from each patient at following four time points: first visit, cheiloplasty, palatoplasty, and 5 years of age. Each maxillary dental cast was scanned, and the linear and angular dimensions were measured. ResultsMaxillary arch width and length of anterior part were larger in the Hotz (+) group than in the Hotz–LA and Hotz (−) groups at the palatoplasty and 5 years of age. The anterior part of the maxillary arch in the Hotz–LA and Hotz (−) groups was smaller and more flattened than that in the Hotz (+) group. ConclusionsThis study suggests that Hotz's plate prevents the maxillary arch from collapsing after cheiloplasty to the palatoplasty. This effect remained up to 5 years of age. However, the effects of Hotz's plate are negated in patients who underwent LA.

Fifteen-Year Follow-Up Results of Presurgical Orthopedics Followed by Primary Correction for Unilateral Cleft Lip Nose in Program SEHATI in Indonesia

Objective : To assess long-term effects of nasal correction in infancy on nasal form and growth in patients with unilateral cleft lip, alveolus, and palate (UCLP). Design : Retrospective longitudinal study. Patients : Seventeen patients with complete UCLP treated in Program SEHATI in Harapan Kita Children and Maternity Hospital, Indonesia, and followed for approximately 15years were enrolled. Interventions : Subjects received presurgical orthopedics using a Hotz's plate and simultaneous primary lip and nose repair in which the lower lateral cartilage was repositioned through a reverse-U incision. Main Outcome Measures : Preoperative and postoperative nasal forms, including the nostril height and width ratio, the ratio of the height of the top of the alar groove, and the ratio of nostril surface areas were analyzed using color photos taken serially. One-way analysis of variance was used for statistical analyses. Results : The nostril height and width ratio and the height of the alar groove were significantly improved postoperatively and maintained for 15years. The mean ratio of nostril surface areas was 1.01 ± 0.12 fifteen years postoperatively, and there was no significant difference from the ratio 1year postoperatively. The major persistent deformities were septal deviation and a small skin web on the nostril rim. Conclusions : Our primary cleft lip nose correction has provided an acceptable nose form and absence of disturbance of the nasal growth in patients with UCLP. However, the repositioning of the nasal cartilage at infancy might not eliminate the need for secondary correction after puberty.

Presurgical Nasoalveolar Molding Orthopedic Treatment Improves the Outcome of Primary Cheiloplasty of Unilateral Complete Cleft Lip and Palate, as Assessed by Naris Morphology and Cleft Gap

We evaluated the effects of presurgical nasoalveolar molding (NAM) with an orthopedic appliance and compared them with a passive orthopedic method (Hotz plate, HP), focusing on the naris morphology and width of the alveolar and palate cleft gap. The subjects were 28 unilateral complete cleft lip and palate patients treated with primary cheiloplasty at Tsukuba University Hospital from 2004 to 2011. Thirteen patients were treated preoperatively with NAM (NAM group), and 15 with HP (HP group). The surgical outcome was assessed according to left-right naris symmetry, as measured by the area ratio, perimeter ratio, aspect a/u ratio (aspect ratio of the affected side/aspect ratio of the unaffected side), and Hausdorff distance. In addition, the alveolar and palate cleft width was measured at the times of orthopedic plate setting and primary cheiloplasty. The aspect ratio was significantly smaller in the NAM group than in the HP group before the operation. In both groups, the aspect ratio, perimeter ratio, and Hausdorff distance were significantly smaller after the operation than before. The width of the alveolar and palate cleft gap was significantly narrowed in the NAM group, and the cleft gap at the initiation of NAM correlated significantly with the Hausdorff distance after cheiloplasty. We found that NAM improved the form of the naris after primary cheiloplasty and decreased the palate cleft gap more effectively than HP and that the width of the palate cleft gap was correlated with the surgical outcome of the naris.

Postnatal treatment factors affecting craniofacial morphology of unilateral cleft lip and palate (UCLP) patients in a Japanese population

We have evaluated the craniofacial morphology of Japanese patients with unilateral cleft lip and palate (UCLP) and assessed the various postnatal factors that affect it. Lateral cephalograms of 140 subjects (mean (SD) aged 7 (2) years) with UCLP were taken before orthodontic treatment. Surgeons from Hokkaido University Hospital had done the primary operations. The craniofacial morphology was assessed by angular and linear cephalometric measurements. Cheiloplasty, palatoplasty, and preoperative orthopaedic treatment were chosen as postnatal factors. To compare the assessments of the postnatal factors, we made angular and linear cephalometric measurements for each subject and converted them into Z scores in relation to the mean (SD) of the two variables. Subjects treated by the modified Millard cheiloplasty had larger sella-nasion-point A (SNA) and nasion-point A-pogonion (NA-POG) measurements than subjects treated by the modified Millard with a vomer flap cheiloplasty. Two-stage palatoplasty showed consistently better craniofacial morphology than the other palatoplasty. Subjects who had preoperative orthopaedic treatment with a Hotz plate had significantly larger upper incisor/sella-nasion (U1-SN) measurements than who had no preoperative orthopaedic treatment or an active plate. We conclude that in subjects treated by a modified Millard type of cheiloplasty, a two-stage palatoplasty, and a Hotz plate there were fewer adverse effects on craniofacial morphology.

A novel method for evaluating postsurgical results of unilateral cleft lip and palate with the use of Hausdorff distance: presurgical orthopedic treatment improves nasal symmetry after primary cheiloplasty

To evaluate surgery results, we established a novel method to digitize nasal morphology with the use of Hausdorff distance and analyzed nose morphology after cheiloplasty. We evaluated the naris after primary cheiloplasty of 30 unilateral cleft lip and palate patients. Similarity between left and right sides was assessed by visual evaluation, area ratio, perimeter ratio, aspect a/u ratio, and Hausdorff distance. The postoperative naris morphology was also compared between 15 patients treated with a Hotz plate before surgery and 15 not treated. Significant correlation with visual evaluation was found for Hausdorff distance. For the groups with and without Hotz plate treatment, the visual evaluation was higher and Hausdorff distance significantly lower in the treated group. The morphologic measurement obtained using the Hausdorff distance was the closest to visual evaluation, and assessment using Hausdorff distance suggested that using a Hotz plate helps retain the symmetry of the nares after cheiloplasty.

Longitudinal Study of Effect of Hotz's Plate and Lip Adhesion on Maxillary Growth in Bilateral Cleft Lip and Palate Patients

To investigate the effects of infant orthopedic treatment and lip adhesion on maxillary growth of patients with bilateral cleft lip and palate (BCLP). Prospective longitudinal study. The present study was conducted at the Cleft Lip and Palate Center, Harapan Kita Children and Maternity Hospital, Indonesia, and the Department of Oral and Maxillofacial Surgery, Kyushu University Hospital, Japan. The study sample consisted of 53 patients with complete BCLP and 10 noncleft patients with other diseases. Patients with BCLP were divided into three groups: H (-), 11 patients treated without Hotz's plate; H (+), 24 treated with Hotz's plate; and LA-H, 18 treated with lip adhesion and Hotz's plate. Serial dental casts were obtained from each BCLP child at the following four time points: first visit, labioplasty, palatoplasty, and 5 years of age. Each maxillary dental cast was scanned, and the linear and angular dimensions were measured. Lip adhesion showed a temporary negative effect. In all patients with BCLP, the surgeries affected the growth of the anterior arch width until the age of 5 years. Collapse of the premaxilla following labioplasty in the H (-) group affected the growth of dental arch length until the age of 5 years. Treatment using Hotz's plate prevented collapse of the premaxilla, and the growth of the arch length was comparable to that observed in the noncleft group.

Three-Dimensional Comparison in Palatal Forms Between Modified Presurgical Nasoalveolar Molding Plate and Hotz's Plate Applied to the Infants With Unilateral Cleft Lip and Palate

The presurgical nasoalveolar molding plate appliance with stent (PNAM) extended from the palatal molding plate; to correct the nostril shape of infants with cleft lip and palate is well known. The PNAM appliance is based on the finding that a high degree of plasticity is maintained in the cartilage of infants during the first 6 weeks after birth. However, on the current PNAM protocol described by Grayson et al. the nasal stent is supposed to be an adjunct to the palatal molding plate after reducing the severity of the alveolar cleft width. We have used the modified Hotz's plate from the setup model and built up the nasal stent even before reducing the severity of the alveolar deformity. In this study we assess the effects of the modified Hotz's plate and the modified PNAM appliance for the alveolar and palatal form. The lateral deviation of the incisal point, the width of the palatal cleft, and the degree of curvature of the palatal vault were first evaluated on plaster models. The PNAM group is smaller on the lateral deviation of the incisal point than the modified Hotz's group. The decreased average width of the palatal cleft and curvature of the palate, was almost the same in both the modified Hotz's and PNAM groups. In comparison with the modified Hotz's plate, the modified PNAM appliance also improves the molding of the alveolar segments and reduces cleft width.

Postoperative Nasal Forms After Presurgical Nasoalveolar Molding Followed by Medial-Upward Advancement of Nasolabial Components With Vestibular Expansion for Children With Unilateral Complete Cleft Lip and Palate

The management for primary unilateral cleft lip nose deformities has not yet been established. In this study, short-term postoperative nasal forms after presurgical nasoalveolar molding (NAM) followed by primary lip repair for children with complete unilateral cleft lip and palate (UCLP) were evaluated and compared with the nasal forms achieved by treatment without nose correction. Fifteen patients with complete UCLP who were treated in our department and followed up for more than 1 year (range 1 to 5 yrs) were enrolled. All subjects underwent presurgical orthopedic treatment with NAM, followed by lip repair using Cronin's triangular flap method with medial-upward advancement of nasolabial components with vestibular expansion. Postoperative nasal forms including nostril height and width ratio, ratio of the height of the top of the alar groove, and curvature of the appropriate circle of the nasal ala were evaluated using color photographs. Fifteen patients with complete UCLP who underwent presurgical orthopedic treatment using a Hotz plate followed by lip repair without nose correction served as controls. The comparison of postoperative nasal forms demonstrated that the nostril height and width ratio and the height of the top of the alar groove in the correction group were significantly superior compared with those of the controls. Our management of cleft lip nose will provide good nasal forms with minimum invasion in patients with UCLP. Long-term follow-up will be necessary to clarify effects on the growth of nasal tissues reconstructed in infancy.

EFFECT OF HOTZ PLATE APPLIANE TO MAXILLARY ARCH DEVELOPMENT PATIENTS WITH CLEFT LIP AND PALATE

The purpose of this study was to analyze the effect of hotz plate appliance to maxillary arch development of complete unilateral cleft lip and palate patient. The subjects were divided into two groups. The first group consisted of 6 patients, aged under two years with hotz appliance, recruited from Hasan Sadikin Hospital Bandung, and the second group, as control group, consisted of 6 patients, aged under two years, without hotz appliance, recruited from Haji Hosiptal Makassar. It was showed that in group with hotz plate appliance, no difference found on the size of anterior maxillary arch and minor maxillary arch. On the other hand, in the control group, minor maxillary arch was longer than major maxillary arch. It was concluded that hotz plate appliances affected that palatal development of patient with complete unilateral cleft lip and palate.

Analysis of hotz plate appliance to the development of maxillary arch growth of patient with cleft lip and palate

This study was an observational, cross sectional study with purpose toanalyze the effect of hotz plate appliance to the development ofmaxillary arch of patients with cleft lip and palate. Twelve sampleswith cleft lip andpalate, age under 2 years were recruitedfrom twodifferent hospitals. Six samples used hotz plate appliance wererecruited from Rumah Sakit Hasan Sadikin, Bandung while the othersix as control didn't use hotz plate appliance were recruited fromRumah Sakit Haji, Makassar. The result showed that minor maxillaryarch was similar in size with major maxillary arch of patient with hotzplate appliance, however, patient without hotz plate appliance,showed longer minor maxillary arch than major maxillary arch. It canbe concluded from this study that hotz plate appliance had an effecton the palatal development of patient with complete unilateral cleft lipand palate and also prevented the collapse of minor maxillary arch toeither anterolateral or anteromedial.

Long-term follow-up study of two-stage palatoplasty with Hotz plate

Long-term follow-up study of two-stage palatoplasty with Hotz plate

Simplified Nasoalveolar Moulding Technique for Treatment of Infants with Cleft Lip and Palate

Objective: To report a simplified technique for nasoalveolar moulding for treatment of infants with unilateral and bilateral cleft lip and palate.Patients and Methods: One or 2 stents made of plastic cobalt-chrome orthodontic wires 0.8-mm thick were used with a conventional palatal plate (Hotz plate) to treat 7 patients with unilateral cleft lip and palate and 3 with bilateral cleft lip and palate.Results: This modified technique for nasoalveolar moulding permitted the nose of patients with unilateral and bilateral cleft lip and palate to be easily and precisely moulded. This technique also reduced stress for the patients and their parents because it did not require extraoral appliances, except for surgical tape over the cleft lip. Time-consuming adjustments of the nasal stent were also unnecessary.Conclusion: The wire nasal stent facilitated nasoalveolar moulding before cheiloplasty for unilateral and bilateral cleft lip and palate.

A new feeding nipple for cleft lip and palate patients wearing a Hotz plate

A new feeding nipple for cleft lip and palate patients wearing a Hotz plate

Vertical changes in the positions of the cleft segments of patients with unilateral cleft lip and palate. Changes from birth to palatoplasty at the age of 10-14 months.

Clinically discernible vertical deviations of the cleft segments in nasal direction were registered and visualized using model series of 16 patients with unilateral cleft lip and palate. All patients were treated according to the cleft concept of the University of Leipzig, with labioplasty being performed at the age of 4-6 months and palatoplasty at the age of 10-14 months. All patients had a modified Hotz plate inserted until the palate was closed. Casts of a collective of non-cleft infants served as controls. The vertical deviations of the segments from the reference plane, defined by us through the tuber points and the canine point of the non-cleft side, were registered metrically by three-dimensional (3D) measuring of maxillary casts, using a reflex microscope. The registered values were represented three-dimensionally, and the absolute growth was compared with the relative vertical changes. The results show that 3D representation with superimposition of the individual results offers the clinician clear, continuous monitoring of the treatment progress. In comparison with the control group, the cleft patients showed significantly greater vertical deviations in nasal direction in the region of the incisor and canine points at each observation timepoint. A significant reduction in vertical divergences was recorded only in the region of the cleft pole point of the larger segment during the study period. The results furthermore suggest that investigation of absolute changes in segment positions alone in comparison with relative growth changes may lead to misinterpretations.

Comparison Between Palatal Configurations in UCLP Infants with and without a Hotz Plate Until Four Years of Age

Abstract Objective: To evaluate the efficacy of presurgical orthopedic treatment three dimensionally, we previously developed a novel measuring system and described the efficacy of the treatment until 18 months of age. The aim of this study was to compare palatal configuration in complete unilateral cleft lip and palate (UCLP) infants fitted with a Hotz plate to those without it until four years of age using the same measuring system. Patients: Twenty complete UCLP infants were divided into two groups. A Hotz plate was used with 12 patients who first visited our clinic from January 1990 to March 1992 and was not used with an additional eight patients who first visited from April 1992 to July 1993. Main outcome measures: Palatal casts taken from birth until four years of age were measured three dimensionally and were compared between the two groups. Results and Conclusions: The width of the palate was larger in the group with a Hotz plate than in the group without it at four years of age. No difference was...

Ｈｏｔｚ床を使用した唇顎口蓋裂患者上顎歯槽形態の三次元的分析

Ｈｏｔｚ床を使用した唇顎口蓋裂患者上顎歯槽形態の三次元的分析