Premaxilla In Patients Research Articles

Repair Sequence and Management of the Premaxilla in Patients With Bilateral Cleft Lip and Palate: A Systematic Review of the Literature.

Bilateral cleft lip and palate (BCLP) remains a difficult surgical problem due to the severely protruding premaxillary segment, with no consensus of optimal treatment sequence in older patients. A systematic review of the literature was performed to assess the current status of BCLP repair based on age. A PRISMA systematic review of the PubMed, Web of Science, and Embase databases was performed using a series of search terms related to BCLP. Studies were categorized based on the age of presentation, repair sequence, and technique. The database search identified 381 articles. Of these, 72 manuscripts were ultimately included. The lip was repaired first in 1077 patients (86.0%), palate first in 161 patients (12.9%), and simultaneous lip and palate in 14 patients (1.1%). Patients less than 6 months old received lip repair first (n = 959, 98.6%), with complications of unaesthetic appearance (n = 86, 62.3%) and midface retrusion (n = 41, 34.1%) in younger patients and wound dehiscence (n = 8, 40%) in older patients. Primary lip repair was preceded by presurgical orthopedics (n = 760) or lip adhesion (n = 272) to reduce lip tension with nasoalveolar molding (n = 452, 62.9%) or the Latham device (n = 282, 37.1%). In older patients, the palate was repaired first or premaxillary setback (n = 222) was indicated in protruded premaxillae greater than 10 mm, but carried the risk of premaxilla mobility (n = 20, 37.7%) and midface retrusion (n = 10, 18.9%). In younger patients, lip repair is performed first with preoperative orthopedics or lip adhesion. In older patients, the palate is more commonly repaired first compared with the lip; however, there is no difference in complication rate.

Prominent premaxilla management on bilateral cleft lip and palate

The treatment cleft lip and palate (CLP) should start at an early age with a multidisciplinary team and with a comprehensive approach. The aim of the management of protruded premaxilla in patients with bilateral CLP is to relocate the premaxilla to achieve surgical closure of the lip. The objective of the case report is to present the surgical-orthodontic treatment for the surgical reposition of the protruded premaxilla in a 3-year-old patient with BCLP. A patient of 3 years old with BCLP his treatment plan is a surgical reposition of the premaxilla and posterior closure of the primary lip. The surgical reposition of the premaxilla was made planning the osteotomy with dental casts. After 6 months of starting the surgical-orthodontic treatment, the patient meets bilateral lip closure satisfactorily without reported complications. Planning of the treatment allows performing a procedure that reduces the likelihood of complications and achieving the closing of the lip to reestablish the function, anatomy, and esthetics.

Impact of Virtual Planning on Surgical Reposition of the Premaxilla Using an Endonasal Approach and Simultaneous Alveoloplasty.

Describe the surgical repositioning of the premaxilla using an innovative minimally invasive endonasal approach and secondary bone graft at the same time. We want to emphasize the importance of virtual surgical planning in this technique. A total of 6 patients with bilateral complete cleft lip and palate underwent a surgical repositioning of the premaxilla. Virtual surgical planning was performed in all cases. The ages varied between 8 and 12 years and all were male. Five patients were in the mixed dentition phase and 1 patient was in the definitive phase. Three of the patients had been prepared with presurgical nasoalveolar molding. The other 3 were not prepared for various reasons. All patients had primary repair of cleft lip and palate. An innovative minimally invasive endonasal approach is presented that has allowed a safe 3-D reposition of the premaxilla in patients with bilateral cleft palate. A simultaneous secondary alveoloplasty with the use of absorbable osteosynthesis is a good choice to achieve symmetry and stability. Virtual surgical planning is an exceptional instrument to make an appropriate presurgical selection of the patients in which combine the 2 procedures.

Secondary alveolar bone graft in patients with bilateral cleft lip and palate submitted to premaxilla repositioning: retrospective study

Introduction and Objective: This study aimed to analyze the effectiveness of the closure of oronasal communication, to report the importance of secondary alveolar bone graft repositioning of the premaxilla in patients with bilateral complete cleft lip and palate. Material and methods: This retrospective study analyzed the medical records obtained from the Cleft Lip and Palate Integral Care Center/ Association of Rehabilitation and Social Development of Cleft Lip and Palate Patients (CAIF/AFISSUR), Curitiba – Parana – Brazil, to obtain statistical data involving 26 records of patients who underwent this surgery in the period between January/2010 – January/2014. Results and Conclusion: The benefits observed were: premaxilla stability, aided by the union of pre-maxillary segments; integrity of oronasal structure; aesthetic improvement; better bone support for the teeth adjacent to the cleft; support for the bridge of the nose reducing facial asymmetry and facilitating future rhinoplasty; orthodontic treatment without the limitation of the bone defect; closure of oronasal communication in 88% of patients.

Secondary alveolar bone graft in patients with bilateral cleft lip and palate submitted to premaxilla repositioning: retrospective study

This study aimed to analyze the effectiveness of the closure of oronasal communication, to report the importance of secondary alveolar bone graft repositioning of the premaxilla in patients with bilateral complete cleft lip and palate. Material and methods: This retrospective study analyzed the medical records obtained from the Cleft Lip and Palate Integral Care Center/ Association of Rehabilitation and Social Development of Cleft Lip and Palate Patients (CAIF/AFISSUR), Curitiba – Paraná – Brazil, to obtain statistical data involving 26 records of patients who underwent this surgery in the period between January/2010 – January/2014. Results and Conclusion: The benefits observed were: premaxilla stability, aided by the union of pre-maxillary segments; integrity of oronasal structure; aesthetic improvement; better bone support for the teeth adjacent to the cleft; support for the bridge of the nose reducing facial asymmetry and facilitating future rhinoplasty; orthodontic treatment without the limitation of the bone defect; closure of oronasal communication in 88% of patients.

A novel active intraoral appliance for presurgical orthopaedic treatment in patients with complete bilateral cleft lip and palate

Management of the protruding/deviated premaxilla in patients with complete bilateral cleft lip and palate is a challenging problem for surgeons and orthodontists. Various passive and active methods have been developed for the presurgical orthopaedic treatment. However, most of these treatments are complicated and laborious for the patient's parents and clinicians. Here, we describe our original active intraoral appliance comprising two components, that is, the premaxillary and palatine process plates, connected with two elastic chains, and we assess its therapeutic efficacy. We retrospectively evaluated 15 patients treated using this appliance during 2006-2012, followed up for an average of 60.3 months (range, 18-97 months). We analysed the cleft widths and maxillary size, obtained pretreatment, post-treatment and pre-palatoplasty. Cleft widths and premaxillary protrusion were significantly decreased post treatment; however, the transverse dimensions were not significantly altered. In all cases, the protruding/deviated premaxilla was set into a suitable position within 1 month, and we could perform one-stage cheiloplasty using the modified Mulliken method with low tension. Our appliance is technically simple to use, less invasive to the skin and bone and cost-effective, with reliable and predictable outcomes. In the follow-up period, we observed no detrimental growth of the maxilla or dentition. Therefore, we consider our appliance to be useful for application in presurgical orthopaedic treatments of complete bilateral cleft lip and palate.

Effective retropulsion and centralization of the severely malpositioned premaxilla in patients with bilateral cleft lip and palate: A novel modified presurgical nasoalveolar molding device with retraction screw

PurposeA novel, modified presurgical nasoalveolar molding (MPNAM) device with retraction screw was designed and used in patients with bilateral complete cleft lip and palate (BCCLP) to rapidly retract and centralize the protuberant and malpositioned premaxilla and correct the nasolabial and palatal deformities. The orthopedic effects and possible complications were evaluated. Patients and methodsNine patients with BCCLP who met the inclusion criteria were selected. After the maxillary model was obtained, the new MPNAM device with retraction screw was designed and worn until cheilorrhaphy. Changes in local deformities and complications were observed continuously, and the orthopedic effect was evaluated. ResultsAll patients quickly adapted to the MPNAM appliance, and the treatment was finished after 5–8 return visits. The columella was significantly prolonged, the nasal tip was elevated, and the collapsed nasal dome was obviously improved. Simultaneously, the premaxilla was rapidly retracted and rotated, and gradually centralized; the clefts were gradually reduced and closed, and a nearly normal dental arch was formed. Although there were some complications, the orthopedic treatment was continued until cheiloplasty. ConclusionsThe MPNAM device with retraction screw can simultaneously correct nasolabial and palatal deformities and also rapidly retract and centralize the premaxilla.

両側唇顎(口蓋)裂術後患者の位置異常をきたした顎間骨に対する骨切りについて

両側唇顎(口蓋)裂術後患者の位置異常をきたした顎間骨に対する骨切りについて

Unusual Clinical Presentation of a Severely Protruding Premaxilla in Patient With Bilateral Clefts

Prominent premaxilla is one of the problems encountered when dealing with bilateral complete cleft lip and palate patients. Secondary alveolar bone grafting with these patients would achieve filling of the osseous defect, supports the alar base, eliminate the oro-nasal fistula and enhance the maxillary instability. This article describes the management of a bilateral cleft lip and palate patient with an extremely protruding premaxilla done in one stage surgery. To our knowledge, this is the first report of such degree of severity in the English literature.

Management of the Prominent Premaxilla in Bilateral Cleft Lip and Palate

This study was designed to present our philosophy in managing the prominent premaxilla in patients with bilateral cleft lip and palate. Indications, contraindications, and the pre- and postoperative orthodontic role are defined. Tertiary care, cleft palate and craniofacial center-academic institution. Under review were four cases of bilateral cleft lip and palate presenting with prominent premaxilla and operated on by a single surgeon between 1996 and 2004. With appropriate patient selection, bilateral alveolar bone grafting with premaxillary repositioning is a safe procedure and can produce good aesthetic and functional results.

Intraoral-appliance modification to retract the premaxilla in patients with bilateral cleft lip.

Management of the protrusive premaxilla in patients with bilateral cleft lip is challenging for the reconstructive team. Several intra- and extraoral orthopedic techniques to reposition the protrusive premaxilla prior to bilateral cleft lip repair have been presented in the literature. A modification to a previously described tissue-borne palatal plate with a latex strap is presented. In the modified plate, the latex strap is replaced by an orthodontic elastomeric chain, and the chain over the prolabium is covered with soft denture liner. This appliance is effective in retracting the premaxilla, noninvasive, easy to construct and adjust, economic, well tolerated by the patient, and accepted by the parents.

Intraoral-Appliance Modification To Retract the Premaxilla in Patients With Bilateral Cleft Lip

Management of the protrusive premaxilla in patients with bilateral cleft lip is challenging for the reconstructive team. Several intra- and extraoral orthopedic techniques to reposition the protrusive premaxilla prior to bilateral cleft lip repair have been presented in the literature. A modification to a previously described tissue-borne palatal plate with a latex strap is presented. In the modified plate, the latex strap is replaced by an orthodontic elastomeric chain, and the chain over the prolabium is covered with soft denture liner. This appliance is effective in retracting the premaxilla, noninvasive, easy to construct and adjust, economic, well tolerated by the patient, and accepted by the parents.

Microwave processing of cleft palate orthopedic expansion devices

This article describes a method for making a palatal expansion device for use in conjunction with orthopedic repositioning of the premaxilla in patients with bilateral cleft palate. The technique of constructing the devices involves the microwave processing of a permanent soft liner and a heat-cured acrylic resin in a single-stage curing cycle. The resultant expansion device has the advantages of a soft liner for retention in the nasal cavity and an oral cavity surface that is smooth and closely adapted to the tissues. A paper cover is used during the flasking process, which allows packing of materials without displacement into undesirable locations.

Management of the premaxilla in bilateral clefts

Surgical management of the premaxilla in patients with bilateral clefting has been a controversial and perplexing problem. This paper discusses method and timing of treatment and proposes a philosphy of surgical management. By proper timing of repositioning procedures and bone grafting, more tissue can be salvaged and a more satisfactory functional result can be obtained.