Objective: Diminished maxillary growth is a consequence of labiopalatal repair, and many patients with cleft lip and palate require Le Fort I advancement. The goal of this study was to determine the frequency of maxillary hypoplasia as measured by need for Le Fort I. Subjects: Retrospective cohort study of males born before 1987 and females before 1989. Records of 173 patients with cleft lip and palate and 34 with cleft palate were reviewed. Methods: Documented age, gender, cleft type, and need for Le Fort I. Pearson chi-square and Fischer's exact analyses were performed to evaluate the frequency of Le Fort I. Results: Of 217 patients with cleft lip and palate or cleft palate, 40 were syndromic; of the remaining 177 patients, 69 had cleft lip, 78 had cleft lip and palate, and 30 had cleft palate. Thirty-seven of 177 patients (20.9%) required Le Fort I, subcategorized by cleft type: 0/69 for cleft lip, 37/78 for cleft lip and palate, and 0/35 for cleft palate (p < .0001). Of the 37/78 (47.4%) clef...

Frequency of Le Fort I osteotomy after repaired cleft lip and palate or cleft palate.

Background: Treatment of midface hypoplasia and forehead retrusion with monobloc advancement is associated with significant complications, including meningitis, prolonged intubation, and frontal bone flap necrosis. To see whether distraction of the monobloc segment offered decreased morbidity, the authors compared clinical outcomes of patients who underwent conventional monobloc advancement with those of patients who underwent monobloc distraction. Methods: Group 1 (conventional monobloc; n = 12) underwent traditional monobloc advancement with bone grafting. Group 2 (modified monobloc; n = 11) did not receive ventriculoperitoneal shunts and underwent the above procedures with placement of a pericranial flap and fibrin glue over the midline defect. Group 3 (monobloc distraction; n = 24) underwent advancement of the monobloc segment by distraction osteogenesis using internal distraction devices. Complications included meningitis, cerebrospinal fluid leak, frontal bone flap loss, and wound infection. Preoperative, postoperative, and follow-up lateral cephalograms were used to assess horizontal changes of the forehead, midface, and maxilla. Results: Group 3 (distraction monobloc) had the lowest complication rate (8 percent), followed by groups 2 (modified monobloc; 43 percent) and 1 (conventional monobloc; 61 percent) (p < 0.05). Group 3 achieved greater advancement (12.6 mm) than did group 2 (9.4 mm) or group 1 (9.1 mm) (p < 0.05). Relapse was least in group 3 (8 percent) compared with groups 2 (67 percent) and 1 (45 percent). Conclusions: Monobloc advancement by distraction osteogenesis had less morbidity and achieved greater advancement with less relapse compared with conventional methods of acute monobloc advancement with bone grafting. Monobloc distraction is superior to conventional methods of acute monobloc advancement and is an alternative to staged fronto-orbital advancement followed by Le Fort III advancement.

Monobloc advancement by distraction osteogenesis decreases morbidity and relapse

Objective: This study aimed to assess the scientific evidence on the efficiency of presurgical infant orthopedic appliances in patients with cleft lip and palate to shed light on a specific, contemporary discussion of whether the appliances have long-term advantages with respect to treatment outcomes. Design: A systematic review. Methods: Two literature surveys from the five electronic databases were performed with a 1-month interval. Randomized controlled trials and controlled clinical trials (controls had no presurgical infant orthopedics) that had follow-up periods of a minimum of 6 years were included in the study. The exceptions to the follow-up limit were studies related to feeding and parent satisfaction. Results: Of the 319 articles retrieved in the literature surveys, 12 were qualified for the final analysis. The level of evidence of these articles ranged from 1b to 4. Eight randomized controlled trials and four controlled clinical trials were available on eight treatment outcomes. The longest fo...

Long-term effects of presurgical infant orthopedics in patients with cleft lip and palate: a systematic review.

Objective: To evaluate the dental arch relationships for a consecutive series from Goteborg, Sweden, who had delayed hard palate closure. Design: Retrospective study. Setting: Sahlgrenska University Hospital, Goteborg, Sweden. Patients: The dental study models of 104 consecutive unilateral cleft lip and palate subjects. The study cohort was born between 1979 and 1994. Longitudinal records were available at ages 5 (n = 94), 10 (n = 97), 16 (n = 59), and 19 years (n = 46). Five assessors rated models according to the GOSLON Yardstick on two separate occasions each. Interventions: These patients had been operated upon according to the Goteborg protocol of delayed hard palate closure (at age 8 years). Results: 85% of subjects were rated in groups 1 and 2 (excellent or very good outcome), 12% were rated in group 3 (satisfactory), and 3% were assigned to group 4 (poor). No patients presented in Group 5 (very poor). Weighted kappa statistics for double determination of Yardstick allocation for five asse...

Analysis of dental arch relationships in swedish unilateral cleft lip and palate subjects : 20-year longitudinal consecutive series treated with delayed hard palate closure

Fourteen patients underwent Le Fort III midface advancement using distraction techniques. Six have cephalometric documentation extending beyond 1 year postoperatively, and the positions of cephalometric points A and orbitale over time are reported here. Excellent stability of advancement at the occlusal level and some relapse at the level of orbitale are documented. Elimination or diminution of obstructive sleep apnea occurred in all patients so affected, and one of two patients with tracheostomy has been decannulated. Speech effects have been mild or transient. No untoward effects on extraocular muscle function have occurred.

Advancement of the midface using distraction techniques.

Objective: To evaluate the effects of active infant orthopedic treatment on dental arch relationships and determine the effect on maxillary growth in children born with unilateral complete cleft lip and palate (UCCLP). Design: The GOSLON Yardstick was used to assess dental models taken on patients treated with and without active infant orthopedics. Patients: Two groups of nonsyndromic Caucasian children born with UCCLP (total n = 40), all treated by the same surgeon and ranging from 5 to 10 years of age, were evaluated. Interventions: One group had a Latham dentomaxillary alignment (DMA) appliance inserted at 5 to 6 weeks of age, after which a lip-nasal adhesion was performed at an average age of 3.5 months. This was followed by more definitive nasolabial repair at the average age of 5.9 months. Those patients treated without preoperative orthopedics underwent a lip-nasal adhesion at average age 1.5 months followed by nasolabial repair at average age 5.1 months. Main Outcome Measures: Randomized ...

The Effects of Active Infant Orthopedics on Occlusal Relationships in Unilateral Complete Cleft Lip and Palate

Nineteen of 30 patients who had midface advancement procedures between 1972 and 1980 had sufficient cephalometric data to be included in this retrospective study. The position of the midface in relation to the cranium and mandible was evaluated immediately postoperatively and for a period of 2 to 11 years (mean 5.8 years). At 1 year, midface position after LeFort III advancement was stable in 12 of 19 patients. Of these 12 patients, 8 showed some evidence of downward and/or forward movement of the midface. The remaining 7 patients showed a minor degree of midface relapse in the first year of follow-up. In 15 of 19 patients, at 2 years or more postoperatively, the final position of the midface was either at, anterior to, or inferior to its immediate postoperative location. Correction of exorbitism remained stable in all but one patient, who required a second advancement of the orbital segment. Three patients required subsequent LeFort I osteotomy to correct class III occlusion. Prognathism was determined to be secondary to mandibular growth, not midface relapse.

Midface Position after Lefort Iii Advancement

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The Effects of Active Infant Orthopedics on Occlusal Relationships in Unilateral Complete Cleft Lip and Palate

Midface Position after Lefort Iii Advancement