Presurgical orthopaedic treatment using hard plates.

Area of Science:

• Craniofacial Surgery
• Pediatric Dentistry
• Orthodontics

Background:

• Unilateral clefts of the lip, alveolus, and palate present significant challenges in pediatric craniofacial development.
• Early intervention is crucial for optimizing maxillary growth and dental arch form in affected children.

Purpose of the Study:

• To evaluate the efficacy of early maxillary orthopedic treatment in conjunction with staged surgical repair for unilateral cleft lip, alveolus, and palate.
• To assess the long-term effects on maxillary arch alignment, alveolar segment stability, and facial growth.

Main Methods:

• A treatment protocol involving early maxillary orthopedic intervention (birth to 1 year) using an acrylic plate, followed by lip repair (3 months) and soft palate closure (12 months).
• Secondary alveolar osteoplasty was performed after three years.
• The orthopedic appliance was adjusted monthly to facilitate passive guidance of maxillary growth.

Main Results:

• Excellent local compatibility and patient acceptance of the orthopedic appliance were observed until tooth eruption.
• Follow-up at three years showed good, harmonious arch alignment without alveolar segment collapse in treated children.
• The cleft width decreased, and the palatal slope steepness reduced, indicating positive maxillary development.

Conclusions:

• Early orthopedic treatment effectively guides maxillary growth and improves arch form in unilateral cleft patients.
• Maxillary development was sustained during treatment but arrested upon cessation, leading to minor alveolar collapse.
• The combined orthopedic and surgical approach offers a promising strategy for managing unilateral clefts.