Introduction: Cleft lip and palate represent the most common facial anomaly in the world, with a prevalence of 4.66‰ in Madagascar in 2016. These malformations constitute aesthetic, functional and social damage. Pre-surgical orthodontic management has not yet been applied in Madagascar. The objective of our study was to report the case of a patient with a cleft lip and palate treated pre-surgically by "Naso-Alveolar Molding". Observation: This is a 3-month-old male child with a bilateral nasolabio-alveolar cleft associated with a total secondary cleft. The initial exo-buccal examination revealed 15mm (left) and 16mm (right) nasal cleft widths, 6mm (left) and 5mm (right) lip cleft widths. The intraoral examination showed 3mm (left) and 4mm (right) of alveolar cleft widths. The treatment consisted of the placement of “Naso-Alveolar Molding”. The evolution having been favorable after a month marked by the reduction of the width of the slits and an aesthetic improvement exo-buccal. Discussion: Pre-surgical orthodontics is performed in infancy to facilitate feeding, reduce cleft width, and reposition deformed nasal cartilages and alveolar processes; to lengthen the deficient columella in the neonatal period. The main objective being to minimize the extent of surgery that would have to be performed. The malleability of the nasal cartilage at the infantile stage indicates the orthodontist to its conception and to ensure a favorable prognosis. Conclusion: The treatment of cleft lip and palate consists of a multidisciplinary approach including Dento-Facial Orthopedics.

Introduction: One of the obstacles to dental care in the general population is dental phobia. Fear of the dentist has a negative impact on oral health, as well as the course of dental care. The objective of this study is to determine the prevalence of dental phobias in the Mahajanga’s population. Method: This is a descriptive retrospective cross-sectional study, using the MDSA scale or modified Corah scale. A cluster survey was conducted to constitute the sample. Results: The study population was 210, among them 57, 2% were women with a sex ratio of 0.73; the age of the study population ranged from 18 to 60 years old, 40% were in the age group of 18 to 35 years old. Age was significantly associated with the occurrence of dental phobia. Anxiogenic factors observed were: the noise of instruments (p = 0.000), anesthesia (p = 0.000) and fear of pain (p = 0.000). Conclusion: This study has shown that dental phobia exists in our society. Improving communication between caregivers and the patient could improve care in the dental environment.

Introduction: Obstructive Syndrom Apnea (OSA) has a worldwide incidence of 0.3 to 5%, predominantly in men. This pathology causes an obstruction of the upper airway with a significant risk of asphyxia and sudden death. The objective of our study was to report the case of a patient with OSA treated in Dento-Facial Orthopedics. Observation: This was a 41-year-old man with risk factors for OSA, dento-arch dysmorphosis, and maxillo-mandibular bone deformity. The nasofibroscopy revealed a narrowed oropharynx, an airway obstruction in the supine position. The polysomnography concluded to the diagnosis of OSA in its severe form with 45 apneas in one night, an oxygen saturation of 85%. The treatment consisted of a mandibular advancement prosthesis. Discussion: OSA is a serious pathology under-diagnosed in Madagascar. Repeated apneas and hypopneas are associated with significant decreases in oxygen partial pressure. The most reliable and widely used test in the world is polysomnography. Treatment of OSA with positive pressure allows the increase of the pressure inside the pharynx. Mandibular advancement prostheses allow for promandibulia. These therapeutic devices improve the quality of life of our patient. By traction system, the device allows a mandibular protrusion during sleep. Conclusion: The treatment of OSA consists of a multidisciplinary management including Dento-Facial Orthopedics and dental prosthesis.