Presurgical cleft lip and palate orthopedics: an overview

Abstract

Patients with cleft lip and/or palate go through a lifelong journey of multidisciplinary care, starting from before birth and extending until adulthood. Presurgical orthopedic (PSO) treatment is one of the earliest stages of this care plan. In this paper we provide a review of the PSO treatment. This review should help general and specialist dentists to better understand the cleft patient care path and to be able to answer patient queries more efficiently. The objectives of this paper were to review the basic principles of PSO treatment, the various types of techniques used in this therapy, and the protocol followed, and to critically evaluate the advantages and disadvantages of some of these techniques. In conclusion, we believe that PSO treatment, specifically nasoalveolar molding, does help to approximate the segments of the cleft maxilla and does reduce the intersegment space in readiness for the surgical closure of cleft sites. However, what we remain unable to prove equivocally at this point is whether the reduction in the dimensions of the cleft presurgically and the manipulation of the nasal complex benefit our patients in the long term.

Pre-surgical Orthopedic (PSO) Pre-maxilla Appliance for Children with Cleft Lip and Palate: A Case Series

“…In the opposite, case 2 showed a higher difficulty for a 3-year old child wearing and adapting to the appliance, resulted in poor prognosis. Unilateral CLP can be treated using passive appliance and active appliance with lip strapping 5 .In case 1, PSO appliance with lip strap was chosen because of significant cleft in palatum extending to lip with protruding premaxilla. While, case 2 introduced PSO appliance without additional features because defect only occurred in palatum.…”

“…Besides, it can function as a rigid platform, towards which the child can press the nipple and feed; and also directs the tongue in to the correct position. Proper tongue position will be useful for developing normal speech and restoring well-functioned mastication 5,6 . The case revealed that The PSO appliance could approximate the segments of the cleft maxilla by allowing spontaneous growth of palatal shelves prior to the reconstructive and definitive surgery.…”

Caracterização do perfil psicológico de individuos com sindrome Opitz GBBB

“…Primeiro por impor a necessidade de longo tratamento multidisciplinar, que de forma alguma finaliza com o fechamento da fissura de lábio, por menor que ela seja. Nos protocolos de tratamento da fissura orofacial, frequentemente, estão incluídas as cirurgias corretivas de lábio, que pode incluir a cirurgias primárias e secundárias; a cirurgia corretiva do palato, que da mesma forma, pode incluir corretivas de fístulas remanescentes; as longas intervenções fonoaudiológicas; os tratamentos odontológicos, ortodônticos e ortognática, entre outros (FREITAS et al, 2012ALZAIN et al, 2017SISCHO;WILSON-GENDERSON;BRODER, 2017 1992). Associado a aparência facial marcante, os indivíduos com síndrome Opitz GBBB, de acordo com dados da literatura, podem apresentar atraso no desenvolvimento e deficiência intelectual, além de alterações no sistema nervoso central (OPITZ, 1987;GUION-ALMEIDA;RICHIERI-COSTA, 1992;MERONI, 2004;HSIEH et al, 2008).…”

Tratamiento y control de salud de niños con fisura labio alvéolo palatina, nacidos en 2015-2016 en el subsector público en Argentina

“…Placa ortopédica. La placa de modelaje naso alveolar, es una técnica que consiste en la colocación de una placa (usualmente de acrílico) que cubre la parte fisurada de la boca del niño y cuyo objetivo es reposicionar los segmentos naso-labiales y maxilares, y acercarlos (125). La placa ortopédica fue preconizada por Mc Neil en 1959, luego, en 1975 Georgide y Latham introdujeron un aparato activo retenido por pines para, simultáneamente retraer la premaxila y expandir los segmentos posteriores en un periodo de varios días.…”

“…Por otro lado, diferentes trabajos de 2018, demostraron que después de la queiloplastía, la placa ortopédica naso-alveolar mejora la simetría nasal y el ángulo de la columela, reduce la brecha (gap) de la fisura alveolar, y mejora la forma del arco dental (129,132). Otros coinciden en que la placa reduce el espacio entre los lados de la fisura, pero no pueden asegurar si estos resultados representan un beneficio real a largo plazo (125).…”