The effect of tongue appliance on the nasomaxillary complex in growing cleft lip and palate patients

Abstract

Midfacial deficiency is a common feature of cleft lip and palate patients due to scar tissue of the lip and palate closure procedure. The aim of this study was to evaluate the effectiveness of the physiological force of the tongue to move the maxilla in forward position. This research has been done experimentally by, before and after treatment following up in private practice. Ten patients (6 female, 4 male) with complete bilateral cleft lip and palate were selected. All of them had Cl III malocclusion with maxillary deficiency due to scar tissue of lip and palate surgery. Their age ranged from 7.6 to 9.8 years. All the patients were delivered tongue appliance to transfer the force of the tongue to maxillary complex. The mean observation time was 13+/-2 months to achieve positive overjet. Pre- and post-lateral cephalograms were compared to evaluate the skeletal changes with paired t-test. The results showed that after the application of tongue appliance, normal sagittal maxillomandibular relationship was achieved. SN-ANS angle was increased 1.9+/-1.8 - P < 0.03. This study showed that the tongue appliance could transfer considerable force during rest and swallowing period to the maxilla. This method might be considered to improve the deficient maxilla by means of growth modification and redirect concept.

Cleft Lip and Palate Patients: Diagnosis and Treatment

“…Maxillary deficiency may be a reflection of the underlying skeletal abnormality for which growth modification and redirection may be indicated with a protraction headgear. Treatment approach to improve the midface deficiency was achieved by using the face mask [2,27], tongue appliance [6], tongue plate [27], protraction head gear [3,28], suborbital protraction appliances [4], ankylosed teeth [29], endosseous implants [30], and surgically assisted orthopedic protraction and distraction osteogenesis [8]. Jamilian et al [6] evaluated the effectiveness of tongue appliance on deficient maxilla in growing cleft lip and palate patients.…”

“…The more posterior the crib, the greater pressure will be. Jamilian et al [6] reported that the anterior part of maxillary plane moved superiorly (anteinclination) and posterior part of it relocated inferiorly. In other words, the maxillary posterior segment is extruded slightly and that is why the lower jaw rotated in a clockwise direction.…”

“…Expansion will lose all maxillary sutures like zygomaxillary, pterygomaxillary, thus, maxilla will transfer more easily in forward direction [35,36]. On the other hand, upper jaw may be expanded in order to improve dental function, reliving crowding, align upper incisors, eliminate functional shifts, provide access for impacted teeth in the cleft site, provide restorative treatment to carious teeth, improve maxillary deficiency, and nasal airway in mixed dentition [6,31]. Maxillary skeletal asymmetry in unilateral lip and palate patients may be reflected in a unilateral posterior cross bite, which may be corrected with a removable appliance with a screw or a quad helix type of appliance in the mixed dentition.…”

“…Maxillary deficiency is a common feature of cleft lip and palate patients due to scar tissue of the lip and palate closure. For treatment of maxillary deficiency, various devices, such as facemask [2], protraction headgear [3], orthopedic mask [4], reverse chin cup [5], tongue appliance [6], tongue plate [7], surgically assisted orthopedic protraction, and distraction osteogenesis have been introduced [8]. Treatment of cleft lip and palate in patients should be started after birth and continues to adulthood.…”

The Effects of Maxillary Protrusion on Pharyngeal Airway Dimensions

“…Numerous appliance designs such as endosseous implants [1], ankylozed teeth [2], surgically assisted orthopedic protraction [3], distraction osteogenesis [4,5], Hybrid Hyrax appliance [6], reverse chin cup [7,8], face mask [9], tongue appliance [10][11][12], and tongue plate [13] have been used for treatment of skeletal Cl III malocclusions. Forward displacement of the maxilla, labial tipping of the maxillary incisors, counter clockwise rotation of the palatal plane, inhibition of anterior mandibular growth, increase of face height, clockwise rotation of the mandible and lingual tipping of the lower incisors have all been shown to take place [14][15][16].…”