Three-Dimensional Comparison between the Palatal Forms in Complete Unilateral Cleft Lip and Palate with and without Hotz Plate from Cheiloplasty to Palatoplasty

Abstract

The palatal forms in 20 infants with a complete unilateral cleft lip, and palate (12 with a Hotz plate and 8 without, selected at random) were studied from birth until 18 months of age. Using techniques developed previously, the degree of curvature In the palate and the magnitude of migration of the maxillary segments were measured three-dimensionally. Furthermore, using a newly developed method to approximate a set of the points on the alveolar ridge to a circle in a plane, the form of the alveolar arch was evaluated. Results from the group with a Hotz plate revealed that the plate possesses four effects not seen in the group without a Hotz plate. The size of the palate was larger, and the sagittal gap between the two segments of the maxilla was smaller. These results suggest that the appliance could stimulate the growth of the segments and could prevent collapse of the maxillary arch from the force of lip closure. Third, the steepness of the segments toward the nasal cavity was smaller, possibly occurring because the appliance prevents tongue intrusion into the cleft. Fourth, the magnitude of migration of the lesser segment toward the cleft edge of the major segment was larger. This result suggests that the appliance could guide the growth of the maxillary segments to narrow the cleft width until 18 months of age.

3D evaluation of maxillary arches in unilateral cleft lip and palate patients treated with nasoalveolar moulding vs. Hotz′s plate

“…The changes found in the maxillary arches of patients who received early pre-surgical orthopaedic treatment were evaluated. It was observed that the anterior dimension of the cleft (APL-APS) showed a statistically significant reduction in all patients, which is in accordance with other authors (16). Between time points A and B, the reduction was significant in those patients who used modified PNAM due to the addition of acrylic and trimming of the plates (17)(18)(19).…”

“…This slight undesired effect might be due to the soft material of the plate. These results do not agree with Mishima et al (16), where the same measurement increased. Baek and Son concluded that the width of the mid-part of the larger and smaller segments decreased from the initial visit until one month before the cheiloplasty during treatment with the plate and, after surgery, it was stable (22).…”

“…Baek and Son concluded that the width of the mid-part of the larger and smaller segments decreased from the initial visit until one month before the cheiloplasty during treatment with the plate and, after surgery, it was stable (22). In this investigation, the distance between the most posterior points of the alveolar crest of the larger and shorter segments (PGL-PGS) in the group with modified PNAM and Hotz 0 s plates increased during the three time points (16,19,22). Fuchigami found that the triangular flap technique with nasal vestibular expansion following simultaneous advancement of nasolabial components on the affected side at the time of primary lip repair provides a large labial soft tissue arch that facilitates the forward moulding of the maxilla, especially of the minor segment in UCLP.…”

Effectiveness of pre‐surgical infant orthopedic treatment for cleft lip and palate patients: a systematic review and meta‐analysis

“…Every effort to diminish bias was made. Sampling bias was minimized, because the patients in the included trials originated from university departments (61)(62)(63)(64)(65) or academic hospitals and CP centers (43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)66). Bias concerning eligibility and quality of the original studies was tackled by having two authors independently assessed the articles, and any disagreement was resolved by consulting the first author until a final consensus was achieved.…”

“…The dentoalveolar changes in the maxillary arch were measured by means of special 3D measurement equipment (3D Tristation Ò ; 3D Reflex Microscope Ò ) in two series of studies (43,55,(62)(63)(64)(65) at four time points: at 1-2 weeks (T1), at 6 months (T2), at 18-19.5 months (T3), and at 48 months (T4). The maxillary arch depth was examined by measuring the depth perpendicular from the top of the interdental papilla between the central incisors (I) to the intertuberosity point distance (TT¢).…”