Transverse Maxillary Arch Changes with the Use of Preoperative Orthopedics in Unilateral Cleft Palate Infants

Abstract

A retrospective clinical study, using a reflex microscope, measured arch widths, palatal shelf widths, cleft widths, and palatal shelf angulation from 26 sets of plaster models of infants' maxillary arches at birth, and at 3 and 6 months. All infants had unilateral clefts of the lip and palate. They were treated with active preoperative orthopedics until lip repair at 3 months and with a passive plate until palate repair. Cleft width significantly decreased during these periods, due to transverse growth, along with relative flattening of the palatal shelves. Arch width contracted slightly anteriorly, but remained stable posteriorly. Preoperative orthopedics may have helped these changes by removing the effects of the tongue action and allowing unrestricted growth of the palatal shelves.

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

“…Pre‐surgical orthopaedics aim is to reduce the width of the cleft, obtain alignment of the segments before cheiloplasty, allow the surgical reparation with minimum tension, normalise the swallowing pattern, avoid the dorsal position of the tongue in the cleft, improve the shape of the arch, position the columella and facilitate surgery .…”

A comparison of results using nasoalveolar moulding in cleft infants treated within 1 month of life versus those treated after this period: development of a new protocol

“…This can largely be attributed to the inadequately substantiated and often implausible claims of its early proponents 1,7,[17][18][19]23 and the use of active appliances that have been shown to impede maxillary growth 4,10 . According to HOTZ & GNOINSKI 11 the primary objective of early orthopaedics is not to facilitate surgery, as postulated by McNeil, but to take advantage of intrinsic developmental potentialities.…”

Oral Rehabilitation of patient with Cleft Lip and Palate- A Case Report

“…The effect of infant orthopaedics on maxillary arch has been a subject of debate for many years, but controversy about justifi cation of the use of the nasoalveolar molding appliance still exists. Advocates of infant orthopaedics claim that the presurgical orthopaedic plate molds the alveolar segments into a better arch form and that with this action the dentomaxillary development would be improved [13,14]. Opponents of this therapy claim that lip surgery alone has the same effect and that presurgical orthopedic plate is only an expensive appliance used to comfort the parents by starting treatment at the earliest possible moment [15,16].…”