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Orthodontics IV > Treatment of Individuals with Cleft Lip and Palate > Flashcards

Treatment of Individuals with Cleft Lip and Palate Flashcards

1
Q

The role of the orthodontist in the TEAM

A
  1. Presurgical Orthopedics (NAM)
  2. Preparation for Bone graft
  3. Preparation for Distraction
  4. Comprehensive Orthodontics
  5. Preparation for Orthognathic Surgery
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2
Q

Presentation Outline:

A
  1. Presurgical Orthopedics (NAM)
  2. Preparation for Bone graft
  3. Preparation for Distraction
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3
Q

Presurgical Orthopedics (NAM)

Unilateral
Cleft Lip and Palate

A
  1. Displaced nasal tip
  2. Depressed alar dome
  3. Skewed columella
  4. Displaced labial frenum
  5. Orbicularis oris runs up into nose
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4
Q

Presurgical Nasoalveolar Molding
Objectives

A
  1. Active molding and repositioning of the deformed nasal cartilage and alveolus
  2. Lengthening of the deficient columella
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5
Q

Neonatal Cartilage

A

High levels of oestrogen and hyaluronic acid result in high plasticity at birth.

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6
Q

Presurgical nasoalveolar molding in infants with cleft lip and palate.

A

Use of the NAM technique has eliminated surgical columella reconstruction and the resultant scar tissue.

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7
Q

Nasoalveolar Molding for Infants Born with Clefts of the Lip, Alveolus, and Palate

A

Utilization of the NAM technique has eliminated surgical scars associated with traditional columella reconstruction, has reduced the number and cost of revision surgical procedures.

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8
Q

Presurgical nasoalveolar molding treatment in cleft lip and palate patients

A

Long term studies on NAM therapy indicate better lip and nasal form , reduced oronasal fistula and labial deformities , 60% reduction in the need for secondary alveolar bone grafting . No effect on growth of midface in sagittal and vertical plane has been recorded up to the age of 18 yrs.

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9
Q

The Effect of Infant Orthopedics on the Occlusion of the Deciduous Dentition in Children With Complete Unilateral Cleft Lip and Palate.

A

IO had no observable effect on the occlusion in the deciduous dentition at 4 and 6 years of age . Considering the occlusion only, there is no need to perform IO in children with UCLP .

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10
Q

A longitudinal three-center study of dental arch relationship in patients with bilateral cleft lip and palate.

A

Delaying hard palate closure and employing infant orthopedics did not appear to be advantageous in the long run.

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11
Q

Long-term effects of presurgical infant orthopedics in patients with cleft lip and palate: a systematic review.

A

More randomized controlled trials need to be done to have evidence regarding the effects of presurgical infant orthopedics in different surgical protocols. Also, the encouraging results about the effect of nasolaveolar molding appliances on nasal symmetry have to be supported by future randomized controlled trials.

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12
Q

Naso Avleolar Molding NAM
Steps

A
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13
Q

Naso Avleolar Molding NAM
Device:

A
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14
Q

Presurgical Orthopedics
Advantages

A
  • Dramatic changes in alveolar, lip and nasal defect
  • Aids in feeding
  • Possible elimination of surgical revisions and bone graft
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15
Q

Presurgical Orthopedics
Disadvantages

A
  • High caregiver demands
  • Expense
  • Frequent visits for adjustments
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16
Q

Presurgical Orthopedics

A
  • Standard of care
  • Trained orthodontist
  • TEAM
17
Q

Bone Grafting

Timing:

A
  • Primary (before 1st year)
  • Secondary – Mixed Dentition (8-11years)
    1/2-2/3 root formation of adjacent tooth
18
Q

Bone Grafting

Benefits

A
  1. Bone support of neighbouring teeth
  2. Closure of oronasal fistulas
  3. Improvement of nasal aesthetics
  4. Unification of maxillary segments
  5. Supports orthodontic and prosthodontic work
  6. Pre-requir
19
Q

Bone Grafting

Donor sites

A
  1. Homogenous versus heterogenous or alloplastic
  2. Trabecular bone is the best choice Bortslap et al 1990
  3. Iliac crest is the GOLD STANDARD Sadove et al.,1990
20
Q

Bone Grafting

Iliac Crest: Best Donor Site

A
  1. Easy access
  2. Adequate bone quantity
  3. Can harvest compact and trabecular bone
21
Q

Bone Grafting

Alveolar Bone graft

A
  1. Union of alveolar segments
  2. Bone for eruption of adjacent teeth
  3. Support of the lip and nose
  4. Good time for nose and lip revisions
22
Q

Bone Grafting

In Summary for Bone Grafts:

A
  1. Expand first
  2. Timing: 2/3 formation of roots of adjacent teeth
  3. Keep the roots away of the cleft
  4. Wait 3-4 months after surgery
  5. Communicate with the surgeon
23
Q

In Summary:

A
  • Presurgical Orthopaedics-> 1st week of life
  • Preparation for Bone graft-> 7-10 yrs
  • Maxillary Distraction-> 12-13 yrs
  • Comprehensive orthodontics-> 12-14 yrs
  • Preparation for orthognathic surgery -> 16-18 yrs

Orthodontics IV (23 decks)

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