Cleft lip and palate is the most common among craniofacial malformations and causes several esthetic and functional implications that require rehabilitation. This paper aims to generally describe the several aspects related to this complex pathology and the treatment protocol used by the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP) along 40 years of experience in the treatment of individuals with cleft lip and palate.

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.

The present work focus the study of cortical bone samples of different origins (human and animal) subjected to different calcination temperatures (600, 900 and 1200 8C) with regard to their chemical and structural properties. For that, not only standard techniques such as thermogravimetric analysis, Fourier transform infrared spectroscopy, X-ray diffraction and scanning electron microscopy were used but also mercury intrusion porosimetry. The latter technique was applied to evaluate the effects of the temperature on the microstructure of the calcined samples regarding porosity and pore size distribution.Although marked alterations in structure and mineralogy of the bone samples on heating were detected, these alterations were similar for each specimen. At 600 8C the organic component was removed and a carbonate apatite was obtained. At 900 8C, carbonate was no longer detected and traces of CaO were found at 1200 8C. Crystallinity degree and crystallite size progressively increased with the calcination temperature, contrary to porosity that strongly decreased at elevated temperatures. In fact, relatively to the control samples, a significant increase in porosity was found in samples calcined at 600 8C (reaching values around 50%). At higher temperatures, a dramatic decrease was observed, reaching, at 1200 8C, values comparable to those of the non-calcined bone. #

Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients.

ABSTRACT:This study aimed at investigating the current distribution of the several types of clefts among the patients receiving treatment at the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC-USP), Bauru, Brazil, for the first time during the year 2000. A total of 803 unoperated patients with cleft lip and/or palate, with or without additional malformations, with no recognizable syndromes, who came to the HRAC-USP for enrollment for treatment during the year 2000. A predominance of complete cleft lip and palate, either unilateral or bilateral, was observed (37.1%), followed by isolated cleft palate (31.7%) and isolated cleft lip (28.4%). A discrete relationship between cleft palate and the female gender was noticed (53%), and males were more affected by the other types of clefts (around 60%). The findings revealed a predominance of complete clefts of the primary and secondary palate, the treatment of which is more complex, and whose frequency is greater in males.

This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.

A poor correlation between the severity of glossoptosis and the severity of clinical manifestations was observed for patients with respiratory obstruction caused by glossoptosis during the first month of life, but the correlation between glossoptosis and respiratory distress according to age was statistically significant. Nasopharyngoscopy is not a good method for predicting the severity of the clinical course of respiratory obstruction caused by glossoptosis.

OBJETIVO: Estimar a prevalência de fissuras orais no Brasil, segundo etiologia e região geográfica. MÉTODOS: Foram levantados os registros de casos de fissura oral entre recém-nascidos no período de 1975 a 1994. As fontes de dados foram o Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo, o Ministério da Saúde -- Departamento de Informática do Sistema Único de Saúde (Datasus) e a Fundação Instituto Brasileiro de Geografia e Estatística. RESULTADOS/CONCLUSÕES: Foram encontrados 16.853 casos novos de fissura oral, estimando-se a prevalência de 0,19 por mil nascidos vivos, com tendência ascendente para os qüinqüênios do período. As regiões Centro-Oeste, Sudeste e Sul apresentaram as maiores taxas. A fissura labial ou lábio-palatina foi mais freqüente (74%) do que a fissura palatina isolada (26%).