The methods of preoperative orthopedics: a "T-traction" procedure for unilateral clefts and a combined premaxillary pressure and expansion procedure for bilateral clefts and of early alveolar bone grafting: the Nordin's "four-flap" technique, are described in detail. The subsequent effects of treatment according to those methods were studied with roentgencephalometric analysis in cleft patients from 7 to 13 years of age. They were divided into two unilateral and one bilateral complete cleft group, all having been early bone grafted. The unilateral groups were composed of one group of 39 children operated on during the period 1960-65 without preoperative "T-traction", and another group, of 46 children, operated on in 1965-72 after preoperative "T-traction". The bilateral group included 19 children operated on 1960-72 after preoperative orthopedics. The same degree of inhibited development of the facial skeleton as found in another Swedish early bone grafted cleft group was not present in our patients. The development of the skeletal profile in our bone grafted cases, especially those in the "T-traction" group, was well within the limits of non-grafted U.S. cases, but differed from non-clefts.
The dental occlusion of children born with complete cleft lip and palate was studied in deciduous and mixed dentition. The children were divided in two unilateral groups: one group of 39 children operated on between 1960-1965 without preoperative orthopedics and another group of 46 children operated on between 1965-1972 after preoperative orthopedics ("T-traction"). One group of 19 children with bilateral clefts operated on 1960-1972 after premaxillary retropositioning pressure, if necessary combined with outward rotation of the lateral maxillary segments was also studied. All children were bone grafted with the "four flap" technique. Comparisons were made with cleft children bone grafted with a different surgical method, with non-grafted U.S. cleft children, with cleft children operated on with infant periosteoplasty and with nonclefts. Crossbites were more frequent in clefts bone grafted with a different surgical method. The results of this study corresponded more to those operated on with infant periosteoplasty or to the non-grafted cases. However, all cleft groups differed significantly from nonclefts with a reduced overjet and overbite and narrower and shorter upper dental arches.
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