Cleft Lip and Palate Treated by Presurgical Orthopedics, Gingivoperiosteoplasty, and Lip Adhesion (POPLA) Compared with Previous Lip Adhesion Method: A Preliminary Study of Serial Dental Casts

Abstract

Comparing the treatment protocols for cleft lip and palate requires a study of facial growth and development. Serial orthodontic study models aid in delineating the effects of surgery on maxillary mandibular relationships. In 1978, a new protocol, POPLA (presurgical orthopedics followed by periosteoplasty and lip adhesion), was developed and put into practice. This article compares the results obtained using POPLA (group I) with those using the previous method (lip adhesion alone) (group II) for cases of unilateral and bilateral clefts. Complete orthodontic study models were available for 124 patients, 63 in group I and 61 in group II. Specific timing sequences and surgical details are discussed. Dental cast analyses evaluated alveolar gap, arch width, anteroposterior distance, incisor crossbite (single tooth and multiple tooth), and buccal crossbite (single and multiple tooth) at birth and at 3, 6, and 9 years of age. X-ray studies evaluated the bony bridge. Additional comments are made regarding the incidents and effects of pharyngeal flaps and bone grafts on maxillary-mandibular relationships. Results included less buccal crossbite in the POPLA group, with a wider transverse distance of the upper dental arch. There was a greater frequency of anterior crossbite in the POPLA group, and the anteroposterior distance was shorter at 6 years of age but less so by age 9. This may be because of the different orthodontic care received by the patients in the two groups. In conclusion, the POPLA approach achieves the main goal of moving the palate into a normal position and stabilizing the arch with a bony bridge that attracts teeth. It avoids the difficult anterior fistulae and presents a more symmetrical platform upon which the lip can be united and the nose can be corrected early.

Influence of lip closure on alveolar cleft width in patients with cleft lip and palate

“…In our study a passive feeding plate in combination with an early lip closure with a restored orbicularis oris muscle was used for molding with 34 clefts being less than 2 mm wide at the time of soft palate closure. Therefore, an active appliance and two-staged lip repair as advocated seemed not to be necessary [21]. This achieved approximation would facilitate primary bone grafting of the alveolar cleft, if desired.…”

Pre-surgical Alveolar Molding in A Newborn Patient with Complete Unilateral Cleft Lip and Palate-A Report

“…Furnas D W in his study on unilateral cleft lip and palate patients stated that initial description of the surgical method and post-operative care for CLAP patients was given by pierre Franco in 1556 [7]. Later in its development, technique advanced and focus shifted towards achieving a precise muscle closure, better aesthetics and a delicate technique, which led to the concept of Pre-surgical orthopaedics [8] for CLAP patients. treatment in 57 infants with unilateral cleft lips and palates with use of alveolar molding plate.…”

Presurgical Infant Orthopedics for Cleft Lip and Palate: A Review

“…In particular, surgical time and sequence of surgery were stated as decisive factors for the final success, rather than the presurgical orthopedic treatment type [7]. It should be kept in mind that the best surgery approach for these patients was not described, and the outcomes were affected not only by presurgical orthopedics, but also by surgery methods [70][71][72][73][74]. There are many surgical alternatives as there are many type of orthopedics.…”