Early Orthopaedic Stabilization Of The Praemaxilla In Complete Bilateral Cleft Lip and Palate In Combination With The Celesnik Lip Repair

Abstract

Co-ordination of maxillary orthopaedics with two-stage lip surgery according to the Celesnik principle for complete BCLP is described, and the results of the procedure are analyzed at the 10 to 15 year age level. Taking advantage of the effects of growth within the first 6 to 8 months of the patient's life, orthopaedics and concomitant surgery achieve a considerable degree of alignment and stabilization of the praemaxilla within the alveolar arch without reverting to any active orthopaedic retrusion. Around age 10 the praemaxilla has assumed a normal sagittal position relative to the anterior cranial base. Due to relatively short and retropositioned mandibles all cases in the sample investigated display rather receding 'Class II type' profiles in early adolescence.

Bilateral cleft lip and palate. Maxillofacial growth and dental development

“…l-4a) (Robertson, 1973). The elastic force exerts a similar backward pressure against the protruding premaxilla as a lip adhesion or the Celesnik procedure (Hotz et al, 1987). Others proposed the use of intraoral traction with slots that are pinned in the palatal bone in order to attain a rapid retrusion (within three to four weeks) of a severely protruded premaxilla (Georgiade et ai, 1968(Georgiade et ai, , 1989Georgiade and Latham, 1975;Bitter, 1992).…”

“…It is well known that surgical procedures have great influence on further growth and development (Friede and Pruzansky, 1972;Berkowitz, 1977;Hotz et al, 1987;Krogman et al, 1982;Kuijpers-Jagtman, 1989;Bardach, 1990;Heidbüchel et al, 1993. The moulding effect of the closed lip brings the alveolar segments closer to each other.…”

“…With respect to dental arch dimensions and occlusion in BCLP patients, only a few longitudinal studies with a sufficient number of patients can be found in the literature (Larson et al, 1983;Bishara et al, 1985;Athanasiou et ai, 1987;Friede et al, 1987;Hotz et al, 1987). Larson et al (1983) evaluated the dental occlusion in the deciduous dentition of 19 children with bilateral clefts who underwent orthopaedic treatment and early bone grafting before orthodontic treatment and after starting orthodontic treatment (about 10 years of age).…”

“…The number of studies concerning treatment results of BCLP patients is rather limited. Long-term evaluations and studies on sample groups that are bigger than 10 patients are few ( Bishara et Olin, 1972;Friede and Pruzansky, 1985;Hotz et al, 1987;Semb, 1991 a,b;Brägger et al, 1991;Bardach et al, 1992).…”

“…Due to the relatively large variation in maxillary morphology and the small number of patients studied, no differences in facial morphology and occlusion between subgroups could be found. Hotz et al (1987) evaluated early orthopaedic treatment in combination with a two-stage lip repair of 14 consecutive BCLP cases at the 10-year age level. An average decrease of 4 to 5 mm in anterior arch length between birth and age 10 was found.…”