The Latham Technique: Contemporary Presurgical Orthopedics for the Complete Oral Cleft Technique and Preliminary Evaluation — A Bone Marker Study

Abstract

The Latham technique is the initial interventional procedure used to treat the facial orthopedic problems found in unilateral cleft lip and palate (UCLP) and bilateral complete cleft lip and palate (BCLP) patients. In UCLP and RCLP deformities, the soft tissue and basal abnormalities have a recognizable pattern of deformity defined by excess or deficiency in anatomic form, position, or direction within the craniofacial milieu. The Latham appliance applies controlled directional forces to reposition the displaced basal segments and realign soft tissue margins of like kind before corrective surgery is performed.This study presents a literature review, explains the clinical technique used for BCLP and UCLP patients, evaluates the initial orthopedic effect caused by the Latham technique, examines the fistulation rate after two closure operations (i.e., lip and alveolar, and later palate), and presents case demonstrations with one UCLP and two BCLP patients. LITERATURE REVIEWThe Latham technique is a variation on an approach that was introduced several decades ago. In the early 1950s, M~N e i l ' .~ and Burston3 first reported on the use and advantages of presurgical orthopedic correction (POC) in UCLP and BCLP patients. Still in use today, the POC technique employs a passive oral prosthesis and external facial or head straps to effect segment repositioning. Another variation of POC for use in UCLP patients, reported Supported in part by rcsearch grant 88-65, Sinai Hospital, lktroit, Mich. Downloaded by: Universite Laval. Copyrighted material.

Tessier No. 3 and No. 4 clefts: Sequential treatment in infancy by pre-surgical orthopedic skeletal contraction, comprehensive reconstruction, and novel surgical lengthening of the ala base-canthal distance

“…The superior orbital rims used for reformatting have less precision and accuracy (Baumrind and Frantz, 1971) compared to bone marker landmarks (Spolyar et al, 1992). Yet, in Table 1C, the bilateral vertical translations were, as expected, equal (0.8 / 0.9 mm) indicating a valid reformatting process.…”

“…Notwithstanding, other UCLP occlusion studies with either passive PSIO and sequential primary bone grafting (Hathaway et al, 1999) or active Latham PSIO without primary alveolar surgery (Chan et al, 2003) showed both protocols achieved dental arch relationships in preadolescence like children without PSIO intervention nor alveolar grafting. Finally, active Latham PSIO treatment categorically shifts the native growth-compensated developmental derangement while normalizing cleft component positions (Spolyar et al, 1992). In a UCLP cast study, larger cleft width (derangement) in infancy between cuspid points was significantly associated with less anterior and posterior dental crossbite at age 5 years (Reiser et al, 2010); would that the native growth-compensated developmental derangement having been normalized by PSIO, then lead to more crossbites?…”

Clinical Outcomes Utilizing a “Modified Latham” Appliance for Presurgical Infant Orthopedics in Patients With Unilateral Complete Cleft Lip and Palate

“…With this shorter treatment course, the “modified Latham” appliance allows operative placement of the device at an older age, while still facilitating correction of the cleft lip between 3 and 4 months of age (Spolyar et al, 1992; Nahai et al, 2005; Hammoudeh et al, 2017). In our series, the “modified Latham” appliance was inserted at an average age of 3.80 months of age.…”

A New Technique for Retracting the Protrusive Premaxilla With Fewer Patient Visits

“…Anchors were needed and were supplied via 4 fixation screws into the hard palate (KLS Martin, Tuttlingen, Germany). Fixation screws were placed under general anesthesia in the same locations that pins of the Latham appliance were located (Spolyar et al, 1992; Figure 2B). This location was selected to avoid tooth germs and provide reliable stabilization.…”