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Simultaneous options for cleft secondary deformities.

Scopelliti D, Fatone FM, Cipriani O, Papi P - Ann Maxillofac Surg (2013)

Bottom Line: The surgical procedures adopted were Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) in 16 patients (65%) and only Le Fort I osteotomy in 9 patients (35%).A relapse of malformation occurred in 4.5% of cases.Concerning the patient questionnaire, 96% of patients were satisfied with the jaw surgery and favorable for combined surgery, 88% were satisfied with lip-nose surgery, and finally 76% would advise to a friend.

View Article: PubMed Central - PubMed

Affiliation: Department of Cranio-Maxillo-Facial Surgery, Santo Spirito Hospital, Rome, Italy.

ABSTRACT

Introduction: So much has been written by so many about secondary procedures in cleft surgery that testify not only the complexity and variable expression of cleft deformity itself but also the need to find methods of primary surgery that will reduce, if not avoid, adverse effects on all the structures and functions involved and affected. It must be the principal aim of cleft surgeon to restore the deformed and displaced regional anatomy to as close to normality as possible, whether or not true hypoplasia exists. The pathogenesis of secondary deformities is related to specific features as: the presence of scar tissues into the cleft basal bone area, that inhibits alveolar growth; scarring of palatal soft tissue, that inhibits growth and causes palatal orientation of dentoalveolar elements; and the exceeding lip tension, that may inhibits maxillary growth along dentoalveolar structures.

Materials and methods: From 2008 to 2011 at the Department of Cranio-Maxillo-Facial Surgery, Santo Spirito Hospital, Rome 25 patients (21 males and 4 females) who had undergone previous surgery for unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) were enrolled in our study. Diagnosis of deformity was made by means of a cephalometric and photographic analysis (Arnett), gipsometry and a radiological assessment (orthopantomography, lateral and frontal cephalometric X-rays). Moreover, every patient was studied with a temporomandibular joint (TMJ) tomography, TMJ magnetic resonance imaging (MRI) and a computerized gnatography to better evaluate potential TMJ dysfunctions. The surgical procedures adopted simultaneously were: Total or segmental maxillomandibular osteotomies, genioplasty, rhinoplasty, labioplasty, and application of facial prosthesis. Every patient received a postoperative questionnaire to evaluate his/her satisfaction with the surgery performed.

Results: The surgical procedures adopted were Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) in 16 patients (65%) and only Le Fort I osteotomy in 9 patients (35%). A relapse of malformation occurred in 4.5% of cases. Concerning the patient questionnaire, 96% of patients were satisfied with the jaw surgery and favorable for combined surgery, 88% were satisfied with lip-nose surgery, and finally 76% would advise to a friend.

Conclusions: Simultaneous correction of the deformities is indicated as to avoid several surgical distresses for the patient, to improve facial aesthetic and function in one surgical step, and to reduce risk of psychological consequences.

No MeSH data available.


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(a-c) Preoperative lateral and frontal cephalometric X-Rays and orthopantomography
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Figure 3: (a-c) Preoperative lateral and frontal cephalometric X-Rays and orthopantomography

Mentions: If we analyze natural history of facial growth in cleft lip and palate patients, we may observe the following features: A reduction of forces that oppose expansion (loss of bone and lip continuity) and a prevalence of expansive forces (tongue pressure and facial growth factors). Thus, an expansion of middle third of the face in horizontal dimension, with an almost normal sagittal growth, a normocclusion in molar and premolar regions with a normal dental eruption (except in the cleft area) occurs.[123] Once the primary surgery takes place, clinical features shows an abnormal growth of basal and alveolar maxillary bone combined with a horizontal incongruence of dentoalveolar arches which result in a complete malocclusion not limited to cleft area. Therefore, even if a good primary surgery has been performed, job is probably not over as secondary treatment has to deal with following specific issues: Dentoskeletal deformities, lip deformities, nose deformities, and hard and soft palate deformities[2345678910] [Figures 1–3].


Simultaneous options for cleft secondary deformities.

Scopelliti D, Fatone FM, Cipriani O, Papi P - Ann Maxillofac Surg (2013)

(a-c) Preoperative lateral and frontal cephalometric X-Rays and orthopantomography
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814667&req=5

Figure 3: (a-c) Preoperative lateral and frontal cephalometric X-Rays and orthopantomography
Mentions: If we analyze natural history of facial growth in cleft lip and palate patients, we may observe the following features: A reduction of forces that oppose expansion (loss of bone and lip continuity) and a prevalence of expansive forces (tongue pressure and facial growth factors). Thus, an expansion of middle third of the face in horizontal dimension, with an almost normal sagittal growth, a normocclusion in molar and premolar regions with a normal dental eruption (except in the cleft area) occurs.[123] Once the primary surgery takes place, clinical features shows an abnormal growth of basal and alveolar maxillary bone combined with a horizontal incongruence of dentoalveolar arches which result in a complete malocclusion not limited to cleft area. Therefore, even if a good primary surgery has been performed, job is probably not over as secondary treatment has to deal with following specific issues: Dentoskeletal deformities, lip deformities, nose deformities, and hard and soft palate deformities[2345678910] [Figures 1–3].

Bottom Line: The surgical procedures adopted were Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) in 16 patients (65%) and only Le Fort I osteotomy in 9 patients (35%).A relapse of malformation occurred in 4.5% of cases.Concerning the patient questionnaire, 96% of patients were satisfied with the jaw surgery and favorable for combined surgery, 88% were satisfied with lip-nose surgery, and finally 76% would advise to a friend.

View Article: PubMed Central - PubMed

Affiliation: Department of Cranio-Maxillo-Facial Surgery, Santo Spirito Hospital, Rome, Italy.

ABSTRACT

Introduction: So much has been written by so many about secondary procedures in cleft surgery that testify not only the complexity and variable expression of cleft deformity itself but also the need to find methods of primary surgery that will reduce, if not avoid, adverse effects on all the structures and functions involved and affected. It must be the principal aim of cleft surgeon to restore the deformed and displaced regional anatomy to as close to normality as possible, whether or not true hypoplasia exists. The pathogenesis of secondary deformities is related to specific features as: the presence of scar tissues into the cleft basal bone area, that inhibits alveolar growth; scarring of palatal soft tissue, that inhibits growth and causes palatal orientation of dentoalveolar elements; and the exceeding lip tension, that may inhibits maxillary growth along dentoalveolar structures.

Materials and methods: From 2008 to 2011 at the Department of Cranio-Maxillo-Facial Surgery, Santo Spirito Hospital, Rome 25 patients (21 males and 4 females) who had undergone previous surgery for unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) were enrolled in our study. Diagnosis of deformity was made by means of a cephalometric and photographic analysis (Arnett), gipsometry and a radiological assessment (orthopantomography, lateral and frontal cephalometric X-rays). Moreover, every patient was studied with a temporomandibular joint (TMJ) tomography, TMJ magnetic resonance imaging (MRI) and a computerized gnatography to better evaluate potential TMJ dysfunctions. The surgical procedures adopted simultaneously were: Total or segmental maxillomandibular osteotomies, genioplasty, rhinoplasty, labioplasty, and application of facial prosthesis. Every patient received a postoperative questionnaire to evaluate his/her satisfaction with the surgery performed.

Results: The surgical procedures adopted were Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) in 16 patients (65%) and only Le Fort I osteotomy in 9 patients (35%). A relapse of malformation occurred in 4.5% of cases. Concerning the patient questionnaire, 96% of patients were satisfied with the jaw surgery and favorable for combined surgery, 88% were satisfied with lip-nose surgery, and finally 76% would advise to a friend.

Conclusions: Simultaneous correction of the deformities is indicated as to avoid several surgical distresses for the patient, to improve facial aesthetic and function in one surgical step, and to reduce risk of psychological consequences.

No MeSH data available.


Related in: MedlinePlus