Three-dimensional nasal septum and maxillary changes following rapid maxillary expansion in patients with cleft lip and palate (original) (raw)
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The Angle Orthodontist, 2015
Objective: To evaluate the anterior and posterior maxillary width, the nasal passage volume, the oropharyngeal minimum axial area, and volume changes in unilateral cleft lip and palate patients treated with one of the following four expanders: Hyrax, Fan-Type, inverted mini-hyrax supported on the first permanent molars (iMini-M), or inverted mini-hyrax supported on the first premolars (iMini-B). Materials and Methods: A total of 40 patients with transverse maxillary deficiency who were submitted for rapid maxillary expansion were divided in four groups according to type of expander used. Cone-beam computed tomography images were taken before and 3 months after expansion. One-way analysis of variance was used to analyze the differences among the groups, and paired t-tests were used to evaluate the changes in each group. Results: All groups showed a significant increase in the anterior maxillary width, with no intergroup differences. The iMini-B was the only group that did not show...
Surgery in Practice and Science, 2021
Objective: the aim of the present review was to assess maxillary expansion (ME) in grafted alveolar arches in patients with cleft lip and palate (CLP). Material and methods: the addressed focused question was: "What are the clinical and radiographic outcomes of ME after alveolar bone grafting (ABG) in patients with CLP? " An electronic search of indexed databases was performed without language and time restrictions, up to and including March 2021, to identify studies that addressed the focused question. Study selection and data extraction were performed independently by 2 authors; and the risk of bias for the clinical studies was assessed using the Downs and Black tool. Any disagreements were resolved through consensus discussion. Results: five studies [2 clinical studies (1 prospective and 1 retrospective) and 3 case reports] were included and processed for data extraction. The outcomes of ME were assessed using cone-beam computed tomography and two-dimensional radiographic imaging 12-months after ABG in 1 clinical study, and 6-months after ME in the other clinical study. In the case reports, the outcomes of ABG after ME were assessed 3-6 months after ME. No significant bone loss of the ABG after ME was reported, and adequate bone volume and bone density were observed at the follow up periods in all studies. Maxillary expansion was achieved after the ABG in all of the studies. Conclusion: the relationship between ABG and ME remains debatable. Further power-adjusted, well-designed, randomized controlled clinical trials are needed to study the outcomes of ME after ABG in patient with CLP.
2000
Objective: The aim of this study was to evaluate the dentoalveolar effects of rapid maxillary expansion in children with unilateral complete cleft lip and palate in comparison with non-cleft patients. Methods: The experimental group (EG) was composed of 25 patients with unilateral and complete cleft lip and palate (9 males and 15 females) with a mean age of 10.6 years. The control group (CG) comprised of 27 patients without cleft lip and palate (14 males and 13 females) with a mean age of 9.1 years. Dental models of the maxillary dental arch were obtained immediately preexpansion (T1) and 6 months post-expansion (T2) at the time of appliance removal. Digital dental models were obtained using the 3Shape R700 3D laser scanner (3Shape A/S, Copenhagen, Denmark). Transversal widths, arch perimeter, arch length, palatal depth, palatal volume, canine and posterior tooth inclination were digitally measured. Paired t-test was used to perform interphase comparisons and independent t-test to perform intergroup comparisons (p<0.05). Results: In the experimental group, the expansion produced a significant increase of all maxillary transverse measurements, palatal volume, arch perimeter and palatal depth while decreased the arch length. RME caused a buccal tip of posterior teeth in patients with UCLP. No differences were observed between experimental and control groups for all the measurements performed except for the intermolar distance (6-6), which showed a greater increase in patients with cleft. Conclusion: Rapid maxillary expansion showed similar dentoalveolar effects in children with UCLP and without oral clefts.
Rapid Maxillary Expansion Treatment in Patients with Cleft Lip and Palate: A Survey on Clinical Experience in the European Cleft Centers, 2023
Cleft lip and palate patients require complex interdisciplinary treatment, including maxillary expansion and secondary alveolar bone grafting. However, the evidence on these treatment procedures and outcomes is lacking. Therefore, this study aimed to survey the subjective observations of European maxillofacial surgeons and orthodontists on the maxillary expansion and bone grafting treatment protocols and the associated complications. An online questionnaire was sent to 131 centers. The questions assessed the participants' demographic data, maxillary expansion and alveolar bone grafting protocols, and the associated complications. Descriptive statistics and a t-test were used to analyze the data. The response rate was 40.5%. The average age for maxillary expansion was 9-10 years. The secondary alveolar bone grafting was planned 5-10 months after the expansion. The most common complications were asymmetric expansion, relapse, and fistula formation. The protocols and materials used vary widely among centers. Anatomical alterations and developmental processes, like tooth eruption adjacent to the cleft, should be seriously considered for treatment planning. This survey showed that there is still a lack of consensus on these treatment procedures. Further clinical trials should focus on long-term outcome evaluation to identify treatment components for optimal alveolar bone substitution and transversal maxillary expansion treatment in patients with clefts.
Journal of Clinical Medicine
This study was intended to evaluate the relationship between secondary alveolar bone grafting (SABG) timing and the alveolar volume in patients with unilateral cleft lip and palate (UCLP). The material consisted of CTs of 35 patients (17 males, 18 females) with UCLP who underwent a one-stage primary cleft repair at a mean age of 8.4 months and SABG at different timings ranges of 1.8–18.8 years. The mean age at CT was 17.2 years. The relative coefficient (Ꞷ) which was independent from factors such as individual maxillary size, gender or age at the CT was introduced in order to compare volumes of the cleft-side in relation to the non-cleft-side alveolus. Pearson correlation coefficient r between Ꞷ coefficient and SABG timing was weak negative (r = −0.34, p = 0.045). The multiple regression analysis implied that the dependent variable-Ꞷ coefficient was associated with independent variables (cleft repair and SABG timings and age at CT) with r2 = 0.228. Only patient’s age at SABG explain...
PLOS ONE
The aim of this study was to evaluate three dimensionally the effect of the combined maxillary expansion and protraction treatment on oropharyngeal airway in children with non-syndromic cleft palate with or without cleft lip (CP/L). Methods CBCT data of 18 preadolescent individuals (ages, 8.4 ± 1.7 years) with CP/L, who underwent Phase I orthodontic maxillary expansion with protraction, were compared before and after treatment. The average length of treatment was 24.1± 7.6 months. The airway volume and minimal cross-sectional area (MCA) were determined using 3DMD Vultus imaging software with cross-sectional areas calculated for each 2-mm over the entire length of the airway. A control group of 8 preadolescent individuals (ages, 8.7 ± 2.6 years) with CP/L was used for comparison. Results There was a statistically significant increase in pharyngeal airway volume after phase I orthodontic treatment in both groups, however, there was no statistically significant change in minimal cross-sectional area in neither study nor control group. Conclusion The findings showed that maxillary expansion and protraction did not have a significant effect on increasing oropharyngeal volume and MCA in patients with CP/L.
Volumetric nasal cavity analysis in children with unilateral and bilateral cleft lip and palate
Laryngoscope, 2015
Objective-Children with cleft lip and palate (CLP) often suffer from nasal obstruction which may be related to effects on nasal volume. The objective of this study is to compare side:side volume ratios and nasal volume in patients with unilateral (UCLP) and bilateral (BCLP) clefts with age-matched controls. Study Design-Retrospective case-control study using three-dimensional nasal airway reconstructions Methods-We analyzed 20 subjects (age range: 7-12 years) with UCLP and BCLP from a regional craniofacial center who underwent cone beam CT (CBCT) prior to alveolar grafting. Ten multi-slice CT images from age-matched controls were also analyzed. Mimics ™ software (Materialise, Inc.) was used to create 3-dimensional reconstructions of the main nasal cavity and compute total and side-specific nasal volumes. Subjects imaged during active nasal cycling phases were excluded. Results-There was no statistically significant difference in affected:unaffected side volume ratios in UCLP (p=0.48) or left:right ratios in BCLP (p=0.25) when compared to left:right ratios in