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Non-surgical correction of class III CLP patients: a sutural manipulation protocol based on timing and severity of the discrepancy | MASTERCLASS
Meazzini, Maria Costanza1,2,3
1Cleft Lip and Palate Regional Center, Operation Smile, S.Paolo Hospital, Milano, Italy; 2Dep.of Maxillo-Facial Surgery, S.Gerardo Hospital, Monza, Italy; 3University of Milano, Italy
Maxillary hypoplasia is a frequent in cleft patients. It may be corrected thanks to the unique biology of circum-maxillary sutures with maxillary orthopedics.
The literature has shown that early treatment rapidly recurs, nevertheless, early maxillary protraction may still be taken into consideration, if specific functional problems exist, especially middle ear infection, otitis media (OM), with subsequent hearing impairment.
On the other hand, long-term results of the application of maxillary protraction technique applied closer to the peak of growth, have been shown to be more stable. Therefore, a later, more complex, approach might be considered if the objective is purely occlusal/esthetic. During adolescence a modified Alternate Rapid Maxillary Expansion-Constriction technique (MART), may obtain a sagittal advancement of A-point, of 5.5±2.8 mm. The position of the maxilla was stable in the long term.
During adolescence, in extremely severe hypoplasia (>10mm), a new protocol is suggested, with MART supported by an initial traction with an extraoral fixed distraction device (RED) to accelerate the sutural distraction process with a sagittal advancement of A-point, of 16.4±5.2 mm. 1 year follow up is available and the maxillary position is stable.
