May Ever Child Sing and Smile – 3rd International Workshop of ICPF
Free Papers from the Scientific Session I
Long Term Outcomes of Surgical Techniques in Cleft Lip and Palate: Dallas Protocol
Author: Kenneth E. Salyer
Baylor College of Dentistry, Dallas, Texas, USA
The standard of care in the developed world for patients with cleft lip and palate and associated craniofacial deformities is treatment by a dedicated team, in a dedicated centre, with a dedicated effort. A multidisciplinary team with a surgical-orthodontic-speech oriented plan, functioning as a true team and utilizing the knowledge and expertise developed over the last 50 years, can consistently provide excellent outcomes while using many different protocols. Diverse opinions continue to exist within this field regarding technique, timing, and sequencing of surgery, as well as an overall assessment of speech, and timing and extent of orthodontic intervention. The Dallas protocol is an interdisciplinary approach, and the results of this centre’s 40 year experience in the treatment of cleft lip and palate patients will be presented as one example. The purpose of this presentation is to review Dallas protocol, demonstrating results achieved, as a basis for discussion by two panels of expert surgeons and orthodontists, thereby offering education regarding varying concepts of successful treatment of the cleft lip and palate patient and insight into these approaches. Why do we do what we do? What experiences were the techniques, sequencing and methods chosen by the various surgeons and orthodontists? What are alternative methods and why should one or another be used? Should these techniques or others be used in developing countries where the conditions, training, education and financial support are major issues? In the future, we should promote and develop evidence-based care for cleft lip and palate patients in developed and developing countries.
Keywords: interdisciplinary, Dallas protocol, evidence-based care
Advantage of primary lip and soft palate repair at six months of age
Author: Davis S. Precious
Dalhousie University, Halifax, Nova Scotia, Canada
Surgical correction of Cleft Lip remains an elusive problem, principally because the fundamental surgical problem is not clearly conceptualised. This failure to accurately define the problem is attributable to the fact that the relevant anatomy is complex, poorly understood and frequently erroneously described. Meaningful correction of Cleft Lip can be achieved only when the surgeon is fully appreciative of both normal and pathological spatial relationships and functions of the anatomical elements particularly the muscular elements which caused a deformity. The treatment goal, therefore, is to obtain an anatomical functional balance between the soft tissues and the skeleton. Accordingly, at the end of the primary asleep operation, the surgeon must have achieved the following:
- Straight nasal septum positioned in the facial midline
- Symmetrical reconstruction of the nasal labial muscles
- Absence of vestibular oral nasal communication
- Functional, patent nostril on the cleft side
- Symmetrical reconstruction of the muscles of the soft palate
Keywords: lip repair, soft palate repair, surgery
clinical evaluation of bilateral transverse facial cleft and their repair
Authors: Guomin Wang, Yusheng Yang, Yilai Wu, Teng Wan, Kenneth Salyer
Cleft research and treatment centre, Shanghai 9th People’s hospital affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai Centre of World Craniofacial Foundation, Shanghai, China
To discuss and evaluate the ideal surgical procedure for the rare case of bilateral transfers facial cleft. The chart of nine patients with bilateral transverse facial clefts (five boys and four girls) who were treated in Shanghai 9th People’s hospital affiliated with Shanghai Jiao Tong University School of Medicine from July 2004 to December 2010 were reviewed. One of them was native eight we are non-native. Age of operations ranged from five months to 63 months with an average of 21.3 months. The length of clefts ranged from 0.6 cm to 19 cm. All patients were treated with incisions simulating the natural extending of the corner of the mouth. All patients healed by the first intention was no pleadings or any other complications with the longest follow-up of 44 months. Both parents and patients were satisfied with the results. A bilateral transverse facial cleft is a rare congenital craniofacial malformation. They’re mainly to procedures for this malformation: W-plasty and incisions simulating the natural extending of the corner of the mouth and the latter is better for Asian patients.
Keywords: clinical evaluation, bilateral transverse facial cleft, natural extending of corner of mouth
midface protraction using miniplate Anchorage and/or destruction osteogenesis in cleft patients
Author: Seung-Hak Baek
Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, Korea
Orthodontic and orthopaedic treatment for cleft patients usually consisted of pre-surgical infant orthopaedics (PSIO), early orthodontic treatment pre-and post-alveolar bone graft (ABG) orthodontic treatment, maxillary protraction therapy, destruction osteogenesis (DO), or orthognathic surgery-related orthodontic treatment. Cleft patients often develop maxillary retrusion due to the combined effects of the congenital deformity and the scar tissue after surgical repairs. Maxillary protraction in cleft patients using orthopaedic appliances (i.e face mask) or DO during early childhood helps to achieve more ballast skeletal harmony and favourable occlusion for future growth to occur. Recently facemask with miniplate (MP-MP) has been introduced and is proved to be more effective for maxillary protraction and to result in a less counter-clockwise rotation of the maxilla and clockwise rotation of the mandible than conventional facemask treatment using intraoral Anchorage. Although the Rigid External Destruction (RED) system has been used widely bowing of the external traction hooks (ETH) and tooth-borne anchorage for the intraoral labiolingual appliance (ILA) can result in an inappropriate change of force application level and vector control, eventually improper rotation of the osteomised bony segment and unwanted dentoalveolar effect. Instead of the ETH and ILA, Direct fixation of the skeletal plate and the maxilla can be another option. However, it also has some disadvantages including inflammation taxation failure and the second surgery to remove the plates. These phenomena could be minimised by the addition of rigidity to the ETHs and fortification of absolute skeletal Anchorage to the ILA. In cases that need a large amount of advancement, and bodily translation or clockwise rotation of the midface and which have oligodontia or anchorage problems for the ILA, Application of the orthodontic mini implant and ligation to the ILA can be a highly effective fixation approach to obtain more accurate vector control. In addition, when DO for cleft patients with midface hyperplasia is planned, the amount of required maxillary advancement, Victor control of the palatal plane and vertical position of the upper incisor would be important factors.
Keywords: maxillary protraction, orthodontic appliances, destruction osteogenesis