Cleft in orthodontics /certified fixed orthodontic courses by Indian dental academy

CLEFT LIP & PALATE IN ORTHODONTICS

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandenacademy.com

Introduction
• Surgical repair alone cannot solve the multiple problems

encountered with the deformities that result from clefts of
the lip and palate.
• The Challenge –
– creation of an aesthetically acceptable correction of the
deficient columella and the deformity of the nasal
cartilages
– continuity of the vermillion border of the lips.

Modern Pre-surgical orthopaedics
• Active and passive appliances
• 1950 Mc neil- used acrylic appliance adapted to cleft
• 1964-Pruzansky opposed presurgical orthopaedicsbelieved spontaneous repositioning of premaxilla followed
lip repair
• 1971-Georgiade placed acrylic expansion plate into
maxillary segments. 2-3 weeks premaxilla was brought into
position

Pre-surgical orthopaedics
• 1980- Latham used pin retained variety

• Split appliance secured to palatal segments with pins in
interosseous position in horizontal processes of maxillary
bone
• Steel bar from one tuberosity to another
• Movable metal arms along each alveolar ridge
• 1 inch activation screw placed anteroposteriorly in cleft


Anatomy of UCLP
• Nasal floor communicates with oral
cavity
• Maxilla on cleft side is hypoplastic
• Columella is displaced to normal

side
• Nasal ala on cleft side is
laterally, posteriorly, and inferiorly

displaced
• Lip muscles insert into ala and
columella


Objectives of Pre-surgical
orthopaedics
• To align and approximate the intra alveolar segments

• To correct the malpositioned nasal cartilages.
• In addition the correction of the position of the philtrum and
columella are performed.


The Impression Technique
• Primary impression – temporary tray adapting
wax over the gumpads
• Addition Silicon Impression Material

• Custom acrylic trays
• Hospital setting

• ALGINATE NOT USED

Molding Plate
• clear acrylic resin

• surgical adhesive tapes that are applied
externally
• modified at weekly intervals to gradually
approximate the alveolar segments and to
reduce the size of the intraoral cleft gap
• plate also acts as an obturator

Taping
• tight apposition of lip segments with micropore
tape, results in the orthopaedic benefits of the
traditional lip adhesion without the consequent

scar
• combined with the moulding plate produces

controlled movement of the anterior alveolar
segments

Nasal Stent
• gradual additions of small amounts of acrylic resin, the stent

is positioned inside the nose underneath the apex of the alar
cartilage on the cleft side
• Moulding the shape of the
– cartilaginous septum
– alar cartilage tip
– medial and lateral crus

Case 1
BABY NASEEMA


Pre treatment


Impression Technique


Molding Plate & Taping


Post Surgical


Pre- Post Comparison


Case 2
BABY ATUL


Pre Teatment


Pre – Post Comparisons


Advantages of PNAM
•

•

•
•

•

Helps guide alveolar segments - almost normal
position, prior to surgery.
Reduction of the cleft gap width facilitates the primary
gingivo-periosteal closure of the defect- greater probability
that a complete osseous bridge will form when the cleft
width is reduced.
Reduces the formation of scar tissue and produces more
consistent postoperative results.
Eliminates the need for secondary 'surgical' columella
elongation and the accompanying scars at the lip columella
junction.
Reduces the number and extent of surgeries that a cleft
patient will undergo during a lifetime.

Complications that may occur
•

Soft tissue breakdown - excessive modification of the
appliance - force application exceeds the tissue tolerance

•

Area of ulceration intraorally or on the nasal lining

•

If parents fail to apply tape and elastics during the
molding, then the appliance will not adequately be
retained during the course of treatment, and progress
would be lost.

•

If the appliance is lost or not worn, a cleft gap that had
been closed early during molding therapy may widen
again as the infant places its tongue into the cleft.

Conclusion
• PNAM remains a controversial part of
comprehensive care for cleft lip and palate
patients
– helps to decrease the tension between the tissues

– help to bring about better aesthetic results post
surgically

• Decreased scarring can also contribute to better
growth and decrease the dento-alveolar effects
of cleft surgeries at a young age.

www.indiandentalacademy.com
Leader in continuing dental education


Cleft in orthodontics /certified fixed orthodontic courses by Indian dental academy

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Cleft in orthodontics /certified fixed orthodontic courses by Indian dental academy