[Treatment of adult patients with upper micrognathia after a series of surgeries for unilateral cleft lip and palate. Part 1].

Abstract

Objective: The aim the study is to improve the quality of treatment for patients with upper micrognathia after a series of surgeries for cleft lip and palate.

Material and methods: 15 patients were treated at the FSBI NMIC «TSNIIS and ChLH» with a diagnosis of upper micrognathia; a condition after a series of operations for unilateral cleft lip and palate. Measurements of the transversal dimensions of the upper jaw were performed based on the results of CBCT. Indications for surgical-assisted expansion of the upper jaw have been determined. At the first stage, the distraction device was modeled and installed, supported by 4 orthodontic implants with an expansion screw of - 10 mm. At the next stage of treatment, a surgically assisted extension of the upper jaw was performed: osteotomy along the lines of Le Fort I. 7 days after the operation, the distraction apparatus was activated: 2 turns in the morning and evening, 0.5 mm per day (1 turn - 0.25 mm). The duration of distraction was 20 days.

Results: After 6 months of using the distraction device, the necessary amount of movement of the upper jaw had been achieved. The average postoperative relapse of maxillary constriction was 0.93 mm. There was an improvement in the relationship between the front and side groups of teeth in the upper and lower jaws, as well as correction of the backward incisor overlap in the front group of teeth in the upper jaw. This indicates that the movement of the maxilla was not only in the transverse plane.

Conclusion: The study confirms the effectiveness of surgically assisted maxillary dilation as a method of correcting upper micrognathia in patients who have undergone a number of operations for cleft lip and palate. The use of an individualized distraction device based on orthodontic implants in combination with surgery ensures the necessary volume of expansion of the upper jaw and minimizes the risk of recurrence of narrowing, typical for patients in this group.