An algorithm of orthodontic treatment of teenagers with the bilateral cleft lip and palate

Abstract

Relevance . Bilateral cleft lip and palate (BCLP) is the malformation of the maxillo-facial region caused by the defect of the alveolar bone, palate and upper lip. According to the World Health Organisation, the incidence rate is 0.61.6 per 1000 newborns. The protrusive premaxilla is often treated by osteotomy for esthetic reasons. However, the osteotomy of the protrusive premaxilla slows down the growth of the child’s midface, which leads to the skeletal deformations with complications. The study explores the method that allows performing the premaxillary osteotomy to improve the facial profile in the long term. Materials and methods . During the study, 12 patients with BCLP aged 10 to 14 were treated from 2016 to 2019. All patients had head computed tomography by Planmeca ProMax. The results were uploaded into the Dolphin Imaging for further cephalometric analysis. The growth was predicted by Ricketts prediction analysis. Results . The patients were divided into two groups according to the type of the facial growth. The patients of the first group were diagnosed with the vertical type of the growth. The treatment was performed with microimplants. The patients of the second group, with a horizontal growth type, underwent osteotomy of the intermaxillary bone. Consequently, the growth was predictable, which improved the overall facial profile. Conclusions . The osteotomy of the premaxillary bone is recommended only in patients over 10-11 years with the protrusive premaxilla who were diagnosed with the horizontal growth type.