Tratamiento Quirugico de La Hipoplasia Mandibular Articulo

23/8/22, 11:19 A comprehensive management protocol to treat cleft maxillary hypoplasia - ScienceDirect
Journal of Cranio-Maxillofacial Surgery

Volume 46, Issue 2, February 2018, Pages 356-361
A comprehensive management protocol to treat cleft maxillary

hypoplasia
Sunil Richardson , Shreya Krishna , Rakshit V. Khandeparker
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Abstract
Aim
To describe a comprehensive management protocol to treat cleft maxillary hypoplasia specific to the
patient's age, degree of hypoplasia and presence or absence of velopharyngeal incompetence (VPI).
Materials and methods

A total of 359 patients suffering from cleft maxillary hypoplasia were retrospectively studied from January
2004 till June 2015. Lateral cephalograms were taken to assess the degree of deformity and advancement
achieved at three intervals. Patients were treated by four treatment modalities: Facemask therapy, Anterior
maxillary advancement, Total maxillary osteogenesis and LeFort I advancement.
Results
359 patients of cleft maxillary hypoplasia were treated and followed up for a mean of 25 ± 3.6 months.
Group I had 20 patients, all in the pre-pubertal age group with less than 11 mm discrepancy. 25% of
patients in this group had relapse; Group II: 196 patients who were all above 11 years of age and included
all grades of hypoplasia, only 6.25% patients had relapse; Group III had 36 patients all with severe form of
hypoplasia and were above 5 years of age. Relapse in this group was 16.6%; Group IV had 102 patients who
were above 16 years of age and had mildmoderate severity of hypoplasia. Relapse rate was 18.75%.
Conclusion
Extensive literature search and our institutional study has helped us formulate a protocol that delineates
the most appropriate treatment modality for a specific age group and degree of hypoplasia also considering
the effect of treatment on velopharyngeal incompetence.
https://www.sciencedirect.com/science/article/abs/pii/S1010518217304262 1/6
Introduction
Maxillary hypoplasia is the most commonly encountered secondary deformity as a result of cleft lip and
palate with a reported incidence of about 15–50% (Liao and Mars, 2005). The reasons understood for this
hypoplasia are twofold, firstly that the cleft maxilla's intrinsic potential of growth is less due to the
developmental deficiency. Secondly, the iatrogenic factor created due to the surgical repair of cleft lip and
palate causes scarring which inhibits the normal growth of the maxilla (Ross, 1987). Due to the class III
malocclusion that develops in these patients, treatment in some form or other is required to restore facial
aesthetics and function. Approximately 25–50% of them require a surgical intervention (Linton, 1998). The
surgical options available to the cleft team are conventional Lefort 1 advancement, and Lefort distraction
osteogenesis (Cheung et al., 2006) and anterior maxillary distraction (Gunaseelan et al., 2007). The non
surgical option of facemask/reverse pull headgear can be done during the growing years of the child
(Buschang et al., 1994, Dogan, 2012). So far, there is no protocol that clearly states the treatment appropriate
for a particular age group for the specific degree of the deformity, and so we have devised a comprehensive
protocol to manage the problem of cleft maxillary hypoplasia keeping these factors in mind.
Section snippets
Materials and methods
This retrospective study included 359 patients suffering from cleft maxillary hypoplasia who were treated
by different treatment modalities from January 2004 till June 2015. All patients presented with reverse
overjet and a retruded midfacial appearance. From 2004 to 2011 the patients were treated at Dr.
Jeyasekharan center for cleft care, Dr Jeyasekharan medical trust Hospital, Nagercoil. From 2012, all cases
were treated at Richardsons Dental and Craniofacial hospital, Nagercoil. There were…
Results
From January 2004 till June 2015, 359 patients of cleft maxillary hypoplasia were treated. They were
followed up for 12 months-9 yrs with a mean of 25 ± 3.6 months. There were 198 (55.1%) males and 161
(44.9%) females in the study. Patients ranged in age from 5 to 40 years with a mean of 20 ± 3.4 years.
Group I: There were 25 patients at the beginning of treatment which reduced to 20 due to non-compliance
to the face mask. All patients in this age group were in the pre-pubertal age group i.e.…
Discussion
While treatment of the primary lip or/and palate deformity is essential, it does have other undesirable
consequences on the growth of the skeleton of the patient. The secondary deformities of the child, which
are class III malocclusion, reverse overjet, nasal base deformities etc. also require appropriate treatment to
rid them of the cleft stigmata.
The most conventional and traditional of all treatment modalities is orthognathic surgery in the form of
LeFort I maxillary advancement (Houston and …
Conclusion
No single treatment modality can be declared as the best treatment because different age groups and
severities of hypoplasia with or without velopharyngeal incompetence require different treatments. The
comprehensive treatment protocol suggested by us would enable a cleft surgeon to be able to treat the
problem of cleft maxillary hypoplasia at any presenting age group, for any degree of hypoplasia keeping
in mind factors like velopharyngeal incompetence. However this study is based on a…
Approval by ethical committee
Yes.…
Source of funding/external support
Nil.…
Whether informed consent sought from patient
Yes.…
Conflicts of interest
Nil.…
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© 2017 Published by Elsevier Ltd on behalf of European Association for Cranio-Maxillo-Facial Surgery.
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23/8/22, 11:19 A comprehensive management protocol to treat cleft maxillary hypoplasia - ScienceDirect

Journal of Cranio-Maxillofacial Surgery

A comprehensive management protocol to treat cleft maxillary

https://doi.org/10.1016/j.jcms.2017.12.005 Get rights and content

Materials and methods

Materials and methods

Approval by ethical committee

Source of funding/external support

Whether informed consent sought from patient

X.X. Wang et al.

E.J. Liou et al.

View more references

LeFort Distraction in the Cleft Patient

A retrospective analysis of complications associated with tooth-borne anterior maxillary

Nasal Obstruction Evaluation After LeFort I Osteotomy: A Pilot Study

Periodontal wound healing and tissue regeneration: A narrative review

View all citing articles on Scopus

Recommended articles (6)

Commentary: “Maxillofacial growth and speech outcome after one-stage or two-stage

Orbital volume and shape in Treacher Collins syndrome

Three-dimensional analysis of cranial base morphology in patients with hemifacial

View full text

Copyright © 2022 Elsevier B.V. or its licensors or contributors.

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