Palate morphology after unilateral and bilateral cleft lip and palate closure.

The aim of the present study was to compare the morphology of the hard palate of patients with uni- and bilateral cleft lip and palate after palatoplasty using vomer and palatal pedicled flaps with the palatal morphology of non-cleft individuals. Eighty patients were enrolled into this retrospective study: 40 patients with cleft lip and palate (30 unilateral, 10 bilateral) and 40 non-cleft patients with class I occlusion, who served as controls. Analysis of the development of the maxillary arch and evaluation of palatal morphology were accomplished from reformatted CT scans from plaster casts of the maxilla at the age of 4, 10 and 15 years (cleft patients) and 10 years (controls). Width and symmetry of the maxillary arch and morphology of the hard palate were assessed in the canine and molar region and compared both among the cleft groups and the controls. Maxillary arch width as assessed from plaster casts did not differ significantly between uni- and bilateral cleft patients and was not significantly different from controls at the age of 10. Deviation from symmetry was present in both types of cleft and significant in unilateral clefts when compared to bilateral clefts and non-cleft patients. Palatal morphology did not differ significantly between uni- and bilateral clefts until the age of 15, but was significantly different from control patients in the molar area at the age of 10 presumably due to the medial shift of soft tissue flaps used for palatoplasty. It is concluded that palatoplasty significantly alters hard palate morphology particularly in the posterior area. The relevance of this alteration for speech and articulation remains to be explored.

Midfacial morphology in children with unilateral cleft lip and palate treated by different surgical protocols.

The purpose of this study was to compare cranio-facial, particularly midfacial morphology, in two groups of children with complete unilateral cleft lip and palate (UCLP) treated at two different cleft centres (Hannover. Germany and Brussels, Belgium) following different surgical treatment protocols. A total of 62 children (40 males; 22 females) with non-syndromic UCLP were included in this study at approximately the age of 10. The Hannover group comprised 36 children, who had repair of the lip at a mean age of 5.83 +/- 1.16 months, followed by repair of the hard and soft palate at a mean age of 29.08 +/- 4.68 and 32.25 +/- 4.29 months. respectively. The Brussels group consisted of 26 children who underwent surgical treatment according to the Malek protocol: the soft palate was closed at a mean age of 3.04 +/- 0.20 months, followed by simultaneous repair of the lip and hard palate at a mean age of 6.15 +/- 0.68 months. Midfacial morphology was evaluated by means of cephalometric analysis according to Ross. The children in the Hannover UCLP group did not differ significantly from those in the Brussels group in the anteroposterior dimension of the midface. However, the maxillary plane was significantly more open in the Brussels group due to less posterior vertical maxillary development.

[The possibilities for surgical correction of dentoalveolar adaptations within skeletal repositioning osteotomy]. / Operative Korrekturmöglichkeiten von dentoalveolären Adaptationen im Rahmen der skelettalen Umstellungsosteotomie.

In the combined surgical orthodontic treatment the essential task is to eliminate the dentoalveolar adaptations of maxillofacial disorders. Additional segmental osteotomies can be considered if these adaptations are excessive or if complications are to be expected during the orthodontic treatment. Possibilities and indications as well as complications and limits of this approach are described.

[Growth induction via condylar reconstruction in children]. / Zur Frage der Wachstumsinduktion durch Kondylusrekonstruktion beim Kind.

Six children, presenting hypoplasia, ankylosis or agenesis of the temporomandibular joint, underwent autologous reconstruction of the condyle. At the time of surgery, the patients were at an age for four to 14 years. Postoperative follow-ups continued the following one to three years, whereby removable orthodontic appliances were used. In all cases postoperative function varied from good to very good and was free of pain. Additionally, in three cases, signs of growth in the area of transplantation were successively achieved. One case showed excessive growth. Regarding these cases of condylar hypoplasia, the rationale for the indication of surgical treatment as well as postoperative orthodontic treatment are discussed.

[Surgery before orthodontic treatment: a concept for timing the combined therapy of skeletal dysgnathias]. / Operation vor kieferorthopädischer Behandlung: ein zeitliches Konzept der kombinierten Therapie skelettaler Dysgnathien.

Postsurgical orthodontic treatment will prevent several disadvantages of the presurgical orthodontic approach: 1. Orthodontic tooth-movements do not interfere with compensatory biological responses. 2. The dental arch alignment is similar to the procedures of any class-I-orthodontic treatment; i.e. dental movements can be based on an already corrected skeletal relation. 3. A possible postsurgical relapse may be easily compensated within the postsurgical orthodontic treatment. Presurgical corrections of dento-alveolar discrepancies are only required to limit an excessive vertical disclusion necessary for a correct sagittal and transverse positioning of the jaws.

[TMJ-function following orthognathic surgery]. / Die Kiefergelenkfunktion nach chirurgisch-orthodontischer Dysgnathiekorrektur.

86 patients with dentofacial anomalies were examined to evaluate signs and symptoms of the stomatognathic system after orthognathic surgery. Clinical signs and symptoms were graded according to the anamnestic and clinical dysfunction index of Helkimo. Restriction of mouth opening in 37 patients influenced the anamnestic dysfunction index mainly to higher postoperative levels although the occurrence of symptoms as pain and tmj sounds decreased. No relationship between tmj pain-dysfunction and type of dysgnathia, surgical approach, molar support before and after surgery, age and sex was noted. It is concluded that surgical correction of dentofacial anomalies has a possible benefitialeffect on certain symptoms as tmj pain, but relief or impairment of clinical signs cannot be predicted preoperatively.

[Growth disorders following fractures of the midface in children]. / Wachstumsstörungen nach Frakturen des Mittelgesichtes im Kindesalter.

12 patients who had suffered mid face fractures during their childhood were examined for skeletal deformities of the facial skull. The cephalometric data showed that neither the position nor the inclination of the maxilla were significantly different from normal anatomy. No correlation was found between the age, the severity of injuries and surgical treatment and resulting deformities.