Dental Arch Relationship Outcomes Following 2-Stage Palatoplasty for Japanese Patients With Complete Unilateral Cleft Lip and Palate: A 3-Center Study.

OBJECTIVE: To compare dental arch relationship outcomes following 3 different 2-stage palatal repair protocols. DESIGN: Retrospective, cross sectional. SETTING: Three cleft palate centers (A, B, C) in Japan. PATIENTS: Ninety (A: 39, B: 26, C: 25) consecutively treated Japanese patients with complete unilateral cleft lip and palate. INTERVENTIONS: In A, the soft palate and the posterior half of the hard palate were repaired at a mean age of 1 year 7 months. In B, the soft palate and hard palate were closed separately at a mean age of 1 year 6 months and 5 years 8 months, respectively. In C, the soft palate and hard palate were closed at a mean age of 1 year and 1 year 5 months, respectively. MAIN OUTCOME MEASURES: Dental arch relationships were assessed using the 5-Year-Olds' (5-Y) index by 5 raters and the Huddart/Bodenham (HB) index by 2 raters. RESULTS: Intra- and inter-rater reliabilities showed substantial or almost perfect agreement for the 5-Y and HB ratings. No significant differences in mean values and distributions of 5-Y scores were found among the 3 centers. The mean HB index scores of molars on the minor segment were significantly smaller in C than those in A and B (P < .05). CONCLUSIONS: There were no significant differences in dental arch relationships at 5 years among the times and techniques of hard palate closure. However, further analysis of the possible influence of infant cleft size as a covariable on a larger sample size is needed.

Orthognathic surgery with iliac bone grafting for an interpositional gap in a patient with type III hemifacial microsomia: A case report.

Hemifacial microsomia (HFM) is characterized by uni- or bilateral microtia and hypoplasia of the mandible, orbits, facial nerve, and adjacent soft tissues. Patients with Pruzansky-Kaban type III HFM show the most severe facial deformities and often encounter difficulty obtaining treatment. In recent years, orthognathic surgery for HFM-related deformities has often been performed after the patient has stopped growing. However, few detailed reports have described the difficulties of orthognathic surgery for patients with type III HFM. This report describes the case of a patient with type III HFM who underwent three unilateral mandibular reconstructions while still growing, including autogenous reconstructions and secondary distraction osteogenesis, followed by orthognathic surgery with iliac bone grafting for an interpositional gap between the proximal and distal segments after she had stopped growing to improve facial asymmetry and malocclusion.

Proportions of malocclusions in Japanese female adolescents over the last 40 years.

PURPOSE: To assess the prevalence of malocclusion in schoolgirls at a private high school and whether it has increased or not over 40 years by comparison with previous surveys on early and middle adolescence in Japan. MATERIALS AND METHODS: Conventional dental examination including evaluation of occlusion was performed in 2,378 schoolgirls who were enrolled in the seventh and the tenth grade between the years 2004 and 2006. The presence of maxillary protrusion, anterior crossbite, edge-to-edge incisor relationship, open bite, deep bite and crowding of teeth was recorded by visual inspection. The prevalences of various types of malocclusion were compared between the two grade groups and with data from the previous surveys. RESULTS: The proportions of malocclusions in the tenth grade (55.7%) and seventh grade (55.3%) were found to be similar. The prevalences of maxillary protrusion, anterior crossbite, edge-to-edge incisor relationship, open bite, deep bite and tooth crowding in the seventh grade students were 9.4%, 0.6%, 4.1%, 0.6%, 8.4% and 19.1%, respectively. The corresponding values in tenth grade students were almost the same except for deep bite, which was significantly lower than that in the seventh grade. Comparison with previous surveys indicated that the proportions of malocclusions taken as a whole had not changed over 40 years, whereas anterior crossbite, edge-to-edge incisor relationship, open bite and tooth crowding had decreased significantly within the last 20 years. CONCLUSION: Significant changes in the proportions of malocclusions as a whole in adolescents were not found over the last four decades.

Orthodontic treatment of an impacted dilacerated maxillary central incisor combined with surgical exposure and apicoectomy.

The impacted incisor was moved into its proper position with surgical exposure and orthodontic traction. Although apicoectomy was performed during the orthodontic treatment, the incisor showed good stability after the long retention period.

Maxillary advancement using distraction osteogenesis with intraoral device.

This article describes the surgical orthodontic treatment of maxillary hypoplasia in a patient with cleft lip and palate using maxillary distraction osteogenesis with internal maxillary distractors. Maxillary advancement was performed to correct the retrusive maxillary facial profile and Class III malocclusion. Rotational movement of the distraction segment was made to correct the upper dental midline. Although maxillary advancement was insufficient because of unexpected breakage of the intraoral distractor after completion of the distraction, skeletal traction with a face mask compensated for the shortage. Successful esthetic improvement and posttreatment occlusal stability were achieved with no discernible relapse after 2 years of retention.

Rotational movement of the anterior maxillary segment by hybrid distractor in patients with cleft lip and palate.

OBJECTIVE: Maxillary anterior segmental distraction osteogenesis (MASDO) is an effective surgical orthodontic treatment for the retruded maxilla in cleft lip and palate because of its benefit of the conservation of velopharyngeal function. Some reports showed MASDO using various devices, but they do not allow the rotational movement of the distracted anterior segment. In this article, we showed MASDO using hybrid distracters (DynaForm System: Stryker Osteosymthesis, Leibinger Micro Implants, Kalamazoo, MI), which allow the advance of the distracted segment with rotational movement. METHOD: The hybrid distractor with 4 metal arms is secured beyond both alveolar osteotomy lines on each side. These 2 distractors permit rotational movement of the segment by controlling the amount of advancement on each side. RESULTS: For 6 patients with cleft lip and palate, MASDO using hybrid distractors was performed and the anterior segment moved at planned positions without any complications except lip discomfort, which disappeared after removal of the distractor. CONCLUSION: MASDO, using an institutionally diagnosed hybrid distractor can successfully achieve the necessary rotational movements of the anterior maxillary segment owing to its design, which incorporates some mechanical flexibility.