RESUMO
Oral rehabilitation of adult patients with cleft lip and palate is related to the severity of the anatomical and functional alterations that hamper the proper closure of the nasopharynx. The ideal treatment is closure by bone graft and orthodontics. However, when surgery is not possible or when the patient does not wish to undergo surgery, a palatal prosthesis may offer the best solution in most clinical situations. The authors of this article propose a new classification to help the practitioner with decision making and prosthetic treatment planning for residual palatoalveolar cleft defects.
Assuntos
Fenda Labial/classificação , Fissura Palatina/classificação , Tomada de Decisões , Obturadores Palatinos , Planejamento de Assistência ao Paciente , Adulto , Fenda Labial/reabilitação , Fissura Palatina/reabilitação , Planejamento de Prótese Dentária , Humanos , Obturadores Palatinos/classificação , Palato Mole/patologia , Insuficiência Velofaríngea/classificação , Insuficiência Velofaríngea/reabilitaçãoRESUMO
Submucous cleft palate is a structural abnormality of the palate. The clinical features vary, as does the functional impairment, which ranges from none to severe. Although there is a poor correlation between the presenting clinical signs and the severity of velopharyngeal insufficiency during speech, a clinical grading system could assist surgical management and allow more meaningful comparisons to be made between outcome studies. The grading system described is based on clinical examination alone and reflects the likely degree of structural abnormality of the musculature of the soft palate.
Assuntos
Fissura Palatina/classificação , Humanos , Fístula Bucal/classificação , Músculos Palatinos/anormalidades , Palato Duro/anormalidades , Palato Mole/anormalidades , Úvula/anormalidades , Insuficiência Velofaríngea/classificaçãoRESUMO
This clinical randomized controlled trial was performed to compare the effects of distraction osteogenesis (DO) and conventional orthognathic surgery (CO) on velopharyngeal function and speech outcomes in cleft lip and palate (CLP) patients. Twenty-one CLP patients who required maxillary advancement ranging from 4 to 10 mm were recruited and randomly assigned to either CO or DO. Evaluation of resonance and nasal emission, nasoendoscopic velopharyngeal assessment and nasometry were performed preoperatively and at a minimum of two postoperative times: 3-8 months (mean 4 months) and 12-29 months (mean 17 months). Results showed no significant differences in speech and velopharyngeal function changes between the two groups. No correlation was found between the amount of advancement and the outcome measures. It was concluded that DO has no advantage over CO for the purpose of preventing velopharyngeal incompetence and speech disturbance in moderate cleft maxillary advancement.