New treatment modality for maxillary hypoplasia in cleft patients. Protraction facemask with miniplate anchorage

Abstract

Objective: To present cleft patients treated with protraction facemask and miniplate anchorage (FM/MP) in order to demonstrate the effects of FM/MP on maxillary hypoplasia.

Materials and methods: The cases consisted of cleft palate only (12 year 1 month old girl, treatment duration = 16 months), unilateral cleft lip and alveolus (12 year 1 month old boy, treatment duration = 24 months), and unilateral cleft lip and palate (7 year 2 month old boy, treatment duration = 13 months). Curvilinear type surgical miniplates (Martin, Tuttlinger, Germany) were placed into the zygomatic buttress areas of the maxilla. After 4 weeks, mobility of the miniplates was checked, and the orthopedic force (500 g per side, 30 degrees downward and forward from the occlusal plane) was applied 12 to 14 hours per day.

Results: In all cases, there was significant forward displacement of the point A. Side effects such as labial tipping of the upper incisors, extrusion of the upper molars, clockwise rotations of the mandibular plane, and bite opening, were considered minimal relative to that usually observed with conventional protraction facemask with tooth-borne anchorage.

Conclusions: FM/MP can be an effective alternative treatment modality for maxillary hypoplasia with minimal unwanted side effects in cleft patients.

Figure 1

Comparison of pretreatment (left) and posttreatment (right) in patient with Class III malocclusion. (a) Facial photographs. (b) Intraoral photographs. (c) Lateral cephalograms. (d) Superimposition (solid line: pretreatment; dotted line: posttreatment).

Figure 2

Schematic drawing of the surgical positioning (a) and intraoral position of the miniplate (b).

Figure 3

Comparison of pretreatment (left) and posttreatment (right) in patient with cleft palate (case 1). (a) Facial photographs. (b) Intraoral photographs. (c) Lateral cephalograms. (d) Superimposition (solid line: pretreatment; dotted line: posttreatment).

Figure 4

Comparison of pretreatment (left) and posttreatment (right) in patient with unilateral cleft lip and alveolus (case 2). (a) Facial photographs. (b) Intraoral photographs. (c) Lateral cephalograms. (d) Superimposition (solid line: pretreatment; dotted line: posttreatment).

Figure 5

Comparison of pretreatment (left) and posttreatment (right) in patient with unilateral cleft lip and palate (case 3). (a) Facial photographs. (b) Intraoral photographs. (c) Lateral cephalograms. (d) Superimposition (solid line: pretreatment; dotted line: posttreatment).