Browsing by Author "Uribe, Maria Francisca"

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    Cleft Lip and Palate Midfacial Hypoplasia: Criteria to Choose the Treatment
    (2022) Farina, Rodrigo; Lolas, Jorge; Moreno, Emilio; Alister, Juan Pablo; Uribe, Maria Francisca; Pantoja, Roberto; Valladares, Salvador; Arrue, Camila
    A series of skeletal and dentoalveolar/occlusal criteria were proposed for choosing the treatment modality for the management of midface hypoplasia in cleft lip/palate patients, focusing on functional improvement, aesthetics, and minimizing the risk of recurrence and secondary alterations. For which, 42 patients with nonsyndromic cleft lip/palate, all with previous primary lip/palate surgeries and without previous osteotomies, were analyzed. Orthognathic surgery (OS) (n = 24) and maxillary distraction osteogenesis (n = 18) with anterior segmental osteotomies (segmental distraction osteogenesis [SD]), alveolar transport disc (TD), and midface total distraction osteogenesis (TDO) by modified Le Fort III osteotomy was done. The average of maxillary advancement for OS was 5.58 +/- 0.83 mm, for SD 9.4 +/- 0.89 mm, for TD 8.00 +/- 1.00 mm, and for TDO was 8.13 +/- 1.55 mm. In the presence of infraorbital and/or zygomatic hypoplasia, TDO was performed using skeletal anchorage, with the requirement of occlusal stability in dental cast in occlusion. In short maxillary arch without dental cast feasibility in occlusion, hypodontia/agenesis or absence of premaxilla, TD and SD was performed. There was only 1 mm of recurrence in 1 patient of each group. Changes in speech were detected in 2 patients in the OS group (8.3%). Orthognathic surgery can be indicated for advancements <= 7 mm not requiring orbito-zygomatic advancement, whereas distraction osteogenesis can be indicated for advances >8 mm with or without the need for orbito-zygomatic advancement, in addition with other dentoalveolar factors and velopharyngeal function.