Maxillary Protraction in Childhood or Adolescence in Cleft Lip and Palate: Limitations, Special ENT/OSAS Indications and Long Term Results

by Meazzini Maria Costanza

Class III malocclusion is common in patients with cleft lip and palate. It is estimated that depending on the surgical protocol and the skill of the surgeon himself, the need for osteotomy at the end of growth varies, in the unilateral forms, between about 15 and 60%. Premature maxillary protraction with the Facial Mask not only does not improve the prognosis in the long term, but is burdened by a relatively rapid relapse, therefore it should only be applied if there are functional indications. The most frequent indications in complete cleft lip and palate are hypoacusias secondary to recurrent catarrhal otitis and tubal dysfunction. Respiratory disorders (OSAS) are rarer. The application of a late protraction technique during adolescence. with a modified Altramec technique, it allows an average skeletal advance of more than 5 millimeters and therefore more similar to a surgical entity for the correction of maxillary retrusion. This technique allows stable results, that is to avoid a final orthognathic surgery without introducing dental compensation, in 80% of female patients and in 60% of male patients.

Learning Objectives

After this lecture, you will be able to understanding when a young patient with cleft lip and palate and a class III malocclusion should be treated and when it is best to wait
After this lecture, you will be able to understand how to coordinate your orthodontic treatment with the ENT, the neurologist (sleep disorders), the speech therapist and the surgeon in the treatment of these children
After this lecture, you will be able to understand a late maxillary advancement technique that allows stable results in a high percent of patients without introducing dental compensation