Stability of orthognatic surgery in cleft lip and palate patients

Introduction: Cleft lip and palate patients have often hypoplasia of midfacial area. Orthognathic surgery is often necessary to achieve good facial aesthetics and functional occlusion. The aim of this study is to evaluate maxillary stability after Le Fort I osteotomy in cleft lip and palate patients. Methods: Five patients, two women and three men, 17-22 years old with unilateral cleft lip and palate underwent comprehensive orthodontic and surgery treatment. The orthodontic treatment was performed at the Department of Orthodontics and Cleft Anomalies, University Hospital Královské Vinohrady and Le Fort I osteotomy at the Department of Maxillofacial Surgery in Masaryk Hospital, Ústí nad Labem. Maxillary stability after orthognathic surgery were measured at cephalograms, which were taken before (T1), first day after the surgery (T2) and 20 months after the procedure on average (T3). The position of maxilla was determined by measuring the SNA angle and horizontal and vertical position of the A point. Frankfort horizontal plane (FH) and line perpendicular to the FH from Porion point (Y), which were drawn on each cephalogram. Vertical dimension was measured as a distance between A point and FH (AX) and horizontal dimension as a distance between A point and the perpendicular line to FH (AY). All values were measured twice in four weeks interval by one evaluator and average values were used to eliminate measurement errors. Results: The SNA angle increased of 5.6° on average in all five patients after surgery, horizontal shift of the point A was 10.7 mm. The relapse was 4.7° in SNA angle and -7.1 mm in point A with major differences among patients. Vertical position of A point was changed by -3,4 mm on average after surgery. In some patients AX distance has grown, in some cases has shortened. Vertical position of A point has changed with high interindividual changes during period after surgery. Conclusion: The maxillary advancement Le Fort I in cleft lip and palate patients is not stable; relapse can be expected. The relapse rate is individual, probably caused by tissue retraction in the original scars or newly formed scar tissue, or by tension of surrounding soft tissues. However, the final occlusion is satisfactory in long-term period according to our experience. More detailed research should be done to determine causes and to investigate the extent of relapse

The Bollard Bone Anchored Miniplates in Patients with Skeletal Class III Malocclusion

Introduction and aim: The aim of this article is to introduce the method of skeletally anchored inter-jaw elastic forces in patients with skeletal class III malocclusion to the dental specialists. Skeletal class III malocclusion is an anomaly that affects 4-14% of the population in the context of anthropological specifics of different ethnic groups, with 0.48-4.0% in the Caucasian European and North American populations.This diagnosis in children often opens many therapeutic embarrassments not only in dentist, but also in orthodontist office. If the skeletal class III malocclusion develops dynamically and, moreover, with the emphasis on the unfavorable type of growth, during the adolescence it may result in the indication of demanding jaw correction operation. This is always accompanied with a complex orthodontic preparation, necessary postoperative orthodontic treatment and a long-term retention phase. In some types of skeletal class III malocclusions, it is possible to successfully intervene during growth. Early differential diagnosis by an orthodontist or maxillofacial surgeon is essential, followed by the determination of the most effective procedure for comprehensive treatment. Except for the described method, skeletal class III malocclusions are treated using removable and fixed appliances or extraoral elastic forces at the time of growth. A goal of this early age treatment is to create and maintain an overbite of the upper frontal teeth, to expand the upper dental arch, and to control the growth tendencies of the lower jaw at the time of dental replacement. Methods: The authors describe a surgical and orthodontic protocol for the use of skeletally anchored Bollard modified miniplates, which offers a therapeutic alternative to challenging orthognathic surgery. With a proper indication, the skeletal class III malocclusion manifestation can be significantly reduced and orthodontically compensated entirely or only partially to reduce the invasivity and extent of the necessary final orthognathic surgical intervention. The presented method offers a possibility of a growth modification of the upper jaw or of the entire stomatognathic system together with occlusion and dental arches relationship. An orthodontic part of the treatment involves adjusting the size and shape of dental arches, especially the transversal dimension of the upper dental arch. Furthermore, by applying elastic forces, the orthodontist regulates the growth of the jaws and adjusts, respectively changes their relationship. A surgical part consists of insertion of the skeletally anchored miniplates for application intermaxillary elastic forces. Results and conclusion: The authors present the therapeutic procedure which, despite its simplicity, remains on a margin of professional interest and out of the spectrum of commonly indicated methods of choice. The therapeutic appliances, considered diagnostic criteria and orthodontic as well as surgical treatment protocol are discussed, including possible complications