Cleft Maxillary Reconstruction

Description

This book aims to teach the reader about all aspects of maxillary cleft reconstruction, with emphasis on management of the patient born with a congenital anomaly, cleft lip and palate, which will usually have been managed by several different providers during earlier childhood. Clinical anatomy, clinical and imaging assessment (including the role of CBCT), orthodontic considerations, surgical repair techniques, the approach in special situations, and outcome evaluation are all thoroughly described. While the focus is especially on the patient with mixed dentition, due attention is paid to prior influences on that stage, as well as to the changes that will occur subsequently. Maxillary cleft reconstruction is a uniquely multidisciplinary component in reconstruction of cleft lip and palate. It is one of the most complex phases of rehabilitation, wherein orthodontics, dentistry, and surgery are immediately involved but presentation and eventual outcomes are heavily influenced by operations during the first year of life and by growth that is unpredictable and iatrogenically altered. This book will be of high educational and practical value to all who have an interest in the management of patients with cleft lip and palate.  Foreword Contents 1: Alveolar Cleft Grafting: Origins, Advances, Prospects 1.1 Introduction 1.2 Therapeutic Maneuvers 1.3 Bone: Physiology and Donor Sites 1.4 Adjunctive Elements 1.5 Summary References 2: Clinical and Diagnostic Anatomy 2.1 Anatomy 2.1.1 Unilateral Cleft Lip and Palate (UCLP) 2.1.2 Bilateral Cleft Lip and Palate (BCLP) 2.1.3 Cleft Palate 2.2 Vasculature 2.3 Conclusion References 3: Clinical and Diagnostic Findings During Mixed Dentition 3.1 Clinical Findings 3.1.1 Nonsurgical Interventions 3.1.2 Primary Cleft Lip Surgery 3.1.3 Primary Cleft Palate Surgery 3.1.4 Oral Soft Tissue 3.1.5 Fistulas 3.1.6 Teeth in Cleft 3.1.7 Malocclusion 3.1.8 Speech 3.1.9 Nasal Deformity 3.1.10 Sleep Disorders 3.2 Diagnostic Findings 3.2.1 Clinical Speech Evaluation 3.2.2 Nasopharyngoscopy 3.2.3 Videofluoroscopic Evaluation 3.2.4 Speech Bulb 3.2.5 Palatal Obturator 3.2.6 Radiographic Studies 3.2.7 Two-Dimensional Imaging 3.2.8 Cone Beam CT 3.3 Conclusions References 4: Orthodontic Considerations for Patients with Cleft Lip and Palate 4.1 Introduction 4.2 Stages of Orthodontics 4.2.1 Neonatal 4.2.2 Primary Dentition 4.2.3 Mixed Dentition 4.2.3.1 Managing Teeth before Alveolar Bone Grafting 4.2.3.2 Retention and Stability during and Post-Bone Graft Surgery 4.2.3.3 Tooth Movement Post Alveolar Bone Graft 4.2.3.4 Orthopedic Forces Post-Operatively 4.2.4 Permanent Dentition References 5: Donor Site Options 5.1 Introduction 5.2 Gingivoperiosteoplasty 5.3 Rib 5.4 Cranium 5.5 Ilium 5.6 Mandible 5.7 Tibia 5.8 Allogeneic Grafts 5.9 Bioceramics 5.10 Xenograft 5.11 BMPs/Factors 5.12 Combined Modalities 5.13 Conclusion References 6: Surgical Repair of Maxillary Unilateral Cleft Defect 6.1 Timing for Surgery 6.2 Preparation 6.3 Techniques 6.3.1 Traditional Anterior Iliac Crest Bone Grafting to Cleft Maxilla: Donor Site 6.3.2 Nontraditional Cleft Maxillary Bone Grafting: Donor Site 6.3.3 Traditional Anterior Iliac Crest Bone Grafting to Cleft Maxilla: Recipient Site (Video 6.6) 6.3.4 Older Patients: Anterior Iliac Crest Bone Grafting to Cleft Maxilla: Recipient Site 6.4 Post op Care References 7: Surgical Repair of Maxillary Bilateral Cleft Defect 7.1 Timing for Surgery 7.2 Preparation 7.3 Technique 7.3.1 Traditional Posterior Iliac Crest Bone Grafting to Cleft Maxilla: Donor Site 7.3.2 Nontraditional Cleft Maxillary Bone Grafting: Donor Site 7.3.3 Traditional Posterior Iliac Crest Bone Grafting to Cleft Maxilla: Recipient Site (Videos 7.1, 7.2, 7.3, 7.4, 7.5, and 7.6) 7.4 Post OP Care References 8: Special Situations 8.1 Buccal “Finger” Flaps – Rotating Flap 8.2 Facial Artery Myomucosal (FAMM) Flaps 8.3 Tongue Flap 8.4 Transport Alveolar Distraction Osteogenesis 8.5 Osteotomies 8.5.1 Premaxillary Osteotomies 8.5.2 Lefort I Osteotomy: Closing the Cleft Dental Gap 8.5.3 Free Flap Surgery 8.6 Other Flaps 8.7 When to Call It Quits? Obturators? Conventional Prosthetics? References 9: Modified Orthognathic Surgery to Manage the Residual Alveolar Cleft(s) 9.1 Unilateral Cleft Lip and Palate Jaw Deformities 9.1.1 Facial Growth Implications in UCLP after Palate Repair in Infancy 9.1.2 Residual Deformities in the Adolescent with UCLP 9.1.3 Orthodontic Considerations in the UCLP Adolescent with a Jaw Deformity 9.1.4 UCLP Orthognathic Surgical Approach 9.1.4.1 Standard Le Fort I Osteotomy 9.1.4.2 Modified (Two-Segment) Le Fort I Osteotomy 9.2 Bilateral Cleft Lip and Palate Jaw Deformities 9.2.1 Facial Growth Implications in BCLP after Palate Repair in Infancy 9.2.2 Residual Deformities in the Adolescent with BCLP 9.2.3 Orthodontic Considerations in the BCLP Adolescent with a Jaw Deformity 9.2.4 BCLP Orthognathic Surgical Approach 9.2.4.1 Standard Le Fort I Osteotomy 9.2.4.2 Modified (3-Segment) Le Fort I Osteotomy 9.3 Cleft Orthognathic Surgery: Avoiding Pitfalls 9.3.1 Mobilization of the Down-Fractured Cleft Maxilla 9.3.2 Horizontal Advancement and Vertical Lengthening of the Cleft Maxilla 9.3.3 Closure of Residual Oro-Nasal Fistula and Alveolar Ridge Management 9.3.4 Managing the Nasal Cavity and Nose 9.3.5 Management of the Mandibular Deformity 9.3.6 Management of the Chin Deformity 9.4 Conclusions References 10: Establishing the Final Occlusion 10.1 The Missing Lateral Incisor 10.2 The Missing Lateral Incisor: Canine Substitution 10.3 The Missing Lateral Incisor – Prosthetic Replacement References 11: Patient Outcomes for Maxillary Cleft Management: Literature Review and Guiding Principles 11.1 Introduction 11.2 Primary Bone Grafting 11.2.1 Cohort Studies 11.2.2 Meta-Analyses and Systematic Reviews 11.3 Gingivoperiosteoplasty 11.3.1 Latham “Pinning” 11.3.1.1 Cohort Studies 11.3.1.2 Meta-Analyses and Systematic Reviews 11.3.2 Naso-Alveolar “Molding” 11.3.2.1 Cohort Studies 11.3.2.2 Meta-Analyses and Systematic Reviews 11.4 “Early” Secondary Bone Grafting (Prior to Canine Eruption) 11.4.1 Cohort Studies 11.4.2 Meta-Analyses and Systematic Reviews 11.5 “Late” Secondary (After Canine Eruption) and Salvage Alveolar Bone Grafting 11.5.1 Cohort Studies 11.6 Simultaneous Management of Residual Alveolar Cleft Defects and Cleft Maxillary Hypoplasia Using Modified Le Fort I (Segmental) Osteotomies 11.6.1 Cohort Studies 11.7 Conclusions 11.8 Current Guiding Principles for Alveolar Cleft Management References