Analysis of bone-reconstructive surgery aimed at normalization of occlusal relationships of the jaws at the final stages of rehabilitation treatment of children with congenital cleft lips and palate (Literature review)

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

BACKGROUND: The completion of medical rehabilitation of children aged 16–18 years with congenital cleft lips and palate is often impossible without surgical correction of occlusal relationships of the jaws and improvement of facial aesthetics. At the same time, the main efforts of the specialists engaged in the treatment of children with orofacial clefts are aimed at correcting local plastic operations of the upper lip, nose, oral cavity, and orthodontic, using non-removable arc equipment, correction of disturbed occlusion.

AIM: Our aim is to study and analyze the problems of final bone reconstructive operations in patients with HRGN.

MATERIALS AND METHODS: The article presents a review of the literature on this topic, based on 61 sources. The literature was searched by keywords in the databases such as PubMed, ScienceDirect, E-library, and Google Scholar from 1938 to 2020. The data on the treatment of children with combined maxillofacial anomalies and deformities with cleft lips and palate, who underwent reconstructive bone operations on the jaws in order to normalize their occlusal relationships, were analyzed.

RESULTS: In order to achieve good morphofunctional and aesthetic results, as well as early socialization of patients with VRGN at the final stages of rehabilitation, complex hardware and surgical treatment are necessary. The indication for reconstructive operations on the jaws in patients is the face disorder and disharmony of the face, which cannot be corrected by orthodontic treatment. The operations should be based on careful planning, including CT modeling, the use of sparing techniques, including various modifications of Le Faure I osteotomy on the upper jaw, and retromolar sagittal osteotomy of the jaw and, according to indications, genioplasty on the lower jaw.

CONCLUSIONS: Two-jaw orthognatic bone reconstructive operations on the jaws to restore the correct bite have recently been used in the complex medical rehabilitation of patients, especially in adolescents with VGN. At the same time, there are a number of unresolved issues of orthodontic and surgical treatment that require further study. There is a strong need for a clear understanding of the age of planning and timing of such operations considering the stage of completion of skeletal growth. The criteria for the patient’s readiness for surgery for multiple occlusive contacts also need to be evaluated. It is of paramount importance to determine the order of performing corrective operations on the soft tissues of the face and oral cavity. Hence there is a necessity to develop new methods of reconstructive operations on the jaws.

Full Text

Restricted Access

About the authors

Mikhail G. Semenov

North-Western State Medical University named after I.I. Mechnikov; H. Turner National Medical Reserch Centre for Children’s Orthopedics and Trauma Surgery

Email: sem_mikhail@mail.ru
ORCID iD: 0000-0002-0803-1923
SPIN-code: 2603-1085

MD, PhD, D.Sc., Professor

Russian Federation, 41 Kirochnaya str., Saint Petersburg, 191015; Saint Petersburg

Sofia A. Botsarova

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: sofhik01@mail.ru
ORCID iD: 0000-0002-4675-8517
SPIN-code: 4930-8561

MD, resident

Russian Federation, 41 Kirochnaya str., Saint Petersburg, 191015

Yulia V. Stepanova

H. Turner National Medical Reserch Centre for Children’s Orthopedics and Trauma Surgery

Email: turner8ord@gmail.com
ORCID iD: 0000-0003-3968-5206
SPIN-code: 8606-0381

MD, PhD

Russian Federation, Saint Petersburg

References

  1. Chujkin SV, Topol’nickij OZ. Lechenie vrozhdjonnoj rasshheliny guby i njoba. Moscow: Moskovskij izdatel’skij dom; 2017. (In Russ.)
  2. Abolmasov NG, Abolmasov NN. Glava 10. Rekonstruktivnye operacii pri razlichnyh anomalijah, deformacijah cheljustej i prikusa / Ortodontija: ucheb. posobie. Moscow: Medicina; 2008. (In Russ.)
  3. Anohina AV. Ranee vyjavlenie i reabilitacija detej s narushenijami formirovanija zubocheljustnoj sistemy. [dissertation] Kazan’; 2004. (In Russ.)
  4. Davletshin NA. Sposob shhadjashhej uranostafiloplastiki, preduprezhdajushhij ukorochenie i rubcevanie mjagkogo neba. Kazanskij medicinskij zhurnal. 2008(4):563–564. (In Russ.)
  5. Kamysheva LI. Ortodonticheskoe lechenie detej s rasshhelinami verhnej guby, al’veoljarnogo otrostka i neba v uslovijah polikliniki v period molochnyh zubov: ucheb. posobie. Moscow: Mosk. Gos. med.-stomatol. un-t.; 2001. (In Russ.)
  6. Korsak AK, Ljubeckij AV, Lapkovskij VI. Hirurgicheskoe lechenie detej s vrozhdennymi rasshhelinami verhnej guby i neba v rannem vozraste. Sovremennaja stomatologija. 2007;4:62–65. (In Russ.)
  7. Davydov BN, Lavrikov VG, Zarnov AV, et al. Osnovnye principy kompleksnogo podhoda v lechenii bol’nyh s vrozhdennymi rasshhelinymi. Stomatologija detskogo vozrasta i profilaktika. 2009;(3–4):18–20. (In Russ.)
  8. Topol’nickij OZ, Gurgenadze AP. Detskaja cheljustno-licevaja hirurgija. Sbornik illjustrirovannyh klinicheskih zadach i testov: uchebnoe posobie. 2-e izd., pererab. i dop. Moscow: GJeOTAR-Media, 2015. (In Russ.)
  9. Persin LS, Elizarova VM, D’jakova SV. Stomatologija detskogo vozrasta. 5 izd., pererab. i dop. Moscow: Medicina; 2006. (In Russ.)
  10. Dmitrienko SV, Fomenko IV, Dmitrienko DS, et al. Primenenie “kojefficienta jeffektivnosti kompleksnoj reabilitacii” dlja analiza rezul’tata lechenija detej s vrozhdennoj odnostoronnej rasshhelinoj verhnej guby i neba. Bjulleten’ Volgogradskogo nauchnogo centra RAMN. 2010;(2):50–53. (In Russ.)
  11. Fomenko IV. Jeffektivnost’ sovremennyh metodov diagnostiki i lechenija v kompleksnoj reabilitacii pacientov s vrozhdennoj odnostoronnej polnoj rasshhelinoj verhnej guby i neba. [dissertation] Volgograd; 2011. (In Russ.)
  12. Andreeva OV. Pojetapnaja reabilitacija detej s vrozhdennoj rasshhelinoj verhnej guby i neba. Vestnik Chuvashskogo universiteta. 2012(3):269–275. (In Russ.)
  13. Semenov MG, Mushkovskaja SS, Kovalenko KJu. Ocenka ostatochnyh i vtorichnyh deformacij srednej zony lica u pacientov s vrozhdennoj odnostoronnej rasshhelinoj verhnej guby. Ortopedija, travmatologija i vosstanovitel’naja hirurgija detskogo vozrosta. 2018;6(3):56–62. (In Russ.). doi: 10.17816/PTORS6356-62
  14. Fedotov RN. Planirovanie i taktika ortognaticheskogo hirurgicheskogo lechenija pacientov posle hejlo- i uranoplastiki. [dissertation] Moscow; 2010. (In Russ.)
  15. Chen KT, Huang CS, Noordhoff SM. Alveolar bone grafting in unilateral complete cleft lip and palate patients. Chang-Keng-I Hsueh. 1994;17(3):226–234.
  16. Evans CA. Orthodontic treatment for patients with clefts. Clinicsin Plastic Surgery. 2004;31(2):271–290. doi: 10.1016/S0094-1298(03)00125-1
  17. Arsenina OI, Malashenkova EI, Pashenko SA. Algoritm ortodonticheskogo lechenija pacientov s vrozhdennoj rasshhelinoj guby, neba i al’veoljarnogo otrostka do i posle kosnoj autoplastiki. Nauchno-prakticheskij zhurnal – Stomatologija. 2017;96(5). (In Russ.)
  18. Semenov MG, Kovalenko KJu. Ocenka stepeni tjazhesti ostatochnyh i vtorichnyh deformacij nosa i guby u vzroslyh pacientov s vrozhdennoj rasshhelinoj verhnej guby. Transljacionnaja medicina: ot teorii k praktike. Materialy 6-j nauchno-prakticheskoj konferencii molodyh uchenyh i specialistov. Saint Petersburg: FGBOU VO SZGMU im. I.I. Mechnikova Minzdrava Rossii; 2018. P. 39–40. (In Russ.)
  19. Posnick JC, Kinard BE. Challenges in the successful reconstruction of cleft lip and palate. Plastic and Reconstructive Surgery. 2020:145(3):591e–603e. doi: 10.1097/prs.0000000000006614
  20. Ewing M, Ross RB. Soft tissue response to orthognathic surgery in persons with unilateral cleft lip and palate. Cleft Palate Craniofac J. 1993;30(3):320–327. doi: 10.1597/1545-1569_1993_030_0320_strtos_2.3.co_2
  21. Posnick JC. Orthognathic surgery in the cleft patient. In: Instructional Courses, Plastic Surgery Education Foundation. St Louis: CV Mosby Co; 1991. P. 129–157.
  22. Posnick JC. The treatment of secondary and residual dentofacial deformities in the cleft patient: Surgical and orthodontic therapy. Secondary Management of Craniofacial Disorders. Clinics of Plastic Surgery. 1997;24:583–597.
  23. Chen PK-T, Por Y-Ch, Liou EJ-W, Chang FCh-Sh. Maxillry distraction osteogenesis in the adolescent cleft patient: 3D CT analysis of linear and volumetric changes over five years. CPCJ. 2011;48:445. doi: 10.1597/09-087
  24. Korotkova NL, Ivanov SJu, Muraev AA, Saf’janova EV. Klinika i lechenie pacientov s zubocheljustnymi anomalijami III klassa po klassifikacii Jenglja, sochetajushhimisja s uvelicheniem i udlineniem nosa. Stomatologija. 2018;97(5):58–61. (In Russ.)
  25. Bujda OA. Jeffektivnost’ ortodonticheskogo i ortopedicheskogo lechenija detej s defektami zubnogo rjada pri vrozhdennoj odnostoronnej polnoj rasshheline verhnej guby i neba. [dissertation] Volgograd; 2004. (In Russ.)
  26. Posnick JC, Ruiz R: (Discussion of) Repair of large anterior palatal fistulas using thin tongue flaps. Annals of Plastic Surgery. 2000;45:114–117. doi: 10.1097/00000637-200045020-00001
  27. Laspos CP, Kyrkanides S, Tallents RH, et al. Mandibular and maxillary asymmetry in individuals with unilateral cleft lip and palate. The Cleft Palate-Craniofacial Journal. 1997;34(3):232–239.
  28. Bill J, Proff P, Bayerlein T, et al. Orthognathic surgery in cleft patients. J Craniomaxillofac Surg. 2006;34(Suppl 2):77–81. doi: 10.1016/S1010-5182(06)60017-6
  29. Steinkamm W. Die Pseudo-Progenie und ihre Behandlung. Berlin, 1938.
  30. Gillies HD, Rowe NL. L’ostéotomie du maxillaire supérieur envisagee essentiellement dans les cas de bec-de-lièvre total. Presse Medicale. 1954;62:215–216.
  31. Gillies HD, Millard DR. The principles and art of plastic surgery. Boston: Little, Brown; 1957.
  32. Willmar K. On Le Fort I osteotomy; A follow-up study of 106 operated patients with maxillo-facial deformity. Scand J PlastReconstr Surg. 1974;12:1–68.
  33. Jackson IT. Cleft and jaw deformities. In: Whitaker LA, Randall P. Symposium on reconstruction of jaw deformities. St Louis: CV Mosby; 1978. P. 243–251.
  34. Drommer R. Selective angiographic studies prior to Le Fort I osteotomy in patients with cleft lip and palate. J Maxillofac Surg. 1979;7:264–270. doi: 10.1016/s0301-0503(79)80051-x
  35. Lanigan DT. Wound healing after multisegmental Le Fort I osteotomy and transection of the descending palatine vessels. J Oral Maxillofac Surg. 1995;53:1433–1434. doi: 10.1016/0278-2391(95)90670-3
  36. Obwegeser HL. Correction of the facial appearance of harelip and cleft palate patients by surgery on the jaws. Exerpta Medica International Congress Series. 1966;141:110–117. doi: 10.1080/08998280.2002.11927848
  37. Obwegeser HL. Surgery as an adjunct to orthodontics in normal and cleft palate patients. Report of the congress. European Orthodontic Society. 1967;42:343–353.
  38. Wunderer S. Die Progenioperationmittles frontal gestieltem maxillofragment. Osterr Z Stomatol. 1962;59:98–102.
  39. Bell WH. Revascularization and bone healing after anterior maxillary osteotomy: A study using adult rhesus monkeys. J Oral Surg. 1969;27:249–255.
  40. Schuchardt G. Ein beitrag zur chirugischen kieferorthopadie unter beru cksichtigung ihrer bedentung fur die behandlung angeborener und erworbener kieferdeformitaten bei soldaten. Dtsch Zahn Mund Kieferheilkd. 1942;9:73–89.
  41. Bell WH, Levy BM. Revascularization and bone healing after posterior maxillary osteotomy. J Oral Surg. 1971;29:313–320.
  42. Posnick JC. Cleft orthognathic surgery: The bilateral cleft lip and palate deformity. In: Posnick JC, ed. Orthognathic surgery: Principles and practice. St. Louis: Elsevier; 2014. P. 1371–1440.
  43. Cheung LK, Chua HD. A meta-analysis of cleft maxillary osteotomy and distraction osteogenesis. Int J Oral Maxillofac Surg 2006;35(1):14–24. doi: 10.1016/j.ijom.2005.06.008
  44. Cheung LK, Chua HD, Hagg MB. Cleft maxillary distraction versus orthognathic surgery: clinical morbidities and surgical relapse. Plast Reconstr Surg. 2006;118(4):996–1008. doi: 10.1097/01.prs.0000232358.31321
  45. Phillips JH, Nish I, Daskalogiannakis J. Orthognathic surgery in cleft patients. Plast Reconstr Surg. 2012;129(3):535e–548e. doi: 10.1097/PRS.0b013e31824128e6
  46. Doucet JC, Herlin C, Bigorre M, et al. Effects of growth on maxillary distraction osteogenesis in cleft lip and palate. J Craniomaxillofac Surg. 2013;41(8):836–841. doi: 10.1016/j.jcms.2013.01.038
  47. Tae KC, Gong SG, Min SK, et al. Use of distraction osteogenesis in cleft palate patients. Angle Orthod. 2003;73(5):602–607. doi: 10.1043/0003-3219(2003)073<0602:UODOIC>2.0.CO;2
  48. Gerbino G, Gervasio FC, Blythe J, Bianchi FA. The management of iatrogenic obstructive sleep apnoea syndrome following bimaxillary surgery in a patient with cleft lip and palate. J Craniomaxillofac Surg. 2016;27(5):1286–1288. doi: 10.1097/SCS.0000000000002747
  49. Karia H, Shrivastav S, Karia AK. Three-dimensional evaluation of the airway spaces in patients with and without cleft lip and palate: A digital volume tomographic study. Am J Orthod Dentofacial Orthop. 2017;152(3):371–381. doi: 10.1016/j.ajodo.2016.12.026
  50. Swennen G, Colle F, De AM, Malevez C. Maxillary distraction in cleft lip palate patients: A review of six cases. J Craniomaxillofac Surg. 1999;10(2):117–122. doi: 10.1097/00001665-199903000-00005
  51. Kuo-Ting Chen P, Por Y-C, Jein-Wein Liou E, Chun-Shin Chang F. Maxillary distraction osteogenesis in the adolescent cleft patient: Three-dimensional computed tomography analysis of linear and volumetric changes over five years. The Cleft Palate-Craniofacial Journal. 2011;48(4):445–454. doi: 10.1597/09-087
  52. Posnick JC, Tiwana PS. Cleft-orthognathic surgery. In: Berkowitz S, ed. Cleft lip and palate. Heidelberg, Berlin: Springer; 2006. P. 573–585. doi: 10.1016/S0094-1298(03)00132-9
  53. Drommer RB. The history of the “Le fort I osteotomy”. J Maxillofacial Surg. 1986;14:119–122. doi: 10.1016/s0301-0503(86)80275-2
  54. Obwegeser HL. Orthognathic surgery and a tale of how three procedures came to be: A letter to the next generations of surgeons. Clinicsin Plastic Surgery. 2007;34(3):331–355. doi: 10.1016/j.cps.2007.05.014
  55. Levy-Bercowski D, DeLeon E Jr, Stockstill JW, et al. Orthognathic cleft-surgical/orthodontic treatment. Semin Orthod. 2011;17(3):197–206. doi: 10.1053/j.sodo.2011.02.004
  56. Andreishhev AR, Chebotarev SJa, Gorban’ VV, Rudoman SO. Ortognaticheskaja hirurgija i konturnaja plastika. Sinergizm ili protivostojanie? Stomatologija. 2020;99(5):103–110.
  57. Andreeva OV. Pojetapnaja reabilitacija detej s vrozhdennoj rasshhelinoj verhnej guby i neba. Vestnik Chuvashskogo universiteta. 2012;(3):269–275. (In Russ.)
  58. Chujkin SV, Persin LS, Davletshin NA. Vrozhdennaja rasshhelina verhnej guby i neba. Moscow: MIA; 2011. P. 173–238. (In Russ.)
  59. Stepanova JuV, Cyplakova MS. Osnovnye napravlenija v kompleksnoj reabilitacii detej s vrozhdennymi rasshhelinami guby i neba. Ortopedija, travmatologija i vosstanovitel’naja hirurgija detskogo vozrasta. 2013;1(1):36–43. (In Russ.). doi: 10.17816/PTORS1136-4
  60. Horoshilkina FJa, Malygin JuM, Persin LS. Lechenie zubocheljustno-licevyh anomalij: ucheb. posobie. Moscow: MIA; 2011. P. 251–275. (In Russ.)
  61. Horoshilkina FJa, Persin LS, Kalashnikova VP. Ortodontija: ucheb. posobie. Moscow: MIA; 2005. Vol. 4. P. 431–440. (In Russ.)

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2021 Semenov M.G., Botsarova S.A., Stepanova Y.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС77-54261 от 24 мая 2013 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies