title: Excessive rapid palatal expansion with Latham appliance for distal repositioning of protruded premaxilla in bilateral cleft lip and alveolus.
abstract: OBJECTIVE
  This article reports a case of bilateral cleft lip and alveolus (BCLA) for which excessive rapid palatal expansion with a Latham appliance was performed for preoperative alignment of the protruded premaxilla. Postoperative changes of maxillary width were investigated with serial plaster casts.
  
  
  RESULTS
  A 3-month-old girl presented with complete BCLA in which the premaxilla was markedly protruded. Preoperative alignment of the protruded premaxilla with a Latham appliance was planned to facilitate primary lip repair. The appliance was placed when the patient was 4.5 months old. The necessary palatal expansion was estimated to be 7.0 mm in order to move the premaxilla backward into the ideal position. After palatal expansion and posterior repositioning of the protruded premaxilla, the primary operation, including cheiloplasty and gingivoperiosteoplasty, was performed when the patient was 7 months old. Excessive maxillary expansion might be a cause of transverse maxillomandibular discrepancy. Measurement with serial plaster casts demonstrated that maxillary widths increased from 42.3 mm pretreatment to 49.0 mm after orthopedic treatment but relapsed markedly to 43.5 mm at 3 months after the primary operation. Therefore, the net change of maxillary widths was only 1.2 mm. After alignment of the protruded premaxilla, tension-free soft tissue repairs were performed, and a harmonious alveolar arch was obtained without change in maxillary width.
  
  
  CONCLUSIONS
  These results indicate that this method is useful for preoperative management of BCLA with protruded premaxilla.
authors.affiliation: Orthodontic Science, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan. e.fukuyama.orts@tmd.ac.jp
authors.forename: Eiji
authors.initials: E
authors.lastname: Fukuyama
authors.forename: Susumu
authors.initials: S
authors.lastname: Omura
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fujita
authors.forename: Kunimichi
authors.initials: K
authors.lastname: Soma
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Torikai
mesh_terms: D000539:Alveolar Process / Q000002:abnormalities*; D000543:Alveoloplasty; D002508:Cephalometry; D002971:Cleft Lip / Q000601:surgery / Q000628:therapy*; D003724:Dental Arch / Q000473:pathology; D005260:Female; D005893:Gingivoplasty; D006801:Humans; D007223:Infant; D008046:Lip / Q000601:surgery; D008437:Maxilla / Q000473:pathology*; D003765:Models, Dental; D016382:Orthodontic Appliance Design; D010155:Palatal Expansion Technique / Q000295:instrumentation*; D010521:Periosteum / Q000601:surgery