title: Modified technique of presurgical infant maxillary orthopedics for complete unilateral cleft lip and palate.
abstract: This article introduces a modified device fabrication and facial taping method that increases the efficiency and efficacy of presurgical infant maxillary orthopedic therapy for babies born with complete cleft lip and palate. Interarch and intra-arch relationships of the maxillary and mandibular dental arches were evaluated on mounted stone models before and after treatment. The palatal plate device was custom-fabricated in a manner that bypassed the need for periodic acrylic addition and removal, thereby eliminating the risk of natural maxillary growth restriction during therapy. Elastic labial tapes were fabricated and applied in a configuration that mimicked normal function of the orbicularis oris muscle. A nasal stent wire was utilized from the initiation of therapy to enhance intraoral retention and stability of the device. Examples of infants undergoing a unilateral complete cleft lip and palate treatment protocol are presented. Treatment objectives were achieved within 7 to 8 weeks of therapy for patients who had an initial alveolar cleft size more than 10 to 12 mm. The modified protocol of presurgical infant maxillary orthopedic therapy is an effective and efficient treatment modality in reversing the pre-existing orofacial dysmorphism by redirecting the infant's natural growth.
authors.affiliation: Philadelphia, Pa. From the Division of Plastic Surgery, The Children's Hospital of Philadelphia; University of Pennsylvania School of Dental Medicine; and University of Pennsylvania School of Medicine.
authors.forename: HyeRan
authors.initials: H
authors.lastname: Choo
authors.forename: Meg
authors.initials: M
authors.lastname: Maguire
authors.forename: David W
authors.initials: DW
authors.lastname: Low
mesh_terms: D002971:Cleft Lip / Q000601:surgery / Q000628:therapy*; D002972:Cleft Palate / Q000601:surgery / Q000628:therapy*; D004867:Equipment Design; D006801:Humans; D007231:Infant, Newborn; D008437:Maxilla / Q000254:growth & development / Q000601:surgery; D010158:Palatal Obturators; D015607:Stents