title: Maxillary growth after the use of protraction head gear in conjunction with presurgical orthopedics and gingivoperiosteoplasty for complete bilateral cleft lip and alveolus patients.
abstract: BACKGROUND
  Maxillary development is often inadequate in bilateral cleft patients. The use of presurgical orthopedics (PSO) and gingivoperiosteoplasty (GPP) may promote bone formation at the alveolar cleft, but can also have detrimental effects on maxillary development. Our objective was to investigate the effect of PSO and GPP on maxillary development in bilateral cleft lip and alveolus (BCLA) patients.
  
  
  METHODS
  We had 3 complete BCLA patients who had received PSO. All patients underwent cheiloplasty and GPP simultaneously. At 4 years, maxillary protraction head gear was used as part of the protocol. They were evaluated by cephalometric analysis at 4 and 8 years of age, and by CT imaging at 5 years of age.
  
  
  RESULTS
  At 4 years of age, patients with all BCLA had anterior crossbite of deciduous central incisors. As a result of maxillary protraction, jaw development at 8 years was good. Among all patients, only one showed bone formation at the alveolar cleft sufficient to avoid alveolar bone grafting (ABG).
  
  
  CONCLUSIONS
  All patients presented anterior crossbite in the premaxillary region, but had good maxillary growth at 8 years old as a result of maxillary protraction. The combination of PSO and GPP can potentially eliminate the need for ABG and does not significantly retard maxillary development. PSO with GPP and protraction head gear may be an option, but long-term growth is not known.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Kanagawa Children's Medical Center, Yokohama, †Hirakawa Orthodontic Clinic, Hirakawa, ‡Fukawa Orthodontic Clinic, Shizuoka, and §Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Hirakawa
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Fukawa
authors.forename: Jiro
authors.initials: J
authors.lastname: Maegawa
mesh_terms: D000543:Alveoloplasty / Q000379:methods*; D002675:Child, Preschool; D002971:Cleft Lip / Q000628:therapy*; D005260:Female; D005893:Gingivoplasty / Q000379:methods*; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000473:pathology; D008437:Maxilla / Q000254:growth & development*; D008445:Maxillofacial Development; D009970:Orthodontics / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*