title: An alternative clinical approach to achieve greater anterior than posterior maxillary expansion in cleft lip and palate patients.
abstract: Cleft lip and palate patients commonly present maxillary constriction, particularly in the anterior region. The aim of this case report was to describe an alternative clinical approach that used a smaller Hyrax screw unconventionally positioned to achieve greater anterior than posterior expansion in patients with complete unilateral cleft lip and palate. The idea presented here is to take advantage of a reduced dimension screw to position it anteriorly. When only anterior expansion was needed (patient 1), the appliance was soldered to the first premolar bands and associated to a transpalatal arch cemented to the first molars. However, when overall expansion was required (patient 2), the screw was positioned anteriorly, but soldered to the first molar bands. Intercanine, premolar, and first molar widths were measured on dental casts with a digital caliper. Pre-expansion and postexpansion radiographs and tomographies were also evaluated. A significant anterior expansion and no intermolar width increase were registered in the first patient. Although patient 2 also presented a greater anterior than posterior expansion, a noteworthy expansion occurred at the molar region. The alternative approach to expand the maxilla in cleft patients reported here caused greater anterior than posterior expansion when the Mini-Hyrax was associated to a transpalatal arch, and its reduced dimension also minimized discomfort and facilitated hygiene.
authors.affiliation: From the *Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil; and †School of Dentistry, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Dauro Douglas
authors.initials: DD
authors.lastname: Oliveira
authors.forename: Flávia Uchôa Costa
authors.initials: FU
authors.lastname: Bartolomeo
authors.forename: Lucas
authors.initials: L
authors.lastname: Cardinal
authors.forename: Daniel Santos Fonseca
authors.initials: DS
authors.lastname: Figueiredo
authors.forename: Juan Martin
authors.initials: JM
authors.lastname: Palomo
authors.forename: Ildeu
authors.initials: I
authors.lastname: Andrade
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D002648:Child; D002971:Cleft Lip / Q000000981:diagnostic imaging / Q000601:surgery*; D002972:Cleft Palate / Q000000981:diagnostic imaging / Q000601:surgery*; D054893:Cone-Beam Computed Tomography; D005260:Female; D006801:Humans; D008297:Male; D010155:Palatal Expansion Technique / Q000295:instrumentation*; D010159:Palate / Q000000981:diagnostic imaging / Q000601:surgery