title: A novel active intraoral appliance for presurgical orthopaedic treatment in patients with complete bilateral cleft lip and palate.
abstract: BACKGROUND
  Management of the protruding/deviated premaxilla in patients with complete bilateral cleft lip and palate is a challenging problem for surgeons and orthodontists. Various passive and active methods have been developed for the presurgical orthopaedic treatment. However, most of these treatments are complicated and laborious for the patient's parents and clinicians. Here, we describe our original active intraoral appliance comprising two components, that is, the premaxillary and palatine process plates, connected with two elastic chains, and we assess its therapeutic efficacy.
  
  
  METHODS
  We retrospectively evaluated 15 patients treated using this appliance during 2006-2012, followed up for an average of 60.3 months (range, 18-97 months). We analysed the cleft widths and maxillary size, obtained pretreatment, post-treatment and pre-palatoplasty.
  
  
  RESULTS
  Cleft widths and premaxillary protrusion were significantly decreased post treatment; however, the transverse dimensions were not significantly altered. In all cases, the protruding/deviated premaxilla was set into a suitable position within 1 month, and we could perform one-stage cheiloplasty using the modified Mulliken method with low tension.
  
  
  CONCLUSIONS
  Our appliance is technically simple to use, less invasive to the skin and bone and cost-effective, with reliable and predictable outcomes. In the follow-up period, we observed no detrimental growth of the maxilla or dentition. Therefore, we consider our appliance to be useful for application in presurgical orthopaedic treatments of complete bilateral cleft lip and palate.
authors.affiliation: Department of Plastic Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai Suma-Ku, Kobe, Japan. Electronic address: kiyapsurg@yahoo.co.jp.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kiya
authors.affiliation: Department of Plastic Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai Suma-Ku, Kobe, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Oyama
authors.affiliation: Department of Dentistry, Kobe Children's Hospital, 1-1-1 Takakuradai Suma-Ku, Kobe, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Sone
authors.affiliation: Kanomi Dental Clinic, 30-1 Minamiekimaecho, Himeji, Hyogo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ishii
authors.affiliation: Department of Plastic Surgery, Osaka University Graduate School of Medicine, 2-2-C11 Yamadaoka, Suita, Osaka, Japan.
authors.forename: Ko
authors.initials: K
authors.lastname: Hosokawa
mesh_terms: D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D002972:Cleft Palate / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010158:Palatal Obturators; D011300:Preoperative Care / Q000295:instrumentation*; D011474:Prosthesis Design; D012189:Retrospective Studies
keywords: Active appliance; Complete bilateral cleft lip and palate; Intraoral appliance; Presurgical orthopaedic treatment; Protruding premaxilla