ORTHOPEDIC MAXILLARY PROTRACTION IN GROWING PATIENTSWITH BILATERAL CLEFT LIP AND PALATE: AN INTEGRATIVE REVIEWOF THE LITERATURE

El Honsali Yasmina; El haddaoui Rajae; Halimi Abdelali; Zaoui Fatima

doi:10.69909/

Authors

El Honsali Yasmina Departamento de Ortopedia Dentofacial, Mohammed V University, Rabat, Marrocos
El haddaoui Rajae Departamento de Ortopedia Dentofacial, Mohammed V University, Rabat, Marrocos
Halimi Abdelali Departamento de Ortopedia Dentofacial, Mohammed V University, Rabat, Marrocos
Zaoui Fatima Departamento de Ortopedia Dentofacial, Mohammed V University, Rabat, Marrocos

DOI:

https://doi.org/10.69909/

Keywords:

Maxillary protraction, Orthodontic, Cleft lip, Growing patients

Abstract

The therapeutic management of patients with cleft lip and palate is challenging, and complete bilateral clefts are the most difficult to treat. These patients have a growth deficit related to early reconstructive procedures. This study aimed to review the literature on maxillary protraction protocols and their effects in growing patients with bilateral cleft lip and palate. The PubMed, ScienceDirect, Cochrane Library, and Virtual Health Library, and Scopus databases were searched using keywords “maxillary protraction”, “bilateral cleft”, and “orthodontic” combined with the Boolean operator “AND”. In total, three protocols for protraction in patients with bilateral cleft lip and palate are reported: face mask protraction with dental anchorage, face mask protraction with skeletal anchorage, and intermaxillary traction with skeletal anchorage. The results suggest that dental and skeletal anchorage protraction therapies effectively treat patients with maxillary hypoplasia, although the specific effects vary according to treatment protocol, type of anchorage, and factors related to cleft
severity and surgical history. Orthopedic protraction of the maxilla has positive aesthetic, skeletal, and functional effects. Early treatment and the use of skeletal anchorages enhance these effects. Large studies are needed to determine the best protocol for optimal results.

References

1. Vyas T, Gupta P, Kumar S, Gupta R, Gupta T, Preet Singh H. Cleft of lip and palate: A review. J Family Med Prim Care. 2020;9(6):26212625.

2. Mai CT, Isenburg JL, Canfield MA, Meyer RE, Correa A, Alverson CJ, Lupo PJ, Riehle-Colarusso T, Cho SJ, Aggarwal D, Kirby RS. National Birth Defects Prevention Network. National population-based estimates for major birth defects, 2010-2014. Birth Defects Res. 2019;111(18):1420-1435.

3. Bennun RD, Harfin HH. Bilateral Cleft Lip and Palate With Facial Dysplasia: Interdisciplinary Treatment and Long-Term Follow-Up. J Craniofac Surg. 2018;29(6):1441-4.

4. Trotman CA, Bruce R.R. Craniofacial Growth in Bilateral Cleft Lip and Palate: Ages Six Years to Adulthood. Cleft Palate Craniofac J. 1993;30(3):261-273.

5. Fariña R, Lolas J, Moreno E, Alister JP, Uribe MF, Pantoja R, Valladares S, Arrué C.Cleft Lip and Palate Midfacial Hypoplasia: Criteria to Choose the Treatment. J Craniofac Surg. 2021.

6. Téllez-Conti C, Mora-Diaz I, Díaz-Báez D, Ocampo-Arias IJ, Jiménez-Luna NI, Niño-Paz JC, González-Carrera MC. Craniofacial Growth Analysis of Individuals With and Without Cleft Lip and Palate in Colombia. Cleft Palate Craniofac J. 2022;59(5):577-588.

7. Palikaraki G, Makrygiannakis MA, Zafeiriadis A, Benetou V, Sanoudos M, Bitsanis I, Tsolakis AL. The effect of facemask in patients with unilateral cleft lip and palate: a systematic review and meta-analysis. Eur J Orthod. 2021;29;43(1):6979.

8. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

9. Ulusoy ME, Koyuncu V, Ceylan S, Akın S. Alterations in facial soft tissue thickness post-facemask treatment in noncleft skeletal Class III and bilateral cleft lip palate Class III patients. Turk J Orthod. 2022;35(3):207-215.

10. Kobayashi S, Hirakawa T, Fukawa T, Maegawa J. Maxillary growth after maxillary protraction: Appliance in conjunction with presurgical orthopedics, gingivoperiosteoplasty, and Furlow palatoplasty for complete bilateral cleft lip and palate patients with protruded premaxilla. J Plast Reconstr Aesthet Surg 2015;68(6):758-63.

11. Tindlund RS, Rygh P. Soft-Tissue Profile Changes during Widening and Protraction of the Maxilla in Patients with

Cleft Lip and Palate Compared with Normal Growth and Development. Cleft Palate Craniofac J. 1993;30(5):454-68.

12. Tindlund RS, Rygh P. Maxillary Protraction: Different Effects on Facial Morphology in Unilateral and Bilateral Cleft Lip and Palate Patients. Cleft Palate Craniofac J. 1993;31(4):296-308.

13. Kim JE. Effects of the long-term use of maxillary protraction facemasks with skeletal anchorage on pharyngeal airway dimensions in growing patients with cleft lip and palate. Korean J Orthod. 2020;25;50(4):238-248.

14. Woon On S, Baek S-H, Choi J-Y. Effect of Long-Term Use of Facemask With Miniplate on Maxillary Protraction in Patients With Cleft Lip and Palate. J Craniofac Surg. 2018;29(2):309-314.

15. Ahn HW, Kim KW, Yang IH, Choi JY, Baek SH. Comparison of the effects of maxillary protraction using facemask and miniplate anchorage between unilateral and bilateral cleft lip and palate patients. Angle Orthod. 2012;82(5):935-41.

16. Jahanbin A, Kazemian M, Eslami N, Saeedi Pouya I. Maxillary Protraction With Intermaxillary Elastics to Miniplates Versus Bone-Anchored Face-Mask Therapy in Cleft Lip and Palate Patients. J Craniofac Surg. 2016;27(5):1247-52.

17. Baeka SH, Kimb KW, Choic JY. New treatment modality for maxillary hypoplasia in cleft patients Protraction facemask with miniplate anchorage. Angle Orthod. 2010;80:783-791.

18. Faco R, Yatabe M, Cevidanes LHS, Timmerman H, De Clerck HJ, Garib D. Bone-anchored maxillary protraction in unilateral cleft lip and palate: a cephalometric appraisal. Eur J Orthod. 2019;41(5):537-543.

19. Han Eur. H, Xu Y-F, Duan Y-F, Lei Y-F. Biomechanical effect of 2 anchorages on maxillary protraction with cleft lip and palate: a finite element analysis. Shanghai Kou Qiang Yi Xue. 2017;26(1):1-6.

20. De Clerck HJ, Cornelis MA, Cevidanes LH, Heymann GC, Tulloch CJ. Orthopedic Traction of the Maxilla With Miniplates: A New Perspective for Treatment of Midface Deficiency. J Oral Maxillofac Surg. 2009;67(10): 2123-2129.

21. Zhang W, Qu HC, Yu M, Zhang Y. The Effects of Maxillary Protraction with or without Rapid Maxillary Expansion and Age Factors in Treating Class III Malocclusion: A Meta-Analysis. PLoS One. 2015 11;10(6):e0130096.

22. Zhang MA, Abdullah MA. Hard and soft tissue correlations in facial profiles: a canonical correlation study. Clin Cosmet Investig Dent. 2015;12(7):9-15.

23. Steegman R, Schoeman A, Dieters A, Jongsma B, Jansma B, van der Meer J, Ren Y. Three-dimensional volumetric changes in the airway of growing unilateral complete cleft lip and palate patients after bone-anchored maxillary protraction Am J Orthod Dentofacial Orthop. 2022;162(6):850-860.

24. Tiwari S, Mustafa K. Bone-anchored maxillary protraction in cleft maxillary hypoplasia: An evaluation of dentoskeletal, soft-tissue, and functional effects. J Cleft Lip Palate Craniofac Anomal 2024;11:102-11.

25. Naqvi ZA, Shivalinga BM, Ravi S, Munawwar SS. Effect of cleft lip palate repair on craniofacial growth. J Orthod Sci. 2015; 4(3):59-64.

26. Buj-Acosta C, Paredes-Gallardo V, Montiel-Company JM, Albaladejo A, Bellot-Arcís C. Predictive validity of the GOSLON Yardstick index in patients with unilateral cleft lip an palate: A systematic review. PLoS One. 2017:1;12(6):e0178497.

27. Harila V, Ylikontiola LP, Sándor GK. Dental arch relationships assessed by GOSLON Yardstick in children with clefts in Northern Finland. Eur J Paediatr Dent. 2014;15(4):389-91.

28. Téllez-Conti C, Mora-Diaz I, Díaz-Báez D, Ocampo-Arias IJ, Jiménez-Luna NE, Niño-Paz JC, González-Carrera MC. Craniofacial Growth Analysis of Individuals With and Without Cleft Lip and Palate in Colombia. Cleft Palate Craniofac J. 2022;59(5):577-588.

29. Cassi D, Di Blasio A, Gandolfinini M, Magnifico M, Pellegrino F, Piancino MJ. Dentoalveolar Effects of Early Orthodontic Treatment in Patients With Cleft Lip and Palate. J Craniofac Surg. 2017;28(8):2021-2026.

30. Ahn HW, Kim SJ, Baek SJ. Miniplate-anchored maxillary protraction in adolescent patients with cleft lip and palate: A literature review of study design, type and protocol, and treatment outcomes. Orthod Craniofac Res. 2021;24 Suppl1:21-30.

31. Meazzini MC, Cohen N, Battista VMA, Incorvati C, Biglioli F, Autelitano L. Orthodontic Pre Grafting Closure of Large Alveolar Bony and Soft Tissue Gaps: A Novel Nonsurgical Protraction of the Lesser Segments in Growing Patients With Cleft Lip and Palate. Cleft Palate Craniofac J. 2022;59(3):347-354.

32. Yang IH, Chang YI, Kim TW, Ahn SJ, Lim WH, Lee NK, Baek SH. Effects of cleft type, facemask anchorage method, and alveolar bone graft on maxillary protraction: a three-dimensional finite element analysis. Cleft Palate Craniofac J 2012;49(2):221-9.