Cleft Lip and Palate Clinical Trial
Official title:
Three Dimensional Changes on Nasal Septum and Alveolar Cleft After Maxillary Expansion: A Case Series
This study evaluates, by means of cone beam computed tomography (CBCT), the alterations in the nasal septum and alveolar cleft volume that occur in cleft lip and palate (CLP) patients after rapid maxillary expansion(RME). 40 unilateral CLP patients (mean age, 11.1 ± 2.2 years) with transverse maxillary deficiency that underwent to RME will be evaluated in this investigation. CBCT images were taken prior to RME (T0) and after the removal of the expander (T1), for adequate secondary bone graft surgical planning. The scans will be used to analyze the effects on the nasal septum, anterior and posterior maxillary basal width (MBW) and alveolar cleft volume.
Rapid maxillary expansion (RME) is performed to correct crossbite in CLP patients as part of
the orthodontic treatment, being able to improve the maxillary transverse dimension, that is
an essential condition for alveolar bone grafting. The primary aim of the secondary graft
surgery is to restore the function and structure of the maxillary arch at the cleft side,
providing support to arch width, minimizing its transverse collapse. However, since RME exert
heavy forces to separate the two maxillary helves, it may significantly widen the alveolar
cleft defect, possibly compromising bone graft success.
Moreover, RME has an important impact on the geometry and function of the nasal cavity,
providing a lateral displacement of the walls and facilitating the airflow through the upper
airways. These effects are very important to CLP patients, since they usually present reduced
upper airway dimensions, adenoid hypertrophy, sleep disorders, oral breathing, and a marked
nasal septal deviation. The nasal septal deviation is one of the major causes of nasal
obstruction in non-cleft patients, and often results in blocking of the nasolacrimal ducts,
sinusitis, ear infections and mouth breathing. However, nasal septum deviation in CLP
patients commonly persists even after surgical repair of the cleft, leading to a chronic
obstruction of the air passage, until the septorhinoplasty, at the age of 14-18 years.
Each expander was cemented with a fluoride releasing cement, and the activation regimen was
established at 2 turns/day until the tip of the lingual cusps of the maxillary teeth touched
the tips of the buccal cusps of the mandibular teeth. After the 3-month retention period, the
expander was removed, and a post-expansion CBCT scanning (T1) was acquired for adequate
secondary bone graft surgical planning.
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