2010 Volume 30 Issue 2 Pages 142-150
Occlusal management for cleft palate patients often lasts a long time, starting in the growth phase. Guidance of jaw development is required, because many factors, including lip and palate surgery, can cause undergrowth of the maxilla. We report herein the case of a patient who underwent long-term monitoring of maxillofacial growth and development, occlusal control and surgical correction from childhood to adulthood, with favorable final outcomes. Maxillofacial growth and development and therapeutic effects are discussed. The patient was a woman with bilateral cleft lip and palate (incomplete on the left). Occlusal management was started at 4 years old. After the end of pubertal growth, she underwent upper right lateral incisor and lower bilateral premolar extraction at another hospital, as visiting our hospital was difficult. During retention, she showed progenia and openbite due to relapse. Skeletal mandibular protrusion due to maxillary undergrowth was diagnosed and surgical correction was performed by maxillary and mandibular osteotomies. The canine was placed in the right cleft defect, and occlusion was established non-prosthetically as a reduction of the dental arch, obtaining favorable results. To evaluate therapeutic effects, maxillofacial growth and development were evaluated longitudinally. Maxillary growth and development were based mostly on inferior components, and anterior growth was basically absent. Although occlusal management was started in early childhood, anterior maxillary growth guidance was not performed. Since maxillary growth is often marked in patients with cleft lip and palate showing normal overjet during the growth phase, improving overjet from the first examination is important.
