Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan.
Am J Orthod Dentofacial Orthop. 2012 Apr;141(4 Suppl):S149-58. doi: 10.1016/j.ajodo.2011.07.025.
Interdisciplinary treatment was used for an adult patient born with complete bilateral cleft lip and palate. He had a severe maxillary deficiency with a wide cleft involving the alveolar and maxillary bone and palate. Reconstruction of the arches and occlusion in patients who missed the optimal treatment time is a difficult task for orthodontists. The clinical examination showed severe hypogenesis of the maxillary bone with a total crossbite. The maxillary dental arch was extremely narrow, and the maxillary incisors showed extensive caries caused by improper oral hygiene. Fixed and removable expansion appliances were used to improve the lateral crossbite. Alveolar bone grafting and unilateral LeFort I maxillary osteotomy were performed on the right side for alignment of the maxillary arch. Mandibular setback with bilateral sagittal split ramus osteotomy was also performed to correct the anteroposterior skeletal discrepancy. After postsurgical orthodontic treatment, prosthetic treatment was carried out for final reconstruction of esthetics and orthognathic function. Interdisciplinary treatment was necessary for this patient to achieve a proper occlusion and better esthetics.
一位成人双侧完全性唇腭裂患者接受了多学科治疗。他上颌骨严重发育不足,牙槽骨和上颌骨及腭部广泛裂隙。对于错过最佳治疗时间的患者,重建牙弓和咬合是正畸医生面临的难题。临床检查显示上颌骨严重发育不全,存在完全性反颌。上颌牙弓极度狭窄,上颌切牙由于口腔卫生不良,广泛龋坏。使用固定和可摘扩弓装置改善侧方反颌。右侧行牙槽骨植骨术和单侧 LeFort I 上颌骨截骨术,以排齐上颌牙弓。行下颌后退术,双侧矢状劈开下颌骨截骨术,以矫正前后骨骼不调。术后正畸治疗后,进行修复治疗,最终实现美观和正颌功能的重建。该患者需要多学科治疗,以获得良好的咬合和美观效果。