The purpose of this case report was to introduce the concept of orthodontic and orthopedic treatment for a growing patient with Tessier number 0 cleft. A 5-year-old boy patient with Tessier number 0 cleft presented congenitally missing maxillary central incisors (MXCI), a bony defect at the premaxil...
The purpose of this case report was to introduce the concept of orthodontic and orthopedic treatment for a growing patient with Tessier number 0 cleft. A 5-year-old boy patient with Tessier number 0 cleft presented congenitally missing maxillary central incisors (MXCI), a bony defect at the premaxilla, a constricted maxillary arch, an anterior openbite, and maxillary hypoplasia. His treatment was divided into three stages: management of the bony defect at the premaxilla and the congenitally missing MXCIs using a fan-type expansion plate, iliac bone grafting, and eruption guidance of the maxillary lateral incisors into the graft area for substitution of MXCIs; management of the maxillary hypoplasia using sequential facemask therapy with conventional and skeletal anchorage; and management of the remaining occlusal problems using fixed orthodontic treatment. The total treatment duration was 15 years and 10 months. Class I canine and Class II molar relationships and normal overbite and overjet were achieved at the end of treatment. Although the long-term use of facemask therapy resulted in significant protraction of the retrusive maxilla, the patient exhibited Class III profile because of continued mandibular growth. However, the treatment result was well maintained after 2 years of retention. The findings from this case suggest that interdisciplinary and customized approaches are mandatory for successful management of maxillary hypoplasia, bony defect, and dental problems in Tessier number 0 cleft. Moreover, considering the potential of orthognathic surgery or distraction osteogenesis, meticulous monitoring of mandibular growth until growth completion is important.
The purpose of this case report was to introduce the concept of orthodontic and orthopedic treatment for a growing patient with Tessier number 0 cleft. A 5-year-old boy patient with Tessier number 0 cleft presented congenitally missing maxillary central incisors (MXCI), a bony defect at the premaxilla, a constricted maxillary arch, an anterior openbite, and maxillary hypoplasia. His treatment was divided into three stages: management of the bony defect at the premaxilla and the congenitally missing MXCIs using a fan-type expansion plate, iliac bone grafting, and eruption guidance of the maxillary lateral incisors into the graft area for substitution of MXCIs; management of the maxillary hypoplasia using sequential facemask therapy with conventional and skeletal anchorage; and management of the remaining occlusal problems using fixed orthodontic treatment. The total treatment duration was 15 years and 10 months. Class I canine and Class II molar relationships and normal overbite and overjet were achieved at the end of treatment. Although the long-term use of facemask therapy resulted in significant protraction of the retrusive maxilla, the patient exhibited Class III profile because of continued mandibular growth. However, the treatment result was well maintained after 2 years of retention. The findings from this case suggest that interdisciplinary and customized approaches are mandatory for successful management of maxillary hypoplasia, bony defect, and dental problems in Tessier number 0 cleft. Moreover, considering the potential of orthognathic surgery or distraction osteogenesis, meticulous monitoring of mandibular growth until growth completion is important.
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제안 방법
The patient was using an eye prosthesis for the right microphthalmia since 1 month of age (Figure 1). He underwent several surgical procedures at different ages as follows: cheiloplasty at 7 months, palatoplasty (V-Y push back method) at 1 year and 11 months, iliac bone grafting (IBG) at 7 years and 7 months, enucleation of the right microphthalmic eyeball and insertion of an orbital medpor implant at 8 years and 10 months, and several eyelid surgical procedures, including a frontalis sling, at 10 years and 1 month.
Figure 9. Lateral cephalogram, postero-anterior cephalogram, and a panoramic radiograph obtained after debonding (21 years and 0 month of age).
The patient exhibited widening of the facial midline structures, including hypertelorism, a well-defined groove between the two alar domes, and an increased columellar width. Intraoral examination revealed an anterior openbite (overbite, −2.
The treatment objectives were as follows: reconstruction of the bony defect at the premaxilla using IBG and eruption guidance for the maxillary permanent lateral incisors into the graft area for substitution of the missing central incisors, correction of the maxillary hypoplasia through maxillary protraction, and establishment of normal overbite and overjet along with Class I canine and Class II molar relationships.
To the best of our knowledge, the concept of orthodontic and orthopedic treatment for patients with Tessier number 0 cleft, which is generally characterized by congenitally missing maxillary permanent incisors, a bony defect at the premaxilla, and maxillary hypoplasia, has not been reported till date. Therefore, the purpose of this case report was to introduce the concept of orthodontic and orthopedic treatment for a growing patient with Tessier number 0 cleft. This case report was reviewed and approved by the Institutional Review Board of School of Dentistry, Seoul National University (S-D20170007).
Three different treatment options were suggested to the patient and his parents: distraction osteogenesis of the maxilla for correction of the maxillary hypoplasia after IBG, growth observation and orthognathic surgery after growth completion, and maxillary protraction using a facemask during the pubertal growth period.
대상 데이터
A 5-year-old boy with Tessier number 0 cleft and right microphthalmia was referred to Department of Orthodontics, Seoul National University Dental Hospital from the Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea.
At the initial visit, the patient exhibited a retrusive maxilla (SNA, 76.3o; A to N per, −3.9 mm; horizontal distance from point A to VRP, 50.1 mm), a high mandibular plane angle (FMA, 31.5o), and a large gonial angle (125.4o).
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