EFFECTS OF PRESURGICAL ORTHOPEDIC TREATMENT IN INFANTS WITH COMPLETE BILATERAL CLEFT-LIP AND PALATE

Objective: To align the protruding premaxilla in infants with bilatera l cleft lip and palate (BCLP), an intraoral appliance (i,e,, Hotz plat e) and an extraoral appliance consisting of a band covering the head a nd elastics are used as a presurgical orthopedic treatment in our clin ic, The aim of this study was to analyze the configuration and positio n of the premaxilla and the vomer in infants with BCLP and to investig ate the factors generating deviation and bending of the vomer and twis ting of the premaxilla, Patients: Palatal casts were obtained serially from 10 infants with complete BCLP from 1 to 3 months of age. Measure ments: These casts were automatically measured using a highly accurate contact-type measuring apparatus. After three-dimensional wire frame models generated from the serial casts were automatically superimposed , the magnitude and direction of the shift were calculated. A discrimi nant analysis was used for investigation of predictor variables genera ting the twisting or bending vomer, Results and Conclusions: The vomer was found to be bent in two infants and the premaxilla was twisted in three infants. In the infants whose vomers were bent, the magnitude o f the posterior shift of the premaxilla was greater than that of the i nferior shift. A discriminant analysis indicated that at 1 month of ag e, a greater inclination and a smaller deviation of the vomer and a lo nger distance between the cleft edges of the lateral segments had a te ndency to be associated with bending of the vomer or twisting of the p remaxilla.