Keywords
orthodontic treatment
speech therapy and psychological support
rehabilitation algorithm
How to Cite
Abstract
In press
Children with congenital cleft lip and palate (CLP) develop a composite complex of anatomical, functional and aesthetic disorders that increase with growth and require comprehensive and multi-stage treatment. Treatment and diagnostic measures require a multidisciplinary approach to overcome the identified problems. The main task of orthodontic support for children with CLP at the stages of primary surgical interventions is aimed at preventing orthognathic surgical correction in the future, by optimizing the choice and tactics of orthodontic treatment within the framework of multidisciplinary comprehensive rehabilitation measures. The purpose of the work is the substantiation, approval and introduction into clinical practice of a complex of medical and diagnostic measures aimed at the rehabilitation of children with CLP. It confirmed that providing the necessary conditions for sucking creates optimal conditions for surgical intervention on the lip and palate. The tactics of orthodontic treatment depended on the period of development of the dentognathic apparatus, age, type of cleft, staging, timing and volume of surgical interventions, quality and methods of surgery, severity of deformations in the transversal and sagittal planes and components of the symptom complex of anomalies and deformations complicating the pathology, psychological and emotional child state, factors of parents and patients communication with the doctor, social and economic components. Removable and fixed orthodontic appliances are used in most cases at the initial stage of treatment for the treatment of dentognathic deformities, obtaining satisfactory sagittal and vertical overlap and normalization of transversal ratios. A separate area of rehabilitation was prevention and treatment of diseases of hard tissues of teeth and periodontal tissues. Speech therapy and psychological support started from 2–3 months. The proposed complex of treatment and diagnostic measures, determined in time, terms, sequence and volume, aimed at the rehabilitation of children with CLP, made it possible to obtain positive anatomical, functional and aesthetic results in 87.6% of children.
Keywords: therapeutic and diagnostic measures, orthodontic treatment, speech therapy and psychological support, rehabilitation algorithm.
References
Yakovenko LM (ed.). Khirurhichna stomatolohiia ta shchelepno-lytseva khirurhiia dytiachoho viku [Surgical stomatology and maxillofacial surgery of childhood]: national textbook. Kyiv: Medicine; 2022. 496 p. Available at: https://www.medpublish.com.ua/hirurgichna-stomatologija-ta-schelepnoliceva-hirurgija-ditjachogo-viku-pidruchnik-vnz-v-r-a-lv-harkov-lm-jakovenko-l-chehova-za-red-lv-harkova/p-672.html [in Ukrainian].
Report on medical care for pregnant women, women giving birth and women who have given birth, on 2022 (form No.21). Statistics. Public Health Center of the Ministry of Health of Ukraine [Internet]. Available at: http://medstat.gov.ua/ukr/statdanMMXIX.html [in Ukrainian].
Abualfaraj R, Daly B, McDonald F, Scambler S. Cleft lip and palate in context: Learning from, and adding to, the sociological literature on long-term conditions. Health (London). 2018;22(4):372-88. DOI: 10.1177/1363459317693409. PMID: 29232992.
Eriguchi M, Watanabe A, Suga K, Nakano Y, Sakamoto T, Sueishi K, Uchiyama T. Growth of palate in unilateral cleft lip and palate patients undergoing two-stage palatoplasty and orthodontic treatment. Bull Tokyo Dent Coll. 2018;59(3):183-91. DOI: 10.2209/tdcpublication.2017-0014. PMID: 30224612.
Khaletska VM. Osoblyvosti likuvannia zvuzhennia verkhnoi shchelepy v transverzalnii ploshchyni u ditei z povnoiu rozshchilynoiu pidnebinnia [Features of treatment of narrowing of the upper jaw in the transverse plane in children with complete cleft palate]. [Dys kand med n, spec. 14.01.22 – Dentistry]. Kharkiv: KhNMU; 2017. 183 p. Available at: https://repo.knmu.edu.ua/handle/123456789/17283 [in Ukrainian].
Sinko K, Cede J, Jagsch R, Strohmayr AL, McKay A, Mosgoeller W, Klug C. Facial aesthetics in young adults after cleft lip and palate treatment over five decades. Sci Rep. 2017;7:15864. DOI: 10.1038/s41598-017-16249-w. PMID: 29158593.
Sharma G. Orthodontic management of cleft lip and palate patients (Chapter). In: Ayse G, (ed.). Current Treatment of Cleft Lip and Palate. UK: IntechOpen; 2020. DOI: 10.5772/intechopen.90076.
Melnyk A, Filonenko V. Clinical and Phonetic Features of Dentognathic Deformations, Their Orthodontic Treatment (Chapter). In: Lavinia Cosmina Ardelean, Laura-Cristina Cristina Rusu (eds). Human Teeth – From Function to Esthetics. UK: IntechOpen; 2023. DOI: 10.5772/intechopen.109636.
Pereira RMR, Siqueira N, Costa E, Vale DD, Alonso N. Unilateral cleft lip and palate surgical protocols and facial growth outcomes. J Craniofac Surg. 2018;29(6):1562-8. DOI: 10.1097/SCS.0000000000004810. PMID: 30373095.
Yakovenko LM, Bidenko NV, Yefymenko VP. Accompanying and dental disease in children with cleft lip and palate. Bulletin of Dentistry. 2023;2(123):165-9. DOI: 10.35220/2078-8916-2023-48-2.29. [in Ukrainian].
Daskalogiannakis J, Mehta M. The need for orthognathic surgery in patients with repaired complete unilateral and complete bilateral cleft lip and palate. Cleft Palate Craniofac Journal. 2009;46(5):498-502. DOI: 10.1597/08-176.1. PMID: 19929100.
Phillips JH, Nish I, Daskalogiannakis J. Orthognathic surgery in cleft patients. Plast Reconstr Surg. 2012;129(3):535-48. DOI: 10.1097/PRS.0b013e31824128e6. PMID: 22374003.
Antonarakis GS, Watts G, Daskalogiannakis J. The need for orthognathic surgery in nonsyndromic patients with repaired isolated cleft palate. Cleft Palate Craniofac Journal. 2015;52(1):8-13. DOI: 10.1597/13-080. PMID: 24437563.
Roy AA, Rtshiladze MA, Stevens K, Phillips J. Orthognathic surgery for patients with cleft lip and palate. Clin Plast Surg. 2019;46(2):157-71. DOI: 10.1016/j.cps.2018.11.002. PMID: 30851748.
Yilmaz H, Demirkaya AA. Orthognathic surgery in cleft lip and palate patients (Chapter). In: Gulsen A (ed.). Current treatment of cleft lip and palate. UK: IntechOpen; 2020. DOI: 10.5772/intechopen.89556.
Fahradyan A, Wolfswinkel EM, Clarke N, Park S, Tsuha M, Urata MM, et al. Impact of the distance of maxillary advancement on horizontal relapse after orthognathic surgery. Cleft Palate Craniofac Journal. 2018;55(4):546-53. DOI: 10.1177/1055665617739731. PMID: 29554455.
Koskela A, Neittaanmaki A, Ronnberg K, Palotie A, Ripatti S, Palotie T. The relation of severe malocclusion to patients’ mental and behavioral disorders, growth, and speech problems. European Journal of Orthodontics. 2020;43(2):1-6. DOI: 10.1093/ejo/cjaa028. PMID: 32346736.
Manfio ASC, Chen A. Orthodontic interventions in cleft lip and palate individuals: an overview of treatment protocol. Oral Health (Canada), 2019 [Internet]. Available at: https://www.oralhealthgroup.com/features/orthodontic-interventions-in-cleft-lip-and-palate-individuals-an-overview-of-treatment-protocol/ [accessed 20 Mar 2024].
Filonenko VV, Kaniura OА, Bidenko NV. Orthodontic diagnostics in children with congenital cleft lip and palate with dentognathic deformities. Rawal Medical Journal. 2023;48(4):936-9. DOI: 10.5455/rmj.20230517091426.
Elabbassy EH, Sabet NE, Hassan IT, Elghoul DH, Elkassaby MA. Bone-anchored maxillary protraction in patients with unilateral cleft lip and palate. Angle Orthod. 2020;90(4):539-47. DOI: 10.2319/091919-598.1. PMID: 33378498.
Garib D, Yatabe M, de Souza Faco RA, Gregorio L, Cevidanes L, de Clercke H. Bone-anchored maxillary protraction in a patient with complete cleft lip and palate: A case report. Am J Orthod Dentofacial Orthop. 2018;153:290-7. DOI: 10.1016/j.ajodo.2016.10.044. PMID: 29407507.
Lee H, Nguyen A, Hong C, Hoang P, Pham J, Ting K. Biomechanical effects of maxillary expansion on a patient with cleft palate: A finite element analysis. Am J Orthod Dentofacial Orthop. 2016;150(2):313-23. DOI: 10.1016/j.ajodo.2015.12.029. PMID: 27476365.
Tong H, Gao F, Yin J, Shi Z, Song T, Li H, Sun X, et al. Three-dimensional quantitative evaluation of midfacial skeletal changes after trans-sutural distraction osteogenesis for midfacial hypoplasia in growing patients with cleft lip and palate. J Craniomaxillofac Surg. 2015;43(9):1749-57. DOI: 10.1016/j.jcms.2015.08.027. PMID: 26421468.
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