Presurgical Orthodontic Preparation Of Newborns With Complete Bilateral Cleft Lip And Palate

Abstract

Background: Bilateral cleft lip and palate (BCLP) can present quite a few challenges in management, especially due to pronounced premaxillary protrusion and displacement of the alveolar segments. While the traditional method of nasoalveolar molding (NAM) and removable appliance has been popular, its limitations in more severe cases have led us to explore alternative approaches. This study aims to evaluate how effectiveness of presurgical appliance fixation with mini-screws with partial vomer osteotomy when compared to the usual removable appliances.

Methods: In this retrospective case-control study, we included 57 infants with complete BCLP. They were divided into two groups: a case group of 27 treated with mini-screws-fixed appliances and partial vomer osteotomy, and a control group of 30 who received removable appliances. We assessed outcomes such as the reduction in cleft width, treatment duration, surgical parameters (like operative time and revision rates), postoperative recovery, and any complications.

Results: Patients who received microimplants showed significantly better cleft reduction (22.0±0.74mm to 9.0±0.3mm, p<0.001) compared to those in the control group (21.5±0.86mm to 12.1±0.95mm, p=0.02). The treatment was also much shorter, lasting 20-25 days for cases versus 7 months for controls. Surgical outcomes were better for the case group, with shorter operative times (98±12 vs. 135±18 minutes, p=0.01), lower revision rates (7.4% vs. 25%, p=0.04), and faster recovery from oral feeding (14±3 vs. 21±5 days, p=0.03). In contrast, 33.3% of control patients developed ulcers, whereas none occurred with the case group.  Conclusion: Combining mini-screws-fixed appliances and partial vomer osteotomy significantly outperforms traditional methods in managing BCLP, offering rapid cleft reduction, improved surgical feasibility, and better postoperative outcomes. This approach shows promise for severe cases, but further long-term studies on growth are needed.