Description of transverse maxillary expansion in patients with bilateral cleft lip and palate undergoing gingivoperiosteoplasty with alveolar bone graft. A preliminary study

¹ Dental surgeon  
² Dentofacial orthopedics specialist  
³ MAFACE rare orofacial deformities reference center  
⁴ University lecturer – Hospital practitioner  
⁵ Fellow, Paris Hospitals  

Address for correspondence: Natacha Niez, Service d’orthodontie Groupe hospitalier Pitié-Salpêtrière 47-83, boulevard de l’Hôpital, 75651 Paris Cedex 13, France. natacha.niez@gmail.com

Abstract

Cleft lip and palate (CLP) is one of the most common facial deformities. Treatment is long and complex, requiring a multidisciplinary team, including an orthodontist, who plays a prime role in ensuring that dental phenomena occur under the best possible conditions allowed by often unfavorable anatomy and growth and healing factors. Orthodontic preparation by maxillary expansion is a key step in management, mandatory ahead of gingivoperiosteoplasty and alveolar bone graft. Since 2000, Pr Vasquez’s maxillofacial and plastic surgery team in the Necker Hospital (Paris, France) has used a treatment protocol involving alveolar cleft repair by gingivoperiosteoplasty and alveolar bone graft at 4-6 years of age.

Orthopedic mechanics induces not only strictly orthopedic effects but also orthodontic dento-alveolar compensation. In CLP, physiology is exceptional in that there is no median palatine suture between fragments, and it can be supposed that the behavior of surrounding structures during maxillary expansion differs from that is a classical patient.

We therefore undertook a radiologic study of the dento-alveolar phenomena accompanying preoperative orthodontic expansion in bilateral CLP patients, in a group selected from those jointly managed by Pr Vazquez’s team and Dr Vi Fane’s team in the Rothschild Hospital (Paris), under the auspices of the MAFACE rare diseases reference center.