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Clinical Oral Investigations
Published in: Clinical Oral Investigations 2/2016

Open Access 01-03-2016 | Review

Management of the premaxilla in the treatment of bilateral cleft of lip and palate: what can the literature tell us?

Authors: Gerhard K. P. Bittermann, Ad P. de Ruiter, Nard G. Janssen, Arnold J. N. Bittermann, Aebele M. van der Molen, Robert J. J. van Es, Antoine J. W. P. Rosenberg, R. Koole

Published in: Clinical Oral Investigations | Issue 2/2016

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Abstract

Objective

In the treatment of bilateral cleft lip and palate (BCLP) patients, there is discussion about the management of the position of the premaxilla. This literature analysis summarises the literature on managing this condition.

Materials and methods

A PubMed, Embase and Cochrane Library search was conducted resulting in 4465 articles which were screened on title and abstract.

Results

Seventy-one articles were available in full text, 16 of which were included in this literature analysis. We searched on keywords timing and technique, complications, growth of the maxilla and results after bone grafting the alveolar process. This literature analysis has shown that there are various ways to correct the position of the premaxilla. These can be divided into primary, early, late secondary and tertiary intervention before the age of 8 years, between the ages of 8 and 12 years and older than 12 years. Correction is done with surgery, orthodontics or a combination, with or without bone grafting.

Conclusions

An osteotomy of the premaxilla in combination with secondary alveolar bone grafting appears to be the most successful technique. Combining early secondary alveolar bone grafting with osteotomy creates more room to ensure a watertight closure of the nasal mucosa resulting in fewer postoperative complications. Before surgery, the orthodontist should try to optimise the position of the premaxilla for its surgical correction prior to bone grafting.

Clinical relevance

The treatment of BCLP patients is still based on experience and expert opinions. This literature analysis tries to give a summery on how to handle the protruded and displaced premaxilla.
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Metadata
Title
Management of the premaxilla in the treatment of bilateral cleft of lip and palate: what can the literature tell us?
Authors
Gerhard K. P. Bittermann
Ad P. de Ruiter
Nard G. Janssen
Arnold J. N. Bittermann
Aebele M. van der Molen
Robert J. J. van Es
Antoine J. W. P. Rosenberg
R. Koole
Publication date
01-03-2016
Publisher
Springer Berlin Heidelberg
Published in
Clinical Oral Investigations / Issue 2/2016
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI
https://doi.org/10.1007/s00784-015-1589-y

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