Effect of Cleft Palate Repair Using Alveolar Extension Technique on Eruption and Growth
Condition: Cleft Palate
MeSH terms: Cleft Palate
Study type: Interventional

Summary: 
      This study aimed to evaluate clinically the "Alveolar extension" technique for palatoplasty
      in cases of primary closure of cleft palate regarding its effect on:

        1. Eruption of Primary dentition.

        2. Maxillary primary teeth undergoing eruption.

        3. The maxillary arch growth.
    

Detailed description: 
      Cleft lip and palate represent the most common of the craniofacial anomalies. They are severe
      congenital malformations with a worldwide frequency ranging between 0.28 and 3.74 per 1000
      live births. Cleft lip and palate occur in around 3 out of every 1000 infants in Egypt.
      Infants born with cleft palates always have eating difficulties due to a lack of oro-nasal
      seal and also have speaking difficulties due to velopharyngeal insufficiency. To ensure
      optimal care, the cleft team may include oral surgeons, plastic surgeons, pediatric dentists,
      orthodontists, and medical specialists in genetics, otolaryngology, pediatrics, and
      psychiatry. These caregivers evaluate the medical condition and development of the patient,
      as well as dental and oral health, facial esthetics, psychological condition, and developing
      of hearing and speech. Pediatric dentists are critical members of this team because they are
      responsible for the patient's overall dental health. A variety of dental anomalies and
      malocclusions are associated with cleft palate; these may occur as a result of primary
      defects being repaired surgically. The management of the cleft patient starts with an early
      focus on newborn's needs. Surgical repair of cleft palates (Palatoplasty) is typically
      performed by one year of age, primarily to facilitate the development of normal speech, as
      this coincides with the age at which the majority of children begin to speak. Hearing and
      swallowing are improved by proper alignment of the soft palatal musculature. The ideal
      palatoplasty technique is one that results in perfect speech without impairing maxillofacial
      growth or hearing. There are numerous surgical techniques for cleft palate repair, each with
      numerous variations. Nevertheless, a few of these techniques are widely used. Veau Wardill
      Kilner Palatoplasty, von Langenbeck, Bardach Two flap Palatoplasty were the most common
      techniques of palatoplasty. These techniques leave a large raw area along the alveolar
      margin, exposing bare bone. With secondary intention, the raw area heals. This results in
      palate shortening and velopharyngeal insufficiency. Additionally, the scar tissue adjacent to
      the alveolar margin results in deformity of the alveolar ridge and dental malalignment. It
      was found that lateral incision reduced the maxillary growth more than mucoperiosteal palatal
      detachment only. Additionally, some studies discovered that when matched normals are compared
      to individuals with unoperated clefts either lip or palate, the cranial base and skeletal
      face are not significantly malrelated. These findings suggest that cleft patient possess
      normal potential and mechanism of growth. The alveolar mucoperiosteum is deprived of blood
      supply from the facial artery in traditional lip repair procedures. Later, during palate
      repair, the palatal incisions isolate the palatal tissues from the greater palatine artery,
      altering the alveolar mucoperiosteum from a highly blood supplied zone between the two
      arteries into a tissue that is predominantly supported by osseous backflow. Thus, the
      disruption of palatal growth is considered in this perspective. The Alveolar Extension
      Palatoplasty (AEP) technique provide tension free flap, less palatal bone exposure after the
      surgery ,as the raw area is on the alveolar crest or tooth margin. It preserves blood supply
      of the palatal gingiva and periosteum. The studies on the influence of that advantage as well
      as the alveolar crest incision on unerupted primary teeth are scanty. So, it will be fruitful
      to study the effect of AEP on teeth undergoing eruption with alveolar bone and maxilla
      growth.
    

Intervention name(s): Palatoplasty; Addition silicone impression
Intervention type(s): Procedure; Diagnostic Test
Intervention description(s): Surgical closure of palatal defect; diagnostic impression for maxillary arch
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Alveolar extension palatoplasty; Bardach; Cleft palate