Avaliação das alterações dento-esqueléticas e faciais em pacientes fissurados submetidos ao protocolo de expansão rápida da maxila

Abstract

Cleft lip and palate are congenital malformations that have accented clinical and psychosocial impact, its etiology is complex involving genetic and environmental factors. The fissure unilateral complete cleft lip and palate is the most common deformity of non-syndromic oral cleft. Patients with clefts most often exhibit maxillary development deficiency in the anteroposterior direction, transverse and vertical, as a consequence of primary surgery (cheiloplasty and palatoplasty) performed during the first year of life. Among the complications involving the rehabilitation of patients with cleft lip and palate, include bites anterior and posterior cross, besides the compromised facial aesthetics due to maxillary retrusion and mandibular prognathism. The rapid maxillary expansion (RME) is the most common method used to correct the transverse maxillary deficiency, and this accomplished by some apparatus expanders. The aim of this study is to fundamentally evaluate the effects of RME in patients with unilateral cleft lip and palate, by computerized cone beam tomography analysis immediately after RME. This project consisted of a series of cases, in which we evaluated 10 patients.For this study, patients with unilateral cleft lip and palate with transversal and anteroposterior maxillary deficiency were treated and subsequently evaluated, with a therapeutic indication for the RME procedure, aged between 5 and 13 years, who sought orthodontic treatment at the Specialized Society for Attention to Fissured of the State De Sergipe (SEAFESE). This is a descriptive study where maxillary expansion alterations were performed in face cone beam computed tomography at the time of pre-expansion (T1) and at the end of the active phase of the expansion (T2), Where they were analyzed with Student's T-test. Possible correlations were analyzed using linear regression tests, or the Pearson test. The results showed that all anterior and posterior transverse measurements in patients with unilateral cleft lip and palate when submitted to the rapid maxillary expansion protocol were statistically significant (p <0.05). Significantly higher dental inclination (p <0.05) was observed when compared to pre-expansion measurements with no difference between the cleft and noncleft side (p> 0.05). Evaluating the displacement of the cleft and noncleft sides, the expansion occurred symmetrically (p> 0.05). In relation to the anteroposterior changes an anterior displacement of the maxilla was found (p <0.05). Thus, it is concluded that the rapid maxillary expansion treatment has immediate beneficial effects for patients with unilateral cleft lip and palate, and other long-term studies are required.