Abida Ijaz, Rashid Mehmood, Junaid Israr.
Management of the cleft deformities at the cleft center of Children`s Hospital Lahore during 5 years (2000 - 2005).
J Pak Dent Assoc Jan ;14(2):67-75.

OBJECTIVE: To describe management of cleft children during five year period from 24-1-2000 to 24-1-2005 at Orthodontic department of the Dental section CH&ICH Lahore, a tertiary level hospital. PATIENTS AND METHODS: This quasi experimental study was conducted on 128 subjects comprising of 72 males and 56 females. Age of these subjects ranged from one day to thirteen years. These patients were classified with Kernahan`s modified double Y system. RESULTS: Thirty six patients out of 54 (42.2% with complete bilateral cleft lip and palate) were treated with custom made orthopedic plate having anteriorly extending acrylic ring. The next common type of cleft seen was complete unilateral cleft lip and palate affecting 27 patients (21%). An unusual finding was complete unilateral cleft lip and palate and partial opposite side cleft. Treatment given to unilateral cleft was pre-surgical infant orthopedic plate given in 30 patients. Supportive instructions were provided to 21 infants that included 10 neonates with Pierre Robin`s sequence. 19 subjects out of the whole sample were given post surgical Obturators for the treatment of residual fistula or cleft following palatal closure. Ten patients were instructed on oral hygiene measures. Four patients were referred for surgical procedures. Three patients in early mixed dentition were provided custom made modified expansion device. One patient in mixed dentition was given Petit headgear after expanding maxilla with splinted hyrax while another one was given holding arch. Three patients, two in mixed dentition and one in permanent dentition were treated with comprehensive fixed mechanics followed by bone graft. CONCLUSION: In bilateral deformities PSIOP with anterior ring produced significant retraction of pre maxilla which made initial lip repair easy. In unilateral cases PROP served the purpose of obturator and improved the function while MED provided an effective substitute to splinted expanders.

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