Комплексна реабілітація пацієнта з вродженою аномалією обличчя. Шлях у 25 років

V. Sokolovskiy; Saulo  Borges; Sergio  Lima; Eudes  Nobrega; V. Yefimenko; O. Shafeta; V. Nagovitsyn; K. Burkland

doi:10.33295/1992-576X-2025-3-77

Authors

V. Sokolovskiy Orthodontist of the highest category, owner and chief physician of the Flash Smile clinic, Kyiv, Ukraine https://orcid.org/0009-0000-4899-9237
Saulo Borges Organizer of the international project Rotary Smile Ukraine, orthodontist, Arcos, Brazil
Sergio Lima Professor, orthognathic surgeon of the Mater Dei clinic, São Paulo, Brazil
Eudes Nobrega Plastic surgeon, Centrinho hospital, Bauru, Brazil
V. Yefimenko Bogomolets National Medical University https://orcid.org/0000-0001-9926-8901
O. Shafeta Bogomolets National Medical University https://orcid.org/0000-0001-8804-7206
V. Nagovitsyn Orthopedic dentist at the “Flash Smile” clinic.
K. Burkland Orthopedic dentist at the “Flash Smile” clinic.

DOI:

https://doi.org/10.33295/1992-576X-2025-3-77

Keywords:

cleft palate, cicatricial deformity of the upper lip and palate, malocclusion, orthodontic treatment, orthognathic surgery, bone grafting, orthopedic treatment, zirconium dioxide bridge construction

Abstract

Relevance. Congenital cleft lip and palate is the third most common congenital anomaly in newborns worldwide (among all congenital anomalies). Depending on the region, the incidence ranges from one case per 400 newborns to one case per 1,500 newborns. In Ukraine, on average, one child is born per 650 newborns. This pathology causes serious functional and aesthetic problems for the patient from birth. The significant variability of congenital disorders does not allow for a fully standardized treatment protocol for these patients, requiring an individualized approach to their solution by doctors of different specializations.
This study aimed to assess the effectiveness of treating a patient with congenital cleft lip and palate from birth until full dental rehabilitation.
Materials and methods. Treatment was conducted from 2001 to 2025 at the Children’s Clinical Hospital No. 7 in Kyiv, the Department of Pediatric Surgical Dentistry and Maxillofacial Surgery of Bogomolets National Medical University, and the Flash Smile private dental clinic.
Conclusions. As a result of long-term work (25 years) by many doctors with narrow specializations, we achieved an excellent aesthetic and functional treatment outcome. Chewing efficiency was restored to 100%, and the aesthetics of the smile and appearance were entirely satisfactory for the patient. Pronunciation remained unaffected, with only minor rhinolalia. During the treatment, we encountered several complex problems that required atypical approaches, which were not included in the protocol treatment methods. The primary challenge in the treatment process was the presence of a severe cicatricial deformation of the palate. To prevent it, it is necessary to use minimally traumatic methods of surgical intervention.
Removable orthodontic appliances showed their low efficiency.
The use of orthognathic surgery enables the effective resolution of bite problems, but it requires a highly qualified surgeon, an extended retention period, and careful postoperative supervision.
Only a comprehensive approach, in full cooperation with the patient’s parents, allowed the team of doctors to achieve an excellent result in a challenging situation.

Downloads

Download data is not yet available.

Author Biographies

V. Yefimenko, Bogomolets National Medical University

Candidate of Medical Sciences, Associate Professor, Head of the Department of Surgical Dentistry and Pediatric Maxillofacial Surgery

O. Shafeta, Bogomolets National Medical University

PhD, Assistant Professor, Department of Pediatric Surgical Dentistry and Maxillofacial Surgery

References

Mink van der Molen, A.B., van Breugel, J.M.M., Janssen, N.G., Admiraal, R.J.C., van Adrichem, L.N.A., Bierenbroodspot, F., Bittermann, D., van den Boogaard, M.-J.H., Broos, P.H., Dijkstra-Putkamer, J.J.M., et al. (2021). Clinical Practice Guidelines on the Treatment of Patients with Cleft Lip, Alveolus, and Palate: An Executive Summary. Journal of Clinical Medicine, 10(21): 4813. DOI: https://doi.org/10.3390/jcm10214813.

de Sa Leitao Pinheiro, F.H., Drummond, R.J., Frota, C.M., Bartzela, T.N., dos Santos, P.B. (2020). Comparison of early and conventional autogenous secondary alveolar bone graft in children with cleft lip and palate: A systematic review. Orthodontics Craniofacial Research, 23(4): 385–397. DOI: https://doi.org/10.1111/ocr.12394.

Doucet, J.C., Russell, K.A., Daskalogiannakis, J., Mercado, A.M., Hathaway, R.R., Semb, G., et al. (2023). Early secondary alveolar bone grafting and facial growth of patients with complete unilateral cleft lip and palate. Cleft Palate-Craniofacial Journal, 60(6): 734–741. DOI: https://doi.org/10.1177/10556656221080990.

Chang, C.S., Wallace, C.G., Hsiao, Y.C., Chiu, Y.T., Pai, B.C.J., Chen, I.J., et al. (2016). Difference in the surgical outcome of unilateral cleft lip and palate patients with and without pre-alveolar bone graft orthodontic treatment. Scientific Reports, 6: 23597. DOI: https://doi.org/10.1038/srep23597.

Ma, L., Hou, Y., Liu, G., Zhang, T. (2021). Effectiveness of presurgical orthodontics in cleft lip and palate patients with alveolar bone grafting: A systematic review. Journal of Stomatology, Oral and Maxillofacial Surgery, 122(1): 13–17. DOI: https://doi.org/10.1016/j.jormas.2020.07.010.

Meyer, S., Mølsted, K. (2013). Long-term outcome of secondary alveolar bone grafting in cleft lip and palate patients: a 10-year follow-up cohort study. Journal of Plastic Surgery and Hand Surgery, 47(6): 503–508. DOI: https://doi.org/10.3109/2000656X.2013.789036.

Russell, K., Long, R.E. Jr., Daskalogiannakis, J., Mercado, A., Hathaway, R., Semb, G., et al. (2016). A multicenter study using the SWAG scale to compare secondary alveolar bone graft outcomes for patients with cleft lip and palate. Cleft Palate-Craniofacial Journal, 53(2): 180–186. DOI: https://doi.org/10.1597/14-215.

Allareddy, V., Bruun, R., MacLaine, J., Markiewicz, M.R., Ruiz, R., Miller, M.A. (2020). Orthodontic preparation for secondary alveolar bone grafting in patients with complete cleft lip and palate. Oral and Maxillofacial Surgery Clinics of North America, 32(2): 205–217. DOI: https://doi.org/10.1016/j.coms.2020.01.003.

de Souza Freitas, J.A., Garib, D.G., Oliveira, M., de C.M.C. Lauris, R., de Almeida, A.L.P.F., Neves, L.T., et al. (2012). Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies — USP (HRAC-USP) - Part 2: Pediatric Dentistry and Orthodontics. Journal of Applied Oral Science, 20(2): 268–281. DOI: https://doi.org/10.1590/s1678-77572012000200024.

Bittermann, G.K.P., de Ruiter, A.P., Janssen, N.G., Bittermann, A.J.N., van der Molen, A.M., van Es, R.J.J., et al. (2016). Management of the premaxilla in the treatment of bilateral cleft of lip and palate: what can the literature tell us? Clinical Oral Investigations, 20(2), 207–217. DOI: https://doi.org/10.1007/s00784-015-1589-y.

Liou, E.J.W., Chen, P.K.T., Huang, C.S., Chen, Y.R. (2004). Orthopedic intrusion of premaxilla with distraction devices before alveolar bone grafting. Plastic and Reconstructive Surgery, 113(3): 818–826. DOI: https://doi.org/10.1097/01.prs.0000105333.88945.08.

Meazzini, M., Lematti, L., Mazzoleni, F., Rabbiosi, D., Bozzetti, A., Brusati, R. (2010). Vertical excess of the premaxilla in bilateral cleft lip and palate patients: a protocol for treatment. Journal of Craniofacial Surgery, 21(2): 499–502. DOI: https://doi.org/10.1097/SCS.0b013e3181cffb4d.

Phadkule, S.S., Shivaprakash, G., Kumar, G.A., Shamnur, N. (2014). Customized appliance for intrusion and retraction of premaxilla in bilateral cleft palate patient. Journal of Indian Orthodontic Society, 48(4): 561–565. DOI: https://doi.org/10.1177/0974909820140809S.

Meazzini, M.C., Cohen, N., Autelitano, L., Radojicic, J. (2021). Non-surgical treatment of vertical excess of the premaxilla in growing bilateral cleft lip and palate patients. Int J Oral Maxillofac Surg, 50(12): 1576–1582. DOI: https://doi.org/10.1016/j.ijom.2021.04.012.

Meazzini, M.C., Cohen, N., Battista, V.M.A., Incorvati, C., Biglioli, F., Autelitano, L. (2022). Orthodontic pre grafting closure of large alveolar bony and soft tissue gaps. Cleft Palate-Craniofacial Journal, 59(3): 347–354. DOI: https://doi.org/10.1177/10556656211007697.

Wirthlin, J.O. (2017). The orthodontist’s role in the management of patients with cleft lip and palate undergoing alveolar bone grafting. Seminars in Orthodontics, 23(3), 268–278. DOI: https://doi.org/10.1053/j.sodo.2017.05.003.

Uzel, A., Benlidayı, M.E., Kürkçü, M., Kesiktaş, E. (2019). The effects of maxillary expansion on late alveolar bone grafting. Journal of Oral and Maxillofacial Surgery, 77(3): 607–614. DOI: https://doi.org/10.1016/j.joms.2018.07.022.

Ahn, H.W., Kim, S.J., Baek, S.H. (2021). Miniplate‐anchored maxillary protraction in adolescent patients with cleft lip and palate. Orthodontics & Craniofacial Research, 24(Suppl 1): 21–30. DOI: https://doi.org/10.1111/ocr.12446.

On, S.W., Baek, S.H., Choi, J.Y. (2018). Effect of long-term use of facemask with miniplate on maxillary protraction in patients with cleft lip and palate. Journal of Craniofacial Surgery, 29(2): 309–314. DOI: https://doi.org/10.1097/SCS.0000000000004122.

Padwa, B.L. (2020). Alveolar bone graft without presurgical orthodontics. Webinar presented at: Third International Cleft Care Workshop. October 2–11, Chennai, India.

Schechter, J., Shetye, P.R. (2024). Orthodontic Treatment of Patients with Cleft Lip and Palate from Birth through Maturity. Seminars in Orthodontics. DOI: https://doi.org/10.1053/j.sodo.2024.09.006.

Cheng, L., Xia, K., Sun, W., Yu, L., Zhao, Z., Liu, J. (2024). Orthodontic camouflage treatment for a patient with bilateral cleft lip and palate. European Journal of Medical Research, 29: 119. DOI: https://doi.org/10.1186/s40001-023-01589-3.

Palikaraki, G., Makrygiannakis, M.A., Zafeiriadis, A.A., et al. (2021). The effect of facemask in patients with unilateral cleft lip and palate: A systematic review and meta-analysis. European Journal of Orthodontics, 43(1): 69–79. DOI: https://doi.org/10.1093/ejo/cjaa027.

Benitez, B.K., Brudnicki, A., Surowiec, Z., et al. (2022). Digital impressions from newborns to preschoolers with cleft lip and palate. JPRAS, 75(11): 4233–4242. DOI: https://doi.org/10.1016/j.bjps.2022.08.015.

Padovano, W.M., Skolnick, G.B., Naidoo, S.D., et al. (2022). Long-term effects of nasoalveolar molding in patients with unilateral cleft lip and palate: A systematic review and meta-analysis. Cleft Palate-Craniofacial Journal, 59(4): 462–474. DOI: https://doi.org/10.1177/10556656211009702.

Jahanbin, A., Shafaee, H., Pahlavan, H., et al. (2022). Efficacy of bone-anchored maxillary protraction in cleft lip and palate patients. Journal of Craniofacial Surgery, 33(3): 777–782. DOI: https://doi.org/10.1097/SCS.0000000000008972.

Monga, N., Kharbanda, O.P., Dave, H., et al. (2022). Presurgical infant orthopaedics and nasoalveolar molding. In: Kharbanda O.P. (Ed.), Cleft Orthodontics. Thieme, 101–117. DOI: https://doi.org/10.1055/b-0042-189212.

Kozelj, V. (2023). Presurgical orthopedic treatment before cheiloplasty in cleft lip and palate. Cleft Palate-Craniofacial Journal, 60(5): 1234–1240. DOI: https://doi.org/10.1597/1545-1569_1999_036_0515_cpbpot_2.3.co_2.

Abd El-Ghafour, M., Aboulhassan, M.A., Fayed, M.M.S., et al. (2021). 3D-Printed Nasoalveolar Molding Appliance in Unilateral Cleft Lip and Palate Infants. Cleft Palate-Craniofacial Journal, 58(2): 1370–1381. DOI: https://doi.org/10.1177/1055665620954321.

Shetye, P.R. (2024). Presurgical lip, alveolus, and nose approximation (PLANA) for infants with clefts. Journal of Craniofacial Surgery, 35(1): 45–50. DOI: https://doi.org/10.1097/SCS.0000000000010107.