Differential approach to the treatment of children with cleft lip and palate in the period of neonatal development

Keys words:
Cleft lip, Cleft palate, Maxillofacial abnormalities, Mouth abnormalities.
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KOREAN RESEARCH SOCIETY
INFORMATION ABOUT THE AUTHORS: 
1 
Department of Otorhinolaryngology, Tashkent 
State Medical Institute, Tashkent, Uzbekistan 
2 
Republican Multidisciplinary Medical Center 
named after U.Khalmuratova, Nukus, Uzbekistan 
3 
Department of ENT Diseases and Surdology of 
Multidiciplinary clinic, Tashkent Medical 
Academy, Tashkent Uzbekistan 
4 
Department of Maxillofacial Surgery, Tashkent 
State Dental Institute, Tashkent, Uzbekistan 
Address for Correspondence:
Makhkamova N.E. Prof, MD, PhD 
Department of Otorhinolaryngology, Tashkent 
State Medical Institute,
103 Tarakkiyot str. 100000 Tashkent, Uzbekistan. 
E-mail: [e-mail]
ORCID: 
https://orcid.org/0000-0003-0064-9806

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Journal of Medicine
Vol. 2, No. 3 (2022): Issue 1
의학 저널
[e-mail]
https://krsjournal.com
45 
Introduction
Cleft lip and palate (CLP) is one of the 
most common malformations of the 
mandibular-facial region (MFD) with a 
tendency to increase. Ranking 3rd-4th in the 
structure of congenital anomalies, it remains 
in one of the first places in terms of the 
severity of anatomical and functional 
abnormalities. Among these, the most severe 
form is bilateral cleft lip and palate, which 
occurs relatively less frequently (15-25%) than 
other forms.
In recent years, many foreign clinics 
have begun to use fixed orthoses with 
intraosseous fixation for intermandibular 
bone (IMB) repositioning and expansion of 
the lateral fragments of the maxilla in children 
with CLP [1–3, 7]. Nowadays, it is becoming 
more and more important to perform primary 
surgery early in the child's development. This 
requires a multidisciplinary approach [4–6]. 
In addition, due to advances in orthodontic 
technology, it is becoming possible to perform 
successful surgery on a child early in life with 
orthodontic preparation.
Purpose 
The aim of the study was to improve 
the effectiveness of treatment of children with 
cleft lip and palate in the neonatal period by 
preoperative orthodontic preparation.
Methods
The 
algorithm 
of 
treatment 
(developed by Mamedov Ad.A. (Federal State 
Budgetary Educational Institution of Higher 
Education First Moscow State Medical 
University named after I.M. Sechenov, 
Ministry of Health of Russia, Department of 
Pediatric Dentistry and Orthodontics) of 
children with unilateral and bilateral cleft lip 
and palate in the period from 2019 to 2021 at 
the stomatology department in collaboration 
with the specialists of U.Khalmuratov RMC 
clinic of Nukus city was applied. We observed 
24 children with unilateral and bilateral CLP 
in maternity clinics and in the Department of 
Oral and Maxillofacial Surgery.
Prior to primary cheiloplasty, a 
modified 
Lantham-type 
orthodontic 
appliance was fixed under endotracheal 
anaesthesia. A partial osteotomy of the 
cochlea was performed at the same time. The 
main distinguishing feature of the approach 
we performed was the partial osteotomy of 
the cecum.
It should be noted that we used 
miniscrews (up to 8-10 mm in length) in the 
intermaxillary bone instead of the planned 
mouthpiece with hooks.
Ultracaine D-C forte solution was used 
as additional anaesthesia before osteotomy in 
all patients. In addition, in patients in the 
second group, the sawing places of the 
coulomb after the osteotomy were filled with 
Q-Oss Synthetic Bone mixed with patient 
plasma with subsequent closure by plastic 
displacement of the tissues of the coulomb 
itself. The choice of anaesthetic is justified by 
the short latency period and good tissue 
tolerance. Ultracaine has a high diffusion 
ability and a high degree of binding to 
proteins, low fat-solubility, which against the 
background of low toxicity allows using a 4% 
solution of the drug.
For a fortnight, the intermaxillary 
bone was pulled toward the fixed appliance 
(retrusion), while the appliance itself moved 
toward the lateral fragments of the upper jaw 
by unscrewing the screw.
Two weeks later, the orthodontic 
appliance was removed and the micro-
implants 
were 
removed 
from 
the 
intermaxillary bone. I.e. the entire appliance 
was removed. After that, a primary one-stage 
bilateral 
(unilateral) 
cheiloplasty 
was 
performed.
Results 
Orthodontic 
approach 
to 
the 
surgical treatment phase.
Diagnostic models 
were studied in 12 patients with bilateral 
CCLP at the first visit according to the 
standard methods (Dolgopolova G.V., 2003). 
The boundaries of the alveolar and palatine 
processes, intermaxillary bone and ossicle 
were contoured and reference points were 
marked on the plaster model with a marker. 
The model was photographed using a digital 
camera with a rigid fixation in the standard 

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Journal of Medicine
Vol. 2, No. 3 (2022): Issue 1
의학 저널
[e-mail]
https://krsjournal.com
46 
position. The obtained image was transferred 
to a computer, where the AUTOCAD 
software was used to create a graphic form of 
the alveolar processes, palatine processes, 
intermaxillary bone and cusp, where 
reference points were plotted, between which 
linear and angular measurements were taken. 
The area of all three fragments (lateral 
fragment area and intermandibular bone 
area), the length of the alveolar processes, the 
width of the cleft palate throughout, the 
longitudinal dimensions of the cleft, and the 
sagittal position of the upper jaw fragments 
were studied graphically.
Orthodontic protocol includes taking 
an impression, making a plaster model (at the 
same time, a control model is cast for further 
study and measurement), making an 
individual tray, taking an impression again 
and casting a plaster model for making an 
individual orthodontic appliance with an 
expander screw and a mouthguard with 
intermandibular screws.
Surgical stage of treatment.
Before 
the surgical treatment, the orthodontic 
appliance is fixed with mini screws on the 
lateral fragments of the upper jaw. Mini-
implants are placed on both sides of the 
intermaxillary bone.
The main feature of our approach is 
that a partial osteotomy of the cusp is 
performed prior to the placement of the 
orthodontic appliance. This shortens the 
preparation 
time 
for 
the 
primary 
cheilorhinoplasty.
The mini-implants are connected to 
the main structure with spring struts. Two 
weeks later, when the optimum condition of 
the intermaxillary bone and lateral fragments 
is achieved, primary cheilorhinoplasty is 
carried out under endotracheal anaesthesia. 
Clinical and biometric studies of the 
jaw models of 12 children with unilateral and 
bilateral CLP in the preoperative period and 
in the postoperative period, normalisation of 
the intermaxillary bone to lateral fragment 
ratio was observed in all patients.