Cleft and Craniofacial Orthodontics

Cover
Title Page
Copyright Page
Contents
Contributors
Preface
About the˜companion website
Part I Introduction to craniofacial orthodontics and team care
	Introduction
		What is craniofacial orthodontics?
		Terminology and definitions
			Craniofacial anomalies and facial differences
			Orofacial clefting
			Complex craniofacial anomalies
		Treatment timeline of craniofacial anomalies
		References
	Chapter 1 Craniofacial team concept and the role of a craniofacial team
		Introduction
		The interdisciplinary team care model
		History of the team model in cleft and craniofacial care
			Lancaster Cleft Palate Clinic
			American Cleft Palate–Craniofacial Association
		Disciplines of the cleft and craniofacial team
			Primary care and pediatric medicine
			Nursing
			Surgery
			Anesthesiology
			Dentistry
			Orthodontics
			Speech and language pathology
			Otolaryngology
			Audiology
			Genetic counseling
			Psychology, counseling, and social work
		Functions of a craniofacial team
			Clinical team care
			Managing quality of care
			Interorganizational involvement
			Professional development and continuing education
		Acknowledgments
		References
	Chapter 2 Evolution of craniofacial orthodontics as a subspecialty
		Introduction
		Role of an orthodontist on a cleft and craniofacial team
		History of craniofacial orthodontics
		Fellowship training in craniofacial orthodontics
			Development of craniofacial orthodontic fellowships
			Training requirement for craniofacial orthodontic fellowships
		Future of craniofacial orthodontics as a subspecialty
		References
Part II Introduction to orofacial clefting
	Chapter 3 Embryology and classification of orofacial clefting
		Introduction
		Embryogenesis of the face
			Pharyngeal arches, pouches, and grooves
			Facial prominences and formation of the face
			Palatal shelves and formation of the palate
		Embryogenesis of orofacial clefting
			Development of clefts of the face, lip, and primary palate
			Development of clefts of the secondary palate
			Microform and subclinical cleft presentations
		Classification of orofacial clefts
			Embryologic and structural approach to cleft classification
			Veau classification of cleft palate
			CLAP method of cleft classification
			International classification of diseases – ICD-11
		Acknowledgments
		References
	Chapter 4 Epidemiology, etiology, and genetics of orofacial clefting
		Introduction
		Epidemiology of orofacial clefting
			Incidence and prevalence
		Etiology and risk factors in orofacial clefting
			Maternal smoking
			Alcohol consumption
			Multivitamin supplementation
			Socioeconomic status
			Gene–environment interaction
		Genetics of orofacial clefting
		Genetics of syndrome-associated orofacial clefting
			Van der Woude syndrome
			CHARGE syndrome
			22q11.2 deletion syndrome
			Ectrodactyly-ectodermal dysplasia-clefting syndrome
			Oral–facial–digital syndrome
			Stickler syndrome
			Kabuki syndrome
		Genetic risk factors in non-syndromic clefting
		Patient evaluation and family counseling
		References
	Chapter 5 Anatomy of cleft lip and palate
		Introduction
		Facial anatomy in unaffected infants
			Bony anatomy of the face
			Soft tissue anatomy of the face and lips
			Anatomy of the nasal cavity
			Anatomy of the oral cavity
			Anatomy of the palate and pharynx
			Anthropometric measurements of unaffected infants
		Anatomy of unilateral cleft lip
		Anatomy of bilateral cleft lip
		Anatomy of cleft palate
		Variations in presentation of orofacial clefting
		Acknowledgments
		References
Part III Management of orofacial clefting – prenatal period and infancy
	Chapter 6 Prenatal diagnosis, family counseling, and infant feeding
		Introduction
		Prenatal diagnosis of orofacial clefting
			Imaging modalities
		Prenatal consultation
			Postnatal care and counseling
		Initial newborn visit
		Physiology of feeding in cleft lip and palate
			Anatomy and physiology of feeding in unaffected infants
			Feeding challenges in cleft lip and palate
		Feeding techniques in cleft lip and palate
			Bottle feeding
			Step-by-step bottle-feeding instructions
			Breast feeding in cleft lip and palate
		Acknowledgments
		References
	Chapter 7 History and current presurgical infant orthopedic treatment
		Introduction
		History of presurgical infant orthopedics
			Pre-nineteenth century
			Nineteenth century
			Twentieth century
		Current presurgical infant orthopedic treatment
			Lip adhesion (surgical)
			Lip taping
			DynaCleft™ positioning strips
			Passive feeding plate
			Passive Hotz plate
			The Latham appliance
			Nasoalveolar molding appliance and its modifications
			Nostril retainer
			Nasal elevator
		Controversies and evidence-based outcomes of presurgical infant orthopedic appliances
		Conclusion
		Acknowledgments
		References
	Chapter 8 Introduction to clinical provision of nasoalveolar molding
		Introduction
		Patient selection
			Age
			Medical comorbidities
			Family motivation, support, and psychosocial factors
			Team support
		Initial team consultation
			Surgeon evaluation
			Orthodontist evaluation
			Nursing and feeding consultation
			Psychological and social work consultation
			Treatment consent
		Impression acquisition
			Consent for impression
			Clinical setting and materials
			Conventional intraoral impression
			Digital impression techniques
		Appliance fabrication
			Stone model preparation
			Acrylic plate fabrication
			Retention buttons
		Appliance delivery
			Delivery appointment
			Base tapes
			Retention tapes
			Caregiver instructions
			Post-insertion follow-up
		Management of treatment challenges
			Managing feeding refusal
			Managing extraoral cheek irritation
			Managing intraoral irritation or ulceration
			Managing poor appliance retention
			Managing Candida albicans
		Monitoring treatment progress
			Progress records and review
			Managing difficulty in alveolar gap closure and nasal shape correction
			Scheduling surgery
			Treatment discontinuation
		Surgical modifications after nasoalveolar molding
			Primary cheilorhinoplasty
			Gingivoperiosteoplasty
		References
	Chapter 9 Nasoalveolar molding in unilateral cleft lip and palate
		Introduction
		Treatment goals of nasoalveolar molding in unilateral cleft lip and palate
			Nose
			Lip
			Alveolus
		Variable presentations of unilateral clefting
			Incomplete cleft lip
			Incomplete cleft lip, nose, and alveolus
			Complete cleft lip, nose, and alveolus
			Complete cleft lip, nose, alveolus, and palate
		Appliance adjustment and activation in unilateral cleft lip and palate
			Retention button position
			Alveolar segment alignment
			Alveolar gap closure
			Correction of vertical alveolar discrepancies
			Compensation for normal growth
			Nasal stent addition
			Adjustment of nasal stent for nasal cartilage molding
			Adjustment of nasal stent for vertical alveolar control
			Taping for alveolar molding
			Taping for lip and nasal molding
		Long-term outcomes of nasoalveolar molding in unilateral cleft lip and palate
			Nasolabial esthetics
			Alveolar molding and secondary alveolar bone graft
			Facial growth
		Acknowledgments
		References
	Chapter 10 Nasoalveolar molding in bilateral cleft lip and palate
		Introduction
		Treatment goals of nasoalveolar molding in bilateral cleft lip and palate
			Nose
			Lip
			Alveolus
		Variable presentations of bilateral clefting
			Incomplete cleft lip
			Incomplete cleft lip, nose, and alveolus
			Complete cleft lip, nose, alveolus, and palate
		Appliance adjustment and activation in bilateral cleft lip and palate
			Retention button position
			Premaxillary retraction
			Alveolar segment alignment
			Alveolar gap closure
			Correction of vertical alveolar discrepancies
			Compensation for normal growth
			Nasal stent addition
			Adjustment of nasal stent for nasal cartilage molding
			Adjustment of nasal stents for columellar lengthening
			Taping for lip and nasal molding
		Management of treatment challenges
			Difficulty in NAM appliance retention
			Difficulty in the appliance engaging the premaxilla
			Difficulty in premaxillary retraction
			Difficulty with insertion of the nasal stent
		Long-term outcomes of nasoalveolar molding in bilateral cleft lip and palate
			Nasolabial esthetics
			Alveolar molding and secondary alveolar bone graft
			Facial growth
		Acknowledgments
		References
	Chapter 11 Technological advancements in presurgical infant orthopedics
		Introduction
		Application of digital three-dimensional technologies in infant orthopedics
			Intraoral digital scanning
			Intraoral scanning procedure
			Image acquisition of the texture of the nose and lip
			Virtual setup and computer-assisted appliance design
			Appliance fabrication and three-dimensional printing
			Appliance delivery and protocol
		Outcomes of digital three-dimensional technologies in infant orthopedics
			Dental cast outcomes
			Photographic outcome studies
			Treatment cost and burden
			Sample cases
		Future of three-dimensional printing technologies in infant cleft and craniofacial care
		Acknowledgments
		References
	Chapter 12 Post-surgical nostril retainer in orofacial clefts
		Introduction
		Post-surgical relapse of the nasal deformity
			Post-surgical alar cartilage relapse after primary surgery
			Post-surgical nostril retainers
		Protocol for using post-surgical nostril retainer
			Immediate post-surgical nostril retainer
			Delayed post-surgical nostril retainer
		The outcome of post-surgical nostril retainers
		References
	Chapter 13 Primary surgical repair for unilateral cleft lip
		Introduction
		Principles of unilateral cleft lip repair
			Defining the elements of the unilateral cleft lip
			Markings for the unilateral cleft lip repair
		Surgical techniques for lip, nose, and alveolar repairs in unilateral cleft lip
			Randall–Tennison repair
			Millard rotation-advancement repair
			Extended Mohler repair
			Fisher anatomic subunit repair
			Gingivoperiosteoplasty
			Primary cleft rhinoplasty
			Lip adhesion
		Postoperative care
		Outcome assessment of primary repair for unilateral cleft lip
			Nasal morphology
			Lip morphology
			Scar tissue
			Revision surgery
		References
	Chapter 14 Primary surgical repair for bilateral cleft lip
		Introduction
		Surgical considerations in primary reconstructive surgery for bilateral cleft lip
		Surgical techniques for lip, nose, and alveolar repairs in bilateral cleft lip
			Repair of the lip, nose, and alveolus in infants treated with nasoalveolar molding
			Lip adhesion – two-stage primary repair
			Early premaxillary repositioning surgery
		Postoperative care
		Outcome assessment of primary repair for bilateral cleft lip
			Nasal morphology
			Lip morphology
			Scar tissue
			Revision surgery
		References
	Chapter 15 Cleft palate repair
		Introduction
		Surgical considerations for cleft palate repair
			Cleft classification
			Non-syndromic and syndromic clefting
			Submucous cleft palate
			Cleft palate in patients with Pierre Robin sequence
		Indications and timing of cleft palate repair
		Surgical techniques for hard palate repair
			Von Langenbeck
			Pushback procedures
			Two-flap palatoplasty
		Surgical techniques for soft palate repair
			Intravelar veloplasty/radical intravelar veloplasty
			Double-opposing Z-plasty/Furlow palatoplasty
		Other adjunctive procedures for palate repairs
			Vomer flap
			Buccal flap palate repair
			Two-stage closure
		Postoperative care
		Outcomes of palate repair and common complications
			Speech
			Fistulae
			Maxillary growth
			Hearing
		Conclusions
		Acknowledgments
		References
	Chapter 16 Otolaryngology considerations in cleft and craniofacial care
		Introduction
		Hearing disorders in patients with cleft lip and palate
			Anatomy and physiology of the auditory apparatus
			Types of hearing impairment
			Middle ear disease in patients with clefts
			Management of middle ear disease in patients with clefts
			Hearing loss in patients with clefts
			Audiologic testing
			Management of hearing loss
		Breathing disorders in patients with orofacial clefts
			Normal respiration during sleep
		Pathological respiration during sleep
		Diagnostic approach to obstructive sleep apnea
		Pathophysiology of obstructive sleep apnea in patients with orofacial clefts
		Management of obstructive sleep apnea in patients with orofacial clefts
		References
Part IV Management of orofacial clefting – preschool years
	Chapter 17 Dental development in children with orofacial clefting
		Introduction
		Oral and dental development in infancy
			Growth and development of the gum pads
			Developmental differences in orofacial clefting
			Dental anomalies of infancy
		Development of primary dentition
			Timing and sequence of eruption in the primary dentition
			Development of the primary dentition in orofacial clefting
			Dental anomalies of the primary dentition
		Development of permanent dentition
			Timing and sequence of eruption in the permanent dentition
			Development of the permanent dentition in orofacial clefting
		Dental anomalies of the permanent dentition
			Dental agenesis
			Maxillary lateral incisor: agenesis, morphological variation, and position
			Premolar agenesis
			Molar agenesis
			Impacted permanent maxillary canines
			Ectopic first molar eruption
			Tooth transposition
		Summary
		References
	Chapter 18 Pediatric dental management in patients with orofacial clefts
		Introduction
		Establishment of cleft/craniofacial dental home and first dental visit
		Behavior guidance
			Basic behavior guidance techniques
			Advanced behavior guidance
		Preventive dental care
			Caries risk in patients with orofacial clefts
			Parent education and counseling
			Caries risk assessment
			Oral hygiene instructions
			Supplemental fluoride and other therapies
			Dental anomalies
			Gingival and periodontal defects
			Restorative care
		Goals of minimally invasive dentistry (MID)
			Fluoride
			Sealants
			Icon resin infiltration
			Silver diamine fluoride
			Alternative restorative technique
			Indirect pulp therapy
			Hall technique
			Non-restorable primary teeth
			No treatment or deferred treatment
			Contraindications to minimally invasive dentistry
		Treatment options and behavior guidance
			Box 18.1
			Box 18.2
			Box 18.3
			Coordination and collaboration with cleft and craniofacial team
			Acknowledgments
		References
	Chapter 19 Normal speech and language and the management of speech disorders in patients with clefts
		Introduction
		Normal speech and language development
			How speech is produced
			Physical prerequisites for speech
			Language development
		Speech and resonance disorders due to cleft lip/palate
			Obligatory distortions and compensatory productions
			Speech disorders secondary to clefts of the primary palate
			Speech disorders secondary to clefts of the primary and secondary palate
			Speech disorders secondary to clefts of the secondary palate
			Resonance disorders secondary to orofacial anomalies and cleft palate
		Management of speech and resonance disorders in cleft lip and palate
			Clinical evaluation
			Instrumental evaluation
			Recommendations
			Speech therapy
		References
	Chapter 20 Management of velopharyngeal dysfunction
		Introduction
		Anatomy and physiology of the velopharyngeal valve
		Velopharyngeal dysfunction
			Velopharyngeal insufficiency
			Velopharyngeal incompetence
			Velopharyngeal mislearning
			Combined type
		Assessment of velopharyngeal dysfunction
			Speech assessment
			Velopharyngeal imaging
		Prosthetic management of velopharyngeal dysfunction
		Surgical management of velopharyngeal dysfunction
			Tonsillectomy and adenoidectomy
			Furlow double-opposing Z-palatoplasty
			Posterior pharyngeal flap
			Sphincter pharyngoplasty
			Posterior pharyngeal wall augmentation
		References
Part V Management of orofacial clefting – preadolescence
	Chapter 21 Orthodontic treatment for orofacial clefting in preadolescence
		Introduction
		Orthodontic treatment in preadolescence
		Early interceptive orthodontics
			Ectopic eruption of maxillary first permanent molars
			Premature loss of primary posterior teeth
			Large anterior palatal fistula
			Correction of early developing anterior crossbite
			Early maxillary expansion
			Early protraction headgear
		Orthodontic preparation for alveolar bone grafting
			Goals of pre-bone graft orthodontics
			Sequencing and timing of orthodontic treatment and surgery
		Pre-adolescent orthodontic treatment after alveolar bone grafting
			Correction of transverse discrepancy
			Correction of anterior–posterior discrepancy
			Alignment of anterior teeth
		References
	Chapter 22 Correcting transverse discrepancies in patients with clefts
		Introduction
		Maxillary transverse discrepancy in cleft lip and palate
			Etiology of transverse discrepancies
			Assessment of transverse discrepancy in patients with clefts
			Anatomical and orthodontic considerations in treatment of maxillary transverse discrepancy
		Expander anchorage
			Tooth-borne expanders
			Bone-borne expanders
			Hybrid expanders
		Maxillary expansion appliances
			Removable expanders
			Quad helix appliance
			NiTi expanders
			Conventional Hyrax and Haas-type expanders
			Fan expander
			Expander with differential opening or double-hinged expander
			Bonded expanders
			Miniscrew-assisted rapid palatal expander
			Archwire expansion
		Outcome studies on maxillary expansion
			Slow and rapid expansion
			Airway and nasal cavity
			Stability
		Final considerations
		References
	Chapter 23 Correcting anteroposterior discrepancies in patients with orofacial clefts
		Introduction
		Anteroposterior discrepancies in cleft lip and palate
			Etiology of anteroposterior discrepancies
			Anatomical considerations
			Assessment of anteroposterior discrepancies
			Orthodontic considerations in treatment of anteroposterior discrepancy
		Biomechanics of maxillary protraction
			Tooth-borne protraction appliances
			Bone-borne protraction appliances
			Hybrid protocols
		Outcome studies on maxillary protraction
			Tooth-borne appliances
			Bone-borne protraction appliances
			Hybrid protocol
		Maxillary protraction appliances
			Tooth-borne appliances
			Bone-borne protraction appliances
			Hybrid appliances
		References
	Chapter 24 Orthodontic preparation for alveolar bone grafting in unilateral cleft lip and palate
		Introduction
		Timing of alveolar bone graft reconstruction
			Gingivoperiosteoplasty
			Primary alveolar bone grafting
			Early secondary alveolar bone grafting
			Secondary alveolar bone grafting
			Late secondary alveolar bone grafting
			Tertiary alveolar bone grafting
		Preoperative evaluation of the cleft site
			Diagnostic records to evaluate alveolar bone at the cleft site
			Alveolar bone following gingivoperiosteoplasty
			Alveolar bone with no history of gingivoperiosteoplasty
			Boundaries of alveolar cleft defect
			Soft tissue considerations (fistulae)
			Alveolar ridge alignment
			Position of teeth (primary, permanent, and supernumerary)
		Pre-surgical orthodontic preparation for alveolar bone grafting
			Maxillary expansion and alveolar segment alignment
			Limited orthodontic tooth movement adjacent to the cleft defect
			Extraction of teeth
			Retention after pre-bone graft orthodontics
		Perioperative phase of bone graft surgery
			Preoperative phase
			Postoperative phase
			Evaluation of diagnostic records after alveolar bone graft surgery and planning orthodontic treatment
		Acknowledgments
		References
	Chapter 25 Orthodontic preparation for alveolar bone grafting in bilateral cleft lip and palate
		Introduction
		Management of the premaxilla
			Primary premaxillary repositioning
			Primary gingivoperiosteoplasty
			Secondary alveolar bone grafting without premaxillary repositioning surgery
			Secondary alveolar bone graft surgery with premaxillary repositioning
			Orthopedic intrusion of the premaxilla followed by secondary alveolar bone graft
			Interdental distraction followed by secondary alveolar bone graft
			Posterior buccal segment osteotomy followed by secondary alveolar bone graft
		Preoperative evaluation of the cleft site
			Diagnostic records to evaluate the position of the premaxilla and alveolar bone at the cleft site
			Alveolar bone following gingivoperiosteoplasty
			Alveolar bone with no history of gingivoperiosteoplasty
			Soft tissue consideration (fistulae)
			Lateral alveolar ridge alignment and arch width
			Position of teeth (primary, permanent, and supernumerary)
		Pre-surgical orthodontic preparation for alveolar bone grafting
			Maxillary expansion and alveolar segment alignment
			Stabilization of the premaxilla and orthodontic retention
		Perioperative phase of bone graft surgery
			Splint design
		References
	Chapter 26 Alveolar bone graft surgery
		Introduction
		Surgical considerations in alveolar bone grafting
			Anatomy of the alveolar defect
			Patient age, dental development, and tooth proximity
			Periodontal and soft tissue
			Cleft involvement
		Principles for cleft alveolar bone grafting
			Site preparation
			Flap design and closure of the nasolabial fistula
			Donor site selection and harvesting
		Secondary alveolar bone grafting in patients with unilateral clefts
		Secondary alveolar bone grafting in patients with bilateral clefts
			Concurrent premaxillary repositioning
		Postoperative management and complications
			Postoperative management
			Complications of alveolar bone grafting
			Factors contributing to alveolar bone graft success
		Alternative graft materials for alveolar cleft reconstruction
			Allograft
			Minimally invasive autograft
			Bone morphogenetic protein
			Tissue-engineered alveolar bone graft and recent advances
		Acknowledgments
		References
	Chapter 27 Outcomes of secondary alveolar bone graft surgery
		Introduction
		Physiology of bone formation in treated alveolar defects
		Bone formation after autogenous alveolar bone graft
		Bone formation after BMP treatment
		Bone formation after gingivoperiosteoplasty
		Assessment of alveolar bone graft success
			Timing of radiographic assessment
			Grading systems for the assessment of alveolar bone grafts
			Success rate of alveolar bone grafting
		Long-term bone maturation and remodeling
			Development of teeth in the bone graft area
			Initiation of orthodontic treatment
			Long-term success and bone volume stability
		Conclusion
		Acknowledgements
		References
	Chapter 28 Orthodontic preparation forpremaxillary repositioning surgery
		Introduction
		Premaxillary position in bilateral cleft lip and palate
			Anatomy of the premaxilla
			Growth and development of the premaxilla
			Etiology of malpositioned premaxilla
		Treatment of premaxillary malpositioning
			Assessment of premaxillary position
			Treatment algorithm for bilateral alveolar cleft based on the position of the premaxilla and width of the cleft
			Timing of correction
			Orthopedic intrusion
			Surgical repositioning of the premaxilla
			Posterior segmental osteotomy
		Interdisciplinary planning of premaxillary repositioning surgery
		Pre-surgical orthodontics
			Records for premaxillary repositioning surgery
			Traditional model surgery for splint construction
			Computerized surgical planning for splint construction
			Orthodontic appliances before surgery
			Surgical procedure and splint insertion
			Postoperative management
			Complications of premaxillary repositioning surgery
			Long-term follow-up
		Acknowledgments
		References
	Chapter 29 Clear aligner therapy forpre-adolescent patients with cleft lip and palate
		Introduction
		Orthodontic preparation and management for secondary alveolar bone grafting
			Interarch coordination
			Management of peri-cleft teeth/alveolar segments
			Peri-surgical management
		Management of the transverse dimension
			Staging of CAT with a maxillary expander
			Staging of CAT with crossbite elastics
		Management of the sagittal relationship
			Staging of CAT with PHG
			Staging of CAT with Class III/II elastics
		Management of the vertical relationship
			Anterior deep bite
			Anterior open bite
		Case selection for CAT versus FAT
		Design of the clear aligners
			Aligner staging
			Attachment selection
			Incorporation of auxiliaries
		Other applications of CAT for CLP and other craniofacial conditions
			Teen care
			Staging of CAT and orthognathic surgery
			Utilizing CAT to manage prosthetic reconstruction of missing and dysmorphic teeth
		The future of CAT for patients with CLP and other craniofacial conditions
		References
Part VI Management of orofacial clefting – early adolescence
	Chapter 30 Orthodontic treatment for mild maxillomandibular discrepancies in early adolescence
		Introduction
		Evaluation of maxillomandibular skeletal discrepancy
			Orthognathic maxillomandibular relationship
			Mild maxillomandibular discrepancy
		Orthodontic treatment of orthognathic and mildly discrepant maxillomandibular relationships
			Monitoring and interceptive management of the developing permanent dentition
			Maxillary transverse correction
			Maxillary anteroposterior correction
			Maxillary tooth size-arch length discrepancy
			Mandibular tooth size-arch length discrepancy
			Management of impacted teeth
			Primary tooth retention without permanent successors
			Management of missing teeth
			Canine substitution
			Prosthetic replacement
			Retention
		Orthodontic treatment stability in mild skeletal discrepancy
			Long-term growth
			Long-term orthognathic surgery need
		References
	Chapter 31 Orthodontic treatment for moderate to severe maxillomandibular discrepancies in early adolescence
		Introduction
		Evaluation of maxillomandibular skeletal discrepancy
			Moderate and severe maxillomandibular discrepancies
			Functional evaluation
		Orthodontic treatment for patients with moderate to severe skeletal discrepancy
			Treatment objectives
			Orthodontic treatment objectives to avoid
		Orthodontic treatment
			Maxillary arch orthodontic treatment
			Mandibular arch treatment
			Orthopedic maxillary protraction
			Late maxillary protraction with maxillary osteotomy
			Distraction osteogenesis
			Early orthognathic surgery
			Retention
		Orthodontic treatment stability in moderate to severe skeletal discrepancy
			Long-term growth
		References
	Chapter 32 Maxillary distraction in adolescent patients with orofacial clefts
		Introduction
		Conventional maxillary advancement versus distraction
		Le Fort I maxillary distraction in patients with orofacial clefts
			Timing of distraction
			Distraction device selection
		Maxillary distraction with external devices
			Orthodontic preparation
			Splint design and construction
			Surgical planning for RED placement
			Surgical procedure and external device placement
			Protocol for distraction and biomechanics
			Post-distraction management and device removal
			Post-distraction orthodontics
			Treatment outcomes of external maxillary distraction
		Maxillary distraction with internal devices
			Orthodontic preparation
			Splint design and construction
			Surgical procedure and internal device placement
			HIMXD protocol for distraction and biomechanics
			Post-distraction management and device removal
			Post-distraction orthodontics
			Treatment outcomes of internal maxillary distraction
		Future directions
		References
	Chapter 33 Alveolar and anterior maxillary distraction in patients with orofacial clefts
		Introduction
		Alveolar distraction osteogenesis in cleft lip and palate treatment
		Biology of alveolar distraction osteogenesis
		Clinical applications of alveolar and segmental distraction osteogenesis
			Vertical alveolar distraction
			Segmental distraction osteogenesis of the anterior maxilla
			Alveolar transport distraction with interdental osteotomies
		Tooth-borne alveolar distraction appliances
			Preoperative orthodontic preparation
			Surgical procedure
			Active distraction
			Consolidation phase and post-distraction management
		Bone-anchored alveolar distraction appliances
			Preoperative orthodontic preparation
			Surgical procedure
			Active distraction
			Consolidation phase and post-distraction management
		Hybrid distraction appliances
		Restorative management after alveolar distraction
		Potential complications of alveolar distraction
		Conclusion
		References
Part VII Management of orofacial clefting – late adolescence and adulthood
	Chapter 34 Orthodontic treatment for orofacial clefting in late adolescence
		Introduction
		Evaluation of patients with clefts in late adolescence
			Assessment of craniofacial growth completion
			Evaluation of treatment needs
		Treatment options
			Orthognathic maxillomandibular relationship
			Mild maxillomandibular skeletal discrepancy
			Moderate and severe maxillomandibular skeletal discrepancy
			Sequencing of soft tissue revisions
		Orthodontic treatment
			Correction of anteroposterior discrepancies
			Correction of transverse discrepancies
			Optimizing position of the teeth
		Adjunctive surgical procedures
			Soft tissue lip and nose revision
			Alloplastic malar implants and fat grafting
		Final restorative dental treatment
			Management of missing teeth
			Cosmetic dentistry
		References
	Chapter 35 Evaluation of patients with clefts for orthognathic surgery
		Introduction
		Assessment of patients for orthognathic surgery
			Chief concerns and goals
			Medical history
			Orthodontic and dental history
			Psychosocial history
		Functional clinical examination
			Evaluation of the dentition and occlusion
			Evaluation of the jaw and temporomandibular joint function
			Evaluation of smile esthetics and lip function
		Facial and extraoral soft tissue evaluation
			Evaluation of facial profile
			Evaluation of vertical facial proportions
			Evaluation of facial symmetry
		Skeletal relationship and radiographic evaluation
			Evaluation of anteroposterior skeletal relationship
			Evaluation of vertical skeletal relationship
			Evaluation of transverse skeletal relationship
			Evaluation of previously grafted alveolus
			Evaluation of craniofacial growth potential
		Dental and occlusal evaluation
			Evaluation of anteroposterior dental relationship
			Evaluation of vertical dental relationship
			Evaluation of transverse dental relationship
			Evaluation of dental perimeter and space requirement
		Interdisciplinary team evaluation
			Surgeon
			Speech and language pathologist
			Otolaryngologist
			Psychologist or social worker
			Nutritionist
		Development of a comprehensive treatment plan
			Surgical prediction
		Presentation of the treatment plan and consent for orthognathic surgery
			Joint treatment plan presentation by the surgeon and the orthodontist
			Surgical consent and risks
		Acknowledgments
		References
	Chapter 36 Orthognathic surgery in patients with clefts – maxillary surgery
		Introduction
		Maxillary hypoplasia in patients with cleft lip and palate
			Incidence and etiology
			Maxillary hypoplasia index
			Treatment options for correction of maxillary hypoplasia
		Pre-surgical orthodontics
			Pre-surgical orthodontic decompensation
			Pre-surgical orthodontic compensation
			Pre-surgical orthodontic treatment
		Le Fort I advancement surgery
			Pre-surgical records
			Pre-surgical treatment planning and surgical simulation
			Traditional model surgery and splint construction for single-piece Le Fort I surgery
			Computerized model surgery and splint construction for single-piece Le Fort I surgery
			Model surgery and splint construction for multisegment Le Fort I surgery
			Preoperative appointment for splint-fit check
			Le Fort I surgery
		Post-surgical orthodontic treatment
			Postoperative care
			Immediate postsurgical orthodontics
			Treatment completion and retention
		Outcomes of Le Fort I advancement surgery
			Surgical complications
			Surgical stability
		References
	Chapter 37 Orthognathic surgery in patients with clefts – maxillary and mandibular surgery
		Introduction
		Indications for maxillary and mandibular surgery in patients with cleft lip and palate
			Correction of facial asymmetry
			Correction of vertical discrepancies
			Correction of severe anteroposterior discrepancies
			Correction of maxillomandibular hypoplasia
		Pre-surgical orthodontics
			Pre-surgical orthodontics for correction of skeletal facial asymmetry
			Pre-surgical orthodontics for correction of skeletal vertical discrepancies
			Pre-surgical orthodontics for correction of severe skeletal anteroposterior discrepancies
			Pre-surgical orthodontics for correction of skeletal maxillomandibular hypoplasia
		Maxillomandibular orthognathic surgery
			Pre-surgical records
			Pre-surgical treatment planning
		Traditional surgical planning using facebow transfer, model surgery, and splint construction
			Facebow transfer and mounting models
			Model surgery for intermediate splint construction
			Model surgery for final splint construction
		Computerized surgical planning and splint construction
			Surgical planning software
			The orientation of three-dimensional craniofacial volume in space
			Three-dimensional identification of hard and soft tissue landmarks
			Three-dimensional surgical simulations for skeletal correction
			Step-by-step surgical simulation planning for two-jaw surgery
			Customized guides, templates, splints, and fixation
			Maxillary advancement and mandibular surgery
		Post-surgical orthodontics
		Outcomes of double-jaw surgery
			Surgical complications
			Surgical stability
		References
	Chapter 38 Surgery first approach in patients with clefts
		Introduction
		Surgery-first orthognathic approach for patients with cleft lip and palate
		Indication and patient selection
		Regional acceleratory phenomenon in the surgery-first approach
		Treatment protocol in surgery-first approach
		Surgery-first for Le Fort I advancement
			Orthodontic appliance placement
			Pre-surgical planning, model surgery, and splint fabrication
			Le Fort I surgery
			Post-surgical orthodontics
		Surgery-first for maxillomandibular orthognathic surgery
			Orthodontic appliance placement
			Pre-surgical planning, model surgery, and splint fabrication
			Maxillomandibular surgery
			Post-surgical orthodontics
		Outcomes of the surgery-first orthognathic approach
			Complications
			Treatment duration
			Short- and long-term surgical stability
			Patient satisfaction
		Future of surgery-first orthognathic approach  for patients with orofacial clefts
			3D-assisted surgical navigation
			Augmented reality and virtual reality
		References
	Chapter 39 Adult orthodontics in patients with clefts
		Introduction
		Assessment of adult patients with clefts seeking orthodontic treatment
			Previously treated adults
			Previously untreated or incomplete treatment
		Orthodontic treatment indications in adult patients with clefts
			Pre-restorative orthodontic treatment
			Correction of orthodontic relapse
			Comprehensive treatment with orthodontic camouflage
			Comprehensive treatment with orthognathic surgery
			Altered treatment goals
		Special considerations for adult patients seeking orthodontic treatment
			Access to care
			Facial esthetic goals
			Occlusion, temporomandibular disorders, and retention
			Restorative dental care and tooth replacement
			Periodontal health
		Developing achievable orthodontic treatment goals
		References
	Chapter 40 Management of missing teeth, dental implants, and prosthetic restoration in orofacial clefts
		Introduction
		Missing, malformed, and transposed teeth
			Prevalence and distribution of missing teeth in patients with clefts
		Orthodontic considerations in the management of missing teeth
			Decision-making with regard to the cleft-side maxillary lateral incisor
			Treatment patterns for the cleft-side maxillary lateral incisor
		Restoration of malformed teeth
		Space closure and substitution
		Prosthetic replacement of missing teeth
		Implant restoration
			Dental implant survival
			Timing of implant placement
			Implant site development
		Conventional fixed prosthodontic replacement
			Resin-bonded bridge
			Tooth-supported fixed bridge
		Autotransplantation
		References
	Chapter 41 Secondary soft tissue revision surgery at skeletal maturity in patients with orofacial clefts
		Introduction
		Secondary lip deformities in unilateral cleft lip
			Upper lip
			Vermilion and mucosa
			Scar hypertrophy
			Perioral musculature
			Surgical correction of secondary lip deformities: unilateral cleft lip
		Secondary lip deformities in bilateral cleft lip
			Prolabium
			Upper lip
			Whistle deformity
			Surgical correction of secondary lip deformities: bilateral cleft lip
		Secondary nasal deformities in unilateral cleft lip and palate
			Alar cartilage
			Columellar asymmetry and nasal projection
			Airway obstruction
			Surgical correction of secondary nasal deformities: unilateral cleft lip and palate
		Secondary nasal deformities in bilateral cleft lip and palate
			Alar cartilage
			Columella shortening
			Surgical correction of secondary nasal deformities: bilateral cleft lip and palate
		Secondary palate deformities
			Velopharyngeal insufficiency
			Oronasal fistula
			Surgical correction of secondary palate deformities
		Paranasal hypoplasia
			Orthognathic surgical alterations
			Fat grafting
			Custom implants
		Adjunctive aesthetic procedures
			Scar revision
			Hair transplantation
		References
Part VIII Outcomes in cleft care
	Chapter 42 Growth and development of the craniofacial skeleton in patients with clefts
		Introduction
		Craniofacial growth and orofacial clefting: infancy (birth to one year)
			Presurgical infant orthopedics
			Primary lip repair
			Primary nasal reconstruction
			Gingivoperiosteoplasty
			Primary alveolar bone grafting
			Primary premaxillary repositioning surgery in bilateral clefts
			Palate repair
		Craniofacial growth and orofacial clefting: pre-school (one to five years)
			Early secondary alveolar bone grafting
			Pharyngeal flap
		Craniofacial growth and orofacial clefting: preadolescence (5–10 years)
			Secondary alveolar bone grafting
			Skeletal changes associated with reverse-pull headgear
		Craniofacial growth and orofacial clefting: adolescence (10–15 years)
			Orthodontic treatment
		Craniofacial growth and orofacial clefting: late adolescence (15–20 years)
			Orthognathic surgery
		Natural growth in adults with untreated orofacial clefts
			Untreated cleft lip and palate
			Untreated cleft palate
		References
	Chapter 43 Standardized diagnostic records in cleft and craniofacial orthodontics
		Introduction
		Purposes of standardized records
		Outcome records and clinical audits
			The clinical audit
		Types of records
			Dimensionality
		Common measurement and rating scales in cleft and craniofacial care
			Dental casts
			Cephalometric analysis
			Photography
			Radiographic assessment of alveolar defects
		Timing of record-taking
		Identification of best practices through multicenter studies – Americleft
		References
	Chapter 44 Radiology in cleft and craniofacial care
		Introduction
		Prenatal imaging
			Ultrasound
			Magnetic resonance imaging
		Postnatal imaging
			Intraoral radiography
			Panoramic radiography
			Cephalometric radiography
			Ultrasound
			Magnetic resonance imaging
			Multislice computed tomography
			Cone-beam computed tomography
		Imaging protocols for patients with orofacial clefts
			Lip repair, tympanostomy, and primary palate repair
			Speech surgery
			Alveolar bone grafting
			Distraction osteogenesis
			Orthognathic surgery
		Outcome assessments of ABG
			Box 44.1
		Radiation protection
			Radiation hygiene
			Factors affecting image quality
			Post-processing and viewing conditions
		Acknowledgments
		References
	Chapter 45 Retention and stability in patients with orofacial clefts
		Introduction
		Retention
		Stability, relapse, and post-treatment change
			Dental stability
			Skeletal stability
			Phenotypic relapse
		Special considerations in retention and stability for patients with orofacial clefts
			Soft tissue factors
			Bony differences
			Growth potential
		Orthodontic retention protocols
			Post-nasoalveolar molding
			Transverse correction with expander
			Anteroposterior correction with headgear
			Comprehensive orthodontic treatment/orthodontic alignment
			Retention adjacent to missing teeth
			Le Fort I distraction
			Le Fort I advancement
			Two-jaw surgery
		Conclusion
		Acknowledgments
		References
	Chapter 46 Psychosocial development and care in patients with orofacial clefting
		Introduction
		Psychosocial development in infancy (prenatal to one year)
			Prenatal diagnosis and parental counseling
			Early postnatal parental counseling
			Psychosocial considerations in pre-surgical infant orthopedics
		Psychosocial development in pre-school (one to five years)
			Psychosocial support
			Psychosocial assessment
		Psychosocial development in pre-adolescence (5–10 years)
			Psychosocial assessment
		Psychosocial development in early adolescence (10–15 years)
			Psychosocial assessment
		Psychosocial development in late adolescence (15–20 years)
		Psychosocial development in adults (20+ years)
		Research and methodological considerations
		References
	Chapter 47 Access issues and burden of care in craniofacial orthodontics
		Introduction
		Adversity in children with orofacial clefts
		Equity, diversity, and inclusion in cleft and craniofacial care
		Burden of care
			Pre-surgical infant orthopedics
			Orthodontic burden
			Patient- and caregiver-reported outcomes
		Barriers to accessing care
		Support and advocacy
		References
	Chapter 48 Application of artificial intelligence in treating patients with cleft and craniofacial anomalies
		Introduction
		Application of artificial intelligence in cleft and craniofacial care
			Detection and classification of craniofacial anomalies by artificial intelligence
			Identifying facial phenotypes of genetic disorders using deep learning
			Analysis of craniofacial anatomy
			Prediction of genetic risk of non-syndromic oral clefts
		Treatment planning assisted by artificial intelligence
			Orthodontic treatment planning
			Planning for craniofacial and plastic surgery
		Customized orthodontic and surgical appliances
		Treatment monitoring and follow-up
		Treatment outcome assessment
		Conclusion
		Acknowledgments
		References
Part IX Orthodontic management of complex craniofacial conditions
	Chapter 49 Orthodontic management in Pierre Robin sequence
		Introduction
		Pierre Robin sequence
			Genetics and embryology
			Epidemiology
			Clinical features
			Classification
			Craniofacial growth
		Craniofacial team, orthodontic, and surgical management
			Infancy (birth to one year)
			Pre-school (one to five years)
			Preadolescence (5–10 years)
			Early adolescence (10–15 years)
			Late adolescence (15–20 years)
			Adult (20+ years)
		References
	Chapter 50 Orthodontic management in craniofacial microsomia
		Introduction
		Craniofacial microsomia
			Genetics and embryology
			Epidemiology
			Clinical features and classification
			Craniofacial growth
		Craniofacial team, orthodontic, and surgical management
			Infancy (birth to one year)
			Pre-school (one to five years)
			Preadolescence (5–10 years)
			Early adolescence (10–15 years)
			Late adolescence (15–20 years)
			Adult (20+ years)
		Acknowledgments
		References
	Chapter 51 Orthodontic management in Treacher Collins syndrome
		Introduction
		Treacher Collins syndrome
			Genetics and embryology
			Epidemiology
			Clinical features and classification
		Orthodontic and craniofacial team management
			Prenatal period and infancy (up to 1 year)
			Pre-school (one to five years)
			Pre-adolescence (5–10 years)
			Early adolescence (10–15 years)
			Late adolescence (15–20 years)
			Adult (+20 years)
		Summary
		References
	Chapter 52 Orthodontic management in syndromic craniosynostosis
		Introduction
		Syndromic craniosynostosis
			Epidemiology
			Genetics and embryology
			Clinical features and classification
			Craniofacial growth
		Craniofacial team, orthodontic, and surgical management
			Infancy (birth to one year)
			Pre-school (one to five years)
			Preadolescence (5–10 years)
			Early adolescence (10–15 years)
			Late adolescence (15–20 years)
			Adult (20+ years)
		Acknowledgments
		References
	Chapter 53 Orthodontic management in cleidocranial dysplasia
		Introduction
		Cleidocranial dysplasia
			Genetics and embryology
			Epidemiology
			Clinical features and classification
			Craniofacial growth
		Craniofacial team, orthodontics, and surgical management
			Infancy (birth to one year)
			Pre-school (one to five years)
			Preadolescence (5–10 years)
			Early adolescence (10–15 years)
			Late adolescence (15–20 years)
			Adult (20+ years)
		References
	Chapter 54 Orthodontic management in Beckwith–Wiedemann syndrome
		Introduction
		Genetics and embryology
		Epidemiology
		Clinical features and classification
		Craniofacial growth
		Craniofacial team, orthodontics, and surgical management
			Infancy (birth to one year)
			Pre-school (one to five years)
			Preadolescence (5–10 years)
			Early adolescence (10–15 years)
			Late adolescence (15–20 years)
			Adult (20+ years)
		References
	Chapter 55 Orthodontic management of achondroplasia
		Introduction
		Achondroplasia
			Genetics and embryology
			Epidemiology
			Diagnosis
			Clinical features
			Craniofacial growth
		Orthodontic and craniofacial team management
			Infancy (birth to one year)
			Pre-school (one to five years)
			Pre-adolescence (5–10 years)
			Early adolescence (10–15 years)
			Late adolescence (15–20 years)
			Adult (+20 years)
		References
	Chapter 56 Overview of other craniofacial conditions
		Introduction
		Neurofibromatosis type 1
			Genetics, embryology, and epidemiology
			Clinical features
			Orthodontic and surgical management
			Craniofacial team management
		Moebius syndrome
			Genetics, embryology, and epidemiology
			Clinical features
			Orthodontic and surgical management
			Craniofacial team management
		Stickler syndrome
			Genetics, embryology, and epidemiology
			Clinical features
			Orthodontic and surgical management
			Craniofacial team management
		Frontonasal dysplasia
			Genetics, embryology, and epidemiology
			Clinical features
			Orthodontic and surgical management
			Craniofacial team management
		Binder syndrome
			Genetics, embryology, and epidemiology
			Clinical features
			Orthodontic and surgical management
			Craniofacial team management
		Solitary median maxillary central incisor syndrome
			Genetics, embryology, and epidemiology
			Clinical features
			Orthodontic and surgical management
			Craniofacial team management
		Turner syndrome
			Genetics, embryology, and epidemiology
			Clinical features
			Orthodontic and surgical management
			Craniofacial team management
		Cherubism
			Genetics, embryology, and epidemiology
			Clinical features
			Orthodontic and surgical management
			Craniofacial team management
		Parry–Romberg syndrome
			Genetics, embryology, and epidemiology
			Clinical features
			Orthodontic and surgical management
			Craniofacial team management
		Vascular malformations
			Genetics, embryology, and epidemiology
			Clinical features
			Orthodontic and surgical management
			Craniofacial team management
		Acknowledgments
		References
	Chapter 57 Distraction osteogenesis in craniofacial syndromes
		Introduction
		Distraction osteogenesis
			Biology of distraction osteogenesis
			Advantages of distraction osteogenesis
		Mandibular distraction
			Types of mandibular distraction devices
			Orthodontic considerations for planning mandibular distraction
			Surgery and device placement
			Management during active distraction
			Distraction completion
			Outcomes of mandibular distraction
		Midface distraction
			Types of maxillary distraction devices
			Orthodontic considerations for planning maxillary distraction
			Surgery and device placement
			Management during active distraction
			Distraction completion
			Outcomes of maxillary distraction
		Simultaneous two-jaw distraction
			Indications
			Devices
			Orthodontic and surgical considerations
			Outcomes of two-jaw distraction
		Cranial distraction
			Indications
		Acknowledgments
		References
	Chapter 58 Orthodontic management of pediatric obstructive sleep apnea
		Introduction
		Pediatric obstructive sleep apnea
			Epidemiology and risk factors
			Symptoms
			Screening, diagnosis, and severity
		Management of pediatric OSA
			Role of an interdisciplinary sleep team
			Conservative treatment
		Adenotonsillectomy
		Other surgical interventions
		Positive airway pressure
		Orthodontic management in pediatric OSA
			Indications for orthodontic management
			Maxillary expansion
			Functional appliance therapy
			Myofunctional therapy
		Airway management in cleft and craniofacial anomalies
			Cleft lip and palate
			Pierre Robin sequence
			Syndromic craniosynostosis
		References
	Chapter 59 Role of the orthodontist in managing facial trauma and post-oncological treatment
		Introduction
		Role of the orthodontist in managing facial trauma
			Non-avulsive dental trauma
			Avulsive dental trauma
			Initiation of orthodontic treatment after dental trauma
			Orthodontic treatment options for condylar fractures
			Orthodontic management of post-surgical malocclusion after facial trauma
		Role of the orthodontist in managing head and neck cancer
			Orthodontic treatment in adolescent cancer survivors
			Orthognathic surgery in late adolescence and adults
		Role of orthodontists in craniofacial reconstruction following oncologic resection
			Orthodontic treatment in preadolescence and early adolescence
			Orthognathic surgery in late adolescence and adults
		References
	Chapter 60 Role of the orthodontist in facial transplantation
		Introduction
		Facial transplantation
			Patient selection
			Indications
			Contraindications
		Components of facial transplants
			Soft tissue
			Skeletal
			Dentition and oral components
		Facial transplantation team
			Team makeup
			Team preparation and cadaveric rehearsals
		Surgery
			Donor selection
			Planning
			Surgery
			Immunosuppression therapy
			Postoperative management
		Management of oral structures
			Pre-surgical and planning phase
			During surgery
			After surgery
		Outcomes of facial transplantation
			Soft tissue
			Skeletal stability
			Occlusal stability
			Rejection
			Revision surgeries
		Future directions in facial transplantation
		Acknowledgments
		References
Index
EULA