NEW APPLIANCE DESIGN FOR RETRACTION OF PROTRUDED PREMAXILLA IN A CLEFT PATIENT-A CASE REPORT

Punam Hossain*, Dhritiman Barman, Ravindra D. Rekhade, Sankha Biswas, Vivek Agarwal and Debpratim Jana

ABSTRACT

Cleft lip and palate is a common congenital facial anomaly. Its incidence is usually between 1 and 1.82 for every 1000 livebirths. Cleft lip and palate is usually associated with maxillary sagittal and transverse discrepancies. Cleft treatment requires a multidisciplinary approach, starting from the birth till adulthood. Objective- Retraction of the premaxilla in bilateral cleft patient. Case report- A 6 years old female patient presented in the Department of Orthodontics and dentofacial Orthopaedics, in Haldia with chief complaint of cleft palate and forwardly placed upper teeth. Extra oral examination revealed mesocephalic head, mesoprosopic facial form, convex facial profile, normal nasolabial angle and deep mentolabial sulcus. Lips were incompetent with interlabial gap was 10 mm at rest and 16 mm during smile. Intraoral examination revealed the patient had early mixed dentition (All the primary teeth and 16, 36, 46), Deep bite, defect in hard palate and normal tongue size. As the premaxilla protruded out, labial sulcus had not formed in maxillary arch. Facial photographs indicated asymmetrical and disproportionate face. She had other additional deformity namely as syndactyly of both hands, bilateral club foot. Treatment- In phase 1, retraction of premaxilla was done with newly designed removable appliance. In phase 2, derotation of the permanent central incisors were achieved using a combination appliance (removable and fixed). In phase 3, a 2×2 fixed appliance was placed for stabilizing the central incisors. In phase 4, utility arch was placed for further control of the anterior segment. The retraction of premaxilla and derotation of central incisors took 1.5 years. Result- The maxillary labial vestibule was developed. Premaxillary protrusion was reduced. The central incisors were derotated. Deep bite correction was achieved. The interlabial gap was reduced. The face became bilaterally symmetrical and proportionate. Conclusion- This case report presents a new dimension for the correction of protrusive premaxilla. Which is economical, easy to fabricate and have good patient compliance.

Keywords: Cleft lip and palate, Protruded premaxilla, New appliance.