THE APPLICATION OF STIMULATOR IN THE TREATMENT OF CLEFT LIP AND PALATE IN GOLDENHAR SYNDROME, TRISOMY 13 AND LOBAR HOLOPROSENCEPHALY WITH A MEDIAN CLEFT LIP

Abstract

The clinical picture of a newborn with a syndromic cleft lip and palate is severe. The orthodontic and surgical treatment of cleft is complex and long-term. It is further complicated by various birth defects which can be life-threatening for a newborn or can make the therapy itself more difficult. The induction of a newborn into total anesthesia with a view to performing the surgery of a cleft is often made difficult or time-limited. This paper presents pre-surgical orthodontic therapy in newborns with three severe types of cleft, UCLP, BCLP and premaxillary agenesis with median cleft lip which occurred within three rare syndromes Goldenhar syndome, lobar holoprosencephaly with a median cleft lip and trisomy 13 (47XX+13). Pre-surgical orthodontic therapy was conducted by means of RBJ stimulators without extra oral fixation, whose construction was conditioned by the type of cleft. With active treatment of RBJ stimulators, the cleft area in all three types of cleft was significantly reduced, as well as the protrusion of the premaxilla in BCLP. By directing the growth of cleft segments of newborn’s upper jaw, the most approximate shape to a healthy newborn’s jaw shape is achieved. All three types of described stimulators used in the therapy of syndromic cleft lip and palate enabled primarily the feeding of newborns, and thus their survival. With their orthopedic treatment they created optimal conditions for successful performing of surgical care of syndromic cleft lip and palate.