Professional Documents
Culture Documents
b
Fig. 23A.1 a, b. Protraction of the maxillary complex using
480
S. Berkowitz
tangular arch with hooks for protraction elastics. d, e, f Delairestyle protraction facial mask used with a fixed labial-palatal
wire framework. Elastic forces of 350400 gm per side can still
be used with this intraoral framework
Chapter 23A
481
482
S. Berkowitz
o
Fig. 23A.3 ax. (continued) i, j Facial photographs at 8 years.
k Orthodontic alignment of incisors prior to secondary alveolar bone graft. l Protraction facial mask with elastics. m, n Class
Chapter 23A
Fig. 23A.3 ax. (continued) q, r Fixed bridge at 18 years of age replacing missing lateral incisor and stabilizing maxillary arch form.
s, t, u 17 years prior to nose-lip revision. v, w, x Facial photos at 19 years, showing good facial symmetry after revision
483
484
S. Berkowitz
Tindlund et al. [1618] conclude that early transverse expansion of the maxilla together with protraction orthodontic treatment is an effective method for
normalizing maxillo-mandibular discrepancies in
cleft lip and palate patients. The average age at the
start of treatment was 6 years, 11 months, and the average duration of treatment was 13 months. Significant changes were achieved due to anterior movement
of the upper jaw and a more posterior positioning of
the lower jaw resulting from clockwise mandibular
rotation.
Berkowitz also found that the combined use of
palatal expansion and protraction forces before the
pubertal growth spurt to be a more efficient means of
gaining orthopedic advancement than the use of protraction forces alone. He speculates that the expansion
forces possibly disarticulate the circumaxillary sutures, thus allowing the maxillary complex to be carried downward and forward more easily.
Delaire et al. [5] and Subtelny [8] have stated that
orthopedic forces applied to the entire maxillary com-
Chapter 23A
References
1. Haas AJ. Palatal expansion: just the beginning of dentofacial orthopedics. Am J Orthod 1970; 57:219255.
2. Delaire J. Considerations sur la croissance faciale (en particulier du maxillaire superieur): deductions therapeutiques.
Rev Stomatol 1971; 72:5776.
3. Delaire J, Verdon P, Lumineau J-P, Chierga-Negrea A, Talmant J, Boisson M. Quelques resultats de tractions extraorales a appui fronto-mentonnier dans le traitement orthopedique des malformations maxillo-mandibulaires de
classe III et des sequelles osseuses des fentes labio-maxillaires. Rev Stomatol 1972; 73:633642.
4. Delaire J, Verdon P, Kenesi MC. Extraorale Zugkraften mit
Stirn-Kinn-Abstutzung zur Behandlung der Oberkieferdeformierungen als Folge von Lippen-Kiefer-Gaumenspalten.
Fortschr Kieferorthop 1973; 34:225237.
5. Delaire J,Verdon P, Flour J. Ziele und Ergebnisse extraoraler
Zuge in postero-anteriorer Richtung in Anwendung einer
orthopdischen Maske bei der Behandlung von Fallen der
Klasse III. Fortschr Kieferorthop 1976; 37:247262.
6. Irie M, Nakamura S. Orthopedic approach to severe skeletal
Class III malocclusion. Am J Orthod 1974; 67:375377.
7. Ranta R. Protraction of cleft maxilla. Eur J Orthod 1988;
10:215222.
8. Subtelny JD. Oral respiration: facial maldevelopment and
corrective dentofacial orthopedics. Angle Orthod 1980;
50:147164.
9. Delaire J, Verdon P, Flour J. Moglichkeiten und Grenzen extraoraler Krafte in postero-anteriorer Richtung unter Verwendung der orthopdischen Maske. Forttschr Kieferorthop 1978; 39:2740.
10. Friede H, Lennartsson B. Forward traction of the maxilla in
cleft lip and palate patients. Eur J Orthod 1981; 3:2139.
11. Sarnas K-V, Rune B. Extraoral traction to the maxilla with
face mask: a follow-up of 17 consecutively treated patients
with and without cleft lip and palate. Cleft Palate J 1987;
24:95103.
12. Berkowitz S. Some questions, a few answers in maxillamandibular surgery. Clin Plast Surg 1982; 9:603633.
485