Cirurgia Ortognática em Pacientes com Fissura Labiopalatina: Abordagem Interdisciplinar
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Introduction - This chapter discusses the aspects of orthognatic surgery related to cleft Lip & palate (CLP) patients. Usually these patients have several prior surgeries to their lips and palate, and this result in a lack of growth in the maxilla. As a result, several patients will have hypoplastic maxillas, and will need to have an orthognatic surgery procedure such as a maxillary advancement. This surgery is usually done after the end of facial growth, and a full multidisciplinary team is needed. Several treatment phases will need to be fulfilled, and particularly the role of orthodontics and phonoaudiology will be observed. Pre-surgical orthodontics - patients with CLP will need to be re-evaluated frequently during their entire life, and orthodontics are usually the professionals that will be most active in this regard. When it comes to an orthognatic surgery decision, they will do a pre-operative orthodontic mechanics to decompensate, align and coordinate the upper and lower teeth. Orthognatic Surgery - the several surgical possibilities are discussed here, and some clinical examples are also shown. Usually the Le Fort I osteotomy is indicated for advancement of the maxilla, but other options include mandibular sagital split osteotomies or variations of the Le Fort I, particularly in bilateral cases. Post-surgical Orthodontics - after he surgery patients usually will need to have a follow up of 6 months when the final dental movements will be done. In some selected cases when the pre-maxilla is still mobile patients ill need to wear orthodontic appliances for very long periods. Phonoaudiology approach - although the interventions done by these professionals are similar to those used in standard orthognatic surgeries, there are some changes that are discussed here. The therapist should be involved since the pre-surgical orthodontic phase, observing speech and masticatory difficulties. Velopharyngeal incompetence is common and needs to be carefully evaluated since the surgery usually will move the maxilla forwards, and possibly worsens this. Treatment in the pre-operative phase can include elongating muscles, massaging the lip scar tissue and others. After the surgery the phonoaudiology therapist will look after oedema control, proper mouth opening and TMJ function, as well as traditional speech therapy.
Fissura Labiopalatina - Fundamentos para a Prática Fonoaudiológica
Oral and Maxillofacial Surgery