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How Should Postoperative Palatal Contraction be Inhibited Following Palatoplasty?: Dental Arch Development due to Artificial Antimolding Action and Natural Molding Action: Clinical Trial

Kitagawa, Taiji DDS; Kohara, Hiroshi DDS, PhD; Sohmura, Taiji DrEng, PhD*; Takahashi, Junzo DrEng, PhD*; Enomoto, Akifumi DDS, PhD; Tanaka, Emiko DDS; Matsuya, Tokuzo DDS, PhD; Kogo, Mikihiko DDS, PhD

doi: 10.1097/
Original Article

Push back palatoplasty induces postoperative contraction and collapse of the dental arch. To inhibit collapse, 2 kinds of intersegment fixation plate, segment yoking plates, were applied. In one method, the segments were fixed with a resin plate onto the mucoperiosteal flap by 2 screws to fix palatal bone for 6 months (PB resin group, number of patients = 11). In the other method, the segments were fixed with a titanium plate by 2 screws onto the palatal bone under the mucoperiosteal flap until 4 years of age (PB titanium group, n = 10). Operation by conventional push back palatoplasty (PB Group, n = 25) was used as a control. Consecutive plaster models were measured by 3-dimensional laser scanner from at palatoplasty up to 4 years of age. In the PB resin group, the anticontraction effect worked only at the early postoperative stage. At 4 years of age, the narrowest intercanine width due to segment rotation caused by medial shift of the cleft side canine point and lateral shift of the cleft side tuberosity point was observed. As a result, a V-shaped dental arch developed. In the PB titanium group, the widest intercanine width due to a rigid anticontraction effect was observed at 4 years of age. Three push back methods demonstrated different arch morphologies due to each rigidity of the plate.

In a comparison study of two methods for prevention of dental arch collapse after push-back palatoplasty, a submucosal titanium plate secured by screws for four years was superior to a surface resin plate secured by screws for six months.

From the *Department of Oral and Maxillofacial Regeneration; †First Department of Oral and Maxillofacial Surgery, and ‡Osaka University Graduate School of Dentistry, Osaka, Japan.

Received June 17, 2003 and accepted for publication, after revision, September 2, 2003.

This study was partly supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (scientific research B 13557176 and exploratory research 12877314). This study was presented at the Annual Meeting of the Japanese Cleft Palate Association, June, 1999, Osaka, Japan

Reprints: Dr. Kitagawa, First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, 1–8 Yamadaoka, Suita City, Osaka, 565–0871, Japan.

© 2004 Lippincott Williams & Wilkins, Inc.