Publicação
Ortopedia pré-cirúrgica no tratamento de doentes portadores de fenda lábio-palatina
| Resumo: | Introduction: Cleft lip and/or palate (CLP) is a common craniofacial malformation with aesthetic, functional and psychosocial impacts. Treatment involves surgery in the first few years of life, but the scar tissue generated can cause jaw deformities. For this reason, dentofacial orthopaedics is necessary as a complement to prevent these complications. The aim of this study is to map the pre-surgical dentofacial orthopaedic approaches described in the literature, as well as to critically evaluate the protocol currently adopted by the Institute of Orthodontics at the Faculty of Medicine of the University of Coimbra.Materials and Methods: A Scoping Review was conducted following PRISMA-ScR methodology, with a protocol registered on the OSF platform. The literature search was performed in PubMed, Cochrane, Embase, and Web of Science databases, including clinical studies on presurgical orthopedics in CLP patients. In parallel, a retrospective clinical study was conducted involving newborns treated with nasoalveolar molding (NAM). Intraoral models were scanned before (T0) and after (T1) treatment, and morphological changes were assessed through linear and angular measurements.Results: The Scoping Review identified 207 studies on presurgical orthopedic treatment in CLP, with a focus on the use of NAM. Most of the studies included were case series, with heterogeneous evidence on the effectiveness of the devices The main benefits reported included the approximation of alveolar segments and aesthetic improvement, but doubts persist about the impact on maxillary growth. In the clinical study, there was a reduction in alveolar clefts in all cases, as well as centralisation of the premaxilla in cases of bilateral clefts. Discussion: Despite the methodological heterogeneity observed, the data obtained in the Scoping Review and the institutional clinical study showed favourable morphological changes, especially when treatment is started early.Conclusion: Despite the inherent limitations, the benefits of NAM outweigh the complications when applied by qualified teams. However, future controlled and rigorous clinical trials are essential to consolidate the scientific evidence of its effectiveness. |
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| Autores principais: | Machado, Ana Catarina Oliveira |
| Assunto: | Cleft Lip Cleft Palate Orthodontics Orthopaedics Fenda do lábio Fenda do palato Ortodontia Ortopedia |
| Ano: | 2025 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Coimbra |
| Idioma: | português |
| Origem: | Estudo Geral - Universidade de Coimbra |
| Resumo: | Introduction: Cleft lip and/or palate (CLP) is a common craniofacial malformation with aesthetic, functional and psychosocial impacts. Treatment involves surgery in the first few years of life, but the scar tissue generated can cause jaw deformities. For this reason, dentofacial orthopaedics is necessary as a complement to prevent these complications. The aim of this study is to map the pre-surgical dentofacial orthopaedic approaches described in the literature, as well as to critically evaluate the protocol currently adopted by the Institute of Orthodontics at the Faculty of Medicine of the University of Coimbra.Materials and Methods: A Scoping Review was conducted following PRISMA-ScR methodology, with a protocol registered on the OSF platform. The literature search was performed in PubMed, Cochrane, Embase, and Web of Science databases, including clinical studies on presurgical orthopedics in CLP patients. In parallel, a retrospective clinical study was conducted involving newborns treated with nasoalveolar molding (NAM). Intraoral models were scanned before (T0) and after (T1) treatment, and morphological changes were assessed through linear and angular measurements.Results: The Scoping Review identified 207 studies on presurgical orthopedic treatment in CLP, with a focus on the use of NAM. Most of the studies included were case series, with heterogeneous evidence on the effectiveness of the devices The main benefits reported included the approximation of alveolar segments and aesthetic improvement, but doubts persist about the impact on maxillary growth. In the clinical study, there was a reduction in alveolar clefts in all cases, as well as centralisation of the premaxilla in cases of bilateral clefts. Discussion: Despite the methodological heterogeneity observed, the data obtained in the Scoping Review and the institutional clinical study showed favourable morphological changes, especially when treatment is started early.Conclusion: Despite the inherent limitations, the benefits of NAM outweigh the complications when applied by qualified teams. However, future controlled and rigorous clinical trials are essential to consolidate the scientific evidence of its effectiveness. |
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