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100th Congress of the European Orthodontic society Logo 2nd to the 6th of June 2025

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100th Congress of the European Orthodontic society Logo 2nd to the 6th of June 2025

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Maria Costanza Meazzini

Maria Costanza Meazzini

Anteroposterior orthopedic management of maxillary deficiencies in cleft patients: indications, timing and stability

Maxillary hypoplasia is a frequent in cleft patients. The literature has shown that early treatment rapidly recurs, nevertheless, early maxillary protraction may still be taken into consideration, if specific functional problems exist, especially  middle ear infection, otitis media (OM), with subsequent hearing impairment. On the other hand, long-term results of the application of maxillary protraction technique applied closer to the peak of growth, have been shown to be more stable. Therefore, a later, more complex, approach might be considered if the objective is purely occlusal/esthetic. During adolescence a modified Alternate Rapid Maxillary Expansion-Constriction technique (MART), may obtain a sagittal advancement of A-point, of 5.5±2.8 mm. The position of the maxilla was stable in the long term. During adolescence in extremely severe hypoplasia (>10mm) a new protocol is suggested, with MART supported by an initial traction with an extraoral fixed distraction device (RED) to accelerate the sutural distraction process with a sagittal advancement of A-point, of 16.4±5.2 mm. 1 year follow up is available and the maxillary position is stable.

Aims and objectives

  • Indications for early maxillary protraction in CLP patients with middle ear infection, otitis media (OM), and subsequent hearing impairment.
  • Long-term results of a modified Altramec technique with TADs (MART) in CLP adolescents with moderate to severe class III.
  • MART supported by an initial traction with an extraoral fixed distraction device (RED) in extremely severe CLP patients.

Learning outcomes

After this lecture, attendees will know:

  • The importance of circum-maxillary sutures.
  • The importance of skeletal anchorage is class III treatment.
  • The limitations and possibilities of facial orthopaedics in maxillary moderate and severe hypoplasia.

 

Speaker biography

Maria Costanza Meazzini is Scientific Director and Orthodontic consultant for Craniofacial anomalies at the CLP Center, Operation Smile Italy, Santi Paolo e Carlo Hospital, in Milano and at the Department of Cranio-Maxillo Facial Surgery, San Gerardo Hospital, Monza, Italy.

She is Adjunct Professor in Craniofacial Anomalies for the residencies in Maxillofacial Surgery and Orthodontics, University of Milano.

She is Vice and Past President of the European Cleft Lip and Palate Craniofacial Association (ECPCA) and Representative and for the European Reference Network (ERNs).

She acquired a Specialty in Orthodontics and Dentofacial Orthopedics and a Master in Medical Sciences in 1995 (1991-1995, Harvard University). Completed a Cranio-Facial and Surgical Orthodontics Fellowship (University of Illinois at Chicago,1995-1996) in 1996 and did trimestral internships at Chung Gung Memorial Hospital (Taipei), Tokyo Medical-Dental University (Tokyo) and Gea-Gonzalez Hospital (Mexico City) for further craniofacial training.

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