TAILIEUCHUNG - Cleft Lip and Palate 2nd Edition - Part 3

20 A Comparison of the Effects of the Latham–Millard POPLA Procedure with a Conservative Treatment Approach on Dental Occlusion and Facial Aesthetics in CUCLP and CBCLP Samuel Berkowitz, Martha Mejia Dental Occlusion One of the most widely debated areas in the treatment of cleft lip and palate involves the use of presurgical orthopedics and periosteoplasty with lip adhesion (POPLA) designed by Ralph Latham (orthodontist) and D. Ralph Millard, Jr. (plastic surgeon) [1, 2]. They contend the POPLA procedure is superior to a conservative nonpresurgical orthopedic treatment (nonPOPLA) for producing more aesthetically appealing lip/nose surgery, while still allowing for good midfacial growth and dental occlusion. | 20 A Comparison of the Effects of the Latham-Millard w POPLA Procedure with a Conservative Treatment Approach on Dental Occlusion and Facial Aesthetics in CUCLP and CBCLP Samuel Berkowitz Martha Mejia Dental Occlusion One of the most widely debated areas in the treatment of cleft lip and palate involves the use of presurgical orthopedics and periosteoplasty with lip adhesion POPLA designed by Ralph Latham orthodontist and D. Ralph Millard Jr. plastic surgeon 1 2 . They contend the POPLA procedure is superior to a conservative nonpresurgical orthopedic treatment non-POPLA for producing more aesthetically appealing lip nose surgery while still allowing for good midfacial growth and dental occlusion in complete unilateral cleft lip and palate CUCLP and complete bilateral cleft lip and palate CBCLP patients. This study compares the dental occlusion of POPLA with conservative nonpresurgical orthopedic treatment non-POPLA which Millard had been using between 1960 and 1980 3 . POPLA proponents and others who may not resort to a lip adhesion but who still use the same presurgical orthopedic procedure designed by Latham in CBCLP patients for forcefully retracting the protruding premaxilla favor the attainment of improved facial aesthetics and palatal arch alignment soon after birth with or without periosteoplasty. They speculate that the early aesthetic benefits will remain as the face grows and develops 4-7 . In CUCLP and CBCLP presurgical orthopedics is usually followed by periosteoplasty in the expectation that the resulting bone bridging created will avert the need for secondary alveolar bone grafts at a later date. It is not a simple or a lightly assumed task to offer a brief challenging the rationale for presurgical orthopedics and periosteoplasty for infants with complete unilateral or complete bilateral cleft lip and palate. Advocates of the POPLA concept or a variant of it are few but well respected. Their proposed goal of making things right and whole as .

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