Dudak Damak Yarıklı Olgularda Üst Çene Genişletme Tedavisi
Özet
Dudak ve damak yarığı (DDY) anomalileri, maksiller yapılarda transversal ve iskeletsel darlıklara yol açarak estetik ve fonksiyonel sorunlara neden olur. Bu olgularda üst çene genişletme tedavisi; okluzal ilişkiyi düzeltmek, ark dizilimini sağlamak ve solunum gibi fonksiyonları iyileştirmek amacıyla interdisipliner protokolün kritik bir parçasıdır. DDY'li olgular, midpalatal sütur eksikliği ve cerrahi skarların yarattığı direnç gibi yapısal farklılıklar nedeniyle DDY'siz bireylerden ayrılır. Tedavi zamanlaması genellikle sekonder alveoler kemik greftlemesi öncesi veya sonrasına göre bireysel olarak planlanır. Genişletme sürecinde Haas, Hyrax, Quad-helix ve Fan tipi sabit/hareketli apareyler ile cerrahi destekli distraktörler tercih edilmektedir. Yapılan biyomekanik ve sonlu elemanlar analizi (FEM) çalışmaları, apareylerin nazomaksiller kompleks ve kemik densitesi üzerinde olumlu etkilerini göstermektedir. Genişletme tedavisi, internazal hacmi artırarak nazal direnci azaltmakta ve hava yoluna olumlu katkı sağlamaktadır. Ancak tedavi sürecinde oronazal fistülün büyümesi, yetersiz genişleme, asimetrik ark formu, relaps ve sekretuar otitis media gibi komplikasyon riskleri mevcuttur. Bu nedenle relapsı önlemek amacıyla uzun dönemli retansiyon apareylerinin kullanımı ve her vakanın anatomik sınırlarına uygun bireysel tedavi algoritmalarının geliştirilmesi başarının temel anahtarıdır.
Cleft lip and palate (CLP) anomalies lead to transverse and skeletal deficiencies in maxillary structures, causing aesthetic and functional impairments. Maxillary expansion therapy in these cases is a critical component of interdisciplinary protocols aimed at correcting occlusal relationships, ensuring arch alignment, and improving functions such as respiration. CLP cases differ from non-CLP individuals due to structural variations including the absence of a midpalatal suture and the restrictive resistance exerted by postsurgical scar tissue. The timing of treatment is planned individually, typically scheduled either before or after secondary alveolar bone grafting. Various appliances, including Haas, Hyrax, Quad-helix, fan-type fixed or removable expanders, and surgically assisted distractors, are utilized during the expansion process. Biomechanical and finite element analysis (FEM) studies demonstrate the positive effects of these appliances on the nasomaxillary complex and bone density. Maxillary expansion also enhances internal nasal volume, thereby reducing nasal resistance and improving the airway. However, the treatment carries risks of complications such as oronasal fistula enlargement, insufficient expansion, asymmetrical arch forms, relapse, and secretory otitis media. Consequently, utilizing long-term retention appliances to prevent relapse and developing individualized treatment algorithms tailored to each patient's anatomical limits are paramount to achieving long-term therapeutic success.
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