Cerebral palsy is a permanent neuromuscular motor disorder that gives rise to many functional problems, including impaired swallowing, chewing and speech. Maxillary transverse deficiency and Angle Class II malocclusion are common. Some of these functional problems can be due to maxillary malocclusion. To our knowledge, no case series has yet been published on orthodontic treatment in children with cerebral palsy. In this chapter, we provide an overview of this topic based on the literature and on our own clinical experience. We consider that some patients with cerebral palsy are susceptible to orthodontic treatment. The keys to success are appropriate patient selection, based on anatomical, physiological and behavioural characteristics, and the degree of involvement of parents and caregivers. Among parents of cerebral palsy children undergoing orthodontic therapy, the perceived level of overall satisfaction was very high and expectations were often exceeded; however, these results are conditioned by factors such as the Peer Assessment Rating (PAR) index. Although some authors reported improvements in aesthetics, speech and oral function, an objective assessment of functional improvement is still lacking. In our experience, correction of resting position and management of neuromuscular alterations are essential if successful orthodontic treatment is to be achieved and relapses avoided.
Part of the book: Cerebral Palsy
Three-dimensional (3D) evaluation of oral and maxillofacial pathology, in comparison with two-dimensional (2D) radiological studies, offers many advantages that can assist in the diagnostic and in the preoperative evaluation of certain lesions and conditions of the jaws, reducing the risk of intraoperative and postoperative complications. The introduction of cone beam computed tomography (CBCT) represents an important technological advance in the context of oral and maxillofacial radiology as it permits the acquisition of high-quality 3D images and dynamic navigation over an area of interest in real time, with a short scan time and lower dose of radiation than conventional computed tomography (CT). The initial indications for CBCT have been extended by the progressive addition of new ones such as evaluation of the extent of osteonecrotic lesions of the jaw due to bisphosphonates, preoperative staging of oral cancer, and planning reconstructive surgery. As a consequence, this radiological technique represents an interesting complement to conventional radiology in those clinical situations in which 3D imaging can facilitate diagnosis and/or treatment.
Part of the book: Computed Tomography