Orthopedic surgery is dangerous, especially for the surgeon! Tool failures belong to the ten most frequent causes of operation delays. Nowadays, hospitals are pressured to optimize procedures and lower costs. Especially, orthopedic surgery is physically demanding for the ergonomics of the surgeon and tools wear out more quickly. Could the evolution of a surgical power tool be used in these scenarios to ease and support the surgeons work, increase the efficiency and flexibility of usage and at the same time offer more control and knowledge about the condition of the tools?

Background:Lower back pain is one of the most common health-related complaints in the adult population. Thirty percent of Americans 65 years and older reported symptoms of lower back pain in 2004. With an aging population, the proportion of people over the age of 65 is expected to reach 20% by the year 2030. Because of this increase in older adults, lumbar spinal stenosis (LSS) associated with arthritic changes will also likely increase. In older adults, lower back pain is most often caused by degenerative lumbar spinal stenosis. Stenosis is the narrowing ofthe spinal canal, causing pressure on the nerve roots and is frequently treated surgically. Lumbar spinal stenosis is one of the most common reasons for back surgery in patients 65 years and older 2. However, risks associated with surgery increase with age 3-5 and older patients may choose non-surgical treatment for their lower back pain, including injection treatment. Injection treatment, usually consisting of anti-inflammatory medications and analgesics, has improved since the mid-1990's when fluoroscopic guidance was developed. Information about injection treatment for lower back pain is limited, especially in the older population. An extensive review of published literature regarding injection treatment revealed a paucity of information about older adults diagnosed with lumbar spinal stenosis. In this study, three aims were designed to gain more information about the effectiveness of injection treatment in older patients with lumbar spinal stenosis. In the first (retrospective) study, information about receipt of second injections and time between injections was collected to examine injection usage. In the second and third (prospective) studies, information about pain relief and functional return following injection treatment was collected to examine the effectiveness of injection treatment in patients age 60 and older diagnosed with lumbar spinal stenosis. To our knowledge, such results have not been repolted for this population in the literature. Objective:Injection treatment is a commonly used non-surgical procedure to alleviate lower back pain in older adults. However, older patients do not have enough information about how long pain relief will last after treatment or the amount of pain relief and functional return they will experience. These studies focused on three topics: 1) usage of injection treatment; 2) effectiveness of injection treatment on pain relief; 3) effectiveness of injection treatment on functional return. In addition, the variations of the effectiveness were examined by selected patient attributes. Methods:In a retrospective study, medical records of patients aged 60 years or older from a high volume dedicated spine center at the University of Massachusetts Memorial Hospital were retrospectively reviewed. This study included those diagnosed with degenerative LSS, who had not received an injection for lower back pain within six months, and whom were treated between June I, 2006 and May 31, 2007. In two prospective studies, patients scheduled for lumbar injection treatment between January 1 and June 30, 2008 were selected from the University of Massachusetts Memorial Hospital Spine Center. Selection criteria included patients age 60 and over, diagnosed with degenerative lumbar spinal stenosis and no previous lumbar injection within 6 months or lumbar surgery within 2 years. The Pain sub-score of the SF-36 questionnaire was used to measure pain at baseline and at one and three months post injection. The Physical Component Score (PCS) of the SF-36 questionnaire and the Oswestry Disability Index (ODI) were used to measure function at baseline and at one and three months post injection. Variations in longitudinal changes in scores by patient characteristics were analyzed in both unadjusted (univariate) analyses using one-way analysis of variance (ANOVA), and adjusted (multiple regression) analyses using linear mixed effects models. Results: In the retrospective cohort, the mean age of the cohort was 68, 64% were female, 59% were married, with a mean Body Mass index of 32 kg/m2. Of 92 eligible patients, 57% returned for a second injection within six months of the first. The mean number of months between injections was 4.8 for all patients, ranging from 1 to 22 months. When patient characteristics were examined, the only variable that showed a statistically significant difference was age. Patients aged 70 years and older were found to be 67% less likely to return for a second injection when compared to patients age 60-69 (OR=0.33 (0.12 - 0.94)p In the prospective cohort, information was collected on 62 patients. Mean Pain scores improved significantly from baseline to one month (14.1 points), and from baseline to three months (8.3 points). Post injection changes in Pain scores varied by Body Mass Index (BMI) and baseline emotional health. Based on a linear mixed effects model analysis, higher baseline emotional health, as measured by the SF-36 Mental Component Score (MCS>50), was associated with greater reduction in pain over three months when compared to lower emotional health (MCS Conclusion: Patients over age 70 do not return for repeat injection as frequently as patients age 60-69. In addition, each year a patient ages over age 60, they are 10% less likely to return for a repeat injection. Lower back pain in older adults with LSS is clinically significantly alleviated after injection treatment. In addition, injection treatment for LSS is associated with return of lost function needed for daily living activities in older adults. Pain relief and functional return varies by patient personal and clinical characteristics. Higher emotional health was associated with more pain relief and more functional return experienced over three months following injection treatment. Additional information is needed about why older patients do not return for second injections at the same rate as younger patients and how emotional health affects response to injection treatment in older adults.

Osteoarthritis (OA), a degenerative disease of articular joints, is the leading cause of chronic disability in the US and affects more than a third of adults over 65 years old. Due to the obesity epidemic and an aging population, the prevalence of OA is expected to rise in both young and old adults. There are no disease modifying OA drugs. Therefore, providing any treatment options that delay the onset or progression of OA is highly desirable. The scope of this dissertation examines two different strategies to promote translational therapies for OA. The first approach investigated whether Smad ubiquitin regulatory factor 2 (Smurf2), an E3 ubiquitin ligase, could be a potential therapeutic target for OA. The second approach examined the incorporation of small chemical residues to enhance the physical and bioactivity of a bioinert scaffold for cartilage tissue repair. Overexpression of Smurf2 in chondrocytes was shown to accelerate spontaneous OA development in mice. We hypothesized that reduced Smurf2 expression could slow the progression of OA and enhance the performance of cells for cartilage repair. By performing surgical destabilization of the medial meniscus (DMM) on Smurf2-deficient mice, loss of Smurf2 was shown to mitigate OA changes in young mice but this protection diminished in older mice. Assessment of Smurf2-deficient chondrocytes in vitro revealed an upregulation of chondrogenic genes compared to wild-type; however, these differences were not seen at the protein level, deterring its potential use for cell-based therapies. During the course of this study, new insights about how age and sex affects different joint compartments in response to DMM surgery were also uncovered. These results broadened existing understanding of DMM-induced OA in mice but also questioned the validity of such a model to identify disease modifying targets that are translatable to OA in humans with advanced age. Due to a lack of innate repair mechanisms in cartilage, damage to cartilage increases the risk of developing OA early. Tissue engineering provides a unique strategy for repairing damaged cartilage by delivering cells in a well-controlled environment that can promote the formation of neotissue. We hypothesized that synthetic chemical residues could enhance the mechanical properties of a bioinert scaffold and promote matrix production of encapsulated chondrocytes. Covalent incorporation of small anionic or zwitterionic chemical residues in a polyethylene glycol-based hydrogel improved its stiffness and resistance to fluid flow, however, the resulting physical environment can also exert a dominant negative effect on matrix production of encapsulated chondrocytes. These results suggest that modulating the biosynthesis of chondrocytes with biochemical signals requires a concurrent reduction in any conflicting mechanotransduction signaling, emphasizing the importance of a degradable system to promote new cartilage formation. In summary, this dissertation establishes Smurf2 as a modulator of OA progression but implies that other factors such as age or protein(s) with redundant Smurf2 functions may play a role in limiting its effect as a therapeutic target. This work also reveals fundamental biology about how chondrocytes behave in response to physical and chemical cues in their microenvironment, which will aid in the design of better scaffolds for cartilage tissue engineering.

La survenue d’une infection péri prothétique (IPP) est la principale complication de la chirurgie prothétique articulaire, depuis son invention par Robert et Jean Judet en 1947. Comme le nombre de prothèses articulaires posées chaque année augmente de façon importante, ces infections sont de plus en plus fréquentes et l’optimisation de leur prise en charge est un enjeu important sur le plan médical et économique.Les modèles animaux d’IPP permettent de comprendre les mécanismes éthio-pathogéniques et tester de nouvelles thérapeutiques. Une analyse critique de la littérature a été effectuée en évaluant chaque modèle selon son type d’inoculation qui influence les taux et la sévérité de l’infection expérimentale obtenue.Un modèle expérimental d’IPP chez le lapin obtenu par remplacement partiel du genou et inoculation locale a été utilisé pour tester l’efficacité de nouvelles thérapeutiques au cours d’infections à deux bactéries multi résistantes qui posent des problèmes en thérapeutique humaine.Dans un 1er temps nous avons évalué l’efficacité de la ceftaroline (CPT) céphalosporine bactéricide in vivo contre le Staphylococcus aureus résistant à la méticilline (SARM) en la comparant à la vancomycine en association ou non à la rifampicine. 5.107UFC (Unités Formant Colonies) de SARM (Concentration Minimale Inhibitrice (CMI) de 0,38, 0,006, et 1 mg/l pour CPT, RIF, et VAN, respectivement) était injecté dans le genou. Les animaux infectés ont été randomisés et recevaient : aucun traitement (contrôles), CPT (60 mg/kg im), VAN (60 mg/kg im), CPT plus RIF (10 mg/kg im), ou VAN plus RIF débutant 7 jours après l'inoculation et durant 7 jours. L’efficacité des traitements a été évaluée sur la quantité de bactéries persistantes dans l’os (tibia proximal) après traitement. Ce travail a montré que la CPT et la VAN étaient efficace en monothérapie mais que seule l’association avec la rifampicine permettait de stériliser la quasi totalité des animaux. La CPT apparaît donc comme un traitement potentiellement efficace dans cette infection.Dans un 2ème temps nous avons étudié l'efficacité de la colistine (COL) dans le ciment, seule ou en combinaison avec des injections intramusculaires (im) de COL et/ou de méropénème (MRP) dans des infections à Klebsiella pneumoniae résistantes aux carbapénèmes (KPC). Un modèle proche de celui décrit pour le SARM a été utilisé. La souche KPC99YC est une souche clinique, résistante à la gentamicine (CMI 8mg/l) intermédiaire à l'imipénème (CMI 4mg/l), et sensible à la COL (CMI 0,25mg/l). L’inoculum était de 1.109UFC. Sept jours après l'infection, les prothèses étaient remplacées par espaceur sans antibiotique (contrôle), ou par espaceur imprégné de COL (3 MUI de COL/40g de ciment), ou par espaceur sans antibiotique et injections de COL (12 mg/kg im), ou l’association des deux, ou injections de COL avec espaceur en ciment imprégné de COL associé ou non à des injections de MRP (80 mg/kg im). Le traitement durait 7 jours. Tous les lapins témoins étaient infectés à J15, avec une moyenne de densité bactérienne de 6,17 [5,69, 7,04] CFU/g d'os. Contrairement à la COL locale, la COL systémique seule ou combinée avec le MRP était plus efficace que le contrôle sur le nombre de bactéries dans l'os à la fin du traitement. L’association COL locale + systémique était significativement plus efficace que le groupe témoin sur le dénombrement bactérien. D’ailleurs, c'était le seul schéma efficace sur le nombre de lapins avec un os stérile et à la limite de significativité par rapport au traitement systémique seul. Une souche résistante à la COL a été détectée dans le traitement local seul mais pas avec l’association de COL locale et systémique.Les modes d’inoculation directs sont les plus efficaces pour reproduire une IPP aigue. Les études expérimentales permettent de tester des traitements innovants en particulier pour les infections à bactéries multi résistantes. / The occurrence of prosthetic joint infection (PJI) is the main complication of joint prosthetic surgery since its invention by Robert and Jean Judet in 1947. Since the number of articular prostheses placed each year increases significantly, these infections are more and more frequent and the optimization of their management is an important medical and economic stake.The animal models of PJI make it possible to understand the ethiopathogenic mechanisms and to test new therapeutics. A critical analysis of the literature was carried out by evaluating each model according to its type of inoculation which influences the rates and the severity of the experimental infection obtained.An experimental model of PJI in rabbits obtained by partial replacement of the knee and local inoculation was used to test the efficacy of new therapeutics during infections with two multi-resistant bacteria which pose problems in human therapeutics.In a first step we evaluated the efficacy of ceftaroline (CPT) cephalosporin bactericidal in vivo against methicillin-resistant Staphylococcus aureus (MRSA) by comparing it with vancomycin (VAN) in combination with or without rifampin (RIF). 5.107UFC MRSA (Minimum Inhibitory Concentration (MIC) of 0.38, 0.006, and 1 mg/l for CPT, RIF, and VAN, respectively) was injected into the knee. Infected animals were randomized to receive no treatment (control), CPT (60 mg/kg im), VAN (60 mg/kg im), CPT plus RIF (10 mg/kg im) or VAN plus RIF, 7 days after inoculation and for 7 days. The efficacy of treatments was evaluated on the amount of persistent bacteria in the bone (proximal tibia) after treatment. This work has shown that CPT and VAN were effective as monotherapy, but only the combination with RIF allowed the sterilization of almost all animals. CPT appears to be a potentially effective treatment in this infection.In a second step we studied the efficacy of colistin (COL) in cement, alone or in combination with intramuscular (im) injections of COL and/or meropenem (MRP) in carbapenem-resistant Klebsiella pneumoniae infections (KPC). A model close to that used for MRSA was used. The strain KPC99YC is a clinical strain, resistant to gentamicin (MIC 8mg/L) intermediate to imipenem (MIC 4mg/l), and sensitive to COL (MIC 0,25mg/l). The inoculum was 1,109UFC. Seven days after the infection, the prosthesis were replaced by antibiotic-free spacer (control), or by COL-impregnated spacer (3 MIU of COL/40g of cement), or by antibiotic-free spacer and COL injections (12 mg/kg im), or the combination of the two, or COL injections with COL-impregnated cement spacer associated or not with MRP injections (80 mg/kg im). The treatment lasted 7 days. All control rabbits were infected at D15, with median and interquartile range (IQR) bone bacterial count of 6.17 [5.69, 7.04] CFU/g of bones. In contrast to local COL, systemic COL alone or combined with MRP was more effective than control on bacterial counts in bone at the end of treatment. The combination of COL local + systemic was significantly more effective than control group on bacterial counts. Interestingly it was the only effective regimen on the number of rabbits with sterile bone and at the limit of significance vs systemic treatment alone. One COL-resistant strain was detected in the COL local treatment alone but not with the combination of local and systemic COL.Direct inoculation modes are most effective in reproducing an acute PJI. The experimental studies allow testing innovative treatments in particular for the infections with multi-resistant bacteria.

No description available.

Introduktion: Preoperativ fasta är sedan många år tillbaka vedertaget inför kirurgi. Bakgrunden är bland annat att förhindra aspiration hos sövd patient som inte kan försvara sin luftväg. Fastan medför emellertid negativa konsekvenser för patienten. För att minska de negativa konsekvenserna har tidigare forskning kunnat påvisa positiva effekter av preoperativ kolhydratladdning i form av exempelvis minskad opioidanvändning och minskat antal vårddygn. Forskning beträffande patientens upplevelse av preoperativ kolhydratladdning är dock begränsad. Syfte: Att belysa upplevelsen av preoperativ kolhydratladdning hos patienter som genomgår elektiv höft- och knäledsplastik. Metod: Semistrukturerade telefonintervjuer med 12 patienter som analyserades med manifest kvalitativ innehållsanalys. Resultat: Hur information gavs från vårdpersonal hade en avgörande betydelse för patienters motivation att dricka preoperativ kolhydratdryck. Även viljan att må så bra som möjligt efter operationen var en stor motivator. Patienter beskrev känslan av att bli pigga och få en kick efter att ha druckit dryckerna, samt att de skulle rekommendera dryckerna till anhöriga. Diskussion: Resultatet visade att informationens utformning var av avgörande betydelse för patientens uppfattning av preoperativ kolhydratladdning och att intaget av dryckerna i många fall gav positiva känslor och förbättrat mående. Slutsats: Informationens ursprung har stor betydelse och preoperativ kolhydratdryck bidrar till känslan av förbättrat mående hos patienter som genomgår elektiv ortopedkirurgi.

Text in Afrikaans / In this quantitative study emphasis is placed on the role of the nurse as a member of the rehabilitation team. Furthermore, the role of the nurse in patient education as well as the importance of effective patient education during the rehabilitation process after hip replacement surgery is emphasised. Various factors that impacted on the rehabilitation process are highlighted. A structured interview schedule was used to interview a group of 20 respondents. All of the respondents participated voluntarily. Orem's Selfcare Theory was used as a theoretical basis for the study. The researcher determined which information respondents regarded as important to attain functional independence during the rehabilitation process. The data gathered would serve as recommendation for a planned information brochure that could in future be given to patients at their first visit to the surgeon before surgery. The brochure could then be used as a basis for patient education in the course of the rehabilitation process. / Advanced Nursing Sciences / M.A. (Verpleegkunde)

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2010. / Patients’ knowledge about the effectiveness of interventions is now recognized as an important facilitator of the implementation of evidence in practice. Evidence-based, patient education programs aim to impart knowledge about the efficacy and effectiveness about interventions to individuals. However, there is currently a lack of structured evidence-based educational programs to educate patients about the evidence-base for interventions prescribed by the health professionals in the field of orthopaedics. OBJECTIVE: The main objective of this study was to develop and validate an Arabic version of an evidence-based educational program for patients who are scheduled to undergo ACL reconstruction surgery in UAE, based on available evidence collated through a systematic review process. METHODS: A systematic review was conducted to generate clinical recommendations which were used to develop the evidence-based educational program. The evidence-based information was derived from secondary research to determine which rehabilitation strategies were most effective in improving outcome measurements following ACL reconstruction surgery. A pre-final draft of the evidence-based educational program was prepared and forward and back translated from English into the Arabic language. Feedback groups of ACL patients and physiotherapists were used to determine the content and face validity of the program. The final draft was validated in a group of 40 ACL patients waiting to undergo ACL reconstruction surgery at Zayed Military hospital and Abu Dhabi Knee and Sports Medicine Centre in the UAE, using checklists. RESULTS: A total of 40 patients undergoing ACL reconstruction surgery consented to participate in this study. All the subjects were male. The age range was between 18 to 38 years old with mean age of 28.5 years (SD 5.75). Most of the patients (65%) underwent ACL reconstruction surgery to the right knee. Of the total sample (n=40), the majority of the subjects who participated in this study (90 %), had ACL surgery for the first time. Most of the responses to the evidence-based educational program checklist were positive. iv CONCLUSION: It can be recommended that the newly-developed evidence-based educational program is a valid tool which can be given to ACL patients prior to ACL reconstruction to prepare them for the rehabilitation postoperatively. By informing patients of their condition, the expected outcomes of their condition and the effect of doing exercises to improve their condition, the patients will be more encouraged to partake in rehabilitation, as they know it is for their own good. This will ultimately improve overall patient care and improve management of ACL patients.

Introdução: O tratamento dos tumores ósseos benignos é frequentemente realizado por abordagem intralesional com curetagem do tumor e preenchimento da falha óssea com substâncias biológicas ou sintéticas. Entre as biológicas estão os vários tipos de enxertos e o maior representante das sintéticas é o cimento ósseo ou polimetilmetacrilato (PMMA). O uso do cimento ósseo compacto pode apresentar problemas devido à necrose térmica, ao afrouxamento asséptico, à incapacidade de remodelação e à elasticidade inadequada em relação ao osso normal. O desenvolvimento de um cimento ósseo esponjoso que atenda a estas demandas mecânicas e biológicas e que seja de fácil manipulação no ambiente cirúrgico tem estimulado alguns pesquisadores. Basicamente, é possível formar poros no interior do cimento por mistura de substâncias hidrossolúveis ou por reação química produtora de gás. Objetivo: Desenvolver e caracterizar fisicamente e mecanicamente um cimento ósseo com poros intercomunicantes de aspecto estrutural esponjoso. Material e métodos: A produção de cimento esponjoso foi realizada misturando-se o PMMA com bicarbonato de sódio e ácido cítrico. Foram confeccionados 90 corpos de prova com 40 mm de altura por 20 mm de diâmetro distribuídos em 6 grupos (n=15): G1 formado por cimento esponjoso em que antes da polimerização do cimento foram adicionados bicarbonato de sódio e ácido cítrico na proporção de 10% em relação ao componente sólido do cimento (polímero); G2 - cimento esponjoso na proporção de 20%; G3 - cimento esponjoso na proporção de 30%; G4 - cimento ósseo de PMMA compacto; G5 - formado por cimento de poliuretana de mamona (Bioósteo®) na proporção de 20%; G6 formado de corpos de prova cilíndricos de osso esponjoso extraído com trefina de côndilos tibiais proximais de bovinos. A qualidade do cimento esponjoso foi avaliada por macroscopia, cálculo de densidade, imersão em azul de metileno, tomografia computadorizada, microscopia eletrônica de varredura e ensaio mecânico de compressão. Resultados: A melhor forma de produção de cimento esponjoso foi pela mistura de PMMA e componentes efervescentes. O teste da imersão em azul de metileno mostrou que os G2 e G3 apresentaram melhor intercomunicabilidade. As análises com o microscópio eletrônico de varredura (MEV) mostraram uma ampla variação no tamanho e distribuição dos poros que medem de 50m a 3mm. Em relação aos ensaios mecânicos não houve diferenças significativas entres os grupos de cimento esponjoso G1, G2 e G3. Estes grupos apresentaram valores pouco inferiores aos do grupo G6 de osso esponjoso bovino. O grupo G4 (PMMA compacto) apresentou valores extremamente altos quando comparado ao osso esponjoso bovino e ao cimento esponjoso. O grupo G5 de cimento ósseo de mamona não atingiu os valores aceitáveis de resistência mecânica. Conclusão: Foi possível desenvolver um cimento esponjoso à base de polimetilmetacrilato pela mistura com os aditivos efervescentes, bicarbonato de sódio e ácido cítrico, que apresenta características físicas e mecânicas desejadas como substituto ósseo esponjoso nas curetagens para tratamento de tumores ósseos benignos. O cimento de mamona esponjoso na forma testada mostrou-se inadequado para os fins pretendidos. / Introduction: Benign bone tumors are usually treated by intralesional curettage. The bone defect may be filled with synthetic or biological substitutes. Polymetylmethacrylate (PMMA) is the most popular synthetic substitute and the solid form is associated to thermal necrosis, aseptic loosening, bone remodeling prevention and distinct elasticity. Research of porous cement that solves these drawbacks and can be molded intraoperatively has encouraged many authors. For surgical purposes, porosity can be achieved by mixing hydrosoluble substances or by gas-foaming reactions. Objective: Development and physical and mechanical characterization of a bone cement with interconnecting pores and cancellous bone like structural aspect. Methods: Porous cement was produced by adding the effervescent components sodium bicarbonate and citric acid to PMMA. Six groups of fifteen cylindrical samples (40 mm height, 20 mm diameter) were compared. G1, G2 and G3 groups consisted of porous cement specimens of PMMA with 10%, 20% and 30% of effervescent components respectively. G4 consisted of solid PMMA cement specimens. G5 group consisted of porous ricinic polyurethane cement (Bioósteo®) with 20% effervescent components specimens. The control group G6 consisted of bovine cancellous bone samples. The porous cements were characterized in terms of porosity, density, pore interconnectivity and compressive strength. Macroscopic evaluation and measuring, methylene blue immersion, Scanning Electron Microscopy (SEM), mechanical testing and a special computed tomography reading software were employed for these evaluations. Results: The pilot study showed that adding effervescent components to PMMA was the best solution for porous cement production. The methylene blue immersion test showed that G2 and G3 groups had better pore interconnection. Scanning electron microscopy (SEM) showed a wide variation in pore size, from 50m to 3mm, and pore distribution. No significant differences between G1, G2 and G3porous cement groups were found regarding to mechanical strength and Young Modulus. Cancellous bovine bone, G6, was slightly stronger and less elastic than these groups. This property is potentially beneficial considering osteointegration as a consequence of Wolfs law. Solid PMMA is extremely strength and inelastic. These properties do not match with cancellous bone. The porous ricinic polyurethane cement (Bioósteo®) is unacceptably weak. Conclusion: Porous cement was developed by adding effervescent components, sodium bicarbonate and citric acid, to polymethylmetacrylate. Physical and mechanical properties are very similar to cancellous bone. Further investigations to evaluate its bone substitute potential should be encouraged. The porous ricinic polyurethane cement (Bioósteo®) is inadequate these purpose.

The aim of this study was to evaluate the dimensional alterations of dental arches of cleft lip and palate children after cheiloplasty at two rehabilitation centers. The sample was composed of 94 digital models and divided in two groups: Group I 23 children, assisted at University of Zurich with presurgical orthopedic intervention (Hotz plate); Group II 24 children, assisted at Hospital for Rehabilitation of Craniofacial Anomalies of the University of São Paulo without presurgical orthopedic intervention. The three dimensional images were used to evaluate before lip repair (stage 1) and approximately 1 year old (stage 2). The obtained measures were: intercanine distance, intertuberosity distance, anterior-posterior arch distance, anterior-posterior cleft length, anterior and posterior cleft width. The comparison between stages 1 and 2 was evaluated in group I, group II and between group I and II. The alterations between groups were verified by Independent t test. If the sample did not present a normal distribution, Wilcoxon and Mann-Whitney tests were used. In Group I, the comparisons between stages 1 and 2 showed that the intertuberosity and anterior-posterior arch distance increased and the intercanine, anterior and posterior cleft distances decreased. In Group II, the comparisons between stages 1 and 2 showed that intertuberosity distance increased and intercanine, anteriorposterior cleft length distances, anterior and posterior cleft widths decreased. The comparison of the dimensional alterations of dental arches between the two rehabilitation centers exhibited differences: in the stage 1, the intercanine distance decreased in Group II; in the stage 2, the anterior cleft width, the intercanine distance and the anterior-posterior cleft length decreased in Group II, suggesting the superposition of maxillary segments; in Group II, there was a greater narrowing of the anterior and posterior cleft widths, suggesting that Hotz plate induced a more evenly and equidistant approximation of maxillary segments in Group I. It is worth emphasizing that more studies should be conduct to reduce the variability in treatment protocols for cleft lip and palate patients, thus assuring the best evidencebased treatment. / O propósito deste estudo foi avaliar as alterações dimensionais dos arcos dentários de crianças com fissura de lábio e palato após a queiloplastia em dois centros de reabilitação. A amostra foi composta por 94 imagens digitais de modelos de gesso, e dividida em dois grupos: Grupo I - 23 crianças, tratas na Universidade de Zurique, com intervenção ortopédica pré-cirúrigica (placa de Holtz); Grupo II - 24 crianças tratadas no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo, sem intervenção ortopédica pré-cirúrgica. As imagens tridimensionais dos modelos de gesso foram avaliados antes da queiloplastia (estágio 1) e com aproximadamente 1 ano de idade (estágio 2). As seguintes dimensões foram obtidas: comprimento anteroposterior da fissura, amplitude anterior da fissura, amplitude posterior da fissura, comprimento anteroposterior do arco, distância intercaninos e distância intertuberosidades. As comparações foram realizadas entre os estágios 1 e 2 e entre os grupos I e II. As diferenças entre os grupos foram verificadas pelo teste t independente, os testes de Wilcoxon e Mann-Whitney foram usados. No Grupo I, entre os estágios 1 e 2, as distâncias intertuberosidade aumentou e as distâncias intercaninos, distância anteroposterior da fissura, amplitude anterior e posterior da fissura diminuíram. A comparação entre as alterações dimensionais dos arcos dentários entre os dois centros de reabilitação apresentaram diferenças: no estágio 1, a distância intercaninos foi menor no Grupo II que no Grupo I; e no estágio 2, a amplitude anterior da fissura, a distância intercaninos e o comprimento anteroposterior da fissura foram menos no Grupo II que no Grupo I, sugerindo sobreposição dos segmentos maxilares. No Grupo II, houve maior estreitamento nas amplitudes anterior e posterior da fissura, sugerindo que a placa de Holtz no Grupo I induziu a aproximação dos segmentos maxilares de forma mais uniforme e equidistante. É importante salientar que mais estudos longitudinais precisam ser conduzidos a fim de reduzir a variabilidade de protocolos de tratamento em pacientes com fissura de lábio e palato, garantindo o melhor tratamento baseado em evidências científicas.