scholarly journals Other Scar Types: Optimal Functional and Aesthetic Outcome of Scarring in Cleft Patients

2020 ◽  
pp. 51-57
Author(s):  
Wouter B. van der Sluis ◽  
Nirvana S. S. Kornmann ◽  
Robin A. Tan ◽  
Johan P. W. Don Griot
Keyword(s):  
Surgical Technique ◽  
Psychosocial Functioning ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Surgical Techniques ◽  
Anatomical Structures ◽  
Patient Dissatisfaction ◽  
Optimal Function ◽  
Scar Management

AbstractCleft lip and palate are facial and oral malformation due to failures in the embryologic craniofacial development during early pregnancy. A unilateral cleft lip and palate is the most common type, whereby the upper lip, the orbicularis muscle, the alveolar bone, the floor of the nose, and the hard and soft palate are interrupted, creating an open communication between nasopharynx and oropharynx. Patients with a cleft lip and palate are treated in specialized cleft centers by a multidisciplinary team. Having cleft lip and/or palate has a noteworthy impact on quality of life and psychosocial functioning. Postoperative scarring is a common cause of patient dissatisfaction. The goal of cleft lip surgery is to close the lip, provide optimal function in terms of speech, mastication, dental protection, breathing and feeding, and provide an aesthetically pleasing facial scar. Precise surgical technique and adequate aligning of anatomical structures is important for the postoperative aesthetic result and scar formation. Different surgical techniques are available for this purpose. Optimal scar management can be divided in surgical (precise surgical technique, planning, and adequate aligning of anatomical structures) and nonsurgical methods (botulinum toxin, silicone application, carbon dioxide fractional laser).

scholarly journals Secondary Lip Correction in a Cleft Lip Patient

2020 ◽  
pp. 535-537
Author(s):  
Wouter B. van der Sluis ◽  
Johan P. W. Don Griot
Keyword(s):  
Quality Of Life ◽  
Psychosocial Functioning ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Open Communication ◽  
Common Cause ◽  
Patient Dissatisfaction ◽  
The Face

AbstractIn unilateral cleft lip and palate, the orbicularis muscle, the alveolar bone, the floor of the nose, and the hard and soft palate are interrupted, creating an open communication between nasopharynx and oropharynx. Patients with a cleft lip and palate are treated in specialized cleft centers by a multidisciplinary team. Having cleft lip and/or palate has a noteworthy impact on quality of life and psychosocial functioning. Surgical scars are in the center of the face and can be quite noteworthy. Postoperative scarring is a common cause of patient dissatisfaction.Here, we describe a patient with an unpleasing esthetic result after surgical correction of unilateral cleft lip and palate in China. After careful surgical planning, scar excision and a single Z-plasty were performed to achieve scar lengthening. Pre- and postoperative images are shown.

Characteristics of asymmetric cleft lip and palate surgical treatment

2021 ◽  
Vol 21 (1) ◽  
pp. 23-31
Author(s):  
Yu. S. Rogozhina ◽  
S. I. Blokhina ◽  
E. S. Bimbas
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Maxillofacial Surgery ◽  
Surgical Techniques ◽  
Correct Choice ◽  
Good Cosmetic ◽  
Reasonable Choice ◽  
Positive Results

Relevance. The correct choice of the surgical technique for the treatment of the congenital asymmetric cleft lip and palate ensures the effectiveness of rehabilitation of patients with this pathology. The purpose is to present the results of the authors’ techniques for the surgical treatment of children with asymmetric cleft lip and/or palate.Materials and methods. Medical records of 687 children treated in 2015-2019 years were retrospectively analyzed at the clinic of maxillofacial surgery “Bonum” MСMC. The prevalence of asymmetric cleft lip and palate in children was determined. The prospective observation group included 84 patients with asymmetric cleft lip and/or palate. Clinical, anthropometric, statistical methods as well as patient photograph analysis and computer technologies were used during the research.Results. Prevalence of congenital asymmetric cleft lip and / or palate was determined (8.59%), classification and novel surgical techniques were offered and the results were evaluated.Conclusions. The prevalence of asymmetric cleft lip and palate is 86 per 1000 newborns with cleft lip and/ or palate. Scientific knowledge about the prevalence of asymmetric cleft lip and palate, as well as the systematization of this type of lesion in classifications, should be present in the practice of a maxillofacial surgeons and rehabilitation physicians who treat patients with this pathology. The proposed surgical techniques for the treatment of asymmetry in bilateral cleftlip and cleft palate provide positive results, excluding the need for further surgery. The reasonable choice of a surgical technique for the treatment of asymmetric cleft lip and palate is individual and may involve the use of additional nanomaterials. The authors’ techniques for the surgical treatment of asymmetric cleft lip and palate can be considered promising and aesthetically justified in view of good cosmetic results and full restoration of functions.

Mind the Gap: Alveolar Bone Graft Revision in the Era of Computed Tomography

2021 ◽  
pp. 105566562110026
Author(s):  
Ema Zubovic ◽  
Gary B. Skolnick ◽  
Abdullah M. Said ◽  
Richard J. Nissen ◽  
Alison K. Snyder-Warwick ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Tertiary Care ◽  
Radiographic Examination ◽  
Graft Take ◽  
Alveolar Bone Grafting ◽  
Ct Evaluation

Objective: To determine the rate of revision alveolar bone grafting (ABG) in patients with cleft lip and palate (CLP) before and after the introduction of postoperative computed tomography (CT). Design: Retrospective case–control study analyzing the incidence of revision ABG in patients with and without postoperative CT scans for graft success evaluation. Setting: Academic tertiary care pediatric hospital. Patients: Eighty-seven patients with CLP or cleft lip and alveolus treated with autologous iliac crest bone grafting for alveolar clefts over a 10-year period (January 2009 to March 2019) with minimum 6-month follow-up. Fifty patients had postoperative CT evaluation; 37 did not. Interventions: Postoperative CT to determine ABG success, versus standard clinical examination and 2-dimensional radiographs. Main Outcome Measures: Requirement for revision ABG, defined as failure of the original graft by clinical or radiographic examination. Results: Fifty-eight percent of patients underwent a postoperative CT scan at median interval of 10 months after surgery. Patients with postoperative CT evaluation had a 44% rate of revision ABG (22/50) for inadequate graft take, compared to 5% (2/37) in patients without postoperative CT ( P < .001; 95% CT, 31%-58% in the CT group, 1%-16% in the non-CT group). Conclusions: Computed tomography evaluation after ABG is associated with a significantly increased revision rate for inadequate graft take. The presence of a secondary palatal fistula at the time of original ABG is not associated with revision requirement. Lack of standardized dental and orthodontic records complicates the study of ABG outcomes and presents an area for systems-based improvement.

scholarly journals Alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients using cone-beam computed tomography evaluation

2021 ◽  
Author(s):  
Marcin Stasiak ◽  
Anna Wojtaszek-Słomińska ◽  
Bogna Racka-Pilszak
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Contralateral Side ◽  
Cone Beam ◽  
Rank Test ◽  
Cross Sectional ◽  
Alveolar Bone Grafting

Abstract Purpose The aims of this retrospective cross-sectional study were to measure and compare labial and palatal alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients, following STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Patients and methods The study group consisted of 21 patients with a mean age of 16 years. High-resolution cone-beam computed tomography was performed at least one year after secondary alveolar bone grafting. The experimental side was the cleft side and the contralateral side without congenital cleft was the control. Measurements were performed on incisors’ midsagittal cross-sections. The Wilcoxon signed-rank test was used for intergroup comparisons. Results The labial and palatal distances between alveolar bone crests and cementoenamel junctions were significantly greater on the cleft side than on the noncleft side. Mean differences were 0.75 and 1.41 mm, respectively. The prevalence of dehiscences at the cleft side maxillary central incisors was 52% on the labial surface and 43% on the palatal surface. In the controls, it was 19% and 14%, respectively. Conclusion The cleft-adjacent maxillary central incisors had more apically displaced alveolar bone crests on the labial and palatal sides of the roots than the controls. Higher prevalence of dehiscences was found on the cleft side. Bone margin differences predispose to gingival height differences of the central incisors. These differences could increase the demands of patients to obtain more esthetic treatment results with orthodontic extrusion and periodontal intervention on the cleft side.

scholarly journals Histologic Aspect of the Curved Vomerine Mucosa in Cleft Lip and Palate

2021 ◽  
pp. 105566562110314
Author(s):  
Benito K. Benitez ◽  
Andrzej Brudnicki ◽  
Prasad Nalabothu ◽  
Jeannette A. von Jackowski ◽  
Elisabeth Bruder ◽  
...  
Keyword(s):  
Nasal Mucosa ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Squamous Metaplasia ◽  
Periodic Acid ◽  
Surgical Techniques ◽  
Basal Cells ◽  
Periodic Acid Schiff ◽  
Tissue Samples ◽  
Nasal Floor

Background: Common surgical techniques aim to turn the entire vomerine mucosa with vomer flaps either to the oral side or to the nasal side. The latter approach is widely performed due to the similarity in color to the nasal mucosa. However, we lack a histologic description of the curved vomerine mucosa in cleft lip and palate malformations. Methods: We histologically examined an excess of curved vomerine mucosa in 8 patients using hematoxylin–eosin, periodic acid–Schiff, Elastin van Gieson, and Alcian blue stains. Tissue samples were obtained during surgery at 8 months of age. Results: Our histological analysis of the mucoperiosteum overlying the curved vomer revealed characteristics consistent with those of an oral mucosa or a squamous metaplasia of the nasal mucosa, as exhibited by a stratified squamous epithelium containing numerous seromucous glands. Some areas showed a palisaded arrangement of the basal cells compatible with metaplasia of respiratory epithelium, but no goblet cells or respiratory cilia were identified. Abundant fibrosis and rich vascularity were present. Conclusion: The vomer mucosa showed no specific signs of nasal mucosa. These findings should be considered in presurgical cleft orthopedics and palatal surgery for further refinement. Shifting the vomer mucosa according to a fixed physiologic belief should not overrule other important aspects of cleft repair such as primary healing and establishing optimal form and function of palatal roof and nasal floor.

Morbidity of Patients with Cleft Lip and Palate Treated with Alveolar Bone Grafting at About 6 Years of Age

2014 ◽  
Vol 72 (9) ◽  
pp. e14
Author(s):  
J.C. Doucet ◽  
A.B. Cardoso ◽  
C.G. Robertson ◽  
D.S. Precious
Keyword(s):  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Alveolar Bone Grafting

Repair of Protruding Bilateral Cleft Lip and Palate With Staged Premaxilla Setback Osteotomy, Cheiloplasty, and Palatoplasty in Trisomy 17p Patient: A Review of Syndromic Clinical Characteristic

2021 ◽  
pp. 105566562110698
Author(s):  
Kristaninta Bangun ◽  
Jessica Halim ◽  
Vika Tania
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Techniques ◽  
Chromosome 17 ◽  
Long Term Effects ◽  
Surgical Strategies ◽  
Increased Risk ◽  
The Cost

Chromosome 17 duplication is correlated with an increased risk of developmental delay, birth defects, and intellectual disability. Here, we reported a female patient with trisomy 17 on the whole short arm with bilateral complete cleft lip and palate (BCLP). This study will review the surgical strategies to reconstruct the protruding premaxillary segment, cleft lip, and palate in trisomy 17p patient. The patient had heterozygous pathogenic duplication of chromosomal region chr17:526-18777088 on almost the entire short arm of chromosome 17. Beside the commonly found features of trisomy 17p, the patient also presented with BCLP with a prominent premaxillary portion. Premaxillary setback surgery was first performed concomitantly with cheiloplasty. The ostectomy was performed posterior to the vomero-premaxillary suture (VPS). The premaxilla was firmly adhered to the lateral segment and the viability of philtral flap was not compromised. Two-flap palatoplasty with modified intravelar veloplasty (IVV) was performed 4 months after. Successful positioning of the premaxilla segment, satisfactory lip aesthetics, and vital palatal flap was obtained from premaxillary setback, primary cheiloplasty, and subsequent palatoplasty in our trisomy 17p patient presenting with BLCP. Postoperative premaxillary stability and patency of the philtral and palatal flap were achieved. Longer follow-up is needed to evaluate the long-term effects of our surgical techniques on inhibition of midfacial growth. However, the benefits that the patient received from the surgery in improving feeding capacity and facial appearance early in life outweigh the cost of possible maxillary retrusion.

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