Facial and Nasolabial Aesthetics of Complete UCLP Submitted to 2-Stage Palate Repair With Vomer Flap

2018 ◽  
Vol 55 (9) ◽  
pp. 1211-1217
Author(s):  
Terumi Okada Ozawa ◽  
Luciana Lais Savero Reis ◽  
Renata Mayumi Kato ◽  
Diógenes Laercio Rocha ◽  
Renata Sathler ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Mixed Dentition ◽  
Single Center ◽  
Facial Profile ◽  
Main Outcome Measure ◽  
Kappa Test ◽  
Palate Repair ◽  
Vomer Flap

Objective: To evaluate the aesthetics of nasolabial appearance and facial profile of children with unilateral cleft lip and palate (UCLP) submitted to 2-stage palate repair with vomerine flap. Design: Retrospective. Setting: Single center. Patients: Forty patients with UCLP, mean age of 7.81 years of both sexes, rehabilitated at a single center by 1 plastic surgeon. Interventions: Lip and anterior palate repair with nasal alar repositioning was performed at 3 to 6 months of age by Millard technique and vomer flap, respectively. Posterior palate was repaired at 18 months by Von Langenbeck technique. Main Outcome Measure(s): Four cropped digital facial photographs of each patient were evaluated by 3 orthodontists to score the nasolabial aesthetics and profile. Frequencies of each score as well means and medians were calculated. Kappa test was used for evaluating inter- and intrarater reproducibility. Results: The nasal form and deviation was scored as good/very good in 70%, fair in 22.5%, and poor in 7.5% of the sample. The nasal–subnasal aesthetic was considered good/very good in 55%, fair in 30%, and poor in 15% of the sample. The lip vermilion border and the white part of surgical scar aesthetics were good/very good in 77.5% and 80%, fair in 17.5% for both categories, and poor in 5% and 2.5% of the cases, respectively. In all, 67.5% showed convex facial profile, 20% was straight, and 12.5% was concave profile. Conclusions: Two-stage palatoplasty presented an adequate aesthetical results for the majority of patients with UCLP in the mixed dentition.

Skeletal and Dental Correction and Stability Following LeFort I Advancement in Patients With Cleft Lip and Palate With Mild, Moderate, and Severe Maxillary Hypoplasia

2021 ◽  
pp. 105566562199610
Author(s):  
Buddhathida Wangsrimongkol ◽  
Roberto L. Flores ◽  
David A. Staffenberg ◽  
Eduardo D. Rodriguez ◽  
Pradip. R. Shetye
Keyword(s):  
Retrospective Study ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Inclusion Criteria ◽  
Maxillary Hypoplasia ◽  
Main Outcome Measure ◽  
Lateral Cephalograms

Objective: This study evaluates skeletal and dental outcomes of LeFort I advancement surgery in patients with cleft lip and palate (CLP) with varying degrees of maxillary skeletal hypoplasia. Design: Retrospective study. Method: Lateral cephalograms were digitized at preoperative (T1), immediately postoperative (T2), and 1-year follow-up (T3) and compared to untreated unaffected controls. Based on the severity of cleft maxillary hypoplasia, the sample was divided into 3 groups using Wits analysis: mild: ≤0 to ≥−5 mm; moderate: <−5 to >−10 mm; and severe: ≤−10 mm. Participants: Fifty-one patients with nonsyndromic CLP with hypoplastic maxilla who met inclusion criteria. Intervention: LeFort I advancement. Main Outcome Measure: Skeletal and dental stability post-LeFort I surgery at a 1-year follow-up. Results: At T2, LeFort I surgery produced an average correction of maxillary hypoplasia by 6.4 ± 0.6, 8.1 ± 0.4, and 10.7 ± 0.8 mm in the mild, moderate, and severe groups, respectively. There was a mean relapse of 1 to 1.5 mm observed in all groups. At T3, no statistically significant differences were observed between the surgical groups and controls at angle Sella, Nasion, A point (SNA), A point, Nasion, B point (ANB), and overjet outcome measures. Conclusions: LeFort I advancement produces a stable correction in mild, moderate, and severe skeletal maxillary hypoplasia. Overcorrection is recommended in all patients with CLP to compensate for the expected postsurgical skeletal relapse.

Should Cleft Surgery Always be Performed During the Matutine Time? Analysis of Early and Late Postoperative Complications in a Cleft Center

2020 ◽  
Vol 57 (11) ◽  
pp. 1332-1335
Author(s):  
Daniel Velez Restrepo ◽  
Marilson Hideki Sato ◽  
Fernanda Saturnino Cardoso ◽  
Renato da Silva Freitas
Keyword(s):  
Statistical Analysis ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Discrete Variables ◽  
Time Analysis ◽  
Main Outcome Measure ◽  
Operating Surgeon ◽  
Type Of Surgery ◽  
Cleft Surgery

Objective: Surgeries performed in the afternoon schedule were discouraged by Smile Train Foundation for patients younger than 2 years. The aim of this study is to present the incidence of complications discriminating time of surgery (morning/afternoon) in a reference center in Curitiba (Brazil) during 2017. Design: Retrospective study that evaluated all cleft surgeries that were performed at Assistance Center for Cleft Lip and Palate during 2017. Complications correlated with surgery period (morning/afternoon), type of surgery, and operating surgeon were studied. Statistical analysis was performed to find any association between discrete variables. Setting: Tertiary, institutional Participants: One hundred eighty-seven patients with cleft lip and/or cleft palate/cleft lip and palate, who were evaluated and submitted to surgery in the center and had less than 24 months of age, were included in the study. Interventions: One hundred twenty-four cheiloplasties and 63 palatoplasties were performed. Main Outcome Measure: Incidence of complications. Results: From the total of cheiloplasties, the number of complications was 2 (1.6%) and from the total of palatoplasties the number of complications was 11 (17%); 8.1% of surgeries that were performed in the morning had any complication compared to 5.1% of surgeries performed in the afternoon. Statistical analysis of discrete variables with χ2 test showed no correlation between surgery schedule and complications (χ2 = 0.62). Conclusion: The number of complications was not higher in the afternoon scheduled surgeries. Surgeon expertise had a statistically significant correlation with the absence of complications (χ2 = 20.57).

scholarly journals Closer to the Truth on National Fistula Prevalence After Unilateral Complete Cleft Lip and Palate Repair? The Cleft Care UK Study

2019 ◽  
Vol 57 (1) ◽  
pp. 5-13
Author(s):  
Arthur S. Yang ◽  
Bruce M. Richard ◽  
Andrew K. Wills ◽  
Osama Mahmoud ◽  
Jonathan R. Sandy ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Palatal Fistula ◽  
The United Kingdom ◽  
Palate Repair

Objectives: To (1) determine the prevalence of nonperialveolar palatal fistula up to age 5 following repair of unilateral cleft lip and palate (UCLP) in the United Kingdom, (2) examine the association of palatoplasty techniques with fistula occurrence, and (3) describe the frequency of fistula repairs and their success. Design: Cross-sectional study. Setting: All 11 centralized regional cleft centers in the United Kingdom. Participants: Two hundred sixty-eight children born between 2005 and 2007 recruited by Cleft Care UK, a nationwide cross-sectional study of all 5-year-old children born with nonsyndromic UCLP. Main Outcome Measure: Nonperialveolar palatal fistula prevalence up to age 5. Results: Fistulas were found in 72 children (31.3%, 95% confidence interval: 25.4%-37.7%) and had no significant association with palate repair sequences. Twenty-four fistulas were repaired by age 5, 12 of which had data showing 10 (83.3%) successful repairs. Conclusion: The prevalence of nonperialveolar fistulas following primary palatoplasty of UCLP in the United Kingdom was higher than previously reported. This information should be part of the preoperative discussion with families. Prospective collection of the presence of fistulas will be necessary before we can associate the occurrence of fistulas with a surgeon, institution, surgical technique, or protocol of care.

The Eurocleft Study: Intercenter Study of Treatment Outcome in Patients with Complete Cleft Lip and Palate. Part 3: Dental Arch Relationships

2005 ◽  
Vol 42 (1) ◽  
pp. 78-82 ◽  
Author(s):  
Kirsten Mølsted ◽  
Viveca Brattström ◽  
Birte Prahl-Andersen ◽  
William C. Shaw ◽  
Gunvor Semb
Keyword(s):  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Northern Europe ◽  
Dental Arch ◽  
Causal Factors ◽  
Main Outcome Measure ◽  
Panel Rating ◽  
Dental Arch Relationship

Objective To compare dental arch relationships up to age 17 in individuals with complete unilateral cleft lip and palate (UCLP) treated at five European centers. Design Longitudinal cohort study, where results were previously reported at 9 years and follow-up measurements were obtained for 12 and 17 years. Setting Multidisciplinary cleft services in Northern Europe. Subjects 127 consecutively treated individuals with repaired UCLP. Main outcome measure Panel rating of dental arch relationship. Results The results revealed that at 17 years of age three of the centers had better ratings in dental arch relationship (means scores: 1.7, 1.9, and 2.2, respectively) than the other two centers (3.3, 3.4) at statistically significant levels (p < .01 to p < .001). Conclusion The results confirm that systematic differences in dental arch relationships may occur between different cleft centers, but do not allow specific causal factors to be identified.

Vomer flap for hard palate repair is related to favorable maxillary growth in unilateral cleft lip and palate

2013 ◽  
Vol 18 (4) ◽  
pp. 1269-1276 ◽  
Author(s):  
Yu-Fang Liao ◽  
Ying-Hsin Lee ◽  
Ruby Wang ◽  
Chiung-Shing Huang ◽  
Philip Kuo-Ting Chen ◽  
...  
Keyword(s):  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Palate Repair ◽  
Maxillary Growth ◽  
Vomer Flap

scholarly journals Facial profile and maxillary arch dimensions in unilateral cleft lip and palate children in the mixed dentition stage

2017 ◽  
Vol 11 (01) ◽  
pp. 076-082 ◽  
Author(s):  
Vellore Kannan Gopinath ◽  
Ab Rani Samsudin ◽  
Siti Noor Fazliah Mohd Noor ◽  
Hady Youssef Mohamed Sharab
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Cranial Base ◽  
Mixed Dentition ◽  
Dental Arch ◽  
Base Length ◽  
Facial Profile ◽  
Arch Width ◽  
Significant Difference ◽  
Maxillary Arch

ABSTRACT Objectives: The aim of this study was to evaluate the vertical and sagittal facial profile and maxillary arch width, depth, and length of patients with unilateral cleft lip and palate (UCLP) and to compare them with healthy noncleft children in the mixed dentition stage (7–13 years). Materials and Methods: This study is conducted at Hospital Universiti Sains Malaysia. UCLP group comprised 48 patients with nonsyndromic UCLP who have had the lip and palate repaired, whereas the control group comprised 48 healthy noncleft cases. The lateral cephalometrics measurements were used to determine the vertical height, sagittal depth of the face, and cranial base length and angle. Maxillary arch dimensions were measured on the study cast including arch width, depth, and length. Results: Vertical facial height and sagittal depth measurements showed a significant decrease (P < 0.05) in the mean growth pattern in UCLP group. The anterior cranial base length (S-N) was shorter in UCLP children (P < 0.001), while Ba-N length had no significant difference (P = 0.639). Nasion-Sella Tursica-Basion angle was significantly higher in the UCLP group (P = 0.016). Dental arch width with reference to canine-to-canine and first premolar-to- first premolar distance was significantly larger in control (P = 0.001). Conclusion: Mean vertical and sagittal facial dimensions in the UCLP children who do not undergo orthodontic treatment are significantly lesser in all directions of growth than healthy noncleft children. The maxillary dental arch had a normal depth but constricted in width and arch length.

scholarly journals Facial profile esthetics in operated children with bilateral cleft lip and palate

2017 ◽  
Vol 22 (4) ◽  
pp. 41-46 ◽  
Author(s):  
Rita de Cássia Moura Carvalho Lauris ◽  
Leopoldino Capelozza Filho ◽  
Louise Resti Calil ◽  
José Roberto Pereira Lauris ◽  
Guilherme Janson ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Mixed Dentition ◽  
Spearman Correlation ◽  
Friedman Test ◽  
Upper Lip ◽  
Oral Clefts ◽  
Facial Profile ◽  
Facial Esthetics ◽  
Bilateral Cleft Lip

ABSTRACT Objective: The aim of this study was to evaluate the facial profile esthetics of rehabilitated children with complete bilateral cleft lip and palate (BCLP), comparing the judgment of professionals related and not related to cleft rehabilitation and laypersons. Methods: Thirty children in the mixed dentition (24 male; 6 female) with a mean age of 7.8 years were evaluated using facial profile photographs by 25 examiners: 5 orthodontists and 5 plastic surgeons with experience in cleft care, 5 orthodontists and 5 plastic surgeons without experience in oral cleft rehabilitation and 5 graduated laymen. Their facial profiles were classified into esthetically unpleasant (grade 1 to 3), esthetically acceptable (grade 4 to 6), and esthetically pleasant (grade 7 to 9). Intraexaminer and interexaminer errors were evaluated using Spearman correlation coefficient and Kendall’s test, respectively. Inter-rater differences were analyzed using Friedman test and Student-Newman-Keuls test for multiple comparisons. Results: Orthodontists dealing with oral clefts rehabilitation considered the majority of the sample as esthetically pleasant. Plastic surgeons of the cleft team and laypersons classified most of the sample as esthetically acceptable. Most of the orthodontists and plastic surgeons not related to cleft care evaluated the facial profile as esthetically unpleasant. The structures associated to unpleasant profiles were the nose, the midface and the upper lip. Conclusions: The facial profile of children with BCLP was classified as esthetically acceptable by laypersons. Professionals related to cleft rehabilitation were more lenient and those not related to cleft care were stricter to facial esthetics than laypersons.

Early Maxillary Dentoalveolar Changes in Children with Unilateral Cleft Lip and Palate After Palatal Repair: A Pilot Study

2021 ◽  
pp. 105566562110537
Author(s):  
Shreepriya Singhania ◽  
Nandlal Bhojraj
Keyword(s):  
Pilot Study ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Anterior Part ◽  
Main Outcome Measure ◽  
Time Points ◽  
Post Surgery ◽  
Intraexaminer Reliability ◽  
Dental Casts

Objective To assess early maxillary dentoalveolar changes in children with unilateral cleft lip and palate (UCLP) up to 6 months after palatoplasty. Design Pilot study. Patients and Participants Eight children with UCLP at the age of 18 to 30 months, who were awaiting palatal repair, were included. Interventions All participants with repaired lip were scheduled for palatal repair between 18 and 24 months by Bardach's technique. Main Outcome Measure(s) Arch widths, arch depths, and arch perimeter was measured on 32 dental casts of 8 participants at 4 time points: just prior to palatal repair (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after palatal repair. Manual method using digital vernier caliper (Zhart, India) was used for model analysis. Intraexaminer reliability was also assessed. Results Only one examiner assessed all the dental casts after blinding. There was a significant decrease in the intercanine width (29.75 ± 1.98 mm at T1 to 26.42 ± 1.67 mm at T4; P < .001) and anterior arch depth (9.86 ± 1.07 mm at T1 to 8.29 ± 1.51 mm at T4; P < .001). Growth occurred in intertuberosity width (38.18 ± 1.40 mm at T1 to 39.76 ± 1.09 mm at T4; P < .001) and total arch depth (24.36 ± 1.21 mm at T1 to 26.79 ± 1.04 mm; P < .001) over 6 months post-surgery. Conclusions There was growth restriction in the anterior part of the palate, whereas the posterior region continued to grow after palatal repair. These changes were observable even in the early months after palatoplasty.

Long-Term Evidence for Favorable Midfacial Growth after Delayed Hard Palate Repair in UCLP Patients

2001 ◽  
Vol 38 (4) ◽  
pp. 323-329 ◽  
Author(s):  
Hans Friede ◽  
Hans Enemark
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Good Alternative ◽  
Speech Development ◽  
Mixed Dentition ◽  
Surgical Methods ◽  
Palate Repair

Objective: To investigate whether delayed hard palate repair resulted in better midfacial growth in the long term than previously achieved with “conventional” surgical methods of palatal closure. Design and Setting: Long-term cephalometric data from patients with unilateral cleft lip and palate were available from two Scandinavian cleft centers. The patients had been treated by different regimens, particularly regarding the method and timing of palatal surgery. Patients were analyzed retrospectively, and one investigator digitized all radiographs. Patients: Thirty consecutively treated subjects from each center, with cephalograms taken at three comparable stages between 10 and 16 years of age. Results and Conclusions: Patients whose hard palates were repaired late (early soft palate closure followed by delayed hard palate repair at the stage of mixed dentition) had significantly better midfacial development than patients in whom the hard palate was operated on early with a vomer flap, and then during the second year of life, the soft palate was repaired with a push-back procedure. As the growth advantage in the delayed hard palate repair group was accomplished without impeding long-term speech development, the delayed repair regimen proved to be a good alternative in surgical treatment of patients with unilateral cleft lip and palate.

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