Oronasal Transfixion Suture to Prevent Uplifted Nasal Floor Deformity in Cleft Lip and Palate Patients: A 5-Year Follow-Up

2018 ◽  
Vol 56 (3) ◽  
pp. 390-394
Author(s):  
Yuta Nakajima ◽  
Shunsuke Yuzuriha ◽  
Fumio Nagai ◽  
Kenya Fujita ◽  
Masahiko Noguchi
Keyword(s):  
Private Practice ◽  
Cleft Lip ◽  
Chart Review ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Tertiary Care ◽  
University Hospital ◽  
Nasal Floor ◽  
Orbicularis Oris Muscle

Objective: In unilateral cleft lip and palate, the reconstructed nasal floor is sometimes uplifted regardless of the reconstructive method used. We used a 5-0 absorbable anchoring suture, the oronasal transfixion suture (ONT suture), to fasten the reconstructed nasal floor to the orbicularis oris muscle to prevent this deformity. This study was performed to evaluate the effects of the ONT suture. Design: Blind retrospective study of photography and chart review. Setting: Shinshu University Hospital, tertiary care, Nagano, Japan. Private practice. Patients: Ninety-three consecutive patients with unilateral complete cleft lip and palate who had undergone primary nasolabial repair in our department and affiliated hospitals between 1999 and 2011 participated in this study. Finally, 45 patients were included. Interventions: The ONT suture was put in place at the time of primary nasolabial repair. Main Outcome Measure: The height of the nasal floor was evaluated on submental view photographs at 5 years old. Results: The ONT suture was applied in 21 patients. The height of the nasal floor on the cleft side was significantly closer to that on the noncleft side with the ONT suture than without the ONT suture ( P = .008). Conclusions: The ONT suture is effective to prevent uplifted nasal floor deformity on the cleft side// in unilateral complete cleft lip and palate at the time of primary nasolabial repair.

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.

Follow-Up Care Barriers for Patients with Orofacial Clefts

2021 ◽  
pp. 105566562110421
Author(s):  
Joshua Van Swol ◽  
Bethany J. Wolf ◽  
Julia Toumey ◽  
Phayvanh Pecha ◽  
Krishna G. Patel
Keyword(s):  
Outcome Measure ◽  
Tertiary Care ◽  
University Hospital ◽  
Exclusion Criteria ◽  
Actual Patient ◽  
The Mean ◽  
Return Visits ◽  
Significant Factors ◽  
Patient Attendance

Objective The aim of this study was to evaluate whether a patient with a cleft's age, associated syndrome, cleft phenotype or travel distance affects their follow-up rate. Design This study is a retrospective review of patients with CL/P treated by a craniofacial clinic. Setting The setting was a craniofacial clinic at a tertiary care university hospital. Patients, Participants Candidates were patients seen by the craniofacial clinic between January 2007 and December 2019. An initial pool of 589 patients was then reduced to 440 due to exclusion criteria. Interventions None Main Outcome Measure(s) The outcome measure was actual patient attendance to the craniofacial team compared to the team goal expectation of annual return visits. Results The mean age of participants at the end of the study was 9.0 ±  5.4 years with a mean follow-up period (total possible follow-up period length based on patient age at presentation and study window) of 5.5 ±  3.6 years. There was no association between cleft phenotype, type of syndrome, or distance to the clinic with attendance. Children with syndromes had an 11% decrease in the odds of attending follow-up visits with each 1-year increase in age compared to a 4% decrease in children without syndromes. Conclusions The only significant factors determining patient attendance were the presence of a syndrome and increasing age.

Overdiagnosis and Medication for Attention-Deficit Hyperactivity Disorder in Children with Cleft: Diagnostic Examination and Follow-Up

2004 ◽  
Vol 41 (4) ◽  
pp. 351-354 ◽  
Author(s):  
Lynn C. Richman ◽  
Susan Ryan ◽  
Tammy Wilgenbusch ◽  
Tom Millard
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Language Learning ◽  
Attention Deficit ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Hospital ◽  
Learning Assessment ◽  
Behavioral Ratings ◽  
Hyperactivity Disorder

Objective To examine the diagnosis of attention-deficit hyperactivity disorder (ADHD) in children with cleft to determine whether language-learning characteristics are taken into account when making this diagnosis. Design Prospective examination of 177 consecutive patients. Objective behavioral ratings, cognitive assessments, and attention/impulsivity testing of 32 of the 177 children with nonsyndromic cleft lip and palate (CLP) who had previously been diagnosed as ADHD and were receiving medication were performed. the prospective 6- to 9-month follow-up examination was examined to determine the accuracy of prior and posttest diagnoses. Setting University hospital-based cleft palate clinic. Main Outcome Measures Pretest/posttest design to determine accuracy of DSM-IV psychiatric diagnosis. Results and Conclusions The results show that the proportion of children originally diagnosed with ADHD (18%) was significantly higher than posttest diagnosis of ADHD (6% p < .001). Also, the frequency of pretest diagnosis of learning disorder (LD; 31%) was significantly different from posttest diagnosis (66% p < .01). The overdiagnosis of ADHD and underdiagnosis of LD in this sample of children with nonsyndromic unilateral cleft lip and palate appears to be due to lack of language-learning assessment.

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.

Follow-up of Electromyographic and Cephalometric Findings in Patients with Unilateral Cleft Lip and Palate after Fifteen Months of Continuous Wearing of a Special Removable Appliance

1995 ◽  
Vol 32 (4) ◽  
pp. 323-327 ◽  
Author(s):  
Raúl Carvajal ◽  
Rodolfo Miralles ◽  
Maria José Ravera ◽  
Andrés Carvajal ◽  
Doris Cauvi ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Paired Comparison ◽  
Normal Growth ◽  
Growth Potential ◽  
Electromyographic Activity ◽  
Orbicularis Oris Muscle ◽  
Removable Appliance ◽  
Cephalometric Measurements

A 15-month follow-up study was conducted on 13 children with unilateral cleft lip and palate. The patients presented with short upper lip, abnormal lip seal, and maxillary retrusion. All had undergone surgery in childhood. Cephalometric and electromyographic measurements were made prior to the start of treatment, 4 months into treatment, and after 15 months of continuous wear of a special removable appliance. The cephalometric measurements on paired comparison showed major improvement in both the sagittal maxillary and dentoalveolar positions. The electromyographic activity of the superior orbicularis oris muscle demonstrated no significant changes over the treatment period. Improvement in the sagittal maxillary and dentoalveolar positions seems to suggest that the elimination of the restrictive effect of the superior orbicularis oris muscle is a good therapeutic approach to promote normal growth potential in children with cleft lip and palate.

Speech in Adults Treated for Unilateral Cleft Lip and Palate: Long-Term Follow-Up after One- or Two-Stage Palate Repair

2017 ◽  
Vol 54 (6) ◽  
pp. 639-649 ◽  
Author(s):  
Staffan Morén ◽  
Maria Mani ◽  
Stålhammar Lilian ◽  
Per Åke Lindestad ◽  
Mats Holmström
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Hospital ◽  
Velopharyngeal Insufficiency ◽  
Control Group ◽  
Two Stage ◽  
One Stage ◽  
Long Term Follow Up

Objective To evaluate speech in adults treated for unilateral cleft lip and palate with one-stage or two-stage palate closure and compare the speech of the patients with that of a noncleft control group. Design Cross-sectional study with long-term follow-up. Participants/Setting All unilateral cleft lip and palate patients born from 1960 to 1987 and treated at Uppsala University Hospital, Sweden, were invited (n = 109). Participation rate was 67% (n = 73) at a mean of 35 years after primary surgery. Forty-seven had been treated according to one-stage palate closure and 26 according to two-stage palate closure. Pharyngeal flap surgery had been performed in 11 of the 73 patients (15%). The noncleft control group consisted of 63 age-matched volunteers. Main Outcome Measure(s) Speech-language pathologists rated perceptual speech characteristics from blinded audio recordings. Results Among patients, seven (10%) presented with hypernasality, 12 (16%) had audible nasal emission and/or nasal turbulence, five (7%) had consonant production errors, one (2%) had glottal reinforcements/substitutions, and one (2%) had reduced intelligibility. Controls had no audible signs of velopharyngeal insufficiency and no quantifiable problems with the other speech production variables. No significant differences were identified between patients treated with one-stage and two-stage palate closure for any of the variables. Conclusions The prevalence of speech outcome indicative of velopharyngeal insufficiency among adult patients treated for unilateral cleft lip and palate was low but higher compared with individuals without cleft. Whether palatal closure is performed in one or two stages does not seem to affect the speech outcome at a mean age of 35 years.

Should Children With Cleft Palate Receive Early Long-Term Tympanostomy Tubes

2017 ◽  
Vol 55 (3) ◽  
pp. 389-395 ◽  
Author(s):  
Amber D. Shaffer ◽  
Matthew D. Ford ◽  
Sukgi S. Choi ◽  
Noel Jabbour
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Tertiary Care ◽  
Tube Placement ◽  
Secondary Palate ◽  
Tympanostomy Tubes ◽  
Prospective Trials

Objectives: To determine whether children with cleft palate might benefit from early long-term tympanostomy tubes with the hypothesis that receiving multiple tubes is associated with shorter duration of first tubes. Design: Retrospective cohort study. Setting: Tertiary care children’s hospital. Participants: Records from 401 consecutive children with cleft palate ± cleft lip, born April 2005 to April 2010, were reviewed. After exclusion of children with cleft repair at an outside hospital, no follow-up after 5 years of age, intact secondary palate, no tubes, or tube replacement at palatoplasty, 105 children remained. Main Outcome Measure: Number of tubes. Results: Armstrong grommet tubes were placed at a median age of 6.7 months (range 2.3-19.6 months). Tubes were replaced in 55.3% of patients, with 34.0% receiving ≥3 sets. Duration of first tubes was significantly longer for children with 1 set of tubes compared with those with multiple sets (median 26 vs 19 months, P = .004). Otorrhea, but not perforation, was associated with longer duration of first tubes (median 27 vs 20.5 months, P = .028). Cleft type did not impact the proportion of patients with multiple tubes. Median age at last tube placement for children with multiple tubes was 5.0 years (range 1.9-8.7 years). Conclusion: Short duration of first tubes is associated with receiving multiple tubes. Because most patients require repeat tubes and many require tubes until school age, there is a significant need for controlled, prospective trials of early long-term tube placement in this population.

A CBCT Based Assessment of Canine Eruption and Development Following Alveolar Bone Grafting in Patients Born With Unilateral Cleft lip and/or Palate

2021 ◽  
pp. 105566562110644
Author(s):  
Hasan Kadi ◽  
Reinhilde Jacobs ◽  
Sohaib Shujaat ◽  
Mathias Lemberger ◽  
Daniel Benchimol ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Vertical Movement ◽  
University Hospital ◽  
Lateral Incisor ◽  
Alveolar Bone Grafting ◽  
Significant Difference

To three-dimensionally assess and visualize the eruption path and development of the maxillary canine following alveolar bone grafting in patients born with cleft lip and palate. A further objective of this analysis was to assess how the presence of the lateral incisor impacts the eruption path of the canine. Observational follow-up study. Stockholm Craniofacial Team, Karolinska University Hospital, Sweden. Thirty children born with non-syndromic unilateral cleft lip with or without palate were consecutively included. CBCT scans of the maxilla were taken six months before and six months after the alveolar bone-grafting surgery for each patient. Canine eruption (angulation and vertical movement) and canine development (length and volume). There was a significant difference pre- and post-operatively of the canine angulation between the cleft and non-cleft sides. The mean angulation on the cleft side was 14.7° (SD  =  11.1°) while on the non-cleft side, it was 4.9° (SD  =  9.2°). No significant differences were noted between cleft-side and non-cleft side canines in terms of amount of vertical eruption and volumetric development. Absence of the lateral incisor did not significantly contribute to either canine angulation or its vertical eruption on the cleft-side. Higher angulation of the canine on the cleft side indicates a higher risk of future canine impaction. Presence or absence of the lateral incisor did not significantly affect canine angulation or its vertical eruption. Increased age and children born with total cleft lip and palate imply a higher risk of angulated canines on the cleft side.

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.

Anthropometric Outcome of Primary Unilateral Cleft Lip Repair in Indonesia

2021 ◽  
pp. 105566562098275
Author(s):  
Robertus Arian Datusanantyo ◽  
Magda Rosalina Hutagalung ◽  
Sitti Rizaliyana ◽  
Djohansjah Marzoeki
Keyword(s):  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Inclusion Criteria ◽  
Initial Size ◽  
Tertiary Center ◽  
Observational Cohort ◽  
Cleft Lip Repair ◽  
Unilateral Cleft Lip Repair ◽  
Junior Residents

Objective: This study aimed to measure and analyze the outcome of primary unilateral cleft lip repair. Design: Observational cohort study. Setting: Surabaya Cleft Lip and Palate (CLP) Center, a major referral center for the Eastern part of Indonesia, affiliated with a tertiary center. Patients, Participants: From 69 patients who met the inclusion criteria, we excluded 31 patients who were more than 2 years of age and were operated on by junior residents under supervision. Interventions: We performed anthropometric measurements of the patients on photographs taken before, immediately after, and a year after the surgery. Main Outcome Measure(s): This study measured nasal width, vertical lip height, horizontal lip length, and philtral height ratios. Results: While nasal width and philtral height ratios decreased significantly ( P = .000 and P = .000, respectively) reaching symmetry immediately after surgery, the horizontal lip length, and vertical lip height ratios remained unchanged ( P = .862 and P = .981, respectively). A year after surgery, the nasal width and horizontal lip length ratios increased significantly ( P = .017 and P = .006, respectively), while philtral height and vertical lip height ratios remained unchanged ( P = .927 and P = .138, respectively). There was no difference in the ratios based on the initial size and completeness of the cleft. Conclusion: In Surabaya CLP Center, the symmetry of nasal width, philtral height, horizontal lip length, and vertical lip height were achieved by the unilateral cleft lip repair despite the initial size and completeness of the cleft.

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