Degree of Asymmetry Between Patients With Complete and Incomplete Cleft Lips

2020 ◽  
pp. 105566562096236
Author(s):  
Diana S. Jodeh ◽  
Sara Soni ◽  
James J. Cray ◽  
S. Alex Rottgers
Keyword(s):  
Surgical Outcomes ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Pearson Correlation ◽  
Statistical Significance ◽  
Intrarater Reliability ◽  
Rater Reliability ◽  
Measured Asymmetry

Introduction: Surgical outcomes for patients with complete cleft lips are not as ideal as those achieved for milder phenotypes. We hypothesized that in addition to the greater width of the cleft, patients with complete cleft lip and palate exhibit a greater degree of hypoplasia and asymmetry. Methods: Stereophotographs of 14 infants with unrepaired unilateral complete and 14 with incomplete cleft lips were measured using Vectra imaging software (Canfield Imaging). Unpaired t tests were used to compare measured asymmetry between groups. Measurements included nasion to endocathion, sn-sbal, subnasale to alare (sn-al), subnasale to crista philtra, subalare to crista philtra (sbal-cphi), chelion to crista philtra, lateral lip element fullness, medial lip element fullness (mef), and non-cleft lip fullness. Duplicate measurements allowed Pearson correlation to be used to determine intra-rater reliability. Statistical significance was set at P < .05. Results: Degree of asymmetry of the nasal base, sn-al, and sn-sbal was significantly greater for patients with complete clefts ( P = .0001, P = .0001). Hypoplasia of the lateral lip element was seen when comparing lateral and mef ( P = .04, P = .004) and lateral lip height (sbal-cphi’’; P = .002). The degree of cupid’s bow asymmetry did not differ between groups ( P = .23). Intrarater reliability was high for all facial measures, ranging from 0.70 to 0.99. Conclusions: More severe, complete cleft lips demonstrate statistically significant greater asymmetry in surgically relevant dimensions. There was greater width of the nasal base. Vertical asymmetry of cupid’s bow was unaffected by cleft severity, but that asymmetry was greater in patients with complete clefts due to hypoplasia of the lateral lip element. This may contribute to the less favorable results in these patients.

Determination of Ethnic Variation in Infant Nasolabial Anthropometry Using 3D Photographs: Implications for Bilateral Cleft Lip Nasal Correction

2021 ◽  
pp. 105566562110244
Author(s):  
Diana S. Jodeh ◽  
Jacqueline M. Ross ◽  
Maria Leszczynska ◽  
Fatima Qamar ◽  
Rachel L. Dawkins ◽  
...  
Keyword(s):  
African American ◽  
Interrater Reliability ◽  
Cleft Lip ◽  
Pearson Correlation ◽  
Statistical Significance ◽  
3D Analysis ◽  
Pediatric Clinic ◽  
Bilateral Cleft Lip ◽  
Post Hoc

Objective: We aimed to assess significant ethnic variabilities in infants’ nasolabial anthropometry to motivate variations in surgical correction of a synchronous bilateral cleft lip/nasal anomaly, specifically whether a long columella is a European feature, therefore accepting a short columella and/or delayed columellar lengthening suitable for reconstruction in ethnic patients. Methods: Thirty-three infants without craniofacial pathology (10 African American [AA], 7 Hispanic [H], and 16 of European descent [C]), ages 3 to 8 months, presenting to the Johns Hopkins All Children’s general pediatric clinic were recruited. Four separate 3D photographs (2 submental and frontal views each) were taken using the Vectra H1 handheld camera (Canfield Imaging). Eighteen linear facial distances were measured using Mirror 3D analysis (Canfield Imaging Systems). Difference between ethnicities was measured using analysis of variance with the Bonferroni/Dunn post hoc comparisons. Pearson correlation was employed for interrater reliability. All statistical analyses were carried out using SPSS version 21.0 (IBM Corp), with statistical significance set at P < .05. Results: Nasal projection (sn-prn) and columella length (sn-c) did not differ significantly between groups ( P = .9). Significant differences were seen between ethnic groups in nasal width (sbal-sbal [C-AA; P = .02]; ac-ac [C-AA; P = .00; H-AA; P = .04]; al-al [C-AA; P = .00; H-AA; P = .001]) and labial length (sn-ls [C-AA; P = .041]; sn-sto [C-AA; P = .005]; Cphs-Cphi L [C-AA; P = .013]; Cphs-Cphi R [C-AA; P = .015]). Interrater reliability was good to excellent and significantly correlated for all measures. Conclusions: African American infants exhibited wider noses and longer lips. No difference was noted in nasal projection or columella length, indicating that these structures should be corrected during the primary cleft lip and nasal repair for all patients and should not be deferred to secondary correction.

Reliability of the SWAG—The Standardized Way to Assess Grafts Method for Alveolar Bone Grafting in Patients with Cleft Lip and Palate

2017 ◽  
Vol 54 (6) ◽  
pp. 680-686 ◽  
Author(s):  
Kathleen Russell ◽  
Ross E. Long ◽  
John Daskalogiannakis ◽  
Ana Mercado ◽  
Ronald Hathaway ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Intrarater Reliability ◽  
Root Coverage ◽  
Treatment Protocols ◽  
Retrospective Comparison ◽  
Alveolar Bone Grafting ◽  
Outcome Comparison ◽  
Better Than

Objective The objective of this study was to test a new method, a Standardized Way to Assess Grafts (SWAG), to rate alveolar bone graft (ABG) outcomes for patients with cleft lip and palate. Design This was a retrospective comparison using the SWAG scale. Setting This study took place in four cleft palate centers with different treatment protocols. Methods A total of 160 maxillary occlusal radiographs taken 3 to 18 months post-ABG for sequentially treated patients with cleft lip and palate were assessed using the SWAG scale. Radiographs were scanned, standardized, blinded, and rated by 6 calibrated orthodontists to assess vertical thirds, bony root coverage, and complete bony fill. All radiographs were rated twice, 24 hours apart, by the same raters. Main Outcomes Intra- and interrater reliabilities were assessed. Results Intrarater reliability was good to very good (.760; .652–.834), and interrater reliability was moderate to good (.606; .569–.681), comparable to previously published methods. Conclusions Rater reliabilities were shown to be comparable to or better than existing methods. The SWAG method was validated for ABG assessments in the mixed and permanent dentitions based on reliabilities in an intercenter outcome comparison.

Birth Weight, Body Length, and Cranial Circumference in Newborns with Cleft Lip or Palate

1998 ◽  
Vol 35 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Magnus Becker ◽  
Henry Svensson ◽  
Bengt Källén
Keyword(s):  
Birth Weight ◽  
Body Length ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Statistical Significance ◽  
The Body ◽  
Control Subjects ◽  
Study Population ◽  
Isolated Cleft Palate ◽  
Pierre Robin

Objective This paper reports on birth weight, body length, body mass index, and cranial circumference at birth of infants with cleft lip and/or palate born between 1973 and 1992. Methods Data were obtained from two nationwide swedish health registries. Infants with syndromes, twins, and infants with immigrant parentage were excluded from the study. Comparisons were made with all singleton births with the same exclusion criteria (n = 2,031,140). Results The body dimensions of infants with isolated cleft lip (n = 865) were found not to differ from those of control subjects, but infants with isolated cleft palate (n = 811) or cleft lip and palate (n = 1139) were found to be lighter and shorter than control subjects. Also, infants with the Pierre Robin sequence (n = 121) had a tendency to be lighter and shorter than control subjects, but these differences did not reach statistical significance despite the large study population.

A Comparison of Three Methods of Repairing the Hard Palate

2002 ◽  
Vol 39 (4) ◽  
pp. 383-391 ◽  
Author(s):  
R. W. Pigott ◽  
E. H. Albery ◽  
I. S. Hathorn ◽  
N. E. Atack ◽  
A. Williams ◽  
...  
Keyword(s):  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Small Sample ◽  
Velopharyngeal Insufficiency ◽  
Strong Trend ◽  
Computer Based ◽  
Palate Repair

Objective To compare growth, speech, and nasal symmetry outcomes of three methods of hard palate repair. Patients Consecutive available records of children born with unilateral bony complete cleft lip and palate over the period 1972 to 1992. Interventions Identical management of lip, nose, alveolus, and soft palate. Hard palate repair by Cuthbert Veau (CV) from 1972 to 1981, von Langenbeck (vL) from 1982 to 1989, or medial Langenbeck (ML) from 1989 to 1991. Outcome Measures For growth: GOSLON yardstick or 5-year model index. For speech: articulation test. Nasal anemometry. For nasal symmetry: Coghlan computer-based assessment. All these measures were developed during the period of data collection but not for this project. Results There was a strong trend toward more favorable anteroposterior maxillary growth with the change from CV to vL to ML techniques. This fell short of statistical significance because of the small sample size. There was a significant reduction in cleft-related articulation faults (p = .01) considered to be related to improved arch form. In the absence of improved rates of velopharyngeal insufficiency or nasal symmetry, increased surgical experience was discounted as a significant contribution to improved growth and articulation outcomes. Conclusions Reduced periosteal undermining and residual exposed palatal shelf from CV to vL to ML improved incisor relationships and articulation.

No Evidence for Linkage and Association between 4q Microsatellite Markers and Nonsyndromic Cleft Lip and Palate in Chilean Case-Parents Trios

2005 ◽  
Vol 42 (3) ◽  
pp. 267-271 ◽  
Author(s):  
Rafael Blanco ◽  
José Suazo ◽  
JoséLuis Santos ◽  
Hernán Carreño ◽  
Hernán Palomino ◽  
...  
Keyword(s):  
Linkage Disequilibrium ◽  
Microsatellite Markers ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Association Studies ◽  
Statistical Significance ◽  
P Value ◽  
Genetic Trait ◽  
Multiple Alleles ◽  
Cleft Lip Palate

Objective Nonsyndromic cleft lip/palate (NSCLP) has the characteristics of a complex genetic trait. Linkage and association studies have suggested that one or more clefting loci may be located on chromosome 4q. The goal of this study was to evaluate the possible linkage and association due to linkage disequilibrium between five microsatellite markers located on 4q28 to 4q33 and NSCLP, using the case-parent trio design. Subjects and Methods A total of 56 Chilean families (32 simplex and 24 multiplex) were recruited. Microsatellite markers were analyzed using polymerase chain reaction with fluorescent-labeled forward primers, followed by electrophoresis on a laser-fluorescent sequencer. Case-parents trios were ascertained to assess linkage and linkage disequilibrium through a multistage procedure. Transmission disequilibrium tests for multiple alleles were carried out to assess the statistical significance of 4q28 to 4q33 microsatellite markers. Results Only weak evidence for linkage was obtained for the FGA marker (asymptotic uncorrected p value = .08 and empirical p value = .05). Only the FGA and UCP1 markers were selected for association analysis in trios, with unrelated cases achieving a nearly significant result for the UCP1 marker (asymptotic uncorrected p value = .07 and empirical p value = .19). Conclusion Though the FGA and UCP1 markers showed nearly significant p values for linkage and association, respectively, the results of the present study provided insufficient evidence of the existence of a major susceptibility locus in the 4q region that was analyzed in the present study.

scholarly journals A perceptual evaluation of resonance disorders in children with repaired unilateral cleft lip and palate in Hospital UniversitiSains Malaysia

2018 ◽  
Vol 17 (2) ◽  
pp. 282-289
Author(s):  
Aimi Syahidah Zulkipli ◽  
Mohammad Khursheed Alam ◽  
Evina Suriakant Patel ◽  
Sanjida Haque
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Science ◽  
Cross Sectional Study ◽  
Speech Sample ◽  
Perfect Agreement ◽  
Cross Sectional ◽  
Rater Reliability ◽  
Perceptual Evaluation ◽  
Resonance Disorder

Background: In most literature regarding speech outcomes in children with repaired cleft lip and palate (CLP), exhibited resonance disorders despite having surgical repair. However, the types and severity of the resonance disorders vary from one individual to another. Thus, perceptual evaluation is important to determine the speech outcomes in individuals with repaired cleft lip and palate.Aim: The aim of this cross sectional study was to determine the types and severity of resonance disorders of children with repaired unilateral cleft lip and palate (UCLP) and describe the inter- and intra-rater reliability of perceptual evaluation of resonance disorders using GOS. SP.PASS’98. Four children with repaired UCLP in Hospital USM with ages ranging from 8 years old to 12 years old was included in this study. During data collection, history taking was first conducted, then participants’ speech sample was collected and lastly oral motor examination was conducted.Results: 50% of the speech sample was then duplicated for inter- and intraexaminer reliability investigations. Exact agreement and kappa values were used for reliability measures. Seventy five percent (75%) (3/4) participants exhibited hypernasality as the type of resonance disorder and 25% (1/4) participant had no evidence of hypernasality or any other types of resonance disorder. No other types of resonance disorders such as hyponasality, mixed resonance or cul-de-saq was noted in the participants. The severity of hypernasality ranged from mild to severe in the participants. Inter-rater reliability showed fair to almost perfect agreement and intra-rater reliability revealed almost perfect agreement.Conclusion: The results obtained from this study was more or less similar to our other studies conducted on the speech outcome of individuals with repaired UCLP. Although surgical intervention has been provided to these individuals, it is important that referrals be made to SLPs to evaluate their speech outcomes. This is to determine a proper management for the individual.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.282-289

scholarly journals Radiological evaluation of secondar y bone grafting results in patients with cleft lip and palate

2021 ◽  
Vol 3 (59) ◽  
pp. 51-55
Author(s):  
Silvia Railean ◽  
◽  
Egor Porosencov ◽  
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Pearson Correlation ◽  
Type I ◽  
Alveolar Ridge ◽  
Radiological Evaluation ◽  
Equal Distribution ◽  
Care Protocol

Introduction. Bone grafts are a necessary component of the care protocol for patients with cleft lip and palate (CLP). Radiological evaluation is an essential tool in evaluating the integration of the bone graft at the cleft area. Aim: Evaluation of the interdental height of the alveolar ridge in patients with CLP at the pre- and postoperative stages in order to assess the integration of bone graft in the cleft area. Material and methods: Cross-sectional clinical study, which included 34 patients with CLP; with equal distribution by gender, with an average age of 17.6±0.43 years. The study group underwent surgical treatment with bone grafting in the cleft region. The radiological evaluation was performed pre- and postoperatively (over 6 months), according to the scale of assessment proposed by Abyholm et al. Statistical evaluation of the data was performed by the Pearson correlation coefficient. Results: Overall, favorable postoperative results were observed. Initially, according to the radiological evaluation, the patients presented at the preoperative stage type III 29.4% (n = 10) and type IV - 70.6% (n = 24) of the interdental height of the alveolar ridge. Following bone grafting, it was recorded at 52.9% (n = 18) - type I, mainly in female patients (n = 11) and 47.1% (n = 16) - type II of the interdental height of the alveolar ridge , being predominantly registered in male patients (n = 10). Statistically significant differences between the sexes were not recorded (p = 0.132). The successful results obtained by secondary bone grafting in the cleft region allowed to continue the rehabilitation treatment of patients with CLP. Conclusion: Radiological evaluation of secondary bone grafting in the cleft area in terms of assessing the height of the alveolar ridge according to the scale of Abyholm et al. is a valuable diagnostic tool, readily available for assessing the condition of the grafted bone.

scholarly journals Planning community-based intervention for speech for children with cleft lip and palate from rural South India: A needs assessment

2017 ◽  
Vol 50 (03) ◽  
pp. 295-301 ◽  
Author(s):  
Subramaniyan Balasubramaniyan ◽  
Vaidyanathan Raghunathan ◽  
B. Rajashekhar ◽  
B. W. C. Sathiyasekaran ◽  
Roopa Nagarajan
Keyword(s):  
Tamil Nadu ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Geographical Location ◽  
Communication Disorders ◽  
Voice Disorder ◽  
Community Based ◽  
Cross Sectional ◽  
Term Care ◽  
Rater Reliability

ABSTRACT Background and Aim: A community-based rehabilitation programme, Sri Ramachandra University-Transforming Faces project, was initiated to provide comprehensive management of communication disorders in individuals with CLP in two districts in Tamil Nadu, India. This community-based programme aims to integrate hospital-based services with the community-based initiatives and to enable long-term care. The programme was initiated in Thiruvannamalai (2005) district and extended to Cuddalore (2011). The aim of this study was to identify needs related to speech among children with CLP, enroled in the above community-based programme in two districts in Tamil Nadu, India. Design: This was a cross–sectional study. Participants and Setting: Ten camps were conducted specifically for speech assessments in two districts over a 12-month period. Two hundred and seventeen individuals (116 males and 101 females) >3 years of age reported to the camps. Methods: Investigator (SLP) collected data using the speech protocol of the cleft and craniofacial centre. Descriptive analysis and profiling of speech samples were carried out and reported using universal protocol for reporting speech outcomes. Fleiss’ Kappa test was used to estimate inter-rater reliability. Results: In this study, inter-rater reliability between three evaluators revealed good agreement for the parameters: resonance, articulatory errors and voice disorder. About 83.8% (n = 151/180) of the participants demonstrated errors in articulation and 69% (n = 124/180) exhibited abnormal resonance. Velopharyngeal port functioning assessment was completed for 55/124 participants. Conclusion: This study allows us to capture a “snapshot” of children with CLP, living in a specific geographical location, and assist in planning intervention programmes.

Treatment Outcome after One-Stage Repair in Children with Complete Unilateral Cleft Lip and Palate Assessed with the Goslon Yardstick

2009 ◽  
Vol 46 (4) ◽  
pp. 374-380 ◽  
Author(s):  
Piotr Fudalej ◽  
Maria Hortis-Dzierzbicka ◽  
Barbara Obloj ◽  
Dorota Miller-Drabikowska ◽  
Zofia Dudkiewicz ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Pearson Correlation ◽  
Interrater Agreement ◽  
Dental Arch ◽  
First Year ◽  
Kappa Statistics ◽  
One Stage ◽  
First Year Of Life ◽  
Plaster Models

Objective: To compare results of Golson Yardstick measurement of dental arch relationships in a sample of 10-year-old Polish children with results of the Golson measurement in published reports. Materials and Methods: Plaster models of 28 consecutively treated subjects with unilateral cleft lip and palate (UCLP) that was repaired with a one-stage simultaneous closure performed in the first year of life. All individuals were born between 1994 and 1995. The Goslon score (categories 1 to 5) was allocated. Intra- and interrater agreement was assessed with kappa statistics and Pearson correlation coefficient. Independent t tests were employed to detect difference between the score in the present and other published samples. Results: Mean Goslon score equaled 2.44; 57% of the patients were allocated Goslon category 1 or 2, 32% were rated Goslon 3, and 11% of the patients were assigned category 4 or 5. Intrarater agreement was between 0.75 and 0.77. Interrater agreement was 0.79. Conclusions: Dental arch relationship following one-stage repair was comparable with the results of the centers with the best outcome.

Comparison of Microbial Activity Among Infants With or Without Using Presurgical Nasoalveolar Molding Appliance

2020 ◽  
Vol 57 (6) ◽  
pp. 762-769
Author(s):  
Hanieh Hassani ◽  
Jung-Wei Chen ◽  
Wu Zhang ◽  
William Hamra
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Pearson Correlation ◽  
Bacterial Count ◽  
Colony Count ◽  
Caries Risk ◽  
Significant Difference ◽  
Cleft Lip Palate ◽  
Ph Level ◽  
Nasoalveolar Molding

Purpose: The aim of the current study is as follows: (1) to study whether wearing the presurgical nasoalveolar molding appliance (PNAM) had facilitated the establishment of Streptococcus mutans and Lactobacillus ( LB) and to determine other factors including pH and caries susceptibility associated with wearing the PNAM. Methods: Saliva samples of 61 infants (4.5 ± 2.06 months old) were collected from the following 3 groups: PNAM (n = 23), healthy (n = 30), and cleft lip and palate (CLP) without any treatment (n = 8). Saliva samples were assessed using selective agar to enumerate total LB and S mutans and subjected to adenosine triphosphate (ATP)-driven bioluminescence determinations using a luciferin-based assay system, and pH level was evaluated. One-way analysis of variance with least significant difference post hoc test ( P < .05) and Pearson correlation were used to evaluate S mutans, LB, pH, and ATP levels. Results: A total of 63 patients (30 healthy patients, 23 patients with cleft lip/palate who had PNAM appliance and 8 patients with cleft lip/palate who did not use the appliance) were seen in this study. There is a significant difference in pH ( P = .012), LB Caries Risk Test ( P < .001), LB colony count ( P < .001), S mutans Caries Risk Test ( P < .001), and S mutans colony count ( P < .001) among the 3 groups (PNAM > CLP > healthy). The ATP level was not significantly different among the 3 groups. Conclusion: Higher bacterial count and lower pH were found in the PNAM group. Cleft lip and/or palate patients wearing the PNAM appliance are at higher risk for dental caries.

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