scholarly journals Final Posttreatment Occlusion in Patients With Unilateral Cleft Lip and Palate

2021 ◽  
pp. 105566562110285
Author(s):  
Christine B. Staudt ◽  
Julia Bollhalder ◽  
Martina Eichenberger ◽  
Giorgio La Scala ◽  
Georges Herzog ◽  
...  
Keyword(s):  
Orthognathic Surgery ◽  
Retrospective Cohort ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Total Sample ◽  
Treatment Center ◽  
Main Outcome Measure ◽  
Males And Females

Objective: To evaluate final posttreatment occlusion in patients with complete unilateral cleft lip and palate (cUCLP) by comparing (1) 3 treatment centers, (2) males and females, (3) cleft and noncleft sides, (4) right- and left-sided clefts, and (5) orthodontic treatment with/without orthognathic surgery (OS). Design: Retrospective cohort study. Patients: Blinded posttreatment dental casts of 56 patients (19.4 ± 1.4 years) with cUCLP from 3 centers in Switzerland. Main Outcome Measure: Occlusal assessment using the modified Huddart/Bodenham (MHB) index. Results: Our sample comprised 35 males and 21 females, 46 with left- and 10 with right-sided clefts, of which 32 had undergone OS. The final posttreatment occlusion showed a median MHB score of 0 (interquartile range: −1.0 to 2.0) in the total sample and did not seem to depend on treatment center, sex, or OS. The MHB scores for the anterior buccal and the buccal segments were more negative on the cleft than on the noncleft side ( P = .002 and P = .006, respectively). When the cleft was on the left side, the MHB score tended to be more positive in the labial ( P = .046) and anterior buccal segments ( P = .034). Conclusions: This study shows a very satisfactory final posttreatment occlusion in patients with cUCLP. The more constricted buccal occlusion on the cleft side emphasizes the attention that should be given in correcting the more medially positioned lesser maxillary segment. The influence of cleft-sidedness should be analyzed further on a sample including more patients with right-sided clefts.

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).

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.

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.

scholarly journals Orthodontic burden of care for patients with a cleft lip and/or palate

2019 ◽  
Vol 46 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Othman Hameed ◽  
Nima Amin ◽  
Priya Haria ◽  
Brijesh Patel ◽  
Norman Hay
Keyword(s):  
Orthognathic Surgery ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Burden Of Care ◽  
Duration Of Treatment ◽  
Street Hospital ◽  
Great Ormond Street Hospital ◽  
Alveolar Bone Grafting

Background: Patients with a cleft lip and/or palate may require multiple episodes of orthodontic treatment, e.g. before alveolar bone grafting, upper arch alignment, orthodontic camouflage and in combination with orthognathic surgery. There is little published regarding the overall orthodontic burden of care for these patients. Aim: To assess the orthodontic burden of care for patients with a cleft lip and/or palate. Method: Data were collected retrospectively from all consecutive cleft patients who had completed orthodontic treatment between January 2014 and December 2015 at Great Ormond Street Hospital, London, United Kingdom. Results: Forty-two patients were included in the study: Twenty-three patients with a cleft lip and palate; nine with an isolated cleft palate; eight with cleft lip and alveolus; and two with cleft lip. The mean age of orthodontic treatment commencement was 13.4 years (range = 8.9–18.2 years) with a mean duration of 3.4 years (range = 1.3–8.3 years). An average of 44 appointments were required with an orthodontist (range = 18–98 appointments). Conclusion: The orthodontic burden of care for patients with cleft lip and/or palate must not be underestimated. The duration of treatment varies depending on the type of cleft diagnosis and whether orthognathic surgery will be required. From this study, a patient with cleft lip and/or palate required an average of 44 orthodontic appointments and a mean duration of treatment of 3.4 years in order to complete their treatment. This is a considerable burden to patients and their guardians, which they must be informed of before commencement of orthodontic treatment.

Dental Arch Relationships and Reverse Headgear Effects in Southern Chinese Patients with Unilateral Cleft Lip and Palate

2018 ◽  
Vol 55 (7) ◽  
pp. 925-934 ◽  
Author(s):  
Yang Rafidah Hassan ◽  
Kwan Lok Tse ◽  
Balvinder Khambay ◽  
Ricky Wing Kit Wong ◽  
Min Gu ◽  
...  
Keyword(s):  
Orthognathic Surgery ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Chinese Patients ◽  
Dental Arch ◽  
Positive Effects ◽  
Southern Chinese ◽  
Kappa Value ◽  
The University

Objective: To evaluate the severity of the dental arch relationships and the treatment outcomes of reverse headgear (RHG) in southern Chinese patients with unilateral cleft lip and palate (UCLP). Design: A retrospective study. Setting: Faculty of Dentistry, The University of Hong Kong. Patients: Thirty-eight UCLP patients with complete records. Among them, 14 were later treated with RHG (RHG group) and 24 were under review (non-RHG group) before definitive orthodontic or in conjunction with orthognathic surgery. Interventions: Study models at T1 (aged 9.4 ± 0.4 years old), prebone grafting and before any orthodontic treatment started; T2 (aged 11.3 ± 0.6 years old), after bone grafting, and RHG treatment (RHG group) or under review (non-RHG group); and T3 (aged 15.3 ± 3.2 years old), pretreatment of definitive orthodontic or in conjunction with orthognathic surgery. Main Outcome Measures: With satisfactory intra- and interexaminer agreement proven by the kappa value, the dental arch relationships of the study models at T1, T2, and T3 were assessed by a solo calibrated examiner using the GOSLON Yardstick. Results: The median GOSLON score for southern Chinese patients with UCLP at T1 was 4.0. Sixty percent of the patients were categorized as “poor” at T1. RHG significantly improved dental arch relationships from T1 to T2, and the improvement was maintained until T3 assessed by the GOSLON Yardstick. Conclusions: The dental arch relationships in southern Chinese UCLP patients at 8 to 10 years old are unfavorable. RHG treatment shows positive effects in improving the dental arch relationships in UCLP patients, as assessed by the GOSLON Yardstick.

scholarly journals Evaluation of patient and parent satisfaction after orthodontic treatment/orthognathic surgery for cleft lip and palate deformity

2019 ◽  
Vol 11 (6) ◽  
pp. 184 ◽  
Author(s):  
Muraleedhara Bhat ◽  
Subramanya Shetty ◽  
Praveen Shetty ◽  
FaizanA Khan ◽  
Akhtar Husain ◽  
...  
Keyword(s):  
Orthognathic Surgery ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Parent Satisfaction

A New Index for Assessing Surgical Outcome in Unilateral Cleft Lip and Palate Subjects Aged Five: Reproducibility and Validity

1997 ◽  
Vol 34 (3) ◽  
pp. 242-246 ◽  
Author(s):  
Nikki E. Atack ◽  
Iain S. Hathorn ◽  
Gunvor Semb ◽  
Tom Dowell ◽  
Jonathan R. Sandy
Keyword(s):  
Surgical Outcome ◽  
Orthognathic Surgery ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Face Validity ◽  
Longitudinal Models ◽  
Examiner Agreement ◽  
Outcome Of Surgery ◽  
Future Growth

Objective This study assessed the reproducibility, reliability, and predictive validity of a previously developed index by the authors for assessing surgical outcome in unilateral cleft lip and palate (UCLP) children aged 5. Methods Sixty randomly selected study models of 5- to 6-year-old complete UCLP subjects were obtained and the index was used to assess their surgical outcomes. Results Assessment of these study models using the new index demonstrated excellent intra-examiner agreement. The inter-examiner agreement was shown to be good. The corresponding longitudinal models at 16 to 18 years of 54 of the initial 5- to 6-year-old sample were also acquired. These subjects had undergone orthodontic treatment but not orthognathic surgery. The need for osteotomy amongst these models was assessed. Between 13% and 18% (depending on examiner) of 5-year-olds' models were scored in the groups likely to require orthognathic surgery. In the corresponding 16- to 18-year-olds' models, 9% were assessed as likely to benefit from an osteotomy. However, on an individual basis, it was not possible to predict future growth from study models at age 5. Conclusions This study has provided a reliable and reproducible index for assessing the outcome of surgery in UCLP subjects earlier than indices already available. True validation of the Index was not possible but it appears that it relies on face validity.

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.

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