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.

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).

Intraoral Photographs for Rating Dental Arch Relationships in Unilateral Cleft Lip and Palate

2009 ◽  
Vol 46 (4) ◽  
pp. 415-419 ◽  
Author(s):  
Yu-Fang Liao ◽  
Chiung-Shing Huang ◽  
I-Feng Lin
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
The Other ◽  
Viable Alternative ◽  
Dental Arch ◽  
Significant Difference ◽  
Intraexaminer Reliability ◽  
Experienced Examiner ◽  
Dental Casts

Background and Purpose: The Goslon Yardstick is one of the most commonly used methods to assess dental arch relationships of patients with unilateral cleft lip and palate. This system was originally applied to dental casts. For reasons of economy and convenience, we aimed to determine whether intraoral photographs could substitute for dental casts for rating dental arch relationships. Methods: Records of 58 patients with nonsyndromic complete unilateral cleft lip and palate from the Chang Gung Craniofacial Center, Taipei, Taiwan, were used in this study. A set of dental casts and digital intraoral photographs taken at around 9 years of age were available for all patients. An experienced examiner rated the dental casts using the Goslon Yardstick to provide the reference scores. The other three examiners rated the intraoral photographs and repeated the rating 1 week later to calculate inter- and intraexaminer reliability. The photographic scores for each examiner were then compared with the reference scores to determine the validity of the photographs. Results: The results showed no significant difference between the rating of dental casts and photographs using the Goslon Yardstick. Reliability was also high for rating on photographs. Conclusions: Intraoral photographs appear to be a viable alternative to the application of the Goslon Yardstick on dental casts.

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.

Photographs of Study Casts: An Alternative Medium for Rating Dental Arch Relationships in Unilateral Cleft Lip and Palate

2004 ◽  
Vol 41 (6) ◽  
pp. 646-650 ◽  
Author(s):  
Pieter J. P. M. Nollet ◽  
Christos Katsaros ◽  
Martin A. van 't Hof ◽  
Catharina A. M. Bongaarts ◽  
Gunvor Semb ◽  
...  
Keyword(s):  
The Netherlands ◽  
Repeated Measures ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Dental Arch ◽  
Reproducible Method ◽  
The University ◽  
Dental Casts

Objective To investigate the reliability of using photographs of study casts as an alternative to casts for rating dental arch relationships. Design Repeated-measures study. Setting Cleft Palate Center of the University Medical Center Nijmegen, Nijmegen, The Netherlands. Patients Records of children with complete unilateral cleft lip and palate (UCLP) (n = 49) at the age of 9 years were included. Mean Outcome Measure(s) Statistics of intra- and interexaminer agreement. Results No significant differences were found between the rating of dental casts and photographs of dental casts, using the Goslon Yardstick. Conclusions Photographs of dental casts provide a consistent, reproducible method for rating dental arch relationships in patients with UCLP at the age of 9 years and provide a reliable alternative to the application of the Goslon Yardstick on dental casts.

scholarly journals Effect of Maxillary Osteotomy on Speech in Cleft Lip and Palate: Instrumental Outcomes of Velopharyngeal Function

2020 ◽  
Vol 57 (11) ◽  
pp. 1320-1331
Author(s):  
Valerie J. Pereira ◽  
Jyrki Tuomainen ◽  
Norman Hay ◽  
Michael Mars ◽  
Archna Suchak ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Consecutive Series ◽  
Time Points ◽  
Post Surgery ◽  
Maxillary Osteotomy ◽  
Significant Difference ◽  
Velopharyngeal Function ◽  
Over Time

Objective: To investigate the effect of maxillary osteotomy on velopharyngeal function in cleft lip and palate (CLP) using instrumental measures. Design: A prospective study. Participants: A consecutive series of 20 patients with CLP undergoing maxillary osteotomy by a single surgeon were seen at 0 to 3 months presurgery (T1), 3 months (T2), and 12 months (T3) post-surgery. Interventions: Nasalance was measured on the Nasometer II 6400. For videofluoroscopy and nasendoscopy data, visual perceptual ratings, for example, palatal lift angle (PLAn), and quantitative ratiometric measurements, for example, closure ratio (CRa), were made using a validated methodology and computer software. Reliability studies were undertaken for all instrumental measures. Main Outcome Measures: Repeated measures analysis of variance (with time at 3 levels) for nasalance and each velar parameter. Planned comparisons across pairs of time points (T1-T2, T1-T3, and T2-T3) including effect sizes. Results: A significant difference over time was found for nasalance ( P = .001) and planned comparisons across pairs of time points were significant between T1 and T2 ( P = .008), T1 and T3 ( P = .002), but not between T2 and T3 ( P = .459) providing evidence that maxillary osteotomy can impact on nasalance adversely and that the changes seen are permanent and stable. There were also significant differences over time for PLAn ( P = .012) and CRa ( P = −.059) and planned comparisons for both velar parameters reflected similar findings to those of nasalance. Conclusions: Maxillary osteotomy can adversely affect velopharyngeal function in patients with CLP. The study provides evidence for a much earlier post-surgery review even as early as 3 months after surgery.

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.

scholarly journals Closing the Loop on Centralization of Cleft Care in the United Kingdom

2017 ◽  
Vol 55 (2) ◽  
pp. 248-251 ◽  
Author(s):  
Andrew R. Ness ◽  
Andrew R. Wills ◽  
Andrea Waylen ◽  
Jackie Smallridge ◽  
Amanda J. Hall ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Previous Survey ◽  
Main Outcome Measure ◽  
The United Kingdom ◽  
Closing The Loop ◽  
Clinical Measures ◽  
The Impact

Objective: We highlight a major study that investigated the impact of reconfigured cleft care in the United Kingdom some 15 years after centralization. We argue that centralization as an intervention has a major impact on outcomes. Setting: Audit clinics held in Cleft Centers in the United Kingdom. Patients, Participants: Five-year-olds born between April 1, 2005, and March 31, 2007, with nonsyndromic unilateral cleft lip and palate. Interventions: Centralization of cleft care. Main Outcome Measure(s): We collected routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) in a very similar way to a previous survey. Results: We identified 359 eligible children and recruited 268 (74.7%) to the study. Overall, their outcomes were better post-centralization. There have been marked improvements in dentoalveolar arch relationships and in speech whereas the prevalence of dental caries and hearing loss are unchanged. Conclusions: Centralized cleft care has changed UK outcomes considerably and there is no argument for returning to a dispersed model of treatment.

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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