Cleft lip and palate: developmental abnormalities of the face, mouth and jaws

Relevance. Cleft lip and palate is one of the severe malformations of the face and jaw, requiring a comprehensive approach to the rehabilitation of the patients, including doctors of various specialties, one of which is orthodontists. A feature of orthodontic treatment is difficulty of fixing bracket systems, as well as lowering the level of oral hygiene, caused by deformation and displacement of fragments of the maxillofacial region.Purpose. Improving the effectiveness of orthodontic treatment and hygiene of the oral caviti in patients with cleft lip and palate in permanent bite period.Materials and methods. A comparison was made of the effetctiveness of fixing brackets systmes with direct and indirect bonding techniques and the effectiveness of oral hygiene during orthodontic treatment using irrigators.Results. The results of the study showed a difference in the effectiveness of using direct and indirect methods of fixing bracket systems in patients with cleft and palate. The use of irrigators as additional means of oral hygiene has demonstrated a positive dynamic of hygiene indices.Conclusions. Results of the study demonstrate the advantages of fixation the brackets by indirect bonding and use additional hygiene products irrigator for improving of oral hygiene.

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How is the face formed and when it goes wrong: In relation to Cleft Lip/Palate

Manchester Medical Journal ◽

10.7227//mmj.0035 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Fozia Khan

Keyword(s):

Cleft Lip ◽

Normal Development ◽

Cleft Lip And Palate ◽

Complex Structure ◽

First Trimester ◽

Facial Defect ◽

Facial Defects ◽

The Face ◽

Embryonic Life ◽

Cleft Lip Palate

The normal development of the face relies upon the correct morphogenesis of structures in utero that usually occurs within the first trimester of embryonic life. The face is a very complex structure involving many genes and factors and with it being such a crucial part of life, both physically and aesthetically and therefore mentally, its important for everything to be just right. However, when the normal process doesn’t go to plan this results in dysmorphogenesis, which cleft lip and palate (CLP) is an example of as the lip/palate doesn’t fuse together and the infant is left with a gap. Although the exact cause of CLP is unknown, it is thought to be a mixture of genetics, environment and the teratogens the mothers are exposed to within the environment. This report will demonstrate the normal development of the face for the purpose of understanding how it goes wrong, resulting in CLP. Since there is still a lot to be understood about CLP it will also shed light on recent advances in relating SHH and certain genes as a possible cause for this dysmorphogenesis. The report will also briefly look at the relation of CLP with the genes associated with syndromic and non-syndromic diseases and the different types of CLP. There are many other facial defects that are a result of dysmorphogenesis, however as CLP is one of the most common yet poorly understood facial defect, it will be the main focus of this report.

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Supernumerary teeth in patients with cleft lip and palate: the tooth germs do not separate

Dental Press Journal of Orthodontics ◽

10.1590/2177-6709.26.4.e21ins4 ◽

2021 ◽

Vol 26 (4) ◽

Author(s):

Alberto CONSOLARO ◽

Maria Carolina Malta MEDEIROS ◽

Dario Augusto Oliveira MIRANDA ◽

Ingrid Araújo de OLIVEIRA

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Permanent Teeth ◽

Supernumerary Teeth ◽

Human Teeth ◽

Tooth Formation ◽

Dental Lamina ◽

The Face ◽

Embryonic Origin ◽

Tooth Germs

ABSTRACT Introduction: Supernumerary teeth in cases of cleft lip and palate do not result from the division of normal germs before the formation of hard tissue. Deciduous and permanent teeth odontogenesis begins after the face has formed, either with or without the cleft. Discussion: The most acceptable hypothesis to enable understanding of the presence of supernumerary teeth on one or both sides of the cleft palate is hyperactivity of the dental lamina in its walls. This hyperactivity, with the formation of more tooth germs, must be attributed to mediators and genes related to tooth formation, under strong influence of local epigenetic factors, whose developmental environment was affected by the presence of the cleft. Conclusion: The current concepts of embryology no longer support the fusion of embryonic processes for the formation of the face, but rather the leveling of the grooves between them. All human teeth have a dual embryonic origin, as they are composed of ectoderm and mesenchyme/ectomesenchyme, but this does not make it easy for them to be duplicated to form supernumerary teeth.

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Novel GREM1 Variations in Sub-Saharan African Patients With Cleft Lip and/or Cleft Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665618754948 ◽

2018 ◽

Vol 55 (5) ◽

pp. 736-742 ◽

Cited By ~ 4

Author(s):

Lord Jephthah Joojo Gowans ◽

Ganiyu Oseni ◽

Peter A. Mossey ◽

Wasiu Lanre Adeyemo ◽

Mekonen A. Eshete ◽

...

Keyword(s):

Cleft Palate ◽

Soft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Sequence Data ◽

Regulatory Elements ◽

The Face ◽

Sub Saharan ◽

African Patients ◽

Coding Variants

Objective: Cleft lip and/or cleft palate (CL/P) are congenital anomalies of the face and have multifactorial etiology, with both environmental and genetic risk factors playing crucial roles. Though at least 40 loci have attained genomewide significant association with nonsyndromic CL/P, these loci largely reside in noncoding regions of the human genome, and subsequent resequencing studies of neighboring candidate genes have revealed only a limited number of etiologic coding variants. The present study was conducted to identify etiologic coding variants in GREM1, a locus that has been shown to be largely associated with cleft of both lip and soft palate. Patients and Method: We resequenced DNA from 397 sub-Saharan Africans with CL/P and 192 controls using Sanger sequencing. Following analyses of the sequence data, we observed 2 novel coding variants in GREM1. These variants were not found in the 192 African controls and have never been previously reported in any public genetic variant database that includes more than 5000 combined African and African American controls or from the CL/P literature. Results: The novel variants include p.Pro164Ser in an individual with soft palate cleft only and p.Gly61Asp in an individual with bilateral cleft lip and palate. The proband with the p.Gly61Asp GREM1 variant is a van der Woude (VWS) case who also has an etiologic variant in IRF6 gene. Conclusion: Our study demonstrated that there is low number of etiologic coding variants in GREM1, confirming earlier suggestions that variants in regulatory elements may largely account for the association between this locus and CL/P.

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Distraction osteogenesis with periodontal rehabilitation: A Case Report

JMS SKIMS ◽

10.33883/jms.v15i1.125 ◽

2012 ◽

Vol 15 (1) ◽

pp. 78-81

Author(s):

Asif Iqbal Khan ◽

Ashok Utreja ◽

Roobal Behal

Keyword(s):

Case Report ◽

Distraction Osteogenesis ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Treatment Modalities ◽

Maxillary Hypoplasia ◽

Alternative Method ◽

End Of Treatment ◽

The Face

Distraction osteogenesis is one of the latest treatment modalities in correcting skeletal discrepancies in the craniofacial region. Maxillary retrusion is a common problem when deformity of the face is concerned, especially in cleft lip and palate patients. Distraction osteogenesis utilizing internal or external has an enormous role in future as an alternative method of skeletal correction in patients with severe maxillary hypoplasia. In addition, periodontal rehabilitation in these patients is of utmost importance especially at the end of treatment. This case report presents one such case of severe maxillary retrusion treated successfully by distraction osteogenesis. JMS 2012;15(1):78-81.

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Transverse Craniofacial Features and Their Genetic Predisposition in Families with Nonsyndromic Unilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/02-134.1 ◽

2004 ◽

Vol 41 (3) ◽

pp. 256-261 ◽

Cited By ~ 12

Author(s):

Young-Jooh Yoon ◽

Marja R. Perkiomaki ◽

Ross H. Tallents ◽

Ingrid Barillas ◽

Roberto Herrera-Guido ◽

...

Keyword(s):

Risk Assessment ◽

General Population ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Cross Sectional ◽

Biological Mothers ◽

Facial Height ◽

The Face ◽

Craniofacial Features ◽

Biological Fathers

Objective The purpose of this study was to evaluate the transverse craniofacial form in families with nonsyndromic cleft lip and palate (NSCLP). It was hypothesized that affected as well as noncleft NSCLP family members are characterized by a common array of craniofacial features that differ from the general population. Design This was a prospective cross-sectional investigation that included affected children with NSCLP and their noncleft parents and siblings. Patients, Participants A total of 114 subjects (14 affected girls, 17 affected girls, 15 unaffected male siblings, 10 unaffected female siblings, 29 unaffected biological mothers, and 29 unaffected biological fathers) were included. Subject records comprised of posteroanterior cephalometric radiographs obtained from all 114 subjects. Main Outcome Measures The width of midfacial structures, including the orbit and nose, was increased in NSCLP families, compared with published norms. Interestingly, the face was disproportionally wider in relation to total facial height. The transverse craniofacial form of children with or without clefts significantly correlated with that of their parents. Mothers displayed strong correlation with their affected and unaffected sons, whereas fathers correlated to their daughters, suggesting a possible sex-linked developmental influence. Conclusion Better understanding of the genetic inheritance of craniofacial features associated with cleft lip and palate may ultimately contribute to the development of cleft risk assessment methods.

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Facial Growth and Development in Unilateral Cleft Lip and Palate during the Period of Puberty: Comparison of the Development after Periosteoplasty and after Primary Bone Grafting

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1994_031_0106_fgadiu_2.3.co_2 ◽

1994 ◽

Vol 31 (2) ◽

pp. 106-115 ◽

Cited By ~ 9

Author(s):

Zbyněk Šmahel ◽

Živa Müllerová

Keyword(s):

Growth And Development ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Bone Grafts ◽

Facial Growth ◽

X Ray ◽

Stage Of Development ◽

Lower Jaw ◽

The Face ◽

Primary Bone

X-ray cephalometry was used in studies of facial growth and development carried out in 32 males with complete unilateral cleft lip and palate. They underwent primary periosteoplasty and were examined at the ages of 10 and 15 years. The results were compared with the development of the face In a longitudinal study of 20 males with the same type of cleft who were operated with a primary bone graft. The series with periosteoplasty showed a more marked proclination of the upper dentoalveolar component with the restoration of a positive overjet, as compared to a persistent anterior crossbite in the males with bone grafts. The lower jaw showed a larger protrusion, while individuals with bone grafts were characterized at the ages of 10 and 15 years by a larger posterior rotation of the mandible. The growth of the maxilla did not differ between series. In both series, there was a marked reduction In the growth of maxillary depth and of upper lip height, while the highest growth rate showed parameters of nasal prominence. An increasing mandibular protrusion and maxillary retrusion resulted in an impairment of sagittal jaw relations and in the flattening of the face, both of which occurred in almost all patients. The rotation of the lower jaw was not correlated with either the convexity of the face, sagittal jaw relations, or an overjet. The independence of developmental changes of selected characteristics at their initial state documented the impossibility of predicting the development of the face on the basis of a single x-ray examination at a given stage of development. Fixed appliances promoted a more marked proclination of upper incisors and the alveolar process than removable appliances, but they exerted no direct action on the other facial parameters studied.

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Evaluation of Secondary and Late Secondary Alveolar Bone Grafting on 66 Unilateral Cleft Lip and Palate Patients

Plastic Surgery ◽

10.1177/2292550317728035 ◽

2017 ◽

Vol 25 (3) ◽

pp. 194-199 ◽

Cited By ~ 4

Author(s):

Ravi Mahajan ◽

Harish Ghildiyal ◽

Ankit Khasgiwala ◽

Gogulnathan Muthukrishnan ◽

Sukhdeep kahlon

Keyword(s):

Bone Grafting ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Late Presentation ◽

Implant Placement ◽

Alveolar Bone Grafting ◽

The Face ◽

Secondary Alveolar Bone Grafting ◽

Bony Consolidation

Objective: The aim of this retrospective study was to evaluate the outcomes of secondary alveolar bone grafting and late secondary alveolar bone grafting in 66 unilateral cleft lip and palate patients. Materials and Methods: The total patients were 66 unilateral cleft lip and palate patients, out of which 19 patients underwent secondary alveolar bone grafting and 47 patients underwent late secondary alveolar bone grafting. Autogenous anterior iliac crest cancellous bone graft was harvested and used for grafting the alveolar clefts. Radiographic assessment based on Enemark’s scoring according to the marginal bone levels was done on the intraoral periapical radiographs taken 6 months after performing the surgery. Results: Twelve (63%) out of the 19 patients on whom secondary alveolar bone grafting was done achieved score 1 (optimal marginal bone levels), whereas only 12 (25%) out of the 47 patients achieved score 1 amongst the late secondary alveolar bone graftings. Overall results showed, probability, P = .034 (statistically significant). Conclusion: This study reaffirmed the fact that alveolar bone grafting when done in preadolescent age group (secondary alveolar bone grafting) gives better results in terms of marginal bony consolidation and maintaining the continuity of the alveolar arch, but the late presentation (late secondary alveolar bone grafting) should not be the refusal criteria for performing the alveolar bone grafting. Although the latter patients may not be rewarded in terms of bony consolidation as much as the preadolescent patients the potential of successful surgery in them still exists in terms of providing a platform for the dental implant placement, improvement in the soft tissue symmetry and aesthetics of the face.

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