Long-Term Effects of Clefts on Craniofacial Morphology in Patients with Unilateral Cleft Lip and Palate

2005 ◽  
Vol 42 (6) ◽  
pp. 601-609 ◽  
Author(s):  
Yu-Fang Liao ◽  
Michael Mars
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Craniofacial Morphology ◽  
Sri Lankan ◽  
Long Term Effects ◽  
Retrospective Case ◽  
Alveolar Cleft ◽  
Dental Cast ◽  
Posterior Height

Objective To identify the long-term effects of clefts (intrinsic and functional) on craniofacial growth and to evaluate the possible association between the sizes of the cleft maxillary segment (intrinsic) and alveolar cleft (functional) and the craniofacial morphology in patients with unilateral cleft lip and palate (UCLP). Design Retrospective case-control study. Setting Sri Lankan Cleft Lip and Palate Project. Subjects Thirty unoperated adult patients with UCLP and 52 normal controls. Main Outcome Measures Maxillary dental cast was used to measure the sizes of the cleft maxillary segment and alveolar cleft. Cephalometry was used to determine craniofacial morphology. Results Patients with UCLP had shorter height of the basal maxilla, shorter posterior length of the basal maxilla, and less protruded basal maxilla at the zygomatic level than did control subjects. In patients with UCLP, the posterior height of the basal maxilla was related to the size of the cleft maxillary segment, and there was a tendency toward significant association between the anterior height of the basal maxilla and the size of the alveolar cleft. Conclusion The adverse effects of clefts on the growth of the maxilla in patients with UCLP are restricted to the basal maxilla in size. This growth inhibition is major in height and minor in length. The reduced posterior height of the basal maxilla in unoperated patients with UCLP might be primarily attributed to intrinsic effects, whereas the reduced anterior height of the basal maxilla might be attributed to functional effects.

Long-Term Effects of Palate Repair on Craniofacial Morphology in Patients with Unilateral Cleft Lip and Palate

2005 ◽  
Vol 42 (6) ◽  
pp. 594-600 ◽  
Author(s):  
Yu-Fang Liao ◽  
Michael Mars
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Cross Sectional Study ◽  
Craniofacial Morphology ◽  
Effective Length ◽  
Long Term Effects ◽  
Cross Sectional ◽  
Alveolar Level ◽  
Palate Repair

Objective To identify the long-term effects of palate repair on craniofacial growth in patients with unilateral cleft lip and palate (UCLP). Design Retrospective cross-sectional study. Setting Sri Lankan Cleft Lip and Palate Project. Subjects Forty-eight adults with nonsyndromic unilateral cleft lip and palate, 29 men and 19 women, had lip repair only (LRO group). Fifty-eight adults with nonsyndromic unilateral cleft lip and palate, 35 men and 23 women, had lip and palate repairs by the age of 9 (LPR group). Main Outcome Measures Clinical notes were used to record surgical treatment histories. Cephalometry was used to determine craniofacial morphology. Results In the lip and palate repair group, the depth of the bony pharynx (Ba-PMP), the maxillary length at the alveolar level (PMP-A), the effective length of the maxilla (Ar-IZ, Ar-ANS, Ar-A), the maxillary protrusion (S-N-ANS, SNA), the anteroposterior jaw relation (ANS-N-Pog, ANB), and the overjet were smaller than in the lip repair only group. There were no significant differences in the maxillary length at the basal level (PMP-IZ, PMP-ANS) and the anterior and posterior maxillary heights (N-ANS and R-PMP, respectively) in the two groups. Conclusion Palate repair inhibits the forward displacement of the basal maxilla and anteroposterior development of the maxillary dentoalveolus in patients with unilateral cleft lip and palate. Palate repair has no detrimental effects on the downward displacement of the basal maxilla or on palatal remodeling in patients with unilateral cleft lip and palate.

Long-Term Effects of Lip Repair on Dentofacial Morphology in Patients with Unilateral Cleft Lip and Palate

2005 ◽  
Vol 42 (5) ◽  
pp. 526-532 ◽  
Author(s):  
Yu-Fang Liao ◽  
Michael Mars
Keyword(s):  
Bone Remodeling ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Adult Patients ◽  
Sri Lankan ◽  
Statistical Control ◽  
Long Term Effects ◽  
Exact Matching ◽  
Lateral Cephalograms

Objective Lateral cephalograms from the growth archive of the Sri Lankan Cleft Lip and Palate Project were analyzed in a cohort design to study the long-term effects of lip repair on dentofacial morphology in patients with unilateral cleft lip and palate. Methods A total of 71 patients were recruited, including 23 adult patients with nonsyndromic unilateral cleft lip and palate without surgical repair and 48 adult patients with nonsyndromic unilateral cleft lip and palate who had lip repair, but without management of alveolus or anterior vomer. The design utilized exact matching on ethnicity and statistical control for gender and age. Results and Conclusions The data support the hypothesis that lip repair primarily produces a bone-bending effect on the anterior maxillary alveolus (alveolar molding), accompanied by controlled uprighting of maxillary incisors, and secondarily produces a bone-remodeling effect (bone resorption) in the base of the anterior maxillary alveolus. When analyzed by the age at lip repair and the surgeon who performed lip repair, early lip repair produced a greater bone-remodeling effect than did late lip repair, and variation in the surgeon who performed lip repair had an insignificant impact on dentofacial morphology after adjusting for covariates.

Craniofacial Morphology in Children with Complete Bilateral Cleft Lip and Palate: Does Infantile Size of the Premaxilla Predetermine Outcome?

2004 ◽  
Vol 41 (4) ◽  
pp. 410-415 ◽  
Author(s):  
Yu-Fang Liao ◽  
Chiung-Shing Huang ◽  
Ya-Yu Tsai ◽  
M. Samuel Noordhoff
Keyword(s):  
Retrospective Study ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Craniofacial Morphology ◽  
University Hospital ◽  
Cephalometric Analysis ◽  
Bilateral Cleft Lip ◽  
Dental Cast ◽  
Craniofacial Characteristics

Objective To evaluate the possible association between the size of the premaxilla in infants and craniofacial morphology in children with complete bilateral cleft lip and palate (CBCLP) and identify the characteristics of craniofacial morphology in children with CBCLP with median facial dysplasia (MFD). Design Retrospective study. Setting A university hospital craniofacial center. Subjects Thirty-four patients with nonsyndromic CBCLP, 24 boys and 10 girls, had large premaxilla (LP group). Thirty-six patients with nonsyndromic CBCLP, 16 boys and 20 girls, had small premaxilla (SP group). Thirteen CBCLP patients with MFD, five boys and eight girls (MFD group). Main Outcome Measures Infant maxillary dental cast at the age of 1 year was used to measure the size of the premaxilla. Cephalometric analysis was used to determine craniofacial morphology in children at the age of 5 years. Results The size of the premaxilla in infants with CBCLP varied greatly. The LP group tended to have a longer maxilla and a more protruded maxilla, producing a better interjaw relation. The opposite phenomena were observed in the MFD group; the SP group yielded results between those of the LP and the MFD groups. Conclusion The size of the premaxilla in infants with CBCLP can be used to predetermine subsequent craniofacial morphology at the age of 5 years. Children with nonsyndromic CBCLP had craniofacial characteristics that differed significantly from those of children with CBCLP with median facial dysplasia.

Repair of Protruding Bilateral Cleft Lip and Palate With Staged Premaxilla Setback Osteotomy, Cheiloplasty, and Palatoplasty in Trisomy 17p Patient: A Review of Syndromic Clinical Characteristic

2021 ◽  
pp. 105566562110698
Author(s):  
Kristaninta Bangun ◽  
Jessica Halim ◽  
Vika Tania
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Techniques ◽  
Chromosome 17 ◽  
Long Term Effects ◽  
Surgical Strategies ◽  
Increased Risk ◽  
The Cost

Chromosome 17 duplication is correlated with an increased risk of developmental delay, birth defects, and intellectual disability. Here, we reported a female patient with trisomy 17 on the whole short arm with bilateral complete cleft lip and palate (BCLP). This study will review the surgical strategies to reconstruct the protruding premaxillary segment, cleft lip, and palate in trisomy 17p patient. The patient had heterozygous pathogenic duplication of chromosomal region chr17:526-18777088 on almost the entire short arm of chromosome 17. Beside the commonly found features of trisomy 17p, the patient also presented with BCLP with a prominent premaxillary portion. Premaxillary setback surgery was first performed concomitantly with cheiloplasty. The ostectomy was performed posterior to the vomero-premaxillary suture (VPS). The premaxilla was firmly adhered to the lateral segment and the viability of philtral flap was not compromised. Two-flap palatoplasty with modified intravelar veloplasty (IVV) was performed 4 months after. Successful positioning of the premaxilla segment, satisfactory lip aesthetics, and vital palatal flap was obtained from premaxillary setback, primary cheiloplasty, and subsequent palatoplasty in our trisomy 17p patient presenting with BLCP. Postoperative premaxillary stability and patency of the philtral and palatal flap were achieved. Longer follow-up is needed to evaluate the long-term effects of our surgical techniques on inhibition of midfacial growth. However, the benefits that the patient received from the surgery in improving feeding capacity and facial appearance early in life outweigh the cost of possible maxillary retrusion.

Transporte óseo alveolar intraoral en pacientes con hendiduras alveolares: serie de casos Intraoral alveolar bone transportation in alveolar cleft patients: case series

2018 ◽  
Vol 45 (4) ◽  
pp. 255-260
Author(s):  
Luis Gonzalez ◽  
Alberto Pedraza
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Average Distance ◽  
Case Series ◽  
Retrospective Case ◽  
Alveolar Cleft ◽  
Fixed Dental Prosthesis ◽  
Case Series Study ◽  
Bone Transportation

Introducción: El tratamiento de la hendidura alveolar, del paciente fisurado, permite un adecuado crecimiento facial. Los injertos óseos han sido el tratamiento ideal. Sin embargo la técnica de distracción osteogénica mediante transporte óseo alveolar intraoral ha demostrado ser muy predecible. Objetivo: Describir los resultados del cierre de la Hendidura alveolar, con la técnica de transporte óseo alveolar intraoral bifocal y trifocal en pacientes labio fisurados. Diseño: Estudio retrospectivo de serie de casos. Materiales y métodos: Fueron tratados 4 pacientes con hendidura alveolar unilateral, manejados con la técnica de transporte óseo alveolar intraoral bifocal y trifocal en el año 2008 al 2009, con un seguimiento hasta el año 2014. Todos los pacientes fueron tratados con un aparato Hyrax® (Dentaurum, Alemania) modificado. Resultados: El promedio de distancia del transporte óseo requerido fue de 9,75mm (rango de 15 mm a 9 mm). Se colocaron 5 implantes dentales rehabilitados con prótesis dental fija. Conclusión: El estudio de los casos clínicos demuestra una predictibilidadelevada así como un rango de éxito alto, en los individuos tratados conesta técnica. Por tal motivo el transporte óseo alveolar intraoral es una alternativa eficaz para el tratamiento de hendiduras alveolares extensas.Introduction: The management of alveolar cleft patients, allows an adequate facial growth in cleft lip and palate patients. Bone grafts have been the gold standard treatment. However, the technique of osteogenic distraction by intraoral alveolar bone transportation has proven to be highly predictable. Objective: To describe the results of alveolar cleft management with the intraoral bifocal and trifocal alveolar bone transportation technique in cleft palate patients. Design of study: Retrospective case series study. Materials and methods: 4 patients with unilateral alveolar cleft were treated with the bifocal and trifocal intraoral alveolar bone transportation technique from 2008 to 2009. The cases were followed up until 2014. All patients were treated with a modified Hyrax® (Dentaurum, Germany) device. Results: The average distance of bone transportation required was 9.75mm (range from 15mm to 9mm). 5 dental implants with fixed dental prosthesis were placed. Conclusion: Clinical cases study demonstrated a high predictability, as well as a high success ratein individuals treated with this technique. Therefore, intraoral alveolar bone transportation is an effective alternative for the management of extensive alveolar clefts.

scholarly journals Maxillary Growth Evaluation Of Patients With Unilateral Complete Cleft Lip And Palate After Two Flap Palatoplasty With Honey Oral Drops

2019 ◽  
Vol 5 (2) ◽  
pp. 211-219
Author(s):  
Prasetyanugraheni Kreshanti ◽  
Siti Handayani ◽  
Forry Fortuna ◽  
Julieta Pancawati ◽  
Amila Jeni Susanto ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Type Iv ◽  
Long Term Effect ◽  
Growth Evaluation ◽  
Maxillary Growth ◽  
Cephalometric Measurements ◽  
Dental Cast ◽  
Control Study

Background : Honey given as oral drops significantly precipitate epithelialization of the lateral palatal defects post two-flap palatoplasty by 2.1 times. Honey is believed to reduce wound contraction, scar formation, and would contribute as an important factor that will result in a satisfactory maxillary growth. The aim of this study is to evaluate maxillary growth as the long-term effect of rapid epithelialization of the palates treated by honey oral drops. Method : This is a case control study consisting of 2 groups; comparing maxillary growth of the UCCLP patients that were and were not given honey as oral drops following their two-flap palatoplasty in 2011-2012. The cephalometric measurements were recorded and the dental cast are evaluated using GOSLON Yardstick method.Result : This study included a total of 20 patients. Goslon Yardstick type IV are the most frequent GOSLON on both groups (40%) with moderate inter-rater reliability between examiner 1-2 and 2-3 (kappa; 0.583 and 0.512) and substantial between examiner 1-3 (kappa 0.716). Forty-percent of SNA angle in the honey group were considered as normal, while only 20% normal SNA angle were found in the control group.Conclusion: Honey oral drops following two-flap palatoplasty resulted in satisfactory SNA angle. As the completion of maxillary growth occurs at the age of 20, the results of this study would only serve as a preliminary report. Other measures to support maxillary growth should also be taken into account. Further studies are warranted to discover innovations in surgical technique that may be a major contributing factor in maxillary growth. Keywords: Maxillary growth, Two Flap Palatoplasty, honey

scholarly journals Systematic Review of the Long-Term Effects of Presurgical Orthopedic Devices on Patient Outcomes

2021 ◽  
pp. 105566562199817
Author(s):  
Katie Garland ◽  
Brendan McNeely ◽  
Luc Dubois ◽  
Damir Matic
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
English Language ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Case Reports ◽  
Confounding Factors ◽  
Long Term Effects ◽  
Device Use

Objective: To perform a systematic review of the literature to identify the long-term effects of presurgical orthopedic (PSO) device use on patient outcomes. Design: A comprehensive literature review of Embase and Ovid databases was performed to identify all English-language publications related to unilateral cleft lip and palate, presurgical devices, and patient outcomes. Studies were excluded if they did not report patient outcomes beyond 2 years of age, did not describe the use of a PSO device, were case reports (n < 10), or were purely descriptive studies. Main Outcome Measures: Reported patient outcomes following the use of PSO devices. Results: Following a review of all articles by 2 independent reviews, 30 articles were selected for inclusion. Overall, there was no reported consensus as to the long-term effects of PSO devices. Furthermore, this study identified that only 10% of published research controlled for confounding factors that could influence the reported results. Confounding factors that were identified included different operating surgeon, different surgical protocols, and different rates of revision surgeries. Conclusions: Overall, this systematic review identified 2 important conclusions. Firstly, there is no consensus in the literature about the long-term effects of PSO devices on long-term patient outcomes. Secondly, research in this domain is limited by confounding factors that influence the applicability of the reported results.

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