Five-Year Experience Comparing Resorbable to Titanium Miniplate Osteosynthesis in Cleft Lip and Palate Orthognathic Surgery

2006 ◽  
Vol 43 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Constantin A. Landes ◽  
Alexander Ballon
Keyword(s):  
Orthognathic Surgery ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Vertical Movement ◽  
Control Group ◽  
Study Group ◽  
Horizontal Movement ◽  
Gonial Angle ◽  
Titanium Miniplate

Objective To evaluate 5-year outcome stability and complications in orthognathic surgery using resorbable versus titanium osteofixation. Patients, Methods Twenty-two cleft lip and palate maxillary retrognathia cases were operated on using either poly (70L-lactide-co-30DL-lactide) or titanium miniplate osteofixation. All had two-piece Le Fort I maxillary advancement osteotomy, 11 had simultaneous mandibular setback, and 13 had alveolar bone grafts. Results Average operative movement and postoperative instability recorded for maxillary horizontal movement (A-point-Nasion) were 2.5 mm and 2.1 mm for the study group, compared with 6.3 mm and 1.9 mm for the control group. For maxillary vertical movement (ANS-Nasion), measured values were 4.9 and 1.3 mm for the study group and 2.3 and 0.9 mm for the controls. For mandibular horizontal movement, measured values were 10.7 mm and 2.8 mm for the study group and 1.9 mm and 0.8 mm for the controls. Gonial angle measures were 7.1° and 3.5° for the study group and 6.7° and 3.1° for the controls. Foreign body granuloma and fistulation occurred in 1 (9%) member of the study group, but was treated successfully with debridement; implant palpability subsided after 24 months. Three (27%) controls required plate removal, but the remaining plates were palpable. Conclusion In the study group, horizontal maxillary stability appeared inferior to vertical stability, but mandibular stability was more reliable. Because groups were not matched for magnitude or direction of movement, the results of this study are preliminary and should be interpreted cautiously.

scholarly journals 4326 Effects of Single-dose Preoperative Pregabalin on Postoperative Pain and Opioid Consumption in Cleft Orthognathic Surgery

2020 ◽  
Vol 4 (s1) ◽  
pp. 29-29
Author(s):  
Abdullah Said ◽  
Ema Zubovic ◽  
Austin Y Ha ◽  
Gary B Skolnic ◽  
Jacob AuBuchon ◽  
...  
Keyword(s):  
Single Dose ◽  
Postoperative Pain ◽  
Orthognathic Surgery ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Opioid Consumption ◽  
Control Group ◽  
Assessment Scores ◽  
Pain Scores ◽  
Post Operative Pain

OBJECTIVES/GOALS: The current opioid epidemic has placed post-operative pain management under scrutiny. Limiting post-operative pain can decrease overall opioid usage in the recovery period, especially after orthognathic surgery. Several studies have illustrated the efficacy of pregabalin in decreasing postoperative pain and opioid usage in adults undergoing orthognathic surgery. We aim to study the effects of a single dose of preoperative pregabalin on postoperative pain and total opioid consumption after orthognathic surgery in individuals with cleft lip and palate. METHODS/STUDY POPULATION: This was a retrospective cohort study of consecutive patients who received Le Fort I midface advancement between June 2012 and July 2019 by one of two surgeons at a single institution. We took advantage of our institution’s implementation, beginning in 2016, of a one-time dose of preoperative pregabalin for LeFort I midface advancement. All patients had diagnosed cleft lip and palate. The treatment group received a one-time preoperative dose of pregabalin. The control group did not receive pregabalin. Total morphine milligram equivalents (MME) consumption was calculated by adding intraoperative opioid administration and postoperative opioid consumption during admission. Postoperative pain control during admission consisted of oral oxycodone and intravenous (IV) hydromorphone or morphine. Duration of hospitalization and pain intensity assessed with the numeric pain rating scale (0-10) were also recorded. The mean postoperative pain assessment scores during admission was calculated for each patient. The median of these individual mean pain assessment scores for each group was subsequently computed. RESULTS/ANTICIPATED RESULTS: Twenty-three patients (14 males, 9 females) were included in this study; 12 patients received pregabalin (median dose: 150mg, range: 100-200mg). Mean age (years) at operation of the pregabalin (18.3 ± 1.9) and control groups (17.8 ± 1.9) were also equivalent (p = 0.571). Median hospital stay for both groups was 1.0 day. The pregabalin group had significantly lower consumption of total opioids during admission (total MME 70.95 MME; IQR: 24.65-150.17) compared to the control group (138.00 MME; IQR: 105.00-232.48) (MU = 31.00, p = 0.031). Although pain scores in the treatment group (3.21 ± 2.03) were lower than in the control group (3.71 ± 2.95), the difference was not statistically significant (p = 0.651, 95% Cl [−1.75, 2.75]). DISCUSSION/SIGNIFICANCE OF IMPACT: Based on the results, a one-time preoperative oral dose of pregabalin before orthognathic surgery in patients with cleft lip and palate reduced total opioid consumption during admission. However, there was no difference in length of stay or pain scores within the two groups. A single preemptive oral dose of pregabalin should be considered an effective adjunct to pain management protocols in patients undergoing orthognathic surgery.

Evaluation of Transverse Maxillary Expansion after a Segmental Posterior Subapical Maxillary Osteotomy in Cleft Lip and Palate Patients with Severe Collapse of the Lateral Maxillary Segments

2014 ◽  
Vol 51 (6) ◽  
pp. 651-657 ◽  
Author(s):  
S. Carpentier ◽  
J. Van Gastel ◽  
J. Schoenaers ◽  
C. Carels ◽  
V. Vander Poorten ◽  
...  
Keyword(s):  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Adult Patients ◽  
Control Group ◽  
Study Group ◽  
Maxillary Expansion ◽  
University Hospitals ◽  
Rapid Palatal Expansion ◽  
Maxillary Osteotomy

Objective The purpose of this longitudinal retrospective study was to evaluate transverse maxillary expansion after a Schuchardt or segmental posterior subapical maxillary osteotomy (SPSMO) in patients with cleft lip and palate (CLP). A second aim was to compare these data with data for adult patients without CLP who were receiving a surgical assisted rapid palatal expansion (SARPE). Method The study group comprised 19 patients with CLP and a severe transversally collapsed maxilla who were treated with SPSMO followed by hyrax expansion at the University Hospitals Leuven. Dental casts of the 19 patients were analyzed before treatment, at maximum expansion, during orthodontic treatment, at the completion of orthodontic treatment. and 2 years after orthodontic treatment and were measured at the canine, premolar, and molar levels. Adult patients without CLP who were enrolled in a prospective study served as the control group. Results Maxillary expansion within the study group was significantly greater ( P < .05) at all measured levels compared with the maxillary arch before treatment. No significant relapse was measured in the study group 2 years after orthodontic treatment. When comparing the study and control groups, the only statistical difference was that canine expansion was significantly greater in the study group. Conclusion SPSMO followed by maxillary expansion and orthodontic treatment is an appropriate treatment option to correct a severe transversally collapsed maxilla in patients with CLP. The overall treatment effect of SPSMO expansion is comparable with the effects of SARPE, although canine expansion was greater in the SPSMO group.

scholarly journals Evaluation of Nasal Airway Volume of Operated Unilateral Cleft Lip and Palate Patients Compared With Skeletal Class III Individuals

2018 ◽  
Vol 56 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Ümit Ertaş ◽  
Mert Ataol
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Control Group ◽  
Nasal Passage ◽  
Study Group ◽  
Nasal Airway ◽  
Class Iii ◽  
Skeletal Class ◽  
Alar Base ◽  
Nasal Function

Cleft lip and palate (CLP) patients have various problems with nasal anatomy beyond just oronasal separation. The alar base, concha, and septum are over impressed in these individuals. Additionally, skeletal class III deformity is seen. These conditions may limit nasal function. In our study, 15 unilateral patients with CLP older than 15 years (10 females, 5 males; mean age: 19.13) who had received surgery were included as the study group, and 15 participants with noncleft skeletal class III deformities were included as the control group (10 females, 5 males; mean age: 19.20). The individuals’ nasal airway volumes (total/cleft side/noncleft side/control/ nasal passages) were examined and compared statistically. The results showed that the study group had significantly higher values in terms of total airway volume ( P < .05). Additionally, there were significant differences between the cleft side and noncleft side volumes, between the cleft side volumes and the volumes of the control group participants, and between the noncleft side volumes and the volumes of the control group participants ( P < .05). There was no difference between the groups in terms of nasopharyngeal ( P = .39) and nasal passage volumes ( P = .73). The results show there are some problems regarding nasal airway volume in patients with CLP, even when lip, palate, and alveolar cleft operations have been performed. The aim of this study was to evaluate differentiation of nasal airway volumes between unilateral patients with CLP and individuals with noncleft skeletal class III serving as the control group.

scholarly journals Evaluation of the presence of MMP-2, TIMP-2, BMP2/4, and TGFβ3 in the facial tissue of children with cleft lip and palate

2018 ◽  
Vol 25 (2) ◽  
pp. 86-94
Author(s):  
Liene Smane ◽  
Mara Pilmane
Keyword(s):  
Cleft Lip ◽  
Transforming Growth Factor ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Bone Cells ◽  
Healing Process ◽  
Matrix Metalloproteinase 2 ◽  
Control Group ◽  
Bonferroni Correction ◽  
Age Range

Cleft lip and palate (CLP) is the most common defect affecting the face. The treatment consists of surgical reconstruction of the anatomical structures of the cleft. Part of the surgical treatment is reconstruction of the alveolar bone by means of autogenic bone grafting (osteoplasty). This study aimed to evaluate the levels of expression of extracellular matrix remodeling factors in the facial tissue of children with a complete unilateral (CU) and a complete bilateral (CB) CLP to assess whether the wound healing process is adequate. Twenty-two CLP patients were enrolled in this study. Tissue samples were collected during alveolar osteoplasty for unilateral (n = 12) or bilateral (n = 10) cleft palate, (age range from 6 years 8 months to 12 years 2 months). Control material was obtained in the case of tooth extraction (age range from 6 years 9 months to 14 years 5 months). Immunohistochemistry was used to assess the levels of matrix metalloproteinase-2 (MMP-2), tissue inhibitor of metalloproteinase-2 (TIMP-2), bone morphogenetic proteins 2 and 4 (BMP2/4), and transforming growth factor β3 (TGFβ3). Numbers of positively stained cells were graded semi-quantitatively. Data were analysed using the Kraskel-Wallis rank test and the Bonferroni correction. The total number of MMP2-positive cells was significantly lower in the CBCLP and in the control group than in the CUCLP (p < 0.001 after the Bonferroni correction). The total number of TIMP2-positive cells was significantly higher in the CUCLP than in the CBCLP and in the control group (p < 0.001; p < 0.003 after the Bonferroni correction). The overall number of BMP2/4, TGFβ3-positive cells was significantly higher in the CUCLP than in the CBCLP and in the control group (p < 0.001 after the Bonferroni correction). The decrease of the relative amount of statistically significant BMP2/4, TGFβ3, MMP-2, TIMP-2 containing bone cells in CBCLP patients identifies affected alveolar bone regeneration and remodeling process.

Maxillary Anterior Tooth Size and Arch Dimensions in Unilateral Cleft Lip and Palate

2008 ◽  
Vol 45 (6) ◽  
pp. 639-646 ◽  
Author(s):  
Benjamin R. K. Lewis ◽  
Melanie R. Stern ◽  
Derrick R. Willmot
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Univariate Analysis ◽  
Chord Length ◽  
Control Group ◽  
Study Group ◽  
Image Analysis System ◽  
Anterior Teeth ◽  
Maxillary Incisors ◽  
Maxillary Cleft

Objective: To investigate differences in size of the maxillary permanent anterior teeth and arch dimensions between individuals with repaired unilateral cleft lip and palate (UCLP) and a matched control group representing the general population. Design: Retrospective study cast review. Participants: Study casts of 30 subjects due to commence orthodontic treatment following an alveolar bone graft (ABG) were collected from the Cleft Lip and Palate Units in South Yorkshire. Thirty control subjects were collected from a previously validated control group of white individuals in South Yorkshire. Main Outcome Measures: Casts were analyzed with an image analysis system to measure the dimensions of the maxillary permanent anterior teeth, incisor chord lengths, and the intercanine and intermolar widths. The results were analyzed statistically using paired t-tests and two-way univariate analysis of variance (ANOVA). Results: The mesiodistal widths of maxillary anterior teeth in the study group were smaller than the noncleft control group (p < .01). The dimensions of the cleft side maxillary incisors and incisor chord length were smaller (p < .05 and p < .01 respectively) compared with the noncleft side. The study group maxillary cleft side incisor chord length and maxillary intercanine width were narrower than the control group (p < .0001). Conclusions: (1) Anterior teeth are smaller mesiodistally in individuals with UCLP. (2) Maxillary incisors are smaller on the cleft side than the noncleft side. (3) UCLP subjects had smaller maxillary cleft side incisor chord lengths and intercanine widths than the control group despite pre-ABG expansion.

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.

Dermatoglyphics and Cheiloscopy as Key Tools in Resolving the Genetic Correlation of Inheritance Patterns in Cleft Lip and Palate Patients: An Assessment of 160 Patients

2017 ◽  
Vol 54 (5) ◽  
pp. 588-594 ◽  
Author(s):  
Priyankar Singh ◽  
Dipesh B. Nathani
Keyword(s):  
Cleft Palate ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Control Group ◽  
Study Group ◽  
Healthy Children ◽  
Type Ii ◽  
Type Iii ◽  
Group B

Objective The objective of this study was to correlate dermatoglyphics and cheiloscopy with genetic inheritance in cleft lip and cleft palate patients. Design and Setting This was a case-control study to look for asymmetry in finger and lip print patterns. All of the participants were divided into two equal groups (40 mothers and 40 fathers in each group). The data were analyzed by three evaluators who were blind to the study to avoid any chances of error. Patients/Participants A sample of 160 sporadic participants were identified and evaluated. Group A was composed of 80 healthy parents not affected by cleft lip and cleft palate but had at least one child born with nonsyndromic cleft. Group B consisted of 80 healthy parents not affected by cleft lip and cleft palate and had healthy children without cleft lip and cleft palate. Main Outcome Measures Main outcome measures were marked dermatoglyphic asymmetry and specific lip print pattern in the study group. Results We found marked asymmetry in various fingerprints and specific type II and type III lip print in the study group when compared with the control group. It was observed that groove count on the lip was significantly more frequent in study group parents. Conclusion Our study determined that there is a significant correlation between increased dermatoglyphic asymmetry and specific type II and type III lip print pattern in parents of children born with cleft. This could act as an important screening marker for the prediction of cleft lip and cleft palate inheritance.

Mandibular Morphology and Spatial Position following One-Stage Simultaneous Repair of Complete Unilateral Cleft Lip and Palate

2008 ◽  
Vol 45 (3) ◽  
pp. 272-277 ◽  
Author(s):  
Piotr Fudalej ◽  
Barbara Obloj ◽  
Zofia Dudkiewicz ◽  
Maria Hortis-Dzierzbicka
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Cranial Base ◽  
Spatial Position ◽  
Control Group ◽  
Gonial Angle ◽  
One Stage ◽  
Irregularity Index ◽  
Lateral Cephalograms ◽  
Mandibular Body

Objective: To assess mandibular structure and spatial position following one-stage simultaneous repair of the unilateral cleft lip and palate. Design: Forty boys and 17 girls with complete unilateral cleft lip and palate who underwent one-stage simultaneous repair of the cleft by the same surgeon at the age of 9.23 months (standard deviation  =  1.74) were selected. Lateral cephalograms taken at the age of approximately 10 years were analyzed and were compared with a sex- and age-matched control group that consisted of individuals with Angle Class I, no crossbite, positive overbite <5 mm, mild crowding (Incisor Irregularity Index <3.5 mm), and harmonious facial build. Results: No intergroup differences were demonstrated regarding structure of the cranial base. The mandible was found to be retruded and at a larger inclination to the cranial base as compared with controls. Both total mandibular length (ArGn) and length of the mandibular body were larger in the control group, at <2 mm. Height of the ramus and gonial angle were similar in both groups. Intergender comparison showed few significant differences in control subjects only (SN, SGo, and NMe variables). Conclusions: The mandible, following a one-stage simultaneous repair of cleft, was found to be retrusive, and the length of mandibular body was <2 mm shorter than that of the controls.

scholarly journals Orthognathic Surgery Combined with Orthodontic Treatment in a Patient with Bilateral Cleft Lip, Palate and Alveolus, Without Alveolar Bone Graft: A Case Report

2021 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
Yudi Siswanto ◽  
Magda Rosalina Hutagalung ◽  
Indri Lakhsmi Putri ◽  
Jusuf Sjamsudin
Keyword(s):  
Bone Graft ◽  
Orthognathic Surgery ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Alveolar Cleft ◽  
Bilateral Cleft Lip ◽  
Cleft Lip Palate

Background: The incidence of cleft lip and palate is 8 in every 10,000 live births. A patient with this condition experiences a deficiency in maxillary growth. Maxillary hypoplasia leads to malocclusion and skeletal disharmony. Orthognathic surgery at skeletal maturity is the standard procedure at the end of the protocol to correct maxillary hypoplasia resulting in malocclusion not correctable with orthodontics alone.Case Presentation and Operation Technique: We report the result of orthognathic surgery performed on a 23 year old male with complete bilateral cleft lip, palate, and alveolus. We proceeded with bimaxillary surgery despite the alveolar cleft. We also recorded a neglected alveolar cleft in which he should have had undergone alveolar bone graft prior to the current procedure. The pre-maxillary segment was stabilized with miniplate followed by Le Fort 1 advancement and mandibular setback guided by an occlusal wafer. Malar augmentation was done by onlay bone grafts. Mandibulo-maxillary fixation was maintained. Postoperatively, a good occlusion and better facial harmony were achieved. He was planned to undergo a septorhinoplasty in the near future.Discussion: Despite adequate treatments following the protocol recommended by many centres, some patients developed some degree of maxillary hypoplasia. A quarter of this population need osteotomies and Le Fort I maxillary osteotomy is the most common procedure to correct retrognathic maxilla.Conclusion: Orthognathic surgery combined with orthodontic treatment in a patient with bilateral cleft lip and palate provided good functional and aesthetic result. However, this procedure cannot replace the standard protocol of having an alveolar bone graft performed before permanent canine eruption to achieve optimal outcomes

scholarly journals High quality nursing based on childlike interest in children with cleft lip and palate: application assessment after operation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi Peng ◽  
Xiaoyan Hao ◽  
Yuan Guo ◽  
Xueqin Zhang ◽  
Yang Li ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hospital Stay ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Healing Time ◽  
Psychological State ◽  
Control Group ◽  
Study Group ◽  
High Quality

Abstract Purpose The aim of this study was to assess the effect of high-quality nursing based on the concept of childlike interest in children with cleft lip and palate following operation on healing time, degree of pain, psychological state, quality of life, and the occurrence of complications. Methods A series of 62 children with cleft lip and palate was treated in our hospital from January 2019 to March 2021. The patients were randomly divided into observation group (31 cases, given high-quality nursing based on childlike interest) and control group (31 cases, given routine nursing intervention). The healing time and hospital stay of the two groups were recorded. The degree of pain, psychological state and quality of life of the two groups before and after intervention were compared, and the occurrence of complications was closely monitored. Results Compared with the control group, the healing time and hospital stay of the study group were significantly shorter after the intervention (P < 0.05). Before the intervention, no significant difference was identified in pain score between the two groups (P < 0.05), after the intervention, however, the pain score of the study group was significantly lower compared with the control group (P < 0.05). Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) scores of the two groups were comparable before intervention (P > 0.05), while after intervention the SDS and SAS scores of the two groups were lower than those before treatment. Compared with the control group, the SDS and SAS scores of the study group were remarkably lower (P < 0.05). Before the intervention, the quality of life scores of the two groups were comparable (P > 0.05), while after the intervention, the scores of quality of life in the two groups were associated with lower outcomes. Compared with the control group, the scores of quality of life in the study group were significant lower (P < 0.05). After the intervention, there were evident fewer incidence of complications in the study group compared to the control group (P < 0.05). Conclusions High quality nursing based on childlike interest exerted beneficial outcomes in terms of shortening the healing time and hospital stay, reducing the degree of pain and complications, as well as improving the psychological state and quality of life of children harboring cleft lip and palate. Additionally, its high safety feature contributes to the wide application for clinical practice.

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