Effect of Infant Orthopedics on Facial Appearance of Toddlers with Complete Unilateral Cleft Lip and Palate (Dutchcleft)

2008 ◽  
Vol 45 (4) ◽  
pp. 407-413 ◽  
Author(s):  
Catharina A. M. Bongaarts ◽  
Birte Prahl-Andersen ◽  
Ewald M. Bronkhorst ◽  
Paul H. M. Spauwen ◽  
Jan W. Mulder ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Controlled Clinical Trial ◽  
Minor Effect ◽  
Facial Appearance ◽  
Surgical Closure ◽  
Significant Difference ◽  
Full Face ◽  
Infant Orthopedics ◽  
Positive Effect

Objective: To evaluate the effect of infant orthopedics (IO) on facial appearance of 54 patients with unilateral cleft lip and palate (UCLP), aged 4 and 6 years. Design: Prospective two-arm randomized controlled clinical trial in three Cleft Palate Centers in the Netherlands (Dutchcleft-trial). Interventions: Patients were divided randomly into two groups. Half of the patients (IO+) had a plate until surgical closure of the soft palate at the age of ± 52 weeks; the other half (IO−) received no intervention. Main Outcome Measures: Facial appearance at 4 and 6 years of age assessed on full face photographs and photographs showing only nose and mouth. Ratings were performed on a VAS-scale by professionals and laymen. Results: At 4 years of age the full face pictures of IO+ children were scored to be more attractive than those of IO− children. However, this difference had disappeared at 6 years of age. At the age of 6, only professionals saw a significant difference on nasolabial photographs between IO+ and IO−. Regression analysis showed a minor effect of occlusion, lip revision, or type of nose reconstruction on the esthetic results. Conclusions: IO had a positive effect on full facial appearance of UCLP children at the age of 4 years, but at the age of 6, only professionals saw a positive effect of IO on the nasolabial photographs. This is irrelevant for UCLP patients since they deal with laymen in their daily life.

Infant Orthopedics Has No Effect on Maxillary Arch Dimensions in the Deciduous Dentition of Children with Complete Unilateral Cleft Lip and Palate (Dutchcleft)

2006 ◽  
Vol 43 (6) ◽  
pp. 665-672 ◽  
Author(s):  
Catharina A. M. Bongaarts ◽  
Martin A. van't Hof ◽  
Birte Prahl-Andersen ◽  
Iris V. Dirks ◽  
Anne M. Kuijpers-Jagtman
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Vertical Position ◽  
Controlled Clinical Trial ◽  
Deciduous Dentition ◽  
Surgical Closure ◽  
Infant Orthopedics ◽  
Maxillary Arch

Objective: Evaluation of the effect of infant orthopedics on maxillary arch dimensions in the deciduous dentition in patients with unilateral cleft lip and palate. Design: Prospective two-arm randomized controlled clinical trial with three participating cleft palate centers. Setting: Cleft palate centers of the Radboud University Nijmegen Medical Center, Academic Center of Dentistry Amsterdam, and University Medical Center Rotterdam, the Netherlands. Patients: Children with complete unilateral cleft lip and palate (n = 54) were included. Interventions: Patients were randomly divided into two groups. Half of the patients (IO+) had a presurgical orthopedic plate until surgical closure of the soft palate at the age of 52 weeks; the other half (IO−) did not undergo presurgical orthopedics. Mean outcome measures: Maxillary arch dimensions were assessed on dental casts at 4 and 6 years of age with measurements for arch width, arch depth, arch length, arch form, and the vertical position of the lesser segment. Contact and collapse were assessed also. Results: There were no clinically significant differences found between IO+ and IO− for any of the variables. Conclusions: Infant orthopedics had no observable effect on the maxillary arch dimensions or on the contact and collapse scores in the deciduous dentition at the ages of 4 and 6 years. Considering the Dutchcleft results to date, there is no need to perform infant orthopedics for unilateral cleft lip and palate patients.

Infant Orthopedics and Facial Appearance: A Randomized Clinical Trial (Dutchcleft)

2006 ◽  
Vol 43 (6) ◽  
pp. 659-664 ◽  
Author(s):  
Charlotte Prahl ◽  
Birte Prahl-Andersen ◽  
Martin A. van't Hof ◽  
Anne M. Kuijpers-Jagtman
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Controlled Trial ◽  
First Year ◽  
Facial Appearance ◽  
Visual Analog Scales ◽  
Z Scores ◽  
Full Face ◽  
Infant Orthopedics

Objective: To study the effect of infant orthopedics on facial appearance. Design: Prospective two-arm randomized controlled trial in parallel with three participating academic cleft palate centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation method. Setting: Cleft Palate Centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. Patients: Infants with complete unilateral cleft lip and palate, no other malformations. Interventions: One group (IO+) wore passive maxillary plates during the first year, the other group (IO−) did not. Main Outcome Measure(s): Two metrical response modalities were used (i.e., visual analog scales and reference scores) to score facial appearance. Full face and cropped photographs were compared with reference photographs and were judged. The photographs were judged by 45 judges, 24 laypeople, and 21 professionals. Transformation of the scores into z scores was applied to compare and to pool both response modalities. The validity of each individual judge was evaluated, as was the reliability of the scales. Differences between the treatment groups were evaluated by means of t tests. Results: Photographs were available of 41 subjects, 21 with and 20 without infant orthopedics. No significant differences were found between groups. Mean z-score values for the full-face photographs were: group IO+ = 0.10 (SD = 0.73) and group IO− = −0.03 (SD = 0.48); for the cropped photographs were: group IO+ = 0.12 (SD = 0.71) and group IO− = −0.06 (SD = 0.55). Conclusions: Infant orthopedics have no effect on facial appearance.

Infant Orthopedics and Facial Growth in Complete Unilateral Cleft Lip and Palate until Six Years of Age (Dutchcleft)

2009 ◽  
Vol 46 (6) ◽  
pp. 654-663 ◽  
Author(s):  
Catharina A. M. Bongaarts ◽  
Birte Prahl-Andersen ◽  
Ewald M. Bronkhorst ◽  
C. Prahl ◽  
Edwin M. Ongkosuwito ◽  
...  
Keyword(s):  
Soft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Controlled Clinical Trial ◽  
Facial Growth ◽  
Hard Tissue ◽  
Surgical Closure ◽  
Randomized Controlled ◽  
Palate Repair ◽  
Infant Orthopedics

Objective: To evaluate longitudinally the effect of infant orthopedics (IO) on dentofacial cephalometric variables in unilateral cleft lip and palate (UCLP) patients from 4 to 6 years of age. Design: Prospective two-arm randomized controlled clinical trial in three cleft palate centers in The Netherlands (Dutchcleft trial). Patients: Fifty-four children with complete UCLP. Interventions: Patients were divided randomly into two groups. Half of the patients (IO+) had IO until surgical closure of the soft palate at the age of ±52 weeks; the other half (IO−) received no intervention. Mean Outcome Measures: Cephalometric values representing soft tissue, hard tissue, and dental structures, measured on lateral headfilms made at 4 and 6 years of age. Results: In the IO+ group, 21 patients were analyzed; in the IO− group, 20 patients were analyzed at age 4 and 22 at age 6. No differences were found between IO+ and IO−, except for two measurements: The interincisal angle was larger and the mentolabial angle was smaller in the IO+ group. Conclusions: For infants with UCLP whose surgical management included soft palate repair at 12 months and delayed hard palate closure, cephalometric outcomes at ages 4 and 6 provide no indication for the type of IO used in this study.

The Effect of Infant Orthopedics on the Occlusion of the Deciduous Dentition in Children with Complete Unilateral Cleft Lip and Palate (Dutchcleft)

2004 ◽  
Vol 41 (6) ◽  
pp. 633-641 ◽  
Author(s):  
Catharina A. M. Bongaarts ◽  
Anne M. Kuijpers-Jagtman ◽  
Martin A. van't Hof ◽  
Birte Prahl-Andersen
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
University Hospital ◽  
Controlled Clinical Trial ◽  
Dental Arch ◽  
Deciduous Dentition ◽  
Surgical Closure ◽  
Infant Orthopedics

Objective Evaluation of the effect of infant orthopedics (IO) on the occlusion of the deciduous dentition in patients with unilateral cleft lip and palate (UCLP). Design Prospective, two-arm, randomized, controlled clinical trial with three participating cleft palate centers (Dutchcleft). Setting Cleft Palate Centers of the University Medical Center Nijmegen, Academic Center of Dentistry Amsterdam, and Dijkzigt University Hospital Rotterdam, The Netherlands. Patients Children with complete UCLP (n = 54) were included. Interventions In a concealed allocation procedure, half of the patients was randomized to wear a plate till surgical closure of the soft palate (IO+), and the other half (IO−) did not have a plate. Mean Outcome Measures Dental arch relationships were assessed at 4 and 6 years of age with the 5-year-old index; the Huddart-score; and measurements of overjet, overbite, and sagittal occlusion. Results There were no significant differences found between the IO+ and IO− groups for the 5-year-old index; the Huddart-score; and overjet, overbite, and sagittal occlusion. Conclusions IO had no observable effect on the occlusion in the deciduous dentition at 4 and 6 years of age. Considering the occlusion only, there is no need to perform IO in children with UCLP.

Maxillary Protraction Therapy in Class III Patients With and Without Cleft Lip and Palate: An Interim Report of a Prospective Comparative Study

2020 ◽  
pp. 105566562095405
Author(s):  
Yifan Lin ◽  
Zhen Fu ◽  
Runzhi Guo ◽  
Lian Ma ◽  
Weiran Li
Keyword(s):  
Treatment Duration ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Controlled Clinical Trial ◽  
Class Iii ◽  
Lower Incisor ◽  
Maxillary Protraction ◽  
Average Treatment ◽  
Significant Difference ◽  
Before And After

Objective: To investigate and compare the effects of maxillary protraction therapy on Class III patients with unilateral cleft lip and palate (UCLP) and Class III patients with noncleft. Design: Prospective controlled clinical trial. Patients: Twenty-six Class III patients with UCLP (mean age: 10.32 ± 1.29 years) and 26 Class III patients with noncleft (mean age: 9.82 ± 1.03 years) were included and treated with maxillary protraction therapy. Interventions: Maxillary protraction therapy was performed with an intraoral Hyrax appliance and extraoral facemask. Cone beam computed tomography scans were taken before and after treatment. Pretreatment skeletal and dental characteristics and treatment changes were analyzed and compared. Results: The average treatment duration was 18.44 ± 4.16 months in the UCLP group, which was substantially longer than the 12.46 ± 4.03-month average treatment duration in the noncleft group ( P < .001). No significant difference was found in the maxillary changes (length, advancement of point A, and SNA angle) and improvement of intermaxillary relationship (ANB angle) between the 2 groups. The UCLP group had 1.40° more mandibular clockwise rotation ( P = .034). Regarding dental changes, the UCLP group had more upper incisor proclination ( P = .006) and less lower incisor retroclination ( P = .023). Conclusions: Approximately extended maxillary protraction therapy in patients with UCLP could be as effective as in patients with noncleft. Further study is required to follow patients until completion of growth to elucidate the long-term stability of the treatment.

Effect of Presurgical Infant Orthopedics on Facial Esthetics in Complete Bilateral Cleft Lip and Palate

1994 ◽  
Vol 31 (1) ◽  
pp. 68-73 ◽  
Author(s):  
R. Bruce Ross ◽  
M.C. Macnamera
Keyword(s):  
Surgical Procedures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Sex Distribution ◽  
Facial Esthetics ◽  
Bilateral Cleft Lip ◽  
Full Face ◽  
Presurgical Orthopedics ◽  
Infant Orthopedics ◽  
Age And Sex

A sample of 40 teenage individuals with repalred complete bilateral cleft lip and palate, 20 of whom had received presurgical infant orthopedics, was obtained to test the effects of presurgical Infant orthopedics on facial esthetics. All subjects had surgery by the same surgeon. The age and sex distribution was approximately equal between the two groups. A panel of five judges evaluated the lip and nose esthetics from full face and profile slides and a mean panel score for each subject was derived for six individual features and three total scores. No difference in the esthetic scores between the two groups could be detected. No differences were found In the number of revisionary surgical procedures required to the lip or nose. The findings indicate that conservative presurgical orthopedics for infants with complete bilateral cleft lip and palate has no lasting effect on the esthetics of the lip and nose, and does not alter the need for subsequent revisionary surgery.

scholarly journals Self-Reports of Psychosocial Functioning among Children and Young Adults with Cleft Lip and Palate

2006 ◽  
Vol 43 (5) ◽  
pp. 598-605 ◽  
Author(s):  
Orlagh Hunt ◽  
Donald Burden ◽  
Peter Hepper ◽  
Mike Stevenson ◽  
Chris Johnston
Keyword(s):  
Young Adults ◽  
Behavioral Problems ◽  
Psychosocial Functioning ◽  
Psychological Functioning ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Self Esteem ◽  
Facial Appearance ◽  
Significant Difference ◽  
Children And Young Adults

Objective: A cross-sectional study was employed to determine the psychosocial effects of cleft lip and/or palate among children and young adults, compared with a control group of children and young adults without cleft lip and palate. Participants: The study comprised 160 children and young adults with cleft lip and/or palate and 113 children and young adults without cleft lip and/or palate. All participants were between 8 and 21 years of age. Outcome measures: Psychological functioning (anxiety, self-esteem, depression, and behavioral problems) was assessed using validated psychological questionnaires. Happiness with facial appearance was rated using a visual analog scale. Social functioning, including experience of teasing/bullying and satisfaction with speech, was assessed using a semistructured interview. Results: Participants with cleft lip and/or palate reported greater behavioral problems (p < .001) and more symptoms of depression (p < .01); they were teased more often (p < .001) and were less happy with their facial appearance (p < .01) and speech (p < .001), compared with controls. There were no significant difference between subjects with cleft lip and/or palate and subjects without cleft lip and/or palate in terms of anxiety (p > .05) or self-esteem (p > .05). Having been teased was a significant predictor of poor psychological functioning, more so than having a cleft lip and/or palate per se (p < .001). Conclusions: Teasing was greater among participants who had cleft lip and/ or palate and it was a significant predictor of poorer psychosocial functioning. Children and young adults with cleft lip and/or palate require psychological assessment, specifically focusing on their experience of teasing, as part of their routine cleft care.

Does Infant Orthopedics and Neonate Lip Surgery Influence the Occlusal Relationship in Patients With Unilateral Cleft Lip and Palate (UCLP)?

2021 ◽  
pp. 105566562098435
Author(s):  
Thalita V. Galassi ◽  
Telma V. Souza-Brosco ◽  
Lucy D. Lopes ◽  
Araci Malagodi de Almeida ◽  
Gisele da Silva Dalben ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Dental Arch ◽  
Surgical Timing ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Spearman Test ◽  
Infant Orthopedics

Objective: To compare occlusal relationship in patients undergoing neonate versus conventional lip surgery (LS) with and without infant orthopedics (IO) by assessment of dental arch relationship in individuals with complete unilateral cleft lip and palate. Material and Methods: Three groups treated by different protocols; Group I: neonate LS (1-15 days) + IO and palatoplasty (13-31 months); Group II: LS (3-12 months) + IO and palatoplasty (15-35 months); and Group III: LS (3-6 months) without IO and palatoplasty (12-18 months). The 112 intraoral photographs of individuals of all groups, obtained between 6 and 12 years of age, were assessed by the occlusal index for intraoral photograph rating. The groups were compared by the χ2 test. The correlation between surgical timing and the scores was tested by the Spearman test ( P < .05). Results: Group I presented the highest percentage of score 5, group II exhibited highest percentage of score 1, and group III presented the lowest percentage of score 5 according to the χ2 test ( P = .029). The Spearman correlation test revealed statistically significant difference between timing of LS and the occlusal index. The earlier the surgical timing, the higher the occlusal index ( P = .019). Conclusions: Infant orthopedics has demonstrated the possibility of postponing primary plastic surgeries. Patients submitted to late lip and palate repair had the best prognosis, while patients undergoing lip repair from 1 to 15 days of life, even operating the palate later, had the worst prognosis. Neonate LS negatively influenced the occlusal relationships.

scholarly journals Effects of rapid maxillary expansion in cleft patients resulting from the use of two different expanders

2016 ◽  
Vol 21 (6) ◽  
pp. 82-90 ◽  
Author(s):  
Daniel Santos Fonseca Figueiredo ◽  
Lucas Cardinal ◽  
Flávia Uchôa Costa Bartolomeo ◽  
Juan Martin Palomo ◽  
Martinho Campolina Rebello Horta ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Rapid Maxillary Expansion ◽  
Cone Beam ◽  
Tomographic Image ◽  
Maxillary Expansion ◽  
Downward Movement ◽  
Computed Tomographic ◽  
Significant Difference ◽  
Maxillary Region

ABSTRACT Objective: The aim of this study was to evaluate the skeletal and dental effects of rapid maxillary expansion (RME) in cleft patients using two types of expanders. Methods: Twenty unilateral cleft lip and palate patients were randomly divided into two groups, according to the type of expander used: (I) modified Hyrax and (II) inverted Mini-Hyrax. A pretreatment cone-beam computed tomographic image (T0) was taken as part of the initial orthodontic records and three months after RME, for bone graft planning (T1). Results: In general, there was no significant difference among groups (p > 0.05). Both showed a significant transverse maxillary expansion (p < 0.05) and no significant forward and/or downward movement of the maxilla (p > 0.05). There was greater dental crown than apical expansion. Maxillary posterior expansion tended to be larger than anterior opening (p < 0.05). Cleft and non-cleft sides were symmetrically expanded and there was no difference in dental tipping between both sides (p > 0.05). Conclusions: The appliances tested are effective in the transverse expansion of the maxilla. However, these appliances should be better indicated to cleft cases also presenting posterior transverse discrepancy, since there was greater expansion in the posterior maxillary region than in the anterior one.

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