Esthetic Analysis of Gingival Components of Smile and Degree of Satisfaction in Individuals with Cleft Lip and Palate

Objective: To evaluate soft tissue characteristics in individuals with cleft lip and palate and the degree of satisfaction of these individuals after rehabilitation. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, Brazil. Patients: Forty-five individuals with repaired complete unilateral cleft lip and palate, aged 15 to 30 years. Interventions: One hundred thirty-five frontal facial photographs were obtained at rest and in natural and forced smile. Specialists in periodontics evaluated the soft tissue characteristics. Both patients and specialists evaluated the smiles and scored them as esthetically unpleasant, acceptable, or pleasant. Main Outcome Measures: Comparison of the cleft area with the contralateral region was performed for evaluation of soft tissue. The results of the degree of satisfaction with smile were expressed as percentages and means. The findings between patients and periodontists experienced or inexperienced with cleft care were compared. Results: Statistically significant differences were observed for alveolar process deficiency and absence of papilla in the esthetic area between groups (p < .05). Results show 84.4% of individuals considered their smile as esthetically pleasant. Specialists in periodontics of both groups scored the natural smile and forced smile as esthetically acceptable. There was a statistically significant difference in the mean of patients compared with both groups of specialists in periodontics (p < .05). Conclusions: Evaluation and knowledge of the soft tissue characteristics is extremely important for successful rehabilitation. The esthetic values and degree of patient satisfaction are essential for treatment success, since smile reconstruction should be esthetically pleasant to the patient.

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A Quantitative Three-Dimensional Assessment of Abnormal Variations in Facial Soft Tissues of Adult Patients with Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2003_040_0544_aqtaoa_2.0.co_2 ◽

2003 ◽

Vol 40 (5) ◽

pp. 544-549 ◽

Cited By ~ 6

Author(s):

Virgilio F. Ferrario ◽

Chiarella Sforza ◽

Claudia Dellavia ◽

Gianluca M. Tartaglia ◽

Davide Sozzi ◽

...

Keyword(s):

Soft Tissue ◽

Cleft Lip ◽

Soft Tissues ◽

Cleft Lip And Palate ◽

Three Dimensional ◽

Z Score ◽

Soft Tissue Profile ◽

Variability Index ◽

The Mean ◽

Facial Soft Tissues

Objective To supply quantitative information about the facial soft tissues of adult operated patients with cleft lip and palate (CLP). Design, Setting, and Patients The three-dimensional coordinates of soft tissue facial landmarks were obtained using an electromagnetic digitizer in 18 Caucasian patients with CLP (11 males and 7 females aged 19 to 27 years) and 162 healthy controls (73 females and 89 males aged 18 to 30 years). From the landmarks, 15 facial dimensions and two angles were calculated. Data were compared with those collected in healthy individuals by computing z-scores. Two summary anthropometric measurements for quantifying craniofacial variations were assessed in both the patients and reference subjects: the mean z-score (an index of overall facial size), and its SD, called the craniofacial variability index (an index of facial harmony). Results In treated patients with CLP, facial size was somewhat smaller than in normal individuals, but in all occasions the mean z-score fell inside the normal interval (mean ± 2 SD). Almost all patients had a craniofacial variability index larger than the normal interval, indicating a global disharmonious appearance. Overall, in patients pronasale, subnasale, and pogonion were more posterior, the nose was shorter and larger, the face was narrower, and the soft tissue profile and upper lip were flatter than in the reference population. Conclusions The facial soft tissue structures of adult operated patients with CLP differed from those of normal controls of the same age, sex, and ethnic group. In this patient group, surgical corrections of CLP failed to provide a completely harmonious appearance, even if the deviations from the reference were limited. Further analyses of larger groups of patients are needed.

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Respiratory Polysomnographic Findings in Patients Treated Primarily for Unilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665617726538 ◽

2017 ◽

Vol 55 (2) ◽

pp. 287-291 ◽

Cited By ~ 1

Author(s):

Davi Sandes Sobral ◽

Gustavo Juliane Faller ◽

Marcus Vinícius Martins Collares

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Sleep Apnea Syndrome ◽

Mixed Dentition ◽

Apnea Hypopnea Index ◽

Craniofacial Anomalies ◽

Obstructive Sleep ◽

The Mean ◽

Airway Abnormalities ◽

Craniofacial Abnormality

Cleft lip and palate (CLP) is the most common congenital craniofacial abnormality. Obstructive sleep apnea syndrome (OSAS) is a highly prevalent but underdiagnosed disease and is frequently associated with craniofacial anomalies. There are few studies describing the sleep breathing pattern of children with CLP. This study sought to characterize the respiratory profile of 23 children with unilateral cleft lip and palate, aged 7-12 years, who had undergone cleft lip and nasal repair at age 3-4 months and palatoplasty at 12-15 months, with a particular focus on evaluating the presence of OSAS in children with CLP. Polysomnography was performed and findings were analyzed descriptively. We found a mean and median for apnea/hypopnea index (AHI) of 1.11/h (SD = 0.78) and 0.9/h, respectively. The mean obstructive apnea index (OAI) was 0.27/h (SD = 0.38) and the median, 0.1/h. Nearly 30% of patients had an AHI above 1.4 events/h. There was no significant oxyhemoglobin desaturation in the study group. In this group, the prevalence of OSAS was higher than in noncleft populations when compared to the normality values adopted. This sample of patients with unilateral cleft lip and palate exhibited an increased prevalence of OSAS during the mixed dentition stage. Although the results showed that OSAS was mild, we advise closer observation of these patients. Polysomnography is recommended for the assessment of children with airway abnormalities, to individualize the extent of treatment.

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Prevalence of Palatal and Alveolar Cysts in Babies with Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/02-139.1 ◽

2004 ◽

Vol 41 (5) ◽

pp. 490-493 ◽

Cited By ~ 8

Author(s):

Karina Mirela Ribeiro Pinto Alves ◽

Virginia Peixoto ◽

Márcia Ribeiro Gomide ◽

Cleide Felíciode Carvalho Carrara ◽

Beatriz Costa

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Sao Paulo ◽

São Paulo ◽

Craniofacial Anomalies ◽

Cross Sectional ◽

Significant Difference ◽

Different Types ◽

Low Prevalence ◽

Posterior Area

Objective To evaluate the prevalence of palatal and alveolar cysts in babies with cleft lip and/or palate. Design Cross-sectional. Setting Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP), Bauru, São Paulo, Brazil. Participants Two hundred ninety-one Caucasian babies divided into four groups according to the type of cleft: cleft lip with or without cleft alveolus (70), complete unilateral cleft lip and palate (112), complete bilateral cleft lip and palate (56), and cleft palate (53). Results A low prevalence of palatal and alveolar cysts was observed among patients with the four different types of clefts, with no statistically significant difference between genders. The maxilla and the anterior area of the mouth were more affected than the mandible and the posterior area. Conclusions The low prevalence of palatal and alveolar cysts in the four groups of babies with clefts included in this study may have been due to the high mean age of the sample.

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Comprehension of Online Educational Material Regarding Orofacial Clefts

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619839576 ◽

2019 ◽

Vol 56 (9) ◽

pp. 1206-1212

Author(s):

Diana S. Jodeh ◽

Aleshia J. Pringle ◽

S. Alex Rottgers

Keyword(s):

Web Sites ◽

Web Site ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

The United States ◽

Educational Material ◽

Reading Level ◽

Significant Difference ◽

The Mean ◽

American Society

Background:Cleft lip and palate are among the common birth defects in the United States. Management is complex and may be difficult for parents and patients to understand. The goal of this study was to evaluate the readability of online educational material provided by the American Society of Plastic Surgeons (ASPS) and the American Cleft Palate-Craniofacial Association (ACPA) websites regarding cleft lip and palate and to assess parents’ comprehension.Methods:Parents of children younger than 10 years of age presenting to the plastic and reconstructive surgery clinic at Johns Hopkins All Children’s Hospital for conditions other than cleft lip and palate were recruited for participation. Parents were given the literature published on the ASPS and ACPA web sites to review and were asked to complete a 5-question test specifically targeted to the content of the passage they reviewed. We tested the readability of the 2 online passages using Readability Studio software (Oleander Software Solutions Ltd).Results:Sixty parents completed the study. Across all groups, the mean score was 4.35 of a possible 5. The mean score was 4.4 for the ASPS web site and 4.29 for the ACPA web site. Fifty-three percent of participants answered all questions correctly. No significant difference in scores was noted between web sites ( P = .48).Conclusions:Despite containing content of varying reading-level difficulty, the literature posted on the ACPA and ASPS web sites concerning cleft lip and palate conveyed information equally well to the target parent demographic with high levels of comprehension.

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Does Unilateral Cleft Lip and Palate Affect the Maxillary Sinus Volume?

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665617726991 ◽

2017 ◽

Vol 55 (2) ◽

pp. 168-172 ◽

Cited By ~ 6

Author(s):

Omer Demirtas ◽

Fahrettin Kalabalik ◽

Asim Dane ◽

Ali Murat Aktan ◽

Ertugrul Ciftci ◽

...

Keyword(s):

Maxillary Sinus ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Control Group ◽

Maxillary Sinus Volume ◽

Intergroup Comparison ◽

Significant Difference ◽

The Mean ◽

And Gender ◽

The Right

Objective: The purposes of this study were to evaluate and compare the maxillary sinus volume (MSV) of patients with a unilateral cleft lip and palate (UCLP) between the cleft side and noncleft side and between adolescent patients with UCLP and a control (noncleft) group using cone beam computed tomography (CBCT). Methods: CBCT images of 44 UCLP patients (29 males and 15 females, with a mean [SD] age of 13.5 [5.0] years) and 44 (22 males and 22 females, with a mean [SD] age 14.9 [4.2] years) age- and sex-matched controls were evaluated in this study. Each maxillary sinus was assessed 3-dimensionally, segmented, and its volume was calculated. Results: There were no statistically significant differences between the age and gender distributions of the groups. There was a statistically significant difference in the MSVs of the cleft (10996.78±3522.89 mm3) versus the noncleft side (10382.3±3416.2 mm3; P < .05)] but no significant difference between the MSVs of the right and left sides ( P > .05). In the intergroup comparison, the mean MSVs of the UCLP patients (10701.52±3369.33 mm3) were significantly smaller than those of the control group (16054.08 ± 5293.96 mm3; P < .001). Conclusions: The MSVs of the UCLP patients showed a statistically significant decrease compared to those of the controls ( P < .001). There was also a significant difference in the MSVs of the cleft and noncleft sides of the UCLP patients ( P < .05).

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Cephalometric Soft Tissue Characteristics of Unilateral Cleft Lip and Palate Patients in Relation to Missing Teeth

BioMed Research International ◽

10.1155/2017/2392808 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7

Author(s):

Khalid A. Almoammar ◽

Hala A. Almarhoon ◽

Waeil Batwa ◽

Nasser Alqahtani ◽

Thikriat Al-Jewair ◽

...

Keyword(s):

Soft Tissue ◽

Surgical Management ◽

Orthodontic Treatment ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Patient Records ◽

Missing Teeth ◽

Lower Lip ◽

Tissue Characteristics ◽

Retrospective Investigation

Objective. This study aimed to evaluate cephalometric soft tissue characteristics in individuals with unilateral complete cleft lip and palate (UCCLP) both with and without missing teeth. Design. A retrospective investigation of patient records, who are being treated at the cleft lip and palate (CLP) clinics at the College of Dentistry. Ninety-six consecutive records of nonsyndromic UCCLP subjects were recruited (33 subjects without missing teeth and 63 subjects with missing teeth). Linear and angular soft tissue measurements obtained from lateral cephalometric radiographs were evaluated and compared among the studied samples. Results. Lower lip was significantly retruded and shorter (p=0.037), p=0.015, respectively; in addition to the fact that shallower mentolabial sulcus (p=0.05) was found in the subjects with missing teeth, the rest of the soft tissue was not significantly different between the two groups. Conclusion. In subjects with a UCCLP anomaly, missing teeth have an effect on lower lip position and length, which influenced the mentolabial sulcus. Lower lip position and length differ between cleft patients who present with either multiple missing teeth or with no missing teeth, and this needs to be considered during orthodontic treatment planning and surgical management for the cleft defect.

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Assessment of Orthodontic Burden of Care in Patients With Unilateral Complete Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665617718825 ◽

2017 ◽

Vol 55 (1) ◽

pp. 74-78 ◽

Cited By ~ 6

Author(s):

Thamara Frascarelli Alberconi ◽

Gabriela Leticia Clavisio Siqueira ◽

Renata Sathler ◽

Katherine A. Kelly ◽

Daniela G. Garib

Keyword(s):

Surgical Procedures ◽

Orthodontic Treatment ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Sao Paulo ◽

São Paulo ◽

Craniofacial Anomalies ◽

Burden Of Care ◽

Intergroup Comparison ◽

The Mean

Objective: To assess the orthodontic burden of care of patients from a Brazilian rehabilitation center (Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo [HRAC-USP]). Design: Retrospective. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo. Interventions: One hundred files of unilateral complete cleft lip and palate patients who had consecutively finished orthodontic rehabilitation at HRAC-USP were evaluated from January 2011 to January 2013. The duration of orthodontic treatment, number of visits, kilometers traveled, number of appliances and surgical procedures performed were recorded. The sample was divided into 2 subgroups according to severity the interarch relation (Goslon Yardstick score) at the beginning of orthodontic treatment. Mann-Whitney test was applied for intergroup comparison ( P < .05). Results: For the total sample (n = 100), the mean time of orthodontic treatment was 140.2 months, the mean number of orthodontic appointments was 61.8, the mean number of appliances was 10, the mean number of surgical procedures was 6.2, and the mean distance traveled to attend the center for orthodontic appointments was 38,978.5 km. The subgroup with the most severe malocclusion (Goslon yardsticks scores 4 and 5) showed a longer orthodontic treatment length, greater number of surgical procedures, and longer distance traveled than those presenting Goslon yardstick scores 1, 2, and 3. Conclusion: Patients with greater severity of the initial malocclusion experienced a higher burden of care than patients with less severity of the initial malocclusion. To reduce the burden of care, research and efforts should focus on minimizing maxillary growth deficiency related to primary surgery.

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Are Teeth Close to the Cleft More Susceptible to Periodontal Disease?

The Cleft Palate-Craniofacial Journal ◽

10.1597/07-226.1 ◽

2009 ◽

Vol 46 (2) ◽

pp. 161-165 ◽

Cited By ~ 11

Author(s):

Ana Lúcia Pompéia Fraga de Almeida ◽

Marly Kimie Sonohara Gonzalez ◽

Sebastião Luiz Aguiar Greghi ◽

Paulo César Rodrigues Conti ◽

Luiz Fernando Pegoraro

Keyword(s):

Periodontal Disease ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Craniofacial Anomalies ◽

Arithmetic Means ◽

Cross Sectional ◽

Clinical Attachment Level ◽

Probing Depth ◽

Significant Difference ◽

Attachment Level

Objective: To evaluate whether teeth close to the cleft area present higher prevalence and severity of periodontal disease than teeth in other regions. Design: Cross-sectional. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo. Patients: There were 400 individuals with complete unilateral or bilateral cleft lip and palate, aged 15 to 49 years, without any previous periodontal treatment. Main Outcome Measures: All clinical parameters were evaluated in six sites for each tooth. The arithmetic means were calculated for each sextant. Results: Of the sextants, 86.75% presented means of probing depth smaller than or equal to 3 mm. No sextant exhibited means of probing depth greater than or equal to 6 mm. There was a statistically significant difference (p < .001) in probing depth according to age, types of cleft, and sextant; 95.87% of sextants presented mean attachment levels smaller than or equal to 3 mm. The sextant with cleft did not present higher means of probing depth, clinical attachment level, plaque index, and gingival index. There was gingival bleeding in 99.08% of the sample and plaque in 97.40%. The type of cleft was not an important factor influencing the prevalence of periodontal disease. Age seems to be an important factor influencing the prevalence and severity of periodontal disease for all aspects investigated. Conclusions: Periodontal disease in individuals with clefts occurred in a similar manner as observed in other populations. The presence of the cleft does not seem to increase the prevalence of the disease.

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The Influence of Orthodontic Treatment on the Goslon Score of Unilateral Cleft Lip and Palate Patients

The Cleft Palate-Craniofacial Journal ◽

10.1597/10-096 ◽

2012 ◽

Vol 49 (2) ◽

pp. 215-220 ◽

Cited By ~ 11

Author(s):

Peter Southall ◽

Mark Walters ◽

Steven Singer

Keyword(s):

Retrospective Study ◽

Treatment Group ◽

Surgical Outcome ◽

Orthodontic Treatment ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Favorable Outcome ◽

Dental Arch ◽

Significant Difference ◽

The Mean

Objective To assess the effect of orthodontic treatment on Goslon Yardstick outcome. Design Retrospective study. Patients A series of 66 consecutive patients born with a complete unilateral left lip and palate. Patients were sorted into a nontreatment group (n = 47) and a treatment group (n = 19). Method Three assessors trained in the use of the Goslon Yardstick ranked the dental arch relationships of study casts taken at 6 and 9 years. Results There was only a fair agreement (κ = .33) between 6- and 9-year Goslon Yardstick scores for the cohort of 66 patients, with a significant (p < .05) difference in the mean score at 6 years (3.17 ± 0.8) and at 9 years (2.88 ± 1.0). Removal of 19 subjects who had orthodontic inventions prior to taking of the 9-year-old study cast improved the agreement to moderate (κ = .52). There was no significant difference (p > .05) in mean scores at 6 and 9 years (3.13 ± 0.9 and 3.17 ± 1.03, respectively). The treatment group exhibited significant differences (p < .001) with mean Goslon Yardstick scores of 3.0 ± 0.9 at 6 and 2.25 ± 0.45 at 9 years. Conclusions The inclusion of patients who had received orthodontic treatment prior to taking of study casts being used for Goslon Yardstick scoring can result in a more favorable outcome. Patients who have received active orthodontic treatment prior to taking of dental casts should be excluded or accounted for in audits to assess primary cleft surgical outcome in patients with a unilateral cleft lip and palate.

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