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.

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.

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.

Results of Randomized Controlled Trial of Soft Palate First versus Hard Palate First Repair in Unilateral Complete Cleft Lip and Palate

2006 ◽  
Vol 43 (3) ◽  
pp. 329-338 ◽  
Author(s):  
Bruce Richard ◽  
Joyce Russell ◽  
Siobhan McMahon ◽  
Ron Pigott
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Primary Repair ◽  
Controlled Trial ◽  
Facial Growth ◽  
Cleft Closure ◽  
Palate Repair ◽  
Intercanine Distance

Objective To compare the outcomes for primary repair of unilateral cleft lip and palate, operating on the soft palate first versus the hard palate first. Design Randomized controlled trial. Setting The Regional Cleft Service of West Nepal. Patients Forty-seven consecutive patients with nonsyndromic unilateral cleft lip and palate, of whom 37 were assessed 4 to 6 years after completing primary surgical repair. Interventions Primary repair of unilateral cleft lip and palate by two differing sequences: (1) soft palate repair, with hard palate and lip repair 3 months later; and (2) lip and hard palate repair, followed by the soft palate repair 3 months later. Main Outcome Measures Analysis of dental study models, weight gain, and speech recordings. Results Four to 7 years after completing the cleft closure, there was no significant difference in facial growth between the two types of repair sequencing. Completing posterior repair first had no effect on anterior alveolar gap width. It narrowed the hard palate gap by reducing the intercanine distance. Anterior repair dramatically closed the anterior alveolar gap, and narrowed the intercanine distance. Comparing anterior alveolar gap width with age at first presentation demonstrated that there was no spontaneous narrowing of the cleft in older children. Completing posterior closure first had a weight gain advantage over anterior closure first. Improved oropharyngeal closure, and thus swallowing, is the likely explanation. Conclusion Changing the sequencing of cleft closure has no demonstrable difference in facial growth at 4 to 7 years after completion of the primary surgery.

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.

Hard Palate Repair Timing and Facial Growth in Unilateral Cleft Lip and Palate: A Longitudinal Study

2006 ◽  
Vol 43 (5) ◽  
pp. 547-556 ◽  
Author(s):  
Yu-Fang Liao ◽  
Timothy J. Cole ◽  
Michael Mars
Keyword(s):  
Longitudinal Study ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Sri Lankan ◽  
Facial Morphology ◽  
Facial Growth ◽  
Clinical Notes ◽  
Timing Effect ◽  
Palate Repair

Objective: To investigate whether timing of hard palate repair had a significant effect on facial growth in patients with unilateral cleft lip and palate (UCLP). Design: Retrospective longitudinal study. Setting: Sri Lankan Cleft Lip and Palate Project. Patients: A total of 104 patients with nonsyndromic UCLP who had hard palate repair by age 13 years, with their 290 cephalometric radiographs taken after lip and palate repair. Main Outcome Measures: Clinical notes were used to record surgical treatment histories. Cephalometry was used to determine facial morphology and growth rate. Results: Timing of hard palate repair had a significant effect on the length and protrusion of the alveolar maxilla (PMP-A and SNA, respectively) and the anteroposterior alveolar jaw relation (ANB) at age 20 years but not on their growth rates. Conclusion: Timing of hard palate repair significantly affects the growth of the maxilla in patients with UCLP. Late hard palate repair has a smaller adverse effect than does early hard palate repair on the growth of the maxilla. This timing effect primarily affects the anteroposterior development of the maxillary dentoalveolus and is attributed to the development being undisturbed before closure of the hard palate.

Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate

2019 ◽  
Vol 57 (4) ◽  
pp. 420-429
Author(s):  
Susanna Botticelli ◽  
Annelise Küseler ◽  
Kirsten Mølsted ◽  
Helene Soegaard Andersen ◽  
Maria Boers ◽  
...  
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Controlled Trial ◽  
Velopharyngeal Insufficiency ◽  
Primary Surgery ◽  
Multicenter Randomized Controlled Trial ◽  
Palate Repair ◽  
Velopharyngeal Function

Aim: To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair. Design: Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft). Setting: Tertiary health care. One surgical center. Patients and Methods: One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months). Main outcome measurements: Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency. Results: No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman = .23; P = .025). The role of the covariate “cleft size at tuberosity level” was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = −.27; P = .004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99). Conclusions: Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low.

Hard Palate Repair Timing and Facial Growth in Cleft Lip and Palate: A Systematic Review

2006 ◽  
Vol 43 (5) ◽  
pp. 563-570 ◽  
Author(s):  
Yu-Fang Liao ◽  
Michael Mars
Keyword(s):  
Systematic Review ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Case Reports ◽  
Case Series ◽  
Long Term Results ◽  
Facial Growth ◽  
Cleft Lip Palate ◽  
Palate Repair

Objective: To evaluate the effect of timing of hard palate repair on facial growth in patients with cleft lip and palate, with special reference to cranial base, maxilla, mandible, jaw relation, and incisor relation. Design: A systematic review. Methods: The search strategy was based on the key words “facial growth,” “cleft lip palate,” and “timing of (hard) palate repair.” Case reports, case-series, and studies with no control or comparison group in the sample were excluded. Results: Fifteen studies met the selection criteria. All the studies were retrospective and nonrandomized. Five studies used cephalometry and casts, seven used cephalometry, and three used casts. Methodological deficiencies and heterogeneity of the studies prevented major conclusions. Conclusion: The review highlights the importance of further research. Prospective well-designed, controlled studies, especially targeting long-term results, are required to elucidate the effect of timing of hard palate repair on facial growth in patients with cleft lip and palate.

Influence of different palate repair protocols on facial growth in unilateral complete cleft lip and palate

2015 ◽  
Vol 43 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Xue Xu ◽  
Hyuk-Jae Kwon ◽  
Bing Shi ◽  
Qian Zheng ◽  
Heng Yin ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Facial Growth ◽  
Palate Repair
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