Effects of Lip Revision Surgery on Long-Term Orosensory Function in Patients with Cleft Lip/Palate

Objective: The objective of this study was to assess the efficacy of presurgical nasoalveolar molding (PNAM) on long-term nasal symmetry and shaping after primary cheiloplasty in patients with unilateral complete cleft lip/palate (UCL/P). Design: This was a two-group, parallel, retrospective, randomized clinical trial. Setting: The setting for this study was the Chang Gung Craniofacial Center in Taoyuan, Taiwan. Patients: Patients were divided into one of the following two groups: infants with UCL/P who underwent PNAM (PNAM group, n = 42) and infants with UCL/P who did not undergo PNAM (non-PNAM group, n = 42). Interventions: Interventions included PNAM and primary cheiloplasty without nasal cartilage dissection. Main Outcome Measures: In this study, 4- to 5-year postoperative full-face and submental oblique photographs were taken of all patients and scored from 1 to 5 points by 10 medical evaluators. The scores were statistically analyzed using repeated-measures analysis of variance, and P < .05 was considered to represent statistical significance. Results: After 1 to 3 months of PNAM but before primary cheiloplasty, the displaced nasal and alveolar cartilage showed obvious improvement. However, the scores in the PNAM and non-PNAM groups at 4 to 5 years postoperatively were 66.62 ± 14.25 and 66.31 ± 15.08, respectively. There was no significant difference between the two groups ( F = 0.009, P = .923). Conclusion: PNAM as an early-stage adjunctive therapy for nasal deformity correction is beneficial before primary cheiloplasty, but it is insufficient to maintain long-term nostril symmetry after primary cheiloplasty without nasal cartilage dissection.

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Aesthetic and Functional Outcome of Surgical and Orthodontic Correction of Bilateral Clefts of Lip, Palate, and Alveolus

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1999_036_0407_aafoos_2.3.co_2 ◽

1999 ◽

Vol 36 (5) ◽

pp. 407-412 ◽

Cited By ~ 11

Author(s):

Alexander Gaggl ◽

Günter Schultes ◽

Hans Kärcher

Keyword(s):

Cleft Lip ◽

Functional Results ◽

Model Analysis ◽

Long Term Results ◽

Slight Reduction ◽

Lateral Cephalograms ◽

Bilateral Cleft Lip ◽

Cleft Lip Palate ◽

Maxilla And Mandible

Objective: To assess the aesthetic and functional long-term results of surgical and orthodontic treatment of patients with bilateral cleft lip, palate, and alveolus. Design: Long-term follow-up study. Setting: Teaching hospital in Austria. Patients: Twenty adult patients who had been operated on as children for bilateral cleft lip, palate, and alveolus. Interventions: Lateral cephalometric and model analysis. The sum of all mesiodistal tooth diameters in the maxilla and mandible were compared with standard Bolton tracings. Main outcome measures: Aesthetic and functional results. Results (model analysis): The upper arch was too wide in 12 patients and the mandibular arch was too wide in 4 patients. In 11 patients, the lateral teeth were crowded, and all had a persistent transverse space deficit and a reduction in sagittal measurements. Fifteen patients had alveolar midline displacement of the maxilla as well as of the mandible. Results (lateral cephalometric measurements): The lateral cephalograms showed a mean sella-nasion-A point angle of 77° and a maxillary baseline-nasion-sella line angle of 9°, indicating a tendency toward maxillary retrognathia. An anterior facial height index of 42% (compared with the standard 58%) indicated a slight reduction in midface height with consequent increase in the height of the lower face. Conclusion: There is specific growth impairment of the midface in adults who were treated as children for bilateral clefts of lip, palate, and alveolus. An optimal result can be achieved only by additional orthognathic surgery (Le Fort II osteotomy).

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