Soft-Tissue Profile Changes during Widening and Protraction of the Maxilla in Patients with Cleft Lip and Palate Compared with Normal Growth and Development

1993 ◽  
Vol 30 (5) ◽  
pp. 454-468 ◽  
Author(s):  
Rolf S. Tindlund ◽  
Per Rygh
Keyword(s):  
Soft Tissue ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Lower Lip ◽  
Maxillary Protraction ◽  
Transverse Expansion ◽  
Short Period ◽  
Soft Tissue Profile ◽  
Lateral Cephalograms ◽  
Maxillary Deficiency

During the last 15 years, cleft lip and palate (CLP) patients with maxillary deficiency in the care of the Bergen CLP team have undergone an interceptive orthopedic treatment phase during the deciduous and mixed dentition period. The present study includes 68 patients who received maxillary transverse expansion by use of a modified quad-helix appliance and 98 cases given maxillary protraction by a facial mask. All cases were treated until an acceptable normal occlusion was attained. Lateral cephalograms were taken immediately before and after the active treatment periods. Sagittal changes of the soft-tissue profile during transverse expansion and protraction were analyzed separately for unilateral complete cleft lip and palate (UCLP) patients and bilateral complete cleft lip and palate (BCLP) patients. The soft-tissue profiles of the groups were compared to growth changes of noncleft age-matched children (NORM group). During the short period of maxillary transverse expansion (mean period, 3.5 months) no significant change of the soft-tissue profile was found, except in the protrusion of the lower lip in the BCLP group. During the period of maxillary protraction (mean periods, 12 months in the UCLP group and 15 months in the BCLP group) the soft-tissue profile improved significantly by reducing the characteristic tendency towards a concave profile in CLP patients with maxillary deficiency. Significant Increases of the sagittal maxillomandlbular lip relation (angle SS-N-SM: mean Increase, 2.5 degrees) and the Holdaway-angle (H-angle: mean increase, 3.0 degrees) were found to be similar in the UCLP and BCLP groups. However, the use of different reference lines for evaluation of treatment effects upon the soft-tissue profile resulted in conflicting findings suggesting that anteriorly situated reference lines are more suitable for the evaluation of CLP patients. Thus, the esthetic line (E.line) indicated a favorable position of the lips after treatment; the subspinale-pogonlon line (ss.pg) revealed an Improved soft-tissue profile; the soft-tissue-facial line (N.PG) showed a retruded nose and upper lip; whereas basal references such as the nasion-sella line (NSL) and the occlusal-line perpendicular (OLP) mainly showed major differences between the CLP groups and the NORM groups.

Intercanine Widening and Sagittal Effect of Maxillary Transverse Expansion in Patients with Cleft Lip and Palate during the Deciduous and Mixed Dentitions

1993 ◽  
Vol 30 (2) ◽  
pp. 195-207 ◽  
Author(s):  
Rolf S. Tindlund ◽  
Per Rygh ◽  
Olav E. Bøe
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Mixed Dentition ◽  
Orthopedic Treatment ◽  
Forward Movement ◽  
Transverse Expansion ◽  
Normal Occlusion ◽  
Lateral Cephalograms ◽  
Quad Helix ◽  
Maxillary Deficiency

Since 1977 cleft lip and palate (CLP) patients with maxillary deficiency have received an interceptive orthopedic treatment consisting of (a) transverse expansion, (b) protraction, and (c) fixed retention. Ideally the treatment should be completed early enough to permit spontaneous eruption of the maxillary permanent incisors into normal occlusion without orthodontic intervention. The early transverse expansion considerably increases space so that unerupted malpositioned incisors spread out spontaneously, creating optimal conditions for eruption and root formation. Dental diagnosis in the cleft areas is made easier. Posterior crossbites in 112 CLP patients were expanded with a modified quad-helix appliance cemented with four bands in the deciduous or mixed dentition. Intercanine widening was about 3 mm per month regardless of cleft type. Several authors have claimed that transverse expansion of the upper jaw will increase sagittal overjet. Other authors have not found such an effect. The sagittal effect on the maxilla was studied in 68 CLP patients who had received transverse expansion. Analysis of the lateral cephalograms revealed no significant sagittal dentofacial maxillary treatment effects involving forward movement of maxilla, but a downward clockwise rotation of the mandible was found.

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

2003 ◽  
Vol 40 (5) ◽  
pp. 544-549 ◽  
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.

Skeletal Response to Maxillary Protraction in Patients with Cleft Lip and Palate before Age 10 Years

1994 ◽  
Vol 31 (4) ◽  
pp. 295-308 ◽  
Author(s):  
Rolf S. Tindlund
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Poor Response ◽  
Mixed Dentition ◽  
Forward Movement ◽  
Maxillary Protraction ◽  
Face Height ◽  
Lateral Cephalograms ◽  
Before And After ◽  
Maxillary Dentition

Over the last 15 years, cleft lip and palate (CLP) patients with maxillary deficiency in the care of the Bergen CLP Team have received interceptive orthopedic treatment to correct anterior and posterior crossbites during the deciduous and mixed dentition periods. The present study comprises 72 subjects of various cleft types with anterior crossbite, treated to an acceptable positive overjet by maxillary protraction using a facial mask (Delaire). Lateral cephalograms were taken immediately before and after the active treatment periods. Individuals exhibiting a favorable (fair) skeletal response to the protraction were compared with those who revealed little, (poor) skeletal response. Two cephalometric variables were chosen for the evaluation of the sagittal skeletal treatment changes: (1) the sagittal maxillomandibular change (change of angle ss-n-sm [ANB]); and (2) the forward movement of the maxilla (change of distance NSP-maxp), where maxp (maxillary point) represents the anterior contour of maxilla and NSP is the perpendicular to the naslon-sella-line (NSL) through sella. A numerical change greater than or equal to the value 1.5 (degrees or mm, respectively) was classified as fair versus poor response revealing a change less than 1.5. Fair-response (favorable response) of sagittal maxillomandibular change was found in 63 % of the cases (mean increase of angle ANB was 3.3 degrees), more often when protraction started early. The length of maxilla was increased, the skeletal maxilla was moved forward 1.8 mm, the upper dentition advanced 3.6 mm, the occlusal line was clockwise rotated, and the anterior face height was increased. Similarly, fair-response of forward movement of maxilla was found in 44% of the cases (mean increase of distance NSP-maxp was 2.4 mm), more often when protraction was started early and after long treatment duration. The maxillary prognathism increased 1.8 degrees, the angle ANB increased 3 degrees, the length of maxilla increased 1.5 mm, and the upper dentition was advanced 3.7 mm. The anterior face height increased with counterclockwise rotation of the nasal line, whereas the occlusal line was clockwise rotated. A paired fair-response of both skeletal maxillomandibular change and skeletal forward movement of maxilla was found in 35% of the cases. During protraction the mean increase of maxillary prognathism was 2.1 degrees, the maxilla moved forward 3.1 mm, the maxillary dentition advanced 4.3 mm, the maxillary length increased 1.9 mm, the ANB angle increased 3.7 degrees, and the lower anterior facial height increased 3.4 mm.

Facial Growth in Patients with Bilateral Cleft Lip and Palate: A Cephalometric Study

1994 ◽  
Vol 31 (3) ◽  
pp. 210-216 ◽  
Author(s):  
Kiki L.W.M. Heidbüchel ◽  
Anne Marie Kuijpers-Jagtman ◽  
Hans Peter M. Freihofer
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Hospital ◽  
Long Term Results ◽  
Facial Growth ◽  
Nasolabial Angle ◽  
Comparison Results ◽  
Soft Tissue Profile ◽  
Lateral Cephalograms ◽  
Bilateral Cleft Lip

In this study, sagittal facial growth of bilateral cleft lip and palate (BCLP) patients between 6 and 20 years of age is analyzed. The data of Nljmegen were derived from 131 lateral cephalograms taken in 21 BCLP patients who were treated In the Cleft Lip and Palate Center of the University Hospital of Nljmegen. Reported data of 90 BCLP patients treated at the Center of Oslo were used as a reference for comparison. Results of this Investigation showed mandibular growth to be similar in both centers. In the premaxillary region some differences were found: The Nljmegen patients presented a more protrusive premaxilla than those at Oslo. The upper front teeth and hence, the premaxilla, were more retroclined In the Nljmegen sample. There were also statistically significant differences in the soft tissue profile. The mean z-score was positive for the nasolabial angle and negative for the angle N'-Sn-Pg'. At 18 years of age, these differences are still apparent. In comparison with Broadbent's values of normal individuals, the SNPg-angle was smaller and the mandibular angle greater in Nljmegen and Oslo. The profiles of the BCLP patients are more convex in Nljmegen and more concave in Oslo than In the noncleft group. Finally, the different treatment strategies of the Cleft Lip and Palate Centers of Nljmegen and Oslo are compared and discussed In terms of their long-term results.

A Cephalometric Evaluation of Lower Lip in Patients with Unilateral Cleft Lip and Palate

2004 ◽  
Vol 41 (5) ◽  
pp. 485-489 ◽  
Author(s):  
T. Ufuk Toygar ◽  
M. Okan Akçam ◽  
Ayça Arman
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Normal Subjects ◽  
Middle Part ◽  
Class I ◽  
Control Group ◽  
Upper Lip ◽  
Lower Lip ◽  
Normal Individuals ◽  
Lateral Cephalograms

Objective The aim of this study was to evaluate cephalometrically the lower lip position and area of patients with unilateral cleft lip and palate (UCLP) comparatively with Class I skeletodental normal subjects. Patients Lateral cephalometric and hand-wrist radiographs obtained from 24 patients with UCLP (mean age 12.86 years), along with 20 normal individuals (mean age 12.33 years) used as a control group, were examined. Design In addition to standard cephalometric dentofacial variables, lower lip area (superior, middle, inferior) was also measured using a digital planimeter on the lateral cephalograms. Results The superior and middle part of the lower lip areas were significantly smaller (p < .05) in the UCLP group, compared to the control group. The inferior and total lower lip areas of patients with UCLP were found to be significantly smaller than controls. The labiomental angle was also smaller (38.79 degrees). Conclusions The results suggest that the lower lip of patients with UCLP is smaller, retruded, and curved, with a deep labiomental sulcus, compared with normal individuals during puberty. Therefore, practitioners should focus not only on the upper lip of patients with UCLP but also should consider the lower lip as it was found distinct from normal individuals during puberty.

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

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.

scholarly journals Validity of a Manual Soft Tissue Profile Prediction Method Following Mandibular Setback Osteotomy

2007 ◽  
Vol 01 (04) ◽  
pp. 202-211 ◽  
Author(s):  
Olga - Elpis Kolokitha
Keyword(s):  
Soft Tissue ◽  
Prediction Method ◽  
Prediction Methods ◽  
Upper Lip ◽  
Lower Lip ◽  
Mandibular Prognathism ◽  
Manual Method ◽  
Mandibular Setback ◽  
Soft Tissue Profile ◽  
Lateral Cephalograms

ABSTRACTObjectives: The aim of this study was to determine the validity of a manual cephalometric method used for predicting the post-operative soft tissue profiles of patients who underwent mandibular setback surgery and compare it to a computerized cephalometric prediction method (Dentofacial Planner). Lateral cephalograms of 18 adults with mandibular prognathism taken at the end of presurgical orthodontics and approximately one year after surgery were used.Methods: To test the validity of the manual method the prediction tracings were compared to the actual post-operative tracings. The Dentofacial Planner software was used to develop the computerized post-surgical prediction tracings. Both manual and computerized prediction printouts were analyzed by using the cephalometric system PORDIOS. Statistical analysis was performed by means of t-test.Results: Comparison between manual prediction tracings and the actual post-operative profile showed that the manual method results in more convex soft tissue profiles; the upper lip was found in a more prominent position, upper lip thickness was increased and, the mandible and lower lip were found in a less posterior position than that of the actual profiles. Comparison between computerized and manual prediction methods showed that in the manual method upper lip thickness was increased, the upper lip was found in a more anterior position and the lower anterior facial height was increased as compared to the computerized prediction method.Conclusions: Cephalometric simulation of post-operative soft tissue profile following orthodonticsurgical management of mandibular prognathism imposes certain limitations related to the methods implied. However, both manual and computerized prediction methods remain a useful tool for patient communication. (Eur J Dent 2007;1:202-211)

A Cephalometric Appraisal of a Group of Children with Surgically Repaired Unilateral Cleft Lip and Palate

1977 ◽  
Vol 4 (1) ◽  
pp. 33-37 ◽  
Author(s):  
John B. Mowbray
Keyword(s):  
Soft Tissue ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Normal Children ◽  
Facial Height ◽  
Soft Tissue Profile ◽  
Base Reference ◽  
Mandibular Retrusion ◽  
Method Of Assessment ◽  
Experimental Group

This study investigated the effect of a standard surgical technique for the repair of unilateral cleft lip and palate by one surgeon. Limitations were set by the numbers available for investigation, however comparison was made between a small group of such treated cases and a group of normal children. The method of assessment was based on a cephalometric analysis with extrapolation to the integumental profile. A number of different points were proposed for attributes of the soft tissue profile. The base reference line used was Sella-Nasion, points A and B and the extrapolations to the overlying soft tissue. Facial convexity was proposed as an angle subtended at the tip of the nose by the chin point and soft tissue nasion. Facial height was measured as a ratio between upper and lower facial dimensions. Lip tissue thickness was a direct measurement. The result of this study supported some findings in other studies. The point of most interest was the small amount of difference between the experimental group and the group used for comparison. Both maxillary and mandibular retrusion was noted and there appeared slight flattening of the soft tissue profile. However, no differences were noted in lip thickness and facial height.

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