Changes in Craniofacial Development Due to Modifications of the Treatment of Unilateral Cleft Lip and Palate

1998 ◽  
Vol 35 (3) ◽  
pp. 240-247 ◽  
Author(s):  
Zbyněk Šmahel ◽  
Živa Müllerova ◽  
Aleš Nejedly ◽  
Ivan Horak
Keyword(s):  
Bone Grafting ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Craniofacial Morphology ◽  
Consecutive Series ◽  
Posterior Displacement ◽  
Surgical Methods ◽  
Primary Bone ◽  
Fixed Appliances

Objective The objective of this study was to evaluate the craniofacial morphology of children with unilateral cleft lip and palate (UCLP) resulting from differing management protocols practiced in Prague from 1945 to 1976. Design The craniofacial morphologies of four groups of patients were compared. Two groups were assessed retrospectively (individuals born from 1945 to 1963), and two groups were followed on a longitudinal basis (individuals born from 1966 to 1976). Setting The study was conducted at the Cleft Lip and Palate Center at the Department of Plastic Surgery, Prague, which has a catchment area population of 6 million. Patients The subjects were a consecutive series of adult males (n = 84) who had complete UCLP without associated malformations. Interventions Patients born from 1945 to 1955 did not receive centralized orthodontic therapy. From 1945 to 1965, the alveolar process in the area of the cleft was not surgically repaired. Primary bone grafting was used for the group born from 1965 to 1972, and primary periosteoplasty was used in the subsequent period. Throughout the period covered by the study, the palate was operated on by pushback and pharyngeal flap surgery. From 1945 to 1965, the lip was repaired initially according to Veau, and later according to Tennison and Randall, and during this time, fixed appliances were used for orthodontic treatment. Results The results for the period from 1945 to 1955 are characterized by mandibular overclosure with anterior crossbite. Centralized orthodontic treatment in the later period improved sagittal jaw relations due to the posterior displacement of the mandible and an edge-to-edge bite was attained, but maxillary retrusion was unchanged. Primary bone grafting increased retrusion of the maxilla, which was compensated by further posterior displacement of the mandible. An edge-to-edge bite was also obtained. Primary periosteoplasty reduced maxillary retrusion, and the marked proclination of the upper dentoalveolar component with fixed appliances resulted in a positive overjet. It was no longer necessary to push the mandible back to the extent required in bone grafting. Conclusion Effective orthodontic treatment made the greatest contribution to improved facial development. It allowed compensation of maxillary retrusion by changes in the position of the mandible or by proclination of the upper dentoal-veolar component with fixed appliances. The applied surgical methods using primary bone grafting caused deterioration of the anterior growth of the maxilla.

Assessment of Dental Arch Relationships in Japanese Patients with Unilateral Cleft Lip and Palate

2006 ◽  
Vol 43 (1) ◽  
pp. 96-102 ◽  
Author(s):  
Takafumi Susami ◽  
Yuji Ogihara ◽  
Masako Matsuzaki ◽  
Miyuki Sakiyama ◽  
Tsuyoshi Takato ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Good Practice ◽  
Weighted Kappa ◽  
Japanese Patients ◽  
Craniofacial Morphology ◽  
Dental Arch ◽  
Kappa Statistics ◽  
Consecutive Series ◽  
Alveolar Bone Grafting

Objective Evaluation of the dental arch relationships of Japanese patients with unilateral cleft lip and palate (UCLP) from the orthodontic clinic of the University of Tokyo Hospital (UTH) compared with patients treated by the Oslo Cleft Team, Norway. Design Retrospective study and comparison with previous reports. Materials Dental models of 24 patients with UCLP in UTH taken before orthodontic treatment and before alveolar bone grafting were included. Surgeons in many hospitals performed primary surgeries. These models were matched for age and gender with 24 models from a consecutive series of patients treated by the Oslo Cleft Team as part of the Eurocran Good Practice Archive. A total of 48 models were evaluated. Main Outcome Measure Dental arch relationship was rated with the Goslon Yardstick. The strength of agreement of rating was assessed with weighted kappa statistics. Results Intra- and interexaminer agreements evaluated by weighted kappa statistics were high, indicating good reproducibility. Almost 60% of the patients in UTH were classified into poor or very poor categories, and the mean Goslon score was 3.50. These results show a contrast to those in Oslo and were the poorest in comparison with previous reports. Conclusion Dental arch relationships in patients with UCLP in UTH were poor. This seemed to be attributable to surgical procedures, but a factor of racial difference in the craniofacial morphology was also considered. Further intercenter research is required to clarify this point.

scholarly journals Surgical Outcomes of Secondary Alveolar Bone Grafting and Extensive Gingivoperiosteoplasty Performed at Mixed Dentition Stage in Unilateral Complete Cleft Lip and Palate

2020 ◽  
Vol 9 (2) ◽  
pp. 576
Author(s):  
Yu-Ying Chu ◽  
Frank Chun-Shin Chang ◽  
Ting-Chen Lu ◽  
Che-Hsiung Lee ◽  
Philip Kuo-Ting Chen
Keyword(s):  
Bone Grafting ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Prospective Trial ◽  
Mixed Dentition ◽  
Alveolar Bone Grafting ◽  
Significant Difference ◽  
Secondary Alveolar Bone Grafting

Secondary alveolar bone grafting (SABG) is associated with donor site morbidities. We aimed to compare the outcomes of SABG and extensive gingivoperiosteoplasty (EGPP) at the mixed dentition stage. This single-blinded, randomized, prospective trial enrolled 50 consecutive patients with unilateral complete cleft lip and palate who had residual alveolar bone cleft, of which 44 (19 SABG, 25 EGPP) completed the study. Bone volumes before surgery, 6 months postoperatively, and 1-year postoperatively were compared using computed tomography. The Bergland scale score was recorded at 6 months postoperatively. Both groups had the same preoperative alveolar cleft volume. On the Bergland scale, 21, 3, and 1 patient in the EGPP group and 16, 2, and 1 patient in the SABG group were classified as types I, II, and IV, respectively, which did not show significant difference. With perioperative orthodontic treatment, the 1-year residual bone defect volume in both groups did not show significant difference (SABG 0.12 cm3 vs. EGPP at 0.14 cm3, p > 0.05). The study was not able to reveal much difference between SABG and EGPP combined with perioperative orthodontic treatment.

A Case Report of Multidisciplinary Treatment of an Adult Patient with Bilateral Cleft Lip and Palate

2014 ◽  
Vol 51 (6) ◽  
pp. 711-721 ◽  
Author(s):  
Tomohiro Fukunaga ◽  
Tadashi Honjo ◽  
Yuichi Sakai ◽  
Kiyo Sasaki ◽  
Teruko Takano-Yamamoto ◽  
...  
Keyword(s):  
Case Report ◽  
Adult Patient ◽  
Bone Grafting ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Multidisciplinary Treatment ◽  
Retention Period ◽  
Bilateral Cleft Lip ◽  
Palate Patient

This is a case report about the successful orthodontic treatment of a bilateral cleft lip and palate patient by using a combination of bone grafting and subsequent prosthodontic rehabilitation. An adult patient with a bilateral cleft lip and palate presented with a concave profile, anterior and lateral crossbite, a markedly deep overbite, and residual bilateral alveolar clefts. His jaw movement patterns were unstable and irregular due to his collapsed bite. Orthodontic treatment with bilateral bone grafting improved his concave profile by downward and backward rotation of the mandible within the freeway space, and optimum occlusion and functionally stable and smooth jaw movements were obtained. After a 6-year retention period, no skeletal relapse could be detected, and his occlusal stability was satisfactory.

Oral Rehabilitation of an Orthodontic Patient with Cleft Lip and Palate and Hypodontia Using Secondary Bone Grafting, Osseo-Integrated Implants, and Prosthetic Treatment

2004 ◽  
Vol 41 (3) ◽  
pp. 279-284 ◽  
Author(s):  
Shingo Kawakami ◽  
Masahiko Yokozeki ◽  
Shinya Horiuchi ◽  
Keiji Moriyama
Keyword(s):  
Bone Grafting ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Oral Rehabilitation ◽  
Anterior Maxilla

Objective Complete skeletal and dental reconstruction of the anterior maxilla is of great importance to patients with cleft lip and palate. Accordingly, osseo-integrated implants have been utilized for dental reconstruction after secondary bone grafting. In this report, the orthodontic management of a patient with unilateral cleft lip and plate with associated hypodontia is described. The patient was treated with comprehensive orthodontic treatment in addition to secondary bone grafting, and dental reconstruction was achieved with a combination of osseo-integrated implants and fixed prosthodontic treatment.

Scandcleft trial of primary surgery for unilateral cleft lip and palate: Craniofacial cephalometrics at 8 years

2020 ◽  
Author(s):  
Annelise Küseler ◽  
Arja Heliövaara ◽  
Kirsten Mølsted ◽  
Agneta Marcusson ◽  
Agneta Karsten ◽  
...  
Keyword(s):  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Controlled Trial ◽  
Craniofacial Morphology ◽  
Primary Surgery ◽  
Growth Studies ◽  
Alveolar Bone Grafting ◽  
Lateral Cephalograms

Summary Background The Scandcleft trial is a randomized controlled trial that includes children with unilateral cleft lip and palate where registrations are standardized and therefore provides the opportunity to describe craniofacial characteristics in a very large sample of patients. Objectives The aim of this study was to describe craniofacial growth and morphology in a large study sample of 8-year-old children with unilateral cleft lip and palate (UCLP); before orthodontic treatment and before secondary alveolar bone grafting; and to compare the cephalometric values with age-matched non-cleft children from previous growth studies to identify the differences between untreated cleft- and non-cleft children. Materials There are 429 eight-year-old UCLP patients in the Scandcleft study group. A total of 408 lateral cephalograms with a mean age of 8.1 years were analysed. Cephalometric analyses were performed digitally. The results from three previously published growth studies on non-cleft children were used for comparison. Results Cephalometric analyses showed a large variation in craniofacial morphology among the UCLP group. In general, they present with significant maxillary retrusion and reduced intermaxillary relationships compared to the age-matched non-cleft children. In addition, the vertical jaw relationship was decreased, mainly due to decreased maxillary inclination. The upper and lower incisors were retroclined. It can be expected that these differences will increase in significance as the children age. Conclusion Results from this study provide proposed norms for the young UCLP before any orthodontic treatment and can be valuable for the clinician in future treatment planning. Trial registration ISRCTN29932826.

Examination of Craniofacial Morphology in 10-Month to 5-Year-Old Children with Cleft Lip and Palate

1997 ◽  
Vol 34 (6) ◽  
pp. 490-497 ◽  
Author(s):  
Carmen Casal ◽  
Alejandro Rivera ◽  
Germán Rubio ◽  
Joan Sentís-Vilalta ◽  
Alfonso Alonso ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Craniofacial Morphology ◽  
Consecutive Series ◽  
Growth Reduction ◽  
Short Term ◽  
Isolated Cleft Palate ◽  
Cephalometric Measurements ◽  
Control Study ◽  
Mandibular Incisors

Objective: The purpose of this study was to assess craniofacial growth In children from 10 months to 5 years of age with cleft lip and/or palate and to develop a systematic method of cephalometric measurements. Design: A case-control study. Setting: Craniofacial unit of a teaching hospital for children. Patients: A consecutive series of the first 22 patients with cleft lip and/or palate who underwent early reconstructive treatment [isolated cleft lip (CL) 6; isolated cleft palate (CP) 7; unilateral cleft lip and palate (UCLP) 7; and bilateral complete cleft lip and palate (BCLP) 2] (mean age, 27.9 months) and 22 age- and sex-matched noncleft children. Interventions: Lateral cephalometric headfilms of the children were taken using a pediatric cephalostat. Main Outcome Measures: Cephalometric landmarks were measured according to Ricketts cephalometry. Results: As compared with controls, CL patients had a lingual position and inclination of maxillary and mandibular incisors, an increase of interincisal angle and a decrease of incisor overjet, an increase in facial convexity, and a decrease in facial depth and mandible body length. In CP patients, palatal plane inclination and mandible arch were significantly reduced. In UCLP patients, there was a decrease in molar relation and incisor overbite, an increase in interincisal angle, reduced position and inclination of maxillary incisors and inclination of mandibular incisors, an increase in facial convexity, and lower facial height. Conclusions: Based on the absence of midface growth reduction, these short-term results suggest a tendency toward normal maxillomandibular growth.

Craniofacial Comparisons in 22-Month-Old Lip-Operated Children with Unilateral Complete Cleft Lip and Palate and Unilateral Incomplete Cleft Lip

2000 ◽  
Vol 37 (3) ◽  
pp. 303-317 ◽  
Author(s):  
N.V. Hermann ◽  
B.L. Jensen ◽  
E. Dahl ◽  
S. Bolund ◽  
S. Kreiborg
Keyword(s):  
Statistical Analysis ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Anterior Part ◽  
Craniofacial Morphology ◽  
Control Group ◽  
Facial Morphology ◽  
Surgical Methods ◽  
Student’S T ◽  
Student’S T Test

Objective The objective of the study was to analyze the craniofacial morphology in infants with unilateral complete cleft lip and palate (UCCLP) in which the lip and the anterior part of the palate had been surgically closed at 2 months of age and to compare the morphology with that of a control group with unilateral incomplete cleft lip (UICL) in which the lip had also been surgically closed at 2 months of age. Design The sample consisted of a total of 108 cleft children all fulfilling the entry criteria, besides diagnosis, as follows: The child was of Danish origin; the age of the child was between 650 and 750 days (approximately 22 months) at the time of examination; the child was healthy except for its single cleft malformation; the surgical procedure in each group had been performed at about 2 months of age by the same surgeon. The surgical methods used were a Tennison procedure (UICL group) and a Tennison procedure supplemented by palatovomer plasty (UCCLP group). Methods The method of investigation was infant cephalometry in the lateral, frontal, and axial projections. Linear, angular, and area variables describing the craniofacial morphology were calculated and supplemented by mean plots from the cephalometric projections in the two groups. Results and Conclusions Statistical analysis based on Student's t test showed that the facial morphology in the 22-month-old UCCLP group differed significantly from that of the UICL group. The most pronounced differences were found in the maxillary complex and the mandible. The deviations observed in the UCCLP group at 22 months of age were similar to those previously observed at 2 months of age. However, several of the dysmorphic traits had become less pronounced; some had remained the same; and a few had become worse with time.

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