Lip Movement in Patients with a History of Unilateral Cleft Lip

2001 ◽  
Vol 38 (5) ◽  
pp. 468-475 ◽  
Author(s):  
Christel A. W. Rutjens ◽  
Paul H. M. Spauwen ◽  
Pascal H. H. M. van Lieshout
Keyword(s):  
Cleft Lip ◽  
Relative Phase ◽  
Cleft Lip And Palate ◽  
General Increase ◽  
Lower Lip ◽  
History Of ◽  
Lip Movement ◽  
Cleft Lip Repair ◽  
Palate Repair ◽  
The Stability

Objective: The influence of a repaired cleft lip on the stability of coordination between upper and lower lip in nonspeech and speech tasks was investigated. Design: First, we looked at the effects of a secondary cleft lip repair in three individuals. Second, we compared subjects with a history of repaired unilateral cleft lip and subjects with no history of cleft lip (controls). Lip coordination was measured using continuous estimates of relative phase. Participants: Subjects were nine children and adolescents with a primary unilateral cleft lip and palate repair and 4 participants without cleft matched for age across different age categories. Results: In general, the averaged relative phase angle (RPA) angle values were smaller than 180 degrees, indicating an upper lip lead for lip closure. Controls showed a tendency toward a more symmetric type of coordination (close to 180 degrees), compared with subjects with a repaired unilateral cleft lip. The controls also showed less variation in coordination between the lips. For the more complex speech tasks, a general increase in variability of the RPA values for all subjects was observed, most likely suggesting a more flexible type of coordination. Regarding the effect of a secondary cleft lip repair, only one of the three patients showed a clearly less symmetric and less stable type of coordination, compared with preoperation results. Conclusions: There appear to be differences in lip coordination between speakers without and speakers with a repaired unilateral cleft lip. Furthermore, it seems that the stability of lip coordination tends to increase with age.

Improved Early Cleft Lip and Palate Complications at a Surgery Specialty Center in the Developing World

2018 ◽  
Vol 55 (8) ◽  
pp. 1145-1152 ◽  
Author(s):  
Eugene Park ◽  
Gaurav Deshpande ◽  
Bjorn Schonmeyr ◽  
Carolina Restrepo ◽  
Alex Campbell
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Developing World ◽  
Cleft Lip And Palate ◽  
Care Delivery ◽  
Complication Rates ◽  
Surgical Mission ◽  
Cleft Palate Repair ◽  
Cleft Lip Repair ◽  
Palate Repair

Objective: To evaluate complication rates following cleft lip and cleft palate repairs during the transition from mission-based care to center-based care in a developing region. Patients and Design: We performed a retrospective review of 3419 patients who underwent cleft lip repair and 1728 patients who underwent cleft palate repair in Guwahati, India between December 2010 and February 2014. Of those who underwent cleft lip repair, 654 were treated during a surgical mission and 2765 were treated at a permanent center. Of those who underwent cleft palate repair, 236 were treated during a surgical mission and 1491 were treated at a permanent center. Setting: Two large surgical missions to Guwahati, India, and the Guwahati Comprehensive Cleft Care Center (GCCCC) in Assam, India. Main Outcome Measure: Overall complication rates following cleft lip and cleft palate repair. Results: Overall complication rates following cleft lip repair were 13.2% for the first mission, 6.7% for the second mission, and 4.0% at GCCCC. Overall complication rates following cleft palate repair were 28.0% for the first mission, 30.0% for the second mission, and 15.8% at GCCCC. Complication rates following cleft palate repair by the subset of surgeons permanently based at GCCCC (7.2%) were lower than visiting surgeons ( P < .05). Conclusions: Our findings support the notion that transitioning from a mission-based model to a permanent facility-based model of cleft care delivery in the developing world can lead to decreased complication rates.

Dental Cast Study of Adult Patients with Untreated Unilateral Cleft Lip or Cleft Lip and Palate in Indonesia Compared with Surgically Treated Patients in the Netherlands

1993 ◽  
Vol 30 (3) ◽  
pp. 313-319 ◽  
Author(s):  
Paul H.M. Spauwen ◽  
Widanto Hardjowasito ◽  
Jan Boersma ◽  
Benny S. Latief
Keyword(s):  
Surgical Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Intervention ◽  
Negative Effects ◽  
Tongue Position ◽  
Cleft Lip Repair ◽  
Palate Repair ◽  
Maxilla And Mandible ◽  
Dental Cast

To determine differences in maxillary and dentoalveolar relationships between untreated and treated patients having unilateral clefts of the lip and alveolus (UCLA) or lip and palate (UCLP), dental cast assessments were done on 70 untreated adult indonesian patients (UCLA-I, UCLP-I) and 67 Dutch patients, surgically treated in infancy (UCLA-D, UCLP-D). The indonesian group consisted of 44 UCLA-I and 26 UCLP-I patients, and the Dutch group of 24 UCLA-D and 43 UCLP-D patients. In the UCLA-I patients, deformities occurred in that part of the dentoalveolar complex that surrounds the cleft. Lip repair in the UCLA-D group more frequently caused deformities in the incisor and buccal areas on the cleft side. In the UCLP-I patients, deformities were present in the incisor and cuspid areas on the cleft side. The buccal segments showed collapse both on the cleft and noncIeft sides. Lip and palate repair in the UCLP-D group caused significantly more deformities in the incisor, cuspid, and buccal areas up to the level of the first molars, both on the cleft and noncleft sides. Surgical treatment seems to cause maxillary and dentoalveolar deformities up to the first molars more frequently, but these are not as pronounced as one would expect: following the practiced surgical regimen, the deformities were usually mild. Negative effects of surgical intervention seem to be antagonized by the restored integrity of the lip and palate leading to orientation of maxillary parts and correction of tongue position, which in turn has a molding effect on the maxilla and mandible.

Effect of Lip Closure on Facial Growth in the Surgically Induced Cleft Rabbit

1978 ◽  
Vol 86 (5) ◽  
pp. ORL-786-ORL-803 ◽  
Author(s):  
Karl J. Eisbach ◽  
Janusz Bardach
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Control Level ◽  
Facial Growth ◽  
Skull Measurements ◽  
Cleft Palate Repair ◽  
Cleft Lip Repair ◽  
Palate Repair ◽  
Maxillary Growth ◽  
Repair Group

This project was designed to determine whether cleft lip repair has an influence on facial growth. To study this, 62 rabbits were divided into four groups: control, control without repair, Millard-type repair, and Bardach-type repair. Surgical clefts of the lip, alveolus, and the palate were created in 6-week-old rabbits. Periodic measurements were made of the pressure exerted by the lip on the maxillary alveolus. The animals were killed 20 weeks postoperatively. The skulls were processed and measurements were taken from the skulls. The pressure measurements showed a definite increase in lip pressure on the maxillary alveolus for the lip repair group. This pressure was high soon after surgery, rapidly returned toward the control level, but never reached it. Skull measurements indicate an inhibition in anterior maxillary growth for the “control without repair” group. This inhibition was even more profound in the two lip repair groups. No significant differences were found in maxillary width or mandibular length. When correlations were made to see if increased lip pressure resulted in decreased anterior maxillary growth, a significant correlation was found for both lip repair groups. This means that as the pressure of the lip repair increased, it resulted in a decrease in anterior maxillary growth. The data reported here indicates that cleft lip surgery must be considered as having a definite influence on anterior maxillary growth inhibition observed in the cleft lip and palate population. Further studies are indicated to determine the role of cleft palate repair on facial growth.

scholarly journals Functional Outcomes of Cleft Lip Surgery. Part II: Quantification of Nasolabial Movement

2007 ◽  
Vol 44 (6) ◽  
pp. 607-616 ◽  
Author(s):  
Carroll-Ann Trotman ◽  
Julian J. Faraway ◽  
H. Wolfgang Losken ◽  
John A. van Aalst
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Mouth Opening ◽  
Upper Lip ◽  
Vertical Movements ◽  
Lower Lip ◽  
Lower Jaw ◽  
Lip Movement ◽  
The Asymmetry

Objective: To explore nasolabial movements in participants with repaired cleft lip and palate. Design: A parallel, three-group, nonrandomized clinical trial. Subjects: Group 1 = 31 participants with a cleft lip slated for revision surgery (revision), group 2 = 32 participants with a cleft lip who did not have surgery (nonrevision), and group 3 = 37 noncleft control participants. Methods: Three-dimensional movements were assessed using a video-based tracking system that captured movement of 38 landmarks placed at specific sites on the face during instructed maximum smile, cheek puff, lip purse, mouth opening, and natural smile. Measurements were made at two time points at least 1 week and no greater than 3 months apart. Summary measurements were generated for the magnitude of upper lip, lower lip, and lower jaw movements and the asymmetry of upper lip movement. Separate regression models were fitted to each of the summary measurements. Results: Lateral movements of the upper lip were greater than vertical movements. Relative to the noncleft group, the revision and nonrevision groups demonstrated 6% to 28% less upper lip movements, with the smiles having the most restriction in movement and greater asymmetry of upper lip movement. Having an alveolar bone graft further increased the asymmetry, while a bilateral cleft lip decreased the asymmetry. Lower jaw movement caused a small increase in upper lip movement. Conclusions: The objective measurement of movement may be used as an outcome measure for cleft lip surgery.

Combined Use of Infraorbital and External Nasal Nerve Blocks for Effective Perioperative Pain Control during and after Cleft Lip Repair

2009 ◽  
Vol 46 (6) ◽  
pp. 629-635 ◽  
Author(s):  
Mariah L. Salloum ◽  
Kyle R. Eberlin ◽  
Navil Sethna ◽  
Usama S. Hamdan
Keyword(s):  
Pain Control ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Intravenous Sedation ◽  
Nerve Blocks ◽  
Perioperative Analgesia ◽  
Combined Use ◽  
Adolescents And Adults ◽  
Cleft Lip Repair ◽  
Palate Repair

Perioperative analgesia in patients undergoing cleft lip and palate repair is complicated by the risk of postoperative airway obstruction. We describe a technique of combined infraorbital and external nasal nerve blocks to reduce the need for opioid analgesia. Using this technique, we have successfully performed cleft lip repair under local anesthesia alone, without general anesthesia or intravenous sedation, in adolescents and adults. In children, this technique can reduce the need for postoperative opioids. We describe this novel analgesic approach to decrease opioid requirements and minimize perioperative risk.

Anophthalmia, Cleft Lip/Palate, Absent Vomer Bone, Nystagmus, and Mental-Motor Retardation: A New Syndrome or Fryns“Anophthalmia-Plus” Syndrome?

2008 ◽  
Vol 45 (3) ◽  
pp. 256-260
Author(s):  
Derya Özçelik ◽  
İbrahim Sağlam ◽  
Fatma Sılan ◽  
Gülbin Sezen ◽  
Toygar Ünveren
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Congenital Nystagmus ◽  
Normal Lymphocyte ◽  
Cleft Lip Palate ◽  
Cleft Palate Repair ◽  
Motor Retardation ◽  
Cleft Lip Repair ◽  
Palate Repair ◽  
Rotation Advancement

Objective: We report that a 4-year-old boy presented with right unilateral complete cleft lip and palate, right anophthalmos, left congenital nystagmus, absence of the vomer bone, mental-motor retardation, and normal lymphocyte karyotype (46, XY). Methods: For reconstruction of the deformities, we performed cleft lip repair by Millard's rotation-advancement technique and planned cleft palate repair. Conclusions: This combination of cleft lip and palate, anophthalmos, congenital nystagmus, absent vomer bone, and mental-motor retardation has not, to our knowledge, previously been described. We suggest that this represents either another case of the rare Fryns “anophthalmia-plus” syndrome or a new syndrome.

scholarly journals Nasal Aesthetic Evaluation Following Pre-Surgical Naso-Alveolar Molding Application: A Single-Blinded Cohort Retrospective Study in Indonesia

2021 ◽  
Vol 8 (1) ◽  
pp. 38-46
Author(s):  
Kristaninta Bangun ◽  
Chaula Luthfia Sukasah ◽  
Jenisa Amanda Sandiarini Kamayana ◽  
Adi Basuki ◽  
Jessica Halim ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Dome Height ◽  
Control Group ◽  
Aesthetic Unit ◽  
History Of ◽  
Palate Repair ◽  
Prior Application ◽  
And Control

Introduction: As a major facial aesthetic unit, the nose is one of the significant features in cleft lip and palate repair. The use of a naso-alveolar molding (NAM) device was known to help narrow the cleft gap and improve nasal aesthetics. This study aims to evaluate post-operative nasal morphology in unilateral cleft lip and palate patients who had used presurgical NAM, particularly in an established craniofacial centre in one of developing countries. Methods: A cohort retrospective study was conducted at Cleft Craniofacial Centre, Cipto Mangunkusumo Hospital Indonesia, comparing the nasal symmetry in unilateral cleft lip patients with and without prior application of NAM (NAM and control group), twelve months following primary cheiloplasty. Differences between the cleft and normal side were assessed using standard basilar view photographs based on five points nasal measurements. Results: A total of twelve patients were enrolled, six with a history of NAM application and six without (control). Overall nasal measurements confirmed a lower mean of differences in the NAM group compared to the control, showing statistically significant results in nostril height, nasal dome height, and columellar height (p <0.05). Conclusion: This study provides an insight that cleft lip patients with a history of NAM application had superior nasal symmetry compared to patients without presurgical NAM application 1-year post-cheiloplasty. Presurgical NAM application is recommended for patients with unilateral cleft lip and palate.

The Relationship Between Maxillary Growth and Speech in Children With a Unilateral Cleft Lip and Palate at 5 Years of Age

2021 ◽  
pp. 105566562110106
Author(s):  
Matthew Fell ◽  
Jibby Medina ◽  
Kate Fitzsimons ◽  
Miriam Seifert ◽  
Anne Roberts ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Poor Growth ◽  
History Of ◽  
Dental Models ◽  
Maxillary Growth ◽  
Growth Scores ◽  
Outcomes For Children ◽  
The Relationship ◽  
Normal Speech

Objective: This study sought to investigate the association between maxillary growth and speech outcomes for children with a repaired unilateral cleft lip and palate (UCLP) at 5 years of age. Participants: In all, 521 children (180 females and 341 males) with a nonsyndromic complete UCLP, born between 2007 and 2012 in England, Wales, and Northern Ireland were included in this study. Outcome Measures: Maxillary growth was analyzed using dental models scored by the 5-Year-Olds’ index, and perceptual speech analyses were scored by the Cleft Audit Protocol for Speech – Augmented rating. Results: Forty-one percent of the children achieved good maxillary growth (scores 1 and 2 on 5-Year-Old’ index). Fifty percent of the children achieved normal speech (achieving UK speech standard 1). Maxillary growth was not found to have an impact on speech outcome when described by the 3 UK National Cleft Lip and Palate Speech Audit Outcome Standards. Analysis according to individual speech parameters showed dentalizations to be less prevalent in children with good maxillary growth compared to fair and poor growth ( P = .001). The remaining speech parameters within resonance, nasal airflow, and articulation categories were not significantly associated with maxillary growth. Conclusion: The findings from this study suggest that children with a history of complete UCLP, who have poor maxillary growth, are not at a higher risk of having major speech errors compared to children with good or fair maxillary growth at 5 years of age.

scholarly journals Atypical Outcomes of Nasal and Lip Appearance After Unilateral Cleft Lip Repair: Judgment by Professionals, Patients, and Laypeople

2021 ◽  
pp. 105566562098280
Author(s):  
Robin A. Tan ◽  
Frans J. Mulder ◽  
Roderic M. F. Schwirtz ◽  
David G. M. Mosmuller ◽  
Henrica C. W. De Vet ◽  
...  
Keyword(s):  
Analysis Of Variance ◽  
Online Survey ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Old Patients ◽  
Rank Score ◽  
Cleft Lip Repair ◽  
Typical Appearance ◽  
Unilateral Cleft Lip Repair ◽  
Insight Into

Objective: To gain more insight into the assessment of “atypical” nasal and lip appearance outcomes compared to “typical” appearance outcomes after unilateral cleft lip and palate (UCLP) repair, when judged by professionals, patients with repaired UCLP, and laypeople. Design: An online survey containing 3 series of photographs with various degrees of “typical” and “atypical” nasal and lip appearance outcomes after UCLP repair was sent to 30 professionals, 30 patients with repaired UCLP, and 50 laypeople in 2 countries. Participants were instructed to rank the photographs from excellent to poor based on overall appearance. Mean rank positions of photographs were analyzed and differences in mean rank score between “typical” and “atypical” results were assessed using a T-test. Agreement of ranking between the 3 groups was assessed with an analysis of variance analysis. Setting: Amsterdam UMC, location VUmc, Netherlands and Boston Children’s Hospital, Boston, USA. Patients: Photographs of 6- to 18-year-old patients with repaired UCLP. Results: “Atypical” appearance outcomes were ranked significantly less favorably (small nostril: P = 0.00; low vermillion border: P = 0.02; whistling deformity: P = 0.00) compared to “typical” outcomes. Difference between professionals, patients and laypeople in rank positioning the photographs was not statistically significant ( P = 0.89). Conclusions: Noses with a smaller nostril and lips containing a whistling deformity were perceived as poorer outcome compared to the “typical” results. Professionals, patients, and laypeople are in agreement when assessing these outcomes.

Anthropometric Outcome of Primary Unilateral Cleft Lip Repair in Indonesia

2021 ◽  
pp. 105566562098275
Author(s):  
Robertus Arian Datusanantyo ◽  
Magda Rosalina Hutagalung ◽  
Sitti Rizaliyana ◽  
Djohansjah Marzoeki
Keyword(s):  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Inclusion Criteria ◽  
Initial Size ◽  
Tertiary Center ◽  
Observational Cohort ◽  
Cleft Lip Repair ◽  
Unilateral Cleft Lip Repair ◽  
Junior Residents

Objective: This study aimed to measure and analyze the outcome of primary unilateral cleft lip repair. Design: Observational cohort study. Setting: Surabaya Cleft Lip and Palate (CLP) Center, a major referral center for the Eastern part of Indonesia, affiliated with a tertiary center. Patients, Participants: From 69 patients who met the inclusion criteria, we excluded 31 patients who were more than 2 years of age and were operated on by junior residents under supervision. Interventions: We performed anthropometric measurements of the patients on photographs taken before, immediately after, and a year after the surgery. Main Outcome Measure(s): This study measured nasal width, vertical lip height, horizontal lip length, and philtral height ratios. Results: While nasal width and philtral height ratios decreased significantly ( P = .000 and P = .000, respectively) reaching symmetry immediately after surgery, the horizontal lip length, and vertical lip height ratios remained unchanged ( P = .862 and P = .981, respectively). A year after surgery, the nasal width and horizontal lip length ratios increased significantly ( P = .017 and P = .006, respectively), while philtral height and vertical lip height ratios remained unchanged ( P = .927 and P = .138, respectively). There was no difference in the ratios based on the initial size and completeness of the cleft. Conclusion: In Surabaya CLP Center, the symmetry of nasal width, philtral height, horizontal lip length, and vertical lip height were achieved by the unilateral cleft lip repair despite the initial size and completeness of the cleft.

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