Influence of Early Hard Palate Closure in Unilateral and Bilateral Cleft Lip and Palate on Maxillary Transverse Growth during the First Four Years of Age

2003 ◽  
Vol 40 (2) ◽  
pp. 126-130 ◽  
Author(s):  
Bernhard Lehner ◽  
Joerg Wiltfang ◽  
Karin Strobel-Schwarthoff ◽  
Michaela Benz ◽  
Ursula Hirschfelder ◽  
...  
Keyword(s):  
Hard Palate ◽  
Primary Closure ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Three Dimensional ◽  
Arch Width ◽  
Significant Difference ◽  
Early Primary ◽  
Delayed Closure ◽  
The University

Objective To evaluate and compare the effects of early primary closure of the hard palate on the anterior and posterior width of the maxillary arch in children with bilateral (BCLP) and unilateral (UCLP) cleft lip and palate during the first 4 years of life. Design A retrospective, mixed-longitudinal study. Setting Cleft Palate Center of the University of Erlangen-Nuremberg. Subjects and Methods The present investigation analyzes longitudinally 42 children with UCLP and 8 children with BCLP between 1996 and 2000 with early simultaneous primary closure of lip and hard palate (4 to 5 months). Palatal arch width was measured on dental casts with a computer-controlled three-dimensional digitizing system, and their growth velocities were calculated from consecutive periods (mean follow-up 39 months). Differences in growth velocities were compared with those of 25 children with UCLP and 15 children with BCLP with delayed closure of hard palate (12 to 14 months). Results and Conclusions There was no significant difference in terms of anterior and posterior maxillary width between early and delayed closure of hard palate within the first 4 years of life.

Comparison between the Palatal Configurations in Complete and Incomplete Unilateral Cleft Lip and Palate Infants under 18 Months of Age

2001 ◽  
Vol 38 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Katsuaki Mishima ◽  
Yoshihide Mori ◽  
Toshio Sugahara ◽  
Masayoshi Sakuda
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Three Dimensional ◽  
Measuring System ◽  
Posterior Arch ◽  
Orthopedic Treatment ◽  
Arch Width ◽  
Significant Difference ◽  
The Difference ◽  
Arch Forms

Objective The purpose of this study was to examine the three-dimensional characteristics of the palatal configurations in incomplete unilateral cleft lip and palate (UCLP) patients and to determine whether there are differences in the effect of early orthopedic treatment between complete and incomplete UCLP patients. Design Eight infants with incomplete UCLP and 12 infants with complete UCLP, selected at random, wore Hotz plates, and 8 other infants with complete UCLP did not. Palatal impressions were taken of these patients immediately after birth and at 1, 2, 3, 4 (just before cheiloplasty), 6, and 18 months of age (just before palatoplasty). Using our measuring system, the palatal casts were measured and compared three-dimensionally. Results and Conclusions The palate of the incomplete UCLP patients measured immediately after birth, compared with complete UCLP, showed: (1) smaller posterior arch width; (2) sagittal arch length did not differ; (3) incisal point was located more mesially; (4) the gap between the alveolar arch forms of the major and minor segments was smaller; and (5) the curvature of the palatal surface forward the nasal cavity in the minor segment was less. At 18 months of age, the following characteristics could be observed: (1) the difference observed at birth in the posterior arch width between the incomplete and complete UCLP infants vanished; (2) a significant difference in the location of the incisal point was observed only between the incomplete UCLP infants and the complete UCLP infants with a Hotz plate; and (3) the curvature was less in the incomplete UCLP infants than in the complete UCLP infants. Furthermore, the morphological change of the palatal surface was less in the incomplete UCLP infants than in the complete UCLP infants. This suggested that any influence of the Hotz appliance might be less in incomplete UCLP than in complete UCLP.

Growth Rate of the Vomer in Normal and Cleft Lip and Palate Human Fetal Specimens

1992 ◽  
Vol 29 (1) ◽  
pp. 38-43 ◽  
Author(s):  
Kyle R. Kimes ◽  
Mark P. Mooney ◽  
Michael I. Siegel ◽  
John S. Todhunter
Keyword(s):  
Growth Rate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Three Dimensional ◽  
Growth Curves ◽  
Reconstruction Technique ◽  
Linear Component ◽  
Volumetric Growth ◽  
Significant Difference ◽  
Postmenstrual Age

The present study, part of an ongoing investigation of normal and dysmorphic development of the human fetal oronasal capsule, examined the rate of growth of the vomer. For comparative purposes, 29 human fetal specimens (20 “normal” and 9 cleft lip and palate [CLP]) were celloidin embedded, sectioned, stained with hematoxylin and eosin, and serially digitized. The specimens ranged from 8 to 21 weeks in postmenstrual age. The application of a well-documented three-dimensional reconstruction technique provided quantification of several aspects of the vomer. CLP vomer length and volume were growing at a faster rate In the 8 to 21 week age range. Growth curves were produced by plotting length and volume against postmenstrual age and a significant difference was noted between the slopes (growth rate) of the linear component of the normal and CLP growth curves for vomer length (p < .001) and volume (p < .001). This study tested the hypothesis of a more rapidly growing 8 to 21 week CLP vomer and observed that the growth trends of the CLP vomer are similar to those of the CLP nasal septum, which also was found to possess a significantly larger (p < .001) volumetric growth rate throughout the course of the vomer. Comparative findings suggest that a pathogenetic correlate of CLP is the rapid enlargement of the midline structures of the oral and nasal capsules.

Gingivoperiosteoplasty and Midfacial Growth

1997 ◽  
Vol 34 (1) ◽  
pp. 17-20 ◽  
Author(s):  
Robert J. Wood ◽  
Barry H. Grayson ◽  
Court B. Cutting
Keyword(s):  
New York ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
New York University ◽  
Lateral Cephalogram ◽  
Primary Surgery ◽  
Lateral Cephalograms ◽  
Significant Difference

The objective of this study was to report the effect of gingivoperiosteoplasty on growth of the midfacial skeleton 6 years following primary surgical repair. Patients with complete unilateral cleft lip and palate who underwent primary cleft lip and nose repair with and without gingivoperiosteoplasty (GPP) were retrospectively compared by means of a lateral cephalogram. Mean age at the time of evaluation was 5.7 years. All patients were treated at the Institute of Reconstructive Plastic Surgery, New York University Medical Center. All surgery and presurgical orthopedics was performed by the same surgeon and the same orthodontist. Twenty-five consecutively treated patients who presented with complete unilateral clefts of the primary and secondary palate were included in the study. Of these, 20 patients were available for 6-year follow-up cephalometric documentation and review. All patients received preoperative orthopedics with passive molding appliances, followed by repair of the lip, alveolus, and nose in a single stage at the age of 3 months. The repair was performed using the rotation/advancement technique. The difference between the two groups was whether or not gingivoperiosteoplasty was performed. The reason for not performing gingivoperiosteoplasty was incomplete approximation of the alveolar segments usually due to a late start in beginning therapy. Lateral cephalograms (68.5 months post primary surgery) were obtained and traced. Cranial base (S–N), maxilla (ANS–PNS), and mandible (Go–Pg) were digitized for shape coordinate analysis. No significant difference in the mean position of ANS–PNS was found between groups (with or without gingivoperiosteoplasty). There was, however, a significant difference In the variance of position for the points ANS–PNS between the groups (p<.002). We were unable to observe any difference (anteroposterior or supero-inferior) in the average position of the hard palate (ANS–PNS) between groups. We conclude that gingivoperiosteoplasty results in a more uniform position of the hard palate (ANS–PNS) relative to patients that did not receive gingivoperiosteoplasty. We were unable to demonstrate any clear impairment of maxillary growth in the patients treated with gingivoperiosteoplasty when compared to patients treated without gingivoperiosteoplasty.

scholarly journals Dental Arch Width Stability after Quadhelix and Edgewise Treatment in Complete Unilateral Cleft Lip and Palate

2007 ◽  
Vol 77 (6) ◽  
pp. 1067-1072 ◽  
Author(s):  
Weiran Li ◽  
Jiuxiang Lin
Keyword(s):  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Three Dimensional ◽  
Dental Arch ◽  
Arch Width ◽  
Basal Bone ◽  
Transverse Stability ◽  
The Difference ◽  
Dental Arch Width

Abstract Objective: To evaluate the transverse stability of the dental arch in unilateral cleft lip and palate (UCLP) patients after orthodontic treatment with quadhelix and edgewise appliances. Materials and Methods: Twenty repaired complete UCLP patients with posterior crossbites were chosen as the study subjects. All had ceased retention at least 15 months previously. Measurements were carried out directly on the pretreatment, posttreatment, and postretention study models using a three-dimensional dental cast analyzer. The interdental widths were measured for the canines, first premolars, second premolars, first molars, basal bone, and the alveolar arch. Two-way analysis of variance and Fisher's LSD was performed in comparing the difference between intervals. Results: Lower inter-first-premolar width and upper arch widths of each region increased significantly (P &lt; .05) after orthodontic treatment. The expansion was greater in the anterior than the posterior region in the upper arch, and the greatest increase was in the upper first premolar region. The upper arch width decreased after retention, with the decrease of the arch width in the upper canine (1.3 ± 0.8 mm) and first premolar (1.5 ± 0.8 mm) regions being statistically significant. The increased upper arch width in each region and the lower inter-first-premolar width maintained significant expansion after retention. Conclusions: The widths of the dental arch increased significantly after expansion with a quadhelix followed by preadjusted edgewise treatment. Relapse occurred, especially in the upper canine and first premolar region, but most of the treatment effect on the upper arch remained after retention.

Evaluation of the Effects of Cheiloplasty on Maxillary Arch in UCLP Infants Using Three-Dimensional Digital Models

2019 ◽  
Vol 56 (8) ◽  
pp. 1013-1019 ◽  
Author(s):  
Thanawut Kongprasert ◽  
Kengkart Winaikosol ◽  
Araya Pisek ◽  
Aggasit Manosudprasit ◽  
Amornrut Manosudprasit ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
High Reliability ◽  
Anterior Part ◽  
Intraclass Correlation ◽  
Dental Arch ◽  
Posterior Arch ◽  
Anterior Arch ◽  
Arch Width ◽  
Significant Difference

Objective: To analyze and identify changes in the maxillary dental arch before and after cheiloplasty in a group of unilateral complete cleft lip and palate (UCLP) infants. Design: This is a cohort study. Material and Method: Study models from 16 infants with nonsyndromic UCLP, who were treated at Khon Kaen University, were taken before (T1) and after cheiloplasty (T2). The dental models underwent a process of scanning through a 3D scanner, from which 9 linear and 2 angular landmarks were evaluated. Paired t test was used to compare the measurement statistically between T1 and T2. Results: Alveolar cleft gap (G-L), anterior basal angle (∠GC-CC′), and anterior arch curvature angle on greater segment (∠GIC) were significantly decreased ( P < .05). Contrarily, anterior ridge length of greater segment (C-I), anterior ridge length of lesser segment (L-C′), and posterior arch width (T-T′) were significantly increased ( P < .05) after cheiloplasty. While, anterior portion of greater segment (I-G), anterior arch width (C-C′), anterior arch depth (I⊥CC′), arch length (G⊥TT′), and arch circumference (T-C-I-G-L-C′-T′) showed no significant difference. The measurements were tested using the Intraclass correlation coefficient. The coefficients indicated high reliability. Conclusion: Cleft gap significantly decreased after lip repair, and the anterior part of maxillary dental arch was also bent palatally after cheiloplasty without any other intervention except cheiloplasty. More studies are needed to assess the amount of lip pressure. If any convincing force is presented, an appliance to prevent undesirable pressure is indicated.

Scandcleft Project Trial 3: Comparison of Speech Outcomes in Relation to Sequence in 2-Stage Palatal Repair Procedures in 5-Year-Olds With Unilateral Cleft Lip and Palate

2020 ◽  
Vol 57 (3) ◽  
pp. 352-363 ◽  
Author(s):  
Christina Persson ◽  
Nina-Helen Pedersen ◽  
Christine Hayden ◽  
Melanie Bowden ◽  
Ragnhild Aukner ◽  
...  
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Composite Measure ◽  
Connected Speech ◽  
Prospective Randomized Clinical Trial ◽  
Speech Characteristics ◽  
Significant Difference ◽  
Age Appropriate

Objective: To compare speech outcome following different sequencing of hard and soft palate closure between arms and centers within trial 3 and compare results to peers without cleft palate. Design: A prospective randomized clinical trial. Setting: Two Norwegian and 2 British centers. Participants: One hundred thirty-six 5-year-olds with unilateral cleft lip and palate were randomized to either lip and soft palate closure at 3 to 4 months and hard palate closure at 12 months (arm A) or lip and hard palate closure at 3 to 4 months and soft palate closure at 12 months (arm D). Main Outcome Measures: A composite measure of velopharyngeal competence (VPC), overall assessment of VPC from connected speech (VPC-Rate). Percentage of consonants correct (PCC), active cleft speech characteristics (CSCs), subdivided by oral retracted and nonoral errors, and developmental speech characteristics (DSCs). Results: Across the trial, 47% had VPC, with no statistically significant difference between arms within or across centers. Thirty-eight percent achieved a PCC score of >90%, with no difference between arms or centers. In one center, significantly more children in arm A produced ≥3 active CSCs ( P < .05). Across centers, there was a statistically significant difference in active CSCs (arm D), oral retracted CSCs (arm D), and DSCs (arms A and D). Conclusions: Less than half of the 5-year-olds achieved VPC and around one-third achieved age-appropriate PCC scores. Cleft speech characteristics were more common in arm A, but outcomes varied within and across centers. Thus, outcome of the same surgical method can vary substantially across centers.

A Comparative Study of Prespeech Vocalizations in Two Groups of Toddlers with Cleft Palate and a Noncleft Group

2000 ◽  
Vol 37 (2) ◽  
pp. 172-178 ◽  
Author(s):  
Elisabeth Willadsen ◽  
Hans Enemark
Keyword(s):  
Mental Retardation ◽  
Retrospective Study ◽  
Cleft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Comparison Group ◽  
Place Of Articulation ◽  
Delayed Closure ◽  
Palatal Surgery

Objective This study examined the prelinguistic contoid (consonant-like) inventories of 14 children with unilateral cleft lip and palate (C-UCLP) at 13 months of age. The children had received primary veloplasty at 7 months of age and closure of the hard palate was performed at 3–5 years. The results of this investigation were compared to results previously reported for 19 children with cleft palate and 19 noncleft children at the age of 13 months. The children with clefts in that study received a two-stage palatal surgery. This surgical procedure was formerly used at our center and included closure of the lip and hard palate at 3 months of age and soft palate closure at 22 months of age. Design Retrospective study. Setting The participants were videorecorded in their homes during play with their mothers. The videotapes were transcribed independently by three trained speech pathologists. Patients Fourteen consecutive patients born with C-UCLP and no known mental retardation or associated syndromes served as subjects. Results The children who received delayed closure of the hard palate demonstrated a significantly richer variety of contoids in their prespeech vocalizations than the cleft children in the comparison group. Both groups of subjects with clefts had significantly fewer plosives in their contoid inventory than the noncleft group, and there was no difference regarding place of articulation between the group that received delayed closure of the hard palate and the noncleft group.

scholarly journals Scandcleft Project Trial 2—Comparison of Speech Outcome in 1- and 2-Stage Palatal Closure in 5-Year-Olds With UCLP

2019 ◽  
Vol 57 (4) ◽  
pp. 458-469
Author(s):  
Inger Lundeborg Hammarström ◽  
Jill Nyberg ◽  
Suvi Alaluusua ◽  
Jorma Rautio ◽  
Erik Neovius ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Burden Of Treatment ◽  
Hearing Thresholds ◽  
Significant Difference ◽  
Age Appropriate ◽  
Velopharyngeal Function

Objective: To investigate in-depth speech results in the Scandcleft Trial 2 with comparisons between surgical protocols and centers and with benchmarks from peers without cleft palate. Design: A prospective randomized clinical trial. Setting: Two Swedish and one Finnish Cleft Palate center. Participants: One hundred twelve participants were 5-years-old born with unilateral cleft lip and palate randomized to either lip repair and soft palate closure at 4 months and hard palate closure at 12 months or lip repair at 3 to 4 months (Arm A), or a closure of both the soft and hard palate at 12 months (Arm C). Main Outcome Measures: A composite measure dichotomized into velopharyngeal competency (VPC) or velopharyngeal incompetency (VPI), overall assessment of velopharyngeal function (VPC-Rate), percentage of consonants correct (PCC score), and consonant errors. In addition, number of speech therapy visits, average hearing thresholds, and secondary surgeries were documented to assess burden of treatment. Results: Across the trial, 53.5% demonstrated VPC and 46.5% VPI with no significant differences between arms or centers. In total, 27% reached age-appropriate PCC scores with no statistically significant difference between the arms. The Finnish center had significantly higher PCC scores, the Swedish centers had higher percentages of oral consonant errors. Number of speech therapy visits was significantly higher in the Finnish center. Conclusion: At age 5, poor speech outcomes with some differences between participating centers were seen but could not be attributed to surgical protocol. As one center had very few participants, the results from that center should be interpreted with caution.

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