Evaluation of a Digital Protocol for Pre-Surgical Orthopedic Treatment of Cleft Lip and Palate in Newborn Patients: A Pilot Study

The aim of this study was to evaluate the accuracy, invasiveness and impact on clinical results of a digital oral impression protocol in the pre-surgical orthopedic treatment (PSOT) of newborn cleft lip and palate (CLP) patients undergoing primary alveolar surgical repair. Six patients were divided, according to impression technique used, into a digital (intraoral scanner (IOS)) and a non-digital (tray and putty (T&P)) group. Parents considered IOS impressions to be less invasive, compared to T&P impressions. The clinician that took all the impressions considered the IOS to be less stressful compared to the T&P method. In two T&P patients, the impression was repeated because some important anatomical details were missing, in one case due to patient regurgitation during the first attempt. No impression was repeated, and any adverse event was reported in the IOS group. There were no significant differences between these two protocols in pre-surgical alveolar gap reduction and surgical challenge. The study results indicate that this digital protocol can accelerate the production process of the passive molding plate with an instantaneous transmission of the digital impression to the dental lab, maintaining the same accuracy level and clinical outcomes of classical techniques and reducing the invasiveness of impression taking, avoiding any risk of impression material ingestion or inhalation.

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Intraoral Digital Impression for Speech Aid/Obturator in Children: Report of 2 Cases

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211002686 ◽

2021 ◽

pp. 105566562110026

Author(s):

Amara Abreu ◽

Maria Helena Lima ◽

Eric Hatten ◽

Laura Klein ◽

Daniel Levy-Bercowski

Keyword(s):

Adverse Effect ◽

Case Report ◽

Young Children ◽

Digital Technology ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Surgical Repair ◽

Digital Impression ◽

Clinical Use ◽

Obturator Prosthesis

Cleft patients may develop an abnormal opening (fistula) between the oral and the nasal cavities. Surgical repair minimizes the adverse effect on speech and feeding. However, an obturator prosthesis is a nonsurgical approach to help close the communication. The purpose of the case report presented is to show the clinical use of an intraoral digital impression in the fabrication of obturator/speech aid appliances in children with cleft lip and palate deformity. Minimal adjustments were needed, and patients and caregivers responded positively. Prostheses demonstrated good stability and retention at delivery. The use of digital technology seems to have several benefits as an alternative method for capturing impressions, especially in young children with cleft lip and palate deformity.

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The Basis for Presurgical Orthopedic Treatment of Infants with Unilateral Complete Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569(2000)037<0026:tbfpot>2.3.co;2 ◽

2000 ◽

Vol 37 (1) ◽

pp. 26-32 ◽

Cited By ~ 13

Author(s):

Vesna Koželj

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Orthopedic Treatment

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Comparison of Direct and Indirect Scanners in Digital Impression Systems: A Narrative Review

Journal of Isfahan Dental School ◽

10.18502/ijds.v17i2.6885 ◽

2021 ◽

Author(s):

Mahsa Abbasi ◽

Behnaz Ebadian ◽

Negin Aminianpour

Keyword(s):

Clinical Studies ◽

Dimensional Accuracy ◽

Clinical Results ◽

Digital Impression ◽

Lower Amount ◽

Intraoral Scanner ◽

Marginal Gap ◽

Accuracy Rate ◽

Impression Materials ◽

Internal Gap

Introduction: Digital impression tools are an alternative to old impression materials and have developed significantly in recent years. These systems generally include two types of scanners: direct and indirect scanners. This article aimed to review and compare these two types of scanners. Description: Data were collected by reviewing a total of forty articles on dimensional accuracy, a combination of scans, and internal and marginal gaps for comparison of direct and indirect scanners. These articles were retrieved from PubMed and Scopus and published between 2010 and 2020 using the following keywords: intraoral scanner, lab scanner, marginal gap, internal gap, and accuracy rate. Results: Direct scanners had a lower amount of marginal and internal gaps, while indirect scanners had a lower deviation in more prepared teeth in the half and full arch due to the ability of stitching scans. Regarding the dimensional accuracy, the results of studies were inconsistent, but clinical studies pointed to the superiority of indirect scanners. The type of scanner suggested being selected depending on conditions such as the size of area, time, convenience of procedure, etc. The clinical results of both types of scanners were clinically acceptable.

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THE MAIN DIRECTIONS IN THE COMPLEX REHABILITATION OF CHILDREN WITH CLEFT LIP AND PALATE

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors1136-43 ◽

2013 ◽

Vol 1 (1) ◽

pp. 36-43 ◽

Cited By ~ 1

Author(s):

Yulia Vladimirovna Stepanova ◽

Margarita Sergeevna Tsyplakova

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Social Adaptation ◽

Psychological Help ◽

Complex Treatment ◽

Upper Lip ◽

Orthopedic Treatment ◽

Professional Psychological Help ◽

Specialized Center ◽

Congenital Cleft

Complex treatment of children with cleft lip and palate is complicated and multi-step. Treatment is conducted by high-skilled specialists. The organization and execution of this complex are possible only at the large specialized center. Coordinator of this work is the maxillofacial surgeon. The performance of rehabilitation circuits includes preoperative orthodontic and orthopedic treatment, operative intervention (reconstructive and plastic surgery), orthodontic and orthopedic treatment after operation. Post-operative conservative treatment prevents the development of secondary deformities of the nose and upper lip. Professional psychological help and long supervision promote the achievement of good social adaptation of patients with congenital cleft lip and palate, improvement of their health.

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Duration of Surgery, Ventilation, and Length of Hospital Stay Do Not Affect Breastfeeding in Newborns After Early Cleft Lip Repair

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620949114 ◽

2020 ◽

pp. 105566562094911

Author(s):

Iva Burianova ◽

Milos Cerny ◽

Jiri Borsky ◽

Kristyna Zilinska ◽

Jana Dornakova ◽

...

Keyword(s):

Hospital Stay ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Surgical Repair ◽

Artificial Ventilation ◽

Duration Of Hospital Stay ◽

Duration Of Surgery ◽

Ventilation Support ◽

Cleft Lip Repair ◽

The Impact

Objective: There are minimal data available on nutrition after early repair of cleft lip and the factors influencing initiation of breastfeeding. This study assessed the impact of the length of surgery, length of ventilation support, and duration of hospital stay on breastfeeding rates after early cleft lip surgery. Design: This is a prospective observational cohort study comparing 2 hospitals providing early surgical repair of facial clefts from January 2014 to December 2016. Both hospitals are designated as Baby-Friendly Hospitals. Demographic and anthropometric data from mothers and newborns were recorded. Setting: Tertiary neonatal and pediatric surgery center. Patients: Hospital A: 61 newborns, Hospital B: 157 newborns. Interventions: Early (day 5 to 14) cheiloplasty in newborns with cleft lip or cleft lip and palate. Main Outcome Measures: Influence of duration of hospital stay, length of operation, and artificial ventilation on the rate of breastfeeding. Results: Significantly, more newborns were breastfed following early surgical repair of an isolated cleft lip compared to those with both cleft lip and palate, in both hospitals (hospital A 82% vs 0%, P = .0001, hospital B 66% vs 5%, P = .0001). Duration of hospital stay, length of operation, and duration of artificial ventilation did not significantly affect the rate of breastfeeding. Conclusions: The factors associated with early cleft lip repair (length of operation, length of ventilation support, and duration of hospital stay) do not affect breastfeeding rate.

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Surgical Repair of Orofacial Clefts in North Kivu Province of Eastern Democratic Republic of Congo (DRC)

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620947604 ◽

2020 ◽

Vol 57 (11) ◽

pp. 1314-1319

Author(s):

Luc Malemo Kalisya ◽

Jacques Fadhili Bake ◽

Bake Elisee ◽

Kavira Nyavandu ◽

Robert Perry ◽

...

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Democratic Republic ◽

Cleft Lip And Palate ◽

Surgical Repair ◽

Democratic Republic Of Congo ◽

Orofacial Clefts ◽

Republic Of Congo ◽

General Surgeons ◽

North Kivu

Background: There is a high prevalence of orofacial clefts in low- and middle-income countries with significant unmet need, despite having 50% of the population younger than 18 years in countries such as the Democratic Republic of Congo (DRC). The purpose of this article is to report on the experience of general surgeons with orofacial clefts at a single institution. Methods: This is a retrospective study of patients treated for cleft lip/palate in the province of North Kivu, DRC between 2008 and 2017. Results: A total of 1112 procedures (122/year) were performed. All procedures were performed by general surgeons following training by an international nongovernmental aid organization. A total of 59.2% of patients were male and the median age was 3.4 years (interquartile range: 0.7-13 years). Average distance from surgical center to patient location was 242.6 km (range: 2-1375 km) with outreach performed for distances >200 kms. A majority (82.1%) of patients received general anesthesia (GA) with significant differences in use of GA, age, weight, and length of stay by major orofacial cleft category. Of the 1112 patients, 86.1% were reported to have cleft lip alone, 10.5% had cleft lip and palate, and 3.4% cleft palate alone. Despite this, only 5.3% of patients underwent surgical repair of cleft palate. Conclusions: Multiple factors including malnutrition, risk of bleeding, procedural complexity, and cosmetic results may contribute to the distribution of procedures performed where most cleft palates are not treated. Based on previously published estimates, unmet needs and social burden of cleft lip and palate are high in the DRC.

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Effects of Presurgical Orthopedic Treatment in Infants with Complete Bilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1998_035_0227_eopoti_2.3.co_2 ◽

1998 ◽

Vol 35 (3) ◽

pp. 227-232 ◽

Cited By ~ 1

Author(s):

Katsuaki Mishima ◽

Toshio Sugahara ◽

Yoshihide Mori ◽

Katsuhiro Minami ◽

Masayoshi Sakuda

Keyword(s):

Discriminant Analysis ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Three Dimensional ◽

Predictor Variables ◽

Measuring Apparatus ◽

Orthopedic Treatment ◽

Wire Frame ◽

Bilateral Cleft Lip ◽

Posterior Shift

Objective To align the protruding premaxilla in infants with bilateral cleft lip and palate (BCLP), an intraoral appliance (i.e., Hotz plate) and an extraoral appliance consisting of a band covering the head and elastics are used as a presurgical orthopedic treatment in our clinic. The aim of this study was to analyze the configuration and position of the premaxilla and the vomer in infants with BCLP and to investigate the factors generating deviation and bending of the vomer and twisting of the premaxilla. Patients Palatal casts were obtained serially from 10 infants with complete BCLP from 1 to 3 months of age. Measurements These casts were automatically measured using a highly accurate contact-type measuring apparatus. After three-dimensional wire frame models generated from the serial casts were automatically superimposed, the magnitude and direction of the shift were calculated. A discriminant analysis was used for investigation of predictor variables generating the twisting or bending vomer. Results and Conclusions The vomer was found to be bent in two infants and the premaxilla was twisted in three infants. In the infants whose vomers were bent, the magnitude of the posterior shift of the premaxilla was greater than that of the inferior shift. A discriminant analysis indicated that at 1 month of age, a greater inclination and a smaller deviation of the vomer and a longer distance between the cleft edges of the lateral segments had a tendency to be associated with bending of the vomer or twisting of the premaxilla.

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