RECONSTRUCTION OF CLEFT LIP AND PALATE AND STANDARDIZATION OF THEIR CLINICAL RECORD FROM INFANCY THROUGH ADOLESCENCE

2021 ◽  
pp. 63-65
Author(s):  
Ashish Kumar
Keyword(s):  
Treatment Planning ◽  
Cleft Lip ◽  
Soft Tissues ◽  
Cleft Lip And Palate ◽  
Vital Role ◽  
Point Of View ◽  
Clinical Record ◽  
Intrinsic Factors ◽  
Future Clinical Practice ◽  
Treatment Procedures

INTRODUCTION: Orthodontics and dentofacial orthopaedics play an important role in reconstruction of child with cleft lip and palate (CLP). In layman term, cleft palate can be dened breach in continuity of the palate. DISCUSSION: Generally, midfacial irregularity and maxillary retrusion are the commonly seen problem after the surgical correction of CLP patients, which occurs mainly because of intrinsic factors, functional or adaptive factors inuencing the position and growth of normal and abnormal part and iatrogenic factors due to effect of treatment procedures. The principle of NAM is “negative sculpturing” and “passive molding” of the alveolus and the soft tissues. Orthodontic techniques are used to mold the maxillary, alveolar, and nasal tissues of an infant with CLP. Despite all the hard work that goes into every case, one aspect seems to be missing among many dentists across the globe is proper documentation of their cases. A proper documentation has many advantages. From start of the treatment planning in diagnosis to follow-up and for patient satisfaction point of view, standardization of clinical record play vital role in management of cleft lip and palate patents. CONCLUSION: The orthodontist play an important role in reconstruction of cleft lip and palate patient from birth to adulthood and provides both esthetic and functional treatment. knowing proper documentation not only improves diagnosis and treatment planning for orthodontist but also improve their future clinical practice

Orthodontic Pre Grafting Closure of Large Alveolar Bony and Soft Tissue Gaps: A Novel Nonsurgical Protraction of the Lesser Segments in Growing Patients With Cleft Lip and Palate

2021 ◽  
pp. 105566562110076
Author(s):  
Maria Costanza Meazzini ◽  
Noah Cohen ◽  
Valeria Marinella Augusta Battista ◽  
Cristina Incorvati ◽  
Federico Biglioli ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Procedures ◽  
Efficient Method ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Soft Tissues ◽  
Cleft Lip And Palate ◽  
Face Mask ◽  
Younger Patients ◽  
Good Healing

Background: Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the dentoalveolar defect are challenging for the surgeon. Some authors successfully used interdental segmental distraction, which requires an additional surgical procedure. Objective: This study evaluates the effectiveness of tooth borne devices utilized to orthopedically advance the lesser segments, with a complete approximation of the soft tissue of the alveolar stumps, allowing traditional simultaneous soft tissue closure and bone grafting, and avoiding the need for supplementary surgery. Methods: Eight growing patients, 2 with unilateral complete cleft lip and palate (UCLP) and 6 with bilateral complete cleft lip and palate (BCLP), with large soft tissue and bony alveolar defects prior to bone grafting were prospectively selected. A banded rapid palatal expander (RPE) in BCLP and a modified RPE in UCLP combined with protraction face mask in younger patients or a modified Alt-Ramec in patients older than 12 years were applied. Radiographic and photographic records were available at T0, at the end of protraction (T1) and at least 1 year after bone grafting (T2). Results: Patients with large gaps showed a significant reduction in the bony cleft area and approximation of the soft tissues at T1. All patients received bone grafting with good healing and ossification at T2. Conclusion: In growing patients with UCLP and BCLP with large gaps, presurgical orthodontic protraction seems to be an efficient method to reduce the cleft defect, minimizing the risk of post grafting fistulas, reducing the need for supplementary surgical procedures.

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.

scholarly journals ROLE OF A PEDODONTIST IN CLEFT LIP AND CLEFT PALATE REHABILITATION - AN OVERVIEW

2021 ◽  
Vol 9 (07) ◽  
pp. 882-906
Author(s):  
Payel Basu ◽  
◽  
Rani Somani ◽  
Deepti Jawa ◽  
Shipra Jaidka ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Multidisciplinary Care ◽  
Vital Role ◽  
Pediatric Dentist ◽  
Orofacial Region ◽  
The Right ◽  
Potential Area

Cleft lip and palate is one of the most common congenital anomalies requiring multidisciplinary care. Such anomaly is associated with many problems such as impaired feeding, defective speech, hearing difficulties, malocclusion, dental abnormalities, gross facial deformity as well severe psychological problems. Cleft of the lip and palate is one of the complex conditions that occur at a functionally potential area in the orofacial region and also at such a crucial time that strategic interventions at the right age by the concerned specialists becomes the need of the hour. Pediatric dentist is an integral part of the cleft rehabilitative process right from the neonatal period upto the phase of permanent dentition. Being well versed with a childs growth and development, both physical and mental, a Pedodontist helps in restoring function and esthetics in a cleft child, in a most empathetic way. This article describes the enormous challenges faced by these innocent souls and the vital role played by a Pedodontist, to provide comprehensive cleft care, be it preventive, restorative, or interventional care, in order to achieve the best possible outcome and meaningfully improve their quality of life.

scholarly journals Cleft Maxillary Hypoplasia

2021 ◽  
pp. 1675-1702
Author(s):  
Philip Mathew ◽  
Mustafa. K ◽  
Paul Mathai
Keyword(s):  
Treatment Planning ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Clinical Problem ◽  
Congenital Defect ◽  
Individualized Treatment ◽  
Maxillary Hypoplasia ◽  
Surgical Interventions ◽  
Detailed Evaluation

AbstractCleft lip and palate patients are born with a challenging deformity that requires multiple surgical interventions in order to reach functional and esthetic harmony. Mid face deficiency in cleft patients is a challenging clinical problem very often encountered in the management of this congenital defect. Cleft maxillary hypoplasia can be attributed to the inherited traits, acquired traits and Induced traits. CLP patients usually present with symptoms varying from malocclusion, retrusion of midface, and a narrow hard palate. A detailed evaluation and individualized treatment planning is of utmost importance in dealing with these patients. Treatment involves the contribution from both the orthodontist and the craniofacial team. The goals for the treatment for cleft maxillary hypoplasia are improvement of aesthetic deficits as well as correction of malocclusion.

OrthoAligner “NAM”: A Case Series of Presurgical Infant Orthopedics (PSIO) Using Clear Aligners

2019 ◽  
Vol 57 (5) ◽  
pp. 646-655 ◽  
Author(s):  
Puneet Batra ◽  
Bruno Frazāo Gribel ◽  
B. A. Abhinav ◽  
Anika Arora ◽  
Sreevatsan Raghavan
Keyword(s):  
Treatment Planning ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Case Series ◽  
3 Dimensional ◽  
The Past ◽  
Belo Horizonte ◽  
Infant Orthopedics

Presurgical infant orthopedics (PSIO) is done to reduce the size of the cleft defect along with improving the arch alignment and nasolabial aesthetics in patients with cleft lip and palate, leading to an improvement of nasolabial aesthetics allowing for a tidier and more aesthetic reparative procedure and postsurgical scar. Since the 2000s, clear aligners have slowly and steadily treaded their way as an acceptable orthodontic modality, with their usage and acceptability increasing considerably over the past decade. Thus, from the knowledge gathered in its 10 years working with 3-dimensional (3-D) diagnosis, treatment planning, and 3-D Printing services, Compass 3D (Belo Horizonte, Brazil) developed the OrthoAligner NAM system. This case series highlights one of the world’s first documented cases of PSIO treated with a series of clear aligners.

Congenital Heart Diseases Associated With Cleft Lip and Palate and Its Impact on Surgical Treatment Planning of Patients With Cleft Lip and Palate—A Cross-Sectional Study

2020 ◽  
pp. 105566562094308
Author(s):  
Gautam Rao ◽  
Anil Desai ◽  
Niranjan Kumar
Keyword(s):  
Surgical Treatment ◽  
Treatment Planning ◽  
Congenital Heart ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Heart Diseases ◽  
Congenital Heart Diseases ◽  
Clinical Records ◽  
Surgical Treatment Planning ◽  
Cleft Surgery

Objectives: The aim of this study is to know the prevalence, type of congenital heart diseases (CHDs), and its association with cleft lip and/or palate and to know the impact of CHDs on surgical treatment planning of cleft lip and palate from a craniofacial hospital specializing in orofacial clefts, head and neck cancer, and trauma management. Design: A total of 1381 patients with nonsyndromic cleft lip and palate were included in the study. This is a hospital-based retro–prospective case record analysis. The data were collected from clinical records of the patients which included clinical, chest radiographic and 2D echocardiographic findings. Total incidence of CHDs and its impact on treatment planning was evaluated using κ statistics and χ2 test. Results: There were 32 (2.32%) cleft lip and palate patients with CHDs. In 2 patients, cleft surgery was delayed by 6 to 9 months to allow the defect to decrease in size. Subacute bacterial endocarditis prophylaxis was administered in 7 patients before cleft surgery. Cardiac surgery was advised prior to cleft surgery in 3 patients. Sixteen patients with CHDs were not taken for cleft surgery considering the potential risk to the patient’s life as they had multiple cardiac anomalies. There were no intraoperative and postoperative complications in these patients. Conclusion: The results emphasize the association between clefting and CHD. The collected data suggest that there should be careful examination of children with cleft lip and palate for signs of heart disease. This could significantly reduce the morbidity/mortality of cleft lip and palate surgery making it more predictable and safer.

scholarly journals Visual and Statistical Modeling of Facial Movement in Patients with Cleft Lip and Palate

2005 ◽  
Vol 42 (3) ◽  
pp. 245-254 ◽  
Author(s):  
Carroll-Ann Trotman ◽  
Julian J. Faraway ◽  
Ceib Phillips
Keyword(s):  
Cleft Lip ◽  
Soft Tissues ◽  
Cleft Lip And Palate ◽  
Principal Component ◽  
Three Dimensions ◽  
Facial Movement ◽  
Movement Data ◽  
Patient Groups ◽  
School Of Dentistry ◽  
Normal Scale

Objective To analyze and display facial movement data from noncleft subjects and from patients with cleft lip and palate by using a new dynamic approach. The hypothesis was that there are differences in facial movement between the patients with cleft lip and palate and the noncleft subjects. Setting Subjects were recruited from the University of North Carolina School of Dentistry Orthodontic and Craniofacial Clinics. Patients, Participants Sixteen patients with cleft lip and palate and eight noncleft “control” subjects. Interventions Video recordings and measurements in three dimensions of facial movement. Main Outcome Measures Principal component (PC) scores for each of six animations or movements and dynamic modeling of mean animations. Statistics Multivariate statistics were used to test for significant differences in the PC mean scores between the patient groups and the noncleft groups. Results No statistically significant differences were found in PC mean scores between the patient groups and the noncleft groups; however, the variability of the effect of clefting on the soft tissues during animation was noted when the noncleft data were used to establish a “normal” scale of movement. Compensatory movements were seen in some of the patients with cleft lip and palate, and the compensation was not unidirectional. Conclusion Measures of mean movement differences as summarized by PC scores between patients with cleft lip and palate and noncleft subjects may be misleading because of extreme variations about the mean in the patient group that may neutralize group differences. It may be more appropriate to compare patients to a noncleft normal scale of movement.

Orthodontic Treatment of Malocclusion Associated with Repaired Complete Clefts of the Lip and Palate

1979 ◽  
Vol 6 (2) ◽  
pp. 73-83 ◽  
Author(s):  
W. C. Shaw
Keyword(s):  
Soft Tissue ◽  
Treatment Planning ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Mixed Dentition ◽  
Deciduous Dentition ◽  
Arch Form ◽  
Progressive Development ◽  
General Care

The literature concerning orthodontic treatment of malocclusion associated with cleft lip and palate has been reviewed. The aims of treatment and a number of skeletal, soft tissue, dento-alveolar and general care factors which influence treatment planning are discussed. The effect of early orthopaedic treatment, examined solely on the grounds of eventual arch form in the deciduous dentition, reveals a prophylactic benefit in some, but not all reports. There would appear to be little benefit in carrying out orthodontic treatment in the deciduous dentition but it is suggested that the progressive development of severe overclosure during the mixed dentition phase should be intercepted using simple appliances. The most important phase of treatment follows eruption of the permanent dentition and appliances are described which are capable of substantial radial and vertical corrections in preparation for a permanent prosthesis.

3D-Printed Models of Cleft Lip and Palate for Surgical Training and Patient Education

2017 ◽  
Vol 55 (3) ◽  
pp. 323-327 ◽  
Author(s):  
Pang-Yun Chou ◽  
Rami R. Hallac ◽  
Ellen Shih ◽  
Jenny Trieu ◽  
Anjani Penumatcha ◽  
...  
Keyword(s):  
Patient Education ◽  
Cleft Palate ◽  
Parental Education ◽  
Cleft Lip ◽  
Soft Tissues ◽  
Cleft Lip And Palate ◽  
3D Models ◽  
Physical Models ◽  
3D Printed ◽  
Manufacturing Techniques

Background: Sculpted physical models and castings of the anatomy of cleft lip and palate are used for parent, patient, and trainee education of cleft lip and palate conditions. In this study, we designed a suite of digital 3-dimensional (3D) models of cleft lip and palate anatomy with additive manufacturing techniques for patient education. Methods: CT scans of subjects with isolated cleft palate, unilateral and bilateral cleft lip and palate, and a control were obtained. Soft tissue and bony structures were segmented and reconstructed into digital 3D models. The oral soft tissues overlying the cleft palate were manually molded with silicone putty and scanned using CT to create digital 3D models. These were then combined with the original model to integrate with segmentable soft tissues. Bone and soft tissues were 3D printed in different materials to mimic the rigidity/softness of the relevant anatomy. These models were presented to the parents/patients at our craniofacial clinic. Visual analog scale (VAS) surveys were obtained pertaining to the particular use of the models, to ascertain their value in parental education. Results: A total of 30 parents of children with cleft conditions completed VAS evaluations. The models provided the parents with a better understanding of their child’s condition with an overall evaluation score of 9.35 ± 0.5. Conclusions: We introduce a suite of 3D-printed models of cleft conditions that has a useful role in patient, parental, and allied health education with highly positive feedback.

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