Evaluation of interdisciplinary treatment outcomes in patients with cleft lip and palate. Part 1.

2018 ◽  
Vol 14 (4) ◽  
pp. 270-283
Author(s):  
Bogna Racka-Pilszak ◽  
Anna Wojtaszek-Słomińska ◽  
Agata Zdun-Ryżewska ◽  
Mikołaj Majkowicz ◽  
Agnieszka Banaszkiewicz ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Multidisciplinary Treatment ◽  
Congenital Defect ◽  
Interdisciplinary Treatment ◽  
Mental Condition ◽  
Language Therapy ◽  
Facial Skeleton ◽  
Before And After ◽  
The University

Cleft palate is the most common congenital defect within the facial skeleton. Coexisting facial deformations are not only visible, but also audible after surgery – children born with cleft lip and palate belong to the risk group for occurrence of speech-language disorders. Due to this fact, they may face inappropriate responses of people around, which may cause poor mental condition. Majority of subjects (ca. 67 percent) experienced unpleasant feelings caused by people around them and noticed contribution of the cleft to lowered selfconfidence. Almost 56 percent of the studied group notices influence of this congenital defect on ability to establish social relationships, and 33 percent – on results achieved at school. <b>Aim.</b> The main aim of the study was to evaluate efficacy of treatment in patients with cleft lip and palate as well as usefulness of applied research tools (questionnaire, GOSLON score). <b>Material and methods.</b> Study material included a group of 45 subjects with unilateral and bilateral cleft lip and palate, who completed multidisciplinary treatment. Mean age of the subjects was 22 years. The study was conducted at the Outpatient Orthodontic Clinic of the University Dentistry Centre of the Medical University of Gdansk. Research methods included evaluation of the occlusal abnormalities before and after treatment using GOSLON score, questionnaire completed by the patient, and specialist speech-language examination. <b>Results.</b> The highest percentage of satisfied patients was observed among subjects, who underwent orthodontic treatment (ca. 90 percent), which corresponded with established improvement in occlusal conditions after treatment. Appearance of the respective facial areas was mainly defined as good or very good. It was also noticed that the more the patient was satisfied with speech-language therapy, the more he/she was satisfied with speech quality. <b>Conclusions.</b> Evaluation of final outcomes of the multidisciplinary treatment in patients with cleft lip and palate constitutes high clinical significance in order to make further development and to evaluate currently used therapeutic management standards.

Presurgical Nasoalveolar Molding Therapy for the Treatment of Bilateral Cleft Lip and Palate: A Preliminary Study

2006 ◽  
Vol 43 (3) ◽  
pp. 321-328 ◽  
Author(s):  
Adam L. Spengler ◽  
Carmen Chavarria ◽  
John F. Teichgraeber ◽  
Jaime Gateno ◽  
James J. Xia
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Average Length ◽  
University Of Texas ◽  
Bilateral Cleft Lip ◽  
Before And After ◽  
Nasal Tip Projection ◽  
A Prospective Study ◽  
The University ◽  
Nasoalveolar Molding

Objective To evaluate the outcome of presurgical nasoalveolar molding therapy in the treatment of patients with bilateral cleft lip and palate. Design A prospective study with blinded measurements. Setting The Cleft and Craniofacial Clinic at the University of Texas at Houston Medical School, Houston, Texas. Patients Eight patients with bilateral cleft lip and palate, treated between 2002 and 2004. Interventions The starting age for presurgical nasoalveolar molding therapy was 34.9 days and the average length of the therapy was 212.5 days. Main Outcome Measures Measurements of intraoral and extraoral casts were performed, and statistical analyses were used to compare the differences between measurements before and after therapy. Results Intraoral measurements demonstrated that there was a statistically significant reduction of the premaxillary protrusion and deviation. There was also a significant reduction in the width of the larger cleft. Extraoral measurements revealed that there was a significant increase in the bi-alar width and in the columellar length and width. Moreover, there was a significant improvement in columellar deviation. Finally, the nostril heights of both sides were increased. Conclusion The authors have quantitatively shown that presurgical nasoalveolar molding therapy has significant advantages in the treatment of bilateral cleft lip and palate patients. It improves the nasal asymmetry and deficient nasal tip projection associated with bilateral cleft lip and palate. It also forces the protruded premaxillary segment into alignment with the dental alveolar segments, improving the shape of the maxillary arch. As a result, the changes associated with presurgical nasoalveolar molding therapy help decrease the complexity of subsequent surgeries.

Acoustic Airway Profiles in Unilateral Cleft Palate Patients

1999 ◽  
Vol 36 (5) ◽  
pp. 434-440 ◽  
Author(s):  
Martin Kunkel ◽  
Ulrich Wahlmann ◽  
Wilfried Wagner
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Contralateral Side ◽  
Cross Sectional ◽  
Topographic Information ◽  
Wide Range ◽  
Before And After ◽  
The Individual ◽  
The University

Objective: This study investigates the nasal airway in unilateral cleft palate patients by means of a noninvasive, objective diagnostic method that provides topographic information about the airway profile. Design: A consecutive sample of patients was measured. Setting: Cleft palate rehabilitation center of the University of Mainz, Germany. Patients: Forty-nine subjects were investigated: 34 full-grown patients with complete unilateral cleft lip and palate and 15 controls with subjective normal nasal patency. Intervention: A transnasal series of three acoustic measurements of nasal volume was performed per nostril; measurements were taken both before and after decongestion with 0.3 mg xylometazoline per nostril. Minimum cross-sectional area, nasal volume, and decongestion capacity were calculated for both the cleft side and the contralateral side and for both nasal sides in controls. Results: Pathologic obstructions (<0.4 cm2) were detected on the cleft side in 75% of patients but were detected in only 15% of patients on the contralateral side (p < .001). The valve area of the cleft side (0.32 ± 0.2 cm2) yielded significantly (p < .001) lower cross-sectional values compared with the contralateral side (0.56 ± 0.1 cm2). Total nasal volume was determined to be 35% smaller on the cleft side (p < .001). Significantly higher decongestion capacity was verified on the cleft side, thus indicating mucosal hypertropy. Conclusion: Despite a wide range of interindividual variability, we recognized a characteristic “descending W” airway pattern in cleft palate patients. Acoustic rhinometry seems to be a powerful tool for acquiring topographic information about the individual airway profile. It has proven helpful in visualizing the location and amount of pathologic obstructions, rendering it especially useful for preoperative investigation and quality control in corrective cleft nose surgery.

Treating Velopharyngeal Inadequacy Using Bilateral Buccal Flap Revision Palatoplasty

2019 ◽  
Vol 4 (5) ◽  
pp. 878-892
Author(s):  
Joseph A. Napoli ◽  
Linda D. Vallino
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
A Priori ◽  
Sufficient Evidence ◽  
Obstructive Sleep ◽  
Before And After ◽  
Buccal Flap

Purpose The 2 most commonly used operations to treat velopharyngeal inadequacy (VPI) are superiorly based pharyngeal flap and sphincter pharyngoplasty, both of which may result in hyponasal speech and airway obstruction. The purpose of this article is to (a) describe the bilateral buccal flap revision palatoplasty (BBFRP) as an alternative technique to manage VPI while minimizing these risks and (b) conduct a systematic review of the evidence of BBFRP on speech and other clinical outcomes. A report comparing the speech of a child with hypernasality before and after BBFRP is presented. Method A review of databases was conducted for studies of buccal flaps to treat VPI. Using the principles of a systematic review, the articles were read, and data were abstracted for study characteristics that were developed a priori. With respect to the case report, speech and instrumental data from a child with repaired cleft lip and palate and hypernasal speech were collected and analyzed before and after surgery. Results Eight articles were included in the analysis. The results were positive, and the evidence is in favor of BBFRP in improving velopharyngeal function, while minimizing the risk of hyponasal speech and obstructive sleep apnea. Before surgery, the child's speech was characterized by moderate hypernasality, and after surgery, it was judged to be within normal limits. Conclusion Based on clinical experience and results from the systematic review, there is sufficient evidence that the buccal flap is effective in improving resonance and minimizing obstructive sleep apnea. We recommend BBFRP as another approach in selected patients to manage VPI. Supplemental Material https://doi.org/10.23641/asha.9919352

Morphologic Effect of Preoperative Maxillofacial Orthopedics (T-Traction) on the Maxilla in Unilateral Cleft Lip and Palate Patients

1993 ◽  
Vol 30 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Margareta Larson ◽  
Kjell-Ove Sällström ◽  
Ola Larson ◽  
John Mcwilliam ◽  
Margareta Ideberg
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
External Device ◽  
Normal Anatomy ◽  
Before And After ◽  
Dental Casts

Sixty-eight children born with complete unilateral cleft lip and palate were studied using dental casts taken at ages 0-0,1; 0,2-0,4; and 0,5-0,6 years of age. They were all treated with preoperative maxillofacial orthopedics using an external device (T-traction). The treatment was started after the first model was taken. Dental casts were analyzed regarding the morphology of the cleft region and the maxillary segments before and after treatment. The measurements were compared with measurements on dental casts of nontreated cleft children of similar age. The results suggest that a more normal anatomy of the cleft region occurs during the first 6 months of life whether preoperative maxillofacial orthopedics (T-traction) is used or not. However, this normalized growth seems to occur faster with the T-traction.

Dental Findings in Parents of Children with Cleft Lip and Palate

1996 ◽  
Vol 33 (5) ◽  
pp. 436-439 ◽  
Author(s):  
Peter J. Anderson ◽  
Anthony L.H., Moss
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Normal Population ◽  
Permanent Teeth ◽  
Dental Anomalies ◽  
Facial Skeleton ◽  
Missing Teeth ◽  
Congenitally Missing Teeth ◽  
Congenitally Missing

The incidence of dental abnormalities in the cleft lip and palate population has been reported to be much higher than in the normal population. The role of genes in the production of a cleft lip and palate, and dental anomalies is thought to be complex, with autosomal dominant, recessive, and x-linked genes all playing a role. Noncleft parents can carry some of the cleft lip and palate genes, which produce clinically subtle manifestations in their facial skeleton. The purpose of this study was to look for evidence of increased dental anomalies in the non-cleft parents of cleft lip and palate children. The dentitions of the parents of 60 children with different types of cleft lip and palate were examined prospectively to see whether or not they exhibited features found more readily in the cleft lip and palate rather than did the normal population. Their dentitions were studied to record the following dental features: congenitally missing teeth, supernumerary teeth, or morphologic changes of the crowns of the permanent teeth. The number and position of any frenal attachments were also recorded. The results of this study did not show any differences in incidence of dental anomalies from the noncleft population. There was no evidence to support the hypothesis that congenital absence of lateral incisors is a microform of cleft lip and palate. Further, these results also failed to reveal any consistent pattern in the number and position of frenal attachments.

scholarly journals Antropometric Evaluation Of Gentur's Cheiloplasty Method In Unilateral Cleft Lip

2017 ◽  
Vol 3 (2) ◽  
pp. 52-60
Author(s):  
Rani Septrina ◽  
Gentur Sudjatmiko
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Anthropometric Data ◽  
Cross Sectional ◽  
Before And After ◽  
Cleft Lip Repair ◽  
Unilateral Cleft Lip Repair ◽  
Palate Patient ◽  
Vertical Height ◽  
Rotation Advancement

Background: Cheiloplasty, the earliest surgical procedure in cleft lip and palate patient, has impact on functional and aesthetical appearance1. The Gentur’s technique is a method of cleft lip surgery that has been developed by him and has been used in RSUPN Cipto Mangunkusumo/Faculty of Medicine Universitas Indonesia2. It uses the rotation-advancement, small triangular, preventing notching concepts with some other details to overcome the wide cleft. This study was conducted to answer whether the Gentur’s technique gives symmetrical result in anthropometric measurements. Methods: Cross sectional analytic study will be taken from medical record in 14 unilateral cleft lip patients underwent cheiloplasty procedure. Direct anthropometric data before and after procedure were analyzed using SPSS17. Anthropometric data such as cupid’s bow, vertical height, horizontal height, vermillion and nostril were noted. Results: From 14 patients, we found 9 patients who underwent surgery in 3 months of age (64.3%) are mostly female (n=9, 64.3%), have complete defect (n=12, 85.8%) and left sided defect (n=8, 57.1%). Gentur’s technique is able to produce significant lip and nose symmetry (CI 95%, pvalue <0.005) in cupid’s bow, vertical height, horizontal height, thickness of vermillion and nose. By doing this technique, the author is able to create good lip and nose symmetry (78.57%) even in wide defect (64.3%) and palatal collapse (57.1%). Conclusion: Gentur’s technique is able to utilize tissue deficiency to create ideal lip and nose in unilateral cleft lip repair even in patients with wide gap.

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.

Skeletal Response to Maxillary Protraction in Patients with Cleft Lip and Palate before Age 10 Years

1994 ◽  
Vol 31 (4) ◽  
pp. 295-308 ◽  
Author(s):  
Rolf S. Tindlund
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Poor Response ◽  
Mixed Dentition ◽  
Forward Movement ◽  
Maxillary Protraction ◽  
Face Height ◽  
Lateral Cephalograms ◽  
Before And After ◽  
Maxillary Dentition

Over the last 15 years, cleft lip and palate (CLP) patients with maxillary deficiency in the care of the Bergen CLP Team have received interceptive orthopedic treatment to correct anterior and posterior crossbites during the deciduous and mixed dentition periods. The present study comprises 72 subjects of various cleft types with anterior crossbite, treated to an acceptable positive overjet by maxillary protraction using a facial mask (Delaire). Lateral cephalograms were taken immediately before and after the active treatment periods. Individuals exhibiting a favorable (fair) skeletal response to the protraction were compared with those who revealed little, (poor) skeletal response. Two cephalometric variables were chosen for the evaluation of the sagittal skeletal treatment changes: (1) the sagittal maxillomandibular change (change of angle ss-n-sm [ANB]); and (2) the forward movement of the maxilla (change of distance NSP-maxp), where maxp (maxillary point) represents the anterior contour of maxilla and NSP is the perpendicular to the naslon-sella-line (NSL) through sella. A numerical change greater than or equal to the value 1.5 (degrees or mm, respectively) was classified as fair versus poor response revealing a change less than 1.5. Fair-response (favorable response) of sagittal maxillomandibular change was found in 63 % of the cases (mean increase of angle ANB was 3.3 degrees), more often when protraction started early. The length of maxilla was increased, the skeletal maxilla was moved forward 1.8 mm, the upper dentition advanced 3.6 mm, the occlusal line was clockwise rotated, and the anterior face height was increased. Similarly, fair-response of forward movement of maxilla was found in 44% of the cases (mean increase of distance NSP-maxp was 2.4 mm), more often when protraction was started early and after long treatment duration. The maxillary prognathism increased 1.8 degrees, the angle ANB increased 3 degrees, the length of maxilla increased 1.5 mm, and the upper dentition was advanced 3.7 mm. The anterior face height increased with counterclockwise rotation of the nasal line, whereas the occlusal line was clockwise rotated. A paired fair-response of both skeletal maxillomandibular change and skeletal forward movement of maxilla was found in 35% of the cases. During protraction the mean increase of maxillary prognathism was 2.1 degrees, the maxilla moved forward 3.1 mm, the maxillary dentition advanced 4.3 mm, the maxillary length increased 1.9 mm, the ANB angle increased 3.7 degrees, and the lower anterior facial height increased 3.4 mm.

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