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

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.

Innovative method to assess maxillary arch morphology in oral cleft: 3d-3d superimposition technique

This study aimed to analyze the maxillary growth and development of children with oral clefts using the innovative method of 3D-3D superimposition technique. Children with unilateral complete cleft lip (UCL) and unilateral cleft lip and palate (UCLP) participated in the study. The impressions of the dental arches were executed 1 day before and 1 year after lip repair surgery. A 3D laser scanner digitized the dental models and the stereophotogrammetry system software analyzed the 3D-3D superimpositions in two groups of matches (same child, UCL and UCLP) and one group of mismatches (different individuals). The differences were evaluated by Root Mean Square (RMS) and expressed in millimeters (mm). Kruskal-Wallis test followed by post-hoc Dunn test and Mann-Whitney test were assessed to compare the groups (α=5%). RMS was 1.34 mm (± 0.37) in UCL group, 1.41 mm (± 0.32) in UCLP group, and 3.38 mm (± 1.28) in mismatches group. RMS was significantly greater in mismatches than in matches groups (p<0.0001). No statistically significant differences occurred between genders. The 3D-3D superimposition technique showed the maxillary development after lip repair surgery in the anterior region of the palate. Thus, it is suggested that the cleft amplitude and the palatal segments proportion influenced the morphological heterogeneity and, consequently, the development and maxillary growth of children with orofacial cleft.

Rehabilitation following surgical management of mneti: a splint in time saves nine!

Introduction: Melanotic neuroectodermal tumour of infancy (MNTI) is a rare, rapidly growing pigmented neoplasm of neural crest origin generally arising in infants during the first year of life. The rehabilitation of the anterior defect is necessary to circumvent feeding problems. The area is also a site for primary growth of maxilla and placing a hard splint would restrict the same. We have used a novel way to use a soft splint to overcome this issue with follow up and re-fabrication. Case report: We report a 7 months old male who presented with a rapidly growing mass history of a rapidly growing mass in the upper front part of the jaw a biopsy showed melanotic neuroectodermal tumour, and complete resection with negative margins was subsequently achieved. The patient was reviewed at follow up with a magnetic resonance imaging, which showed no residual remnants. Rehabilitation was done with a soft splint to avoid restriction of maxillary growth. Conclusion: Due to its rapid growth potential and locally destructive behaviour, early diagnosis is extremely important to limit local expansion. The treatment of choice for melanotic neuroectodermal tumour of infancy (MNTI) is surgical excision. Rehabilitation is also important with due attention to avoiding restriction maxillary growth, this was overcome by use of soft splint which has scantly been reported in literature.

Assessment of dental arch relationships in 5-year-old children with unilateral cleft lip and palate after neonatal cleft lip repair

Background Non-syndromic cleft lip and palate (CLP) is one of the most common craniofacial malformations. The purpose of this study was to assess the dental arch relationships in 5-year-old children with non-syndromic unilateral cleft lip and palate (UCLP) and to compare the results with the data published by other cleft centers. Methods The models of forty-six patients with unilateral cleft lip and palate taken at the age of five were scored. Neonatal cleft lip repair and one-stage palatal closure at the age from 6 to 13 months were performed in all patients by the same surgeon according to the same protocol. The outcomes of the dental arch relationships were assessed and categorized by three orthodontists experienced in cleft care; for scoring the 5 Year Olds´ index was used. Results The mean score of the 5 Year Olds´ index was 2.42. Of all the patients, 57% belonged to groups 1 and 2 (good result), 24% to group 3 (fair result), and 19% to groups 4 and 5 (poor result). These results were compared with the data published by other cleft centers. The outcomes of our method were comparable to the results achieved by other cleft centers which followed different surgical protocols. Conclusions The results of our study showed that neonatal cleft lip repair and one-stage palatal closure lead to satisfactory maxillary growth and interdental relationships.

Long Term Evaluation Of Maxillary Growth After ‘The Non Denuded Palatoplasty’ Technique

Background : Conventional Two Flap Palatoplasty technique will produce lateral defects without any periosteal coverage. These denuded lateral defects are prone to contamination and infection. These will result in wound contraction, scar formation and maxillary growth impairment. In 2011, we studied “The Non Denuded Palatoplasty” technique. This technique precipitated the epithelialization process of the lateral defects. Faster epithelialization is expected to decrease wound contraction and good maxillary growth. Method : This is a case control study to compare the maxillary growth of 2 groups consists of unilateral cleft lip and palate patients repaired with “The Non Denuded Palatoplasty” technique and Conventional Two Flap Palatoplasty. The outcome will be evaluated from cephalometry and the dental cast for each patient is evaluated using GOSLON YARDSTICK method. Data will be analyzed using SPSS version 20. Result : A total of 4 patients in The Non Denuded Palatoplasty group and 10 in the Conventional Two Flap Palatoplasty. The cephalometric SNA, SNB and ANB point showed Class III skeletal jaw relationship or deficient maxilla. Meanwhile the GOSLON yardstick type III are the most common GOSLON on both group with good inter-ratter reliability (p=0.839) based on Mann Whitney test. In these study, there was no correlation between cephalometric variables with GOSLON score. Conclusion: Our results showed that modification (The Non Denuded Palatoplasty) technique made no statistically significant difference to the maxillary growth. However this study has several limitations, one of which being the small sample size due to family, social and other factors that are beyond the control of the investigating team. Also the evaluation was conducted in patients aged 7-9 years, hence the result of this study is not the final outcome. Keywords: maxillary growth evaluation, cephalometry, Goslon Yardstick, two flap palatoplasty

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: maxillary growth at eight years of age

Summary Objectives To assess differences in craniofacial growth at 8 years of age according to the different protocols for primary cleft surgery in the Scandcleft project. Design and setting Prospective, randomized, controlled clinical trial (RCT) involving 10 centres, including non-syndromic Caucasians with unilateral cleft lip and palate (UCLP). In Trial 1, a common surgical method (1a) with soft palate closure at 3–4 months of age and hard palate closure at 12 months of age was tested against similar surgery but with hard palate repair at 36 months (delayed hard palate closure) (1b). In Trial 2, the common method (2a) was tested against simultaneous closure of both hard and soft palate at 1 year (2c). In Trial 3, the common method (3a) was tested against hard palate closure together with lip closure at 3 months of age and soft palate closure at 1 year of age (3d). Participants were randomly allocated by use of a dice. Operator blinding was not possible but all raters of all outcomes were blinded. Subjects and methods The total number of participating patients at 8 years of age was 429. Lateral cephalograms (n = 408) were analysed. The cephalometric angles SNA and ANB were chosen for assessing maxillary growth for this part of the presentation. Results Within each trial (Trial 1a/1b, Trial 2a/2c, and Trial 3a/3d), there was no difference in cephalometric values between the common and the local arm. There were no statistically significant differences in the SNA and ANB angles between the common arm in Trial 1a (mean SNA 77.8, mean ANB 2.6) and Trial 2a (mean SNA 79.8, mean ANB 3.6) and no difference between Trial 1a and Trial 3a, but a statistical difference could be seen between Trial 2a and Trial 3a (mean SNA 76.9, mean ANB 1.7). However, the confidence interval was rather large. Intra- and inter-rater reliability were within acceptable range. Conclusions The timing and the surgical method is not of major importance as far as growth outcomes (SNA and ANB) in UCLP are concerned. Registration ISRCTN29932826 Protocol The protocol was not published before trial commencement.