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Duc Ky Tran T, Hoai Phuong L, Nguyen Thanh Chon H. Morphological Changes in Maxillary Arch Post-Cheiloplasty in Cleft Lip and Palate Infants: A Case Series. Cleft Palate Craniofac J 2025:10556656251325343. [PMID: 40094615 DOI: 10.1177/10556656251325343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2025] Open
Abstract
ObjectiveThis study evaluated the effectiveness of cleft lip repair in modifying maxillary arch morphology in infants with complete unilateral cleft lip and palate (cUCLP) over a 6-month period.DesignProspective case series.SettingMy Thien Hospital of Odonto-Stomatology, Ho Chi Minh City, Vietnam.ParticipantsFifteen infants with cUCLP, average age 5.07 months.InterventionAll infants underwent unilateral cleft lip repair using Fisher's technique. Maxillary arch impressions were taken before surgery and 6 months postoperatively and converted into 3D models.Main Outcome MeasuresAnalysis focused on maxillary arch dimensions in anteroposterior and transverse directions, changes in cleft width, curvature of the larger segment, and position of the proximal edge.ResultsAlveolar cleft width (GL) and anterior curvature angle (∠GIC) showed significant reductions (P < .05). Additionally, posterior arch width (TT'), maxillary arch depth (I-TT'), and anterior arch depth (I-CC') showed significant increases (P < .05), while anterior arch width (CC') remained unchanged (P = .87). Measurements demonstrated high reliability with ICC > 0.75 for all parameters.ConclusionUnilateral cleft lip repair in cUCLP infants significantly narrowed the alveolar cleft width and reduced the anterior curvature angle. Increases in posterior arch width and maxillary arch depth were also observed. These morphological changes are crucial for planning future surgical interventions to optimize outcomes.
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Affiliation(s)
- Truong Duc Ky Tran
- Maxillofacial Surgery Department, National Hospital of Odonto-Stomatology in Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Lam Hoai Phuong
- Hong Bang International University, Ho Chi Minh City, Viet Nam
- My Thien Hospital of Odonto-Stomatology, Ho Chi Minh City, Vietnam
| | - Ho Nguyen Thanh Chon
- Department of Maxillofacial Surgery, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Brudnicki A, Petrova T, Dubovska I, Kuijpers-Jagtman AM, Ren Y, Fudalej PS. Alveolar Bone Grafting in Unilateral Cleft Lip and Palate: Impact of Timing on Palatal Shape. J Clin Med 2023; 12:7519. [PMID: 38137587 PMCID: PMC10743654 DOI: 10.3390/jcm12247519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/24/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Alveolar bone grafting (ABG) is a critical surgical intervention in patients with a cleft of the alveolus, aimed at reconstructing the alveolar ridge to facilitate proper eruption, periodontal support, and alignment of adjacent permanent teeth. The optimal timing for ABG remains debated, with late secondary ABG between the ages of 9 and 11 being widely adopted. This study compared the palatal shapes of 28 children at a mean age of 9.5 years (SD = 0.7) who underwent early secondary ABG at a mean age of 2.1 years (SD = 0.6) or 33 children at a mean age of 10.8 years (SD = 1.5) who underwent late secondary ABG at a mean age of 8.6 years (SD = 1.3) to 60 non-cleft controls at a mean age of 8.6 years (SD = 1.2). The palatal shapes were captured with 239 landmarks digitized on the palate on a digital model. Utilizing geometric morphometric methods, i.e., generalized Procrustes superimpositions, principal component analysis, and permutation tests, we assessed the impact of ABG timing on palatal morphology. The first five principal components (PCs) explained 64.1% of the total shape variability: PC1 = 26.1%; PC2 = 12%; PC3 = 11.9%; PC4 = 7.8%; and PC5 = 6.4%. The Procrustes distance between both cleft groups and the control group was more than twice as large as the Procrustes distance between the early ABG and late ABG groups. Nonetheless, all intergroup differences were statistically significant. Our findings suggest that early ABG has a limited negative effect on palatal shape, providing comparable outcomes to late ABG. The study highlights the potential suitability of early ABG, challenging conventional practices and encouraging further exploration into its long-term effects on maxillary growth.
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Affiliation(s)
- Andrzej Brudnicki
- Department of Pediatric Surgery, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Tereza Petrova
- Department of Orthodontics and Cleft Anomalies, 3rd Medical Faculty, Faculty Hospital Royal Vineard, Dental Clinic, Charles University, 11636 Prague, Czech Republic;
| | - Ivana Dubovska
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, 77900 Olomouc, Czech Republic (P.S.F.)
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, Medical Faculty, University of Bern, 3010 Bern, Switzerland
- Faculty of Dentistry, Universitas Indonesia, Campus Salemba, Jakarta 10430, Indonesia
| | - Yijin Ren
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Piotr S. Fudalej
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, 77900 Olomouc, Czech Republic (P.S.F.)
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, Medical Faculty, University of Bern, 3010 Bern, Switzerland
- Department of Orthodontics, Jagiellonian University in Cracow, 31-007 Krakow, Poland
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Cardoso JF, Pucciarelli MGR, Laurenti JAS, Laposta AFE, Neppelenbroek KH, Oliveira TM, Soares S. Arch Symmetry in Patients Without and With Cleft Lip and Palate After Orthodontic/Rehabilitative Treatment-A Stereophotogrammetry Study. Cleft Palate Craniofac J 2023; 60:1565-1571. [PMID: 35769043 DOI: 10.1177/10556656221110096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To evaluate and compare the dental arch symmetry of individuals with and without cleft lip and palate after orthodontic/rehabilitation treatment. Cross-sectional study. Tertiary cleft center in Brazil. Fifty-five participants aged between 18 and 30 years were divided into 3 groups according to treatment. Patients that received either a fixed partial denture (FPD) or implant-supported crown (ISC) in the cleft area or only orthodontic treatment, noncleft patients (NC). An analysis was performed using digitized dental casts scanned by laser and software. The following linear measurements were evaluated: incisor-canine; canine-molar; incisor-molar; surface and volume of the palatal region. Three-way ANOVA was used to compare the study factors: group (FPD/ISC/NC) and side (right/left) followed by the Tukey test to verify their interaction (α = .05). The results showed statistically significant differences among groups for the maxillary linear measurements canine-molar and incisor-molar, but not for incisor-canine. No statistically significant differences were found regarding the side for the maxillary measurements, while the factor interaction showed similarity only for incisor-canine. The mandibular measurements showed no statistical differences among groups, sides, or factor interactions. In surface and volume, all values in patients with cleft presented lesser than in without cleft patients. Regardless of the rehabilitation, arch symmetry can be achieved in the incisor-canine dimension in the cleft area.
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Affiliation(s)
- Jefferson Freire Cardoso
- Department of Prosthodontics and Periodontology, Faculdade de Odontologia de Bauru, Universidade de São Paulo (USP), Bauru, SP, Brazil
| | - Maria Giulia Rezende Pucciarelli
- Department of Prosthodontics and Periodontology, Faculdade de Odontologia de Bauru, Universidade de São Paulo (USP), Bauru, SP, Brazil
| | | | | | - Karin Hermana Neppelenbroek
- Department of Prosthodontics and Periodontology, Faculdade de Odontologia de Bauru, Universidade de São Paulo (USP), Bauru, SP, Brazil
| | - Thaís Marchini Oliveira
- Department of Pediatric Dentistry, Orthodontics and Public Health, Faculdade de Odontologia de Bauru, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo (USP), Bauru, SP, Brazil
| | - Simone Soares
- Department of Prosthodontics and Periodontology, Faculdade de Odontologia de Bauru, Universidade de São Paulo (USP), Bauru, SP, Brazil
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo (USP), Bauru, SP, Brazil
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Jaklová LK, Velemínská J, Dupej J, Moravec T, Bejdová Š. Palatal surface development from 6 years of age to early adulthood: data modelling using 3D geometric morphometrics. Clin Oral Investig 2023; 27:2347-2358. [PMID: 36627532 DOI: 10.1007/s00784-023-04857-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/02/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The study followed the modelling of postnatal growth of a healthy palate of the Central European (Czech) population sample based on transverse data on sex and age from 6 to 19 years. MATERIALS AND METHODS Digitised 3D models of 212 healthy palatal surfaces were evaluated using 3D geometric morphometrics and superimpositions. The individuals were grouped based on age (preschool, younger and older school age, younger and older adolescents, young adults) and sex (♂ n = 101, ♀ n = 111). RESULTS Female palatal development was non-linear and was interrupted between the 10-12 years and then proceeded intensively until the age of 15 when it ceased. In contrast, male-modelled growth was consistent throughout the follow-up and continued linearly until at least 19 years of age. The palate did not widen further with increasing age, and primarily palatal vaulting and heightening were found. The characteristics and distribution of areas with extensive modelled growth changes were comparable in females and males, as confirmed by the location of principal components (PC1 and PC2) within modal space and growth trajectories. The extent of sexual dimorphism increased from 15 years of age due to pubertal spurt combined with earlier completion of palatal development in females. CONCLUSIONS The study showed modelled healthy palatal development from 6 years of age to early adulthood, which might be utilised as reference standards for the Central European population sample. CLINICAL RELEVANCE The comparison of normal reference subjects with patients with cranio-maxillo-facial dysmorphologies represents the first step in diagnosing and establishing effective therapy.
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Affiliation(s)
- Lenka Kožejová Jaklová
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Viničná 7, 128 43, Prague 2, Czech Republic.
| | - Jana Velemínská
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Viničná 7, 128 43, Prague 2, Czech Republic
| | - Ján Dupej
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Viničná 7, 128 43, Prague 2, Czech Republic
| | - Tomáš Moravec
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Viničná 7, 128 43, Prague 2, Czech Republic
| | - Šárka Bejdová
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Viničná 7, 128 43, Prague 2, Czech Republic
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Influence of Bone-Borne Trans-Sutural Distraction Osteogenesis Therapy on the Hard Palate of Growing Children With Cleft Lip and Palate. J Craniofac Surg 2022; 33:390-394. [DOI: 10.1097/scs.0000000000008043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hajiazizi R, Golshah A, Azizi B, Nikkerdar N. Assessment of the asymmetry of the lower jaw, face, and palate in patients with unilateral cleft lip and palate. Contemp Clin Dent 2022; 13:40-49. [PMID: 35466301 PMCID: PMC9030302 DOI: 10.4103/ccd.ccd_652_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/17/2020] [Accepted: 10/10/2020] [Indexed: 11/05/2022] Open
Abstract
Background: This study aimed to assess the asymmetry of the lower jaw, face, and palate in patients with unilateral cleft lip and palate (UCLP) using photography, cone-beam computed tomography (CBCT), and digitized three-dimensional casts. Methods: This case–control study was conducted on photographic, CBCT, and digital cast records of 14 UCLP patients and 24 healthy controls between 10 and 16 years. Totally, 65 variables were measured on photographs, CBCT scans, and on digitized casts. Measurements were compared between the two groups and within each group between the two sides. For easier measurement, in patients who had right side CLP, the cleft was transferred to the left side and in subjects without cleft, mild chin deviation was transferred to the left side. Results: The anteroposterior dimensions of the two condyles in the UCLP group were greater than those in the control group, while the mediolateral dimensions of the left condyle and ramus height, mandibular body length, and total length of the mandible in the control group were greater than those in the UCLP group. Right ocular, nasal, and angular variables were greater in the UCLP group. Other variables except for the palatal width from the right canine to midline were greater in the control group. Conclusion: Our findings highlighted the presence of asymmetry in the nasal and palatal areas in patients with UCLP while these patients had no significant difference with healthy controls in the relationship of condyles with the temporomandibular fossa.
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Stereophotogrammetry to evaluate young adults with and without cleft lip and palate after orthodontic and restorative treatment. J Prosthet Dent 2021; 128:355-360. [PMID: 33589235 DOI: 10.1016/j.prosdent.2020.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/23/2022]
Abstract
STATEMENT OF PROBLEM Patients with cleft lip and palate generally present with lateral incisor agenesis, which may be treated with an implant-supported prosthesis. However, whether implants can stabilize the dental arches in patients with cleft lip and palate is unclear. PURPOSE The purpose of this retrospective clinical study was to analyze the stability of the maxillary dental arch after orthodontic treatment and oral rehabilitation in the cleft area with an implant-supported prosthesis or a fixed partial denture. MATERIAL AND METHODS Fifty-five participants, 20 with unilateral cleft lip and palate rehabilitated with implants (CLPI), 15 with unilateral cleft lip and palate rehabilitated with fixed partial dentures (CLPFP), and 20 in the noncleft group (NCLP) and their gypsum casts (N=110) were digitized and evaluated through 3D stereophotogrammetry. Measurements were made on casts obtained immediately after the orthodontic treatment (T1); for the cleft lip and palate group, casts were made 1 year after implant-supported restoration placement (T2), and for the noncleft group, 1 year after the conclusion of the orthodontic treatment (T2). The dimensions of the dental arches were measured digitally. Formula Δ=T2-T1 evaluated the stability of dental arches for intercanine distances, intermolar distances, arch length, palate surface, and volume (3D). Stability (Δ) was compared through 1-way ANOVA in all groups (α=.05). RESULTS A statistically significant difference was found in the stability of the CLPI and CLPFP groups for intercanine measurement (P=.002). For the intermolar measurement, a statistically significant difference was detected between the CLPFP and NCLP groups (P=.002). From the 3D measurements, the stability was similar in all groups. CONCLUSIONS In patients with clefts, a fixed partial denture may provide better stability of the orthodontic outcomes than an implant-supported prosthesis. However, greater instability occurred at the molar area.
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8
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Bruggink R, Baan F, Kramer G, Claessens C, Kuijpers-Jagtman AM, Bronkhorst EM, Maal TJJ, Ongkosuwito E. The effect of lip closure on palatal growth in patients with unilateral clefts. PeerJ 2020; 8:e9631. [PMID: 32821547 PMCID: PMC7396139 DOI: 10.7717/peerj.9631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022] Open
Abstract
Objectives The objective of this study was to compare maxillary dimensions and growth in newborns with Complete Unilateral Cleft Lip and Palate (UCLP) to healthy newborns before and after cheiloplasty. Additionally, a palatal growth curve is constructed to give more information about the natural growth before surgical intervention. Methods Twenty-eight newborns with complete UCLP were enrolled in this study. Multiple plaster-casts of each child during their first year were collected and grouped in before and after cheiloplasty. A previous developed semi-automatic segmentation tool was used to assess the maxillary dimensions and were compared to a healthy control group. Z-scores were calculated to indicate differences between the two populations and if cheiloplasty had influence on maxillary growth. Furthermore, the prediction model created in a previous study was used to indicate differences between predictions and the outcome in UCLP measurements. The analysis was tested for inter- and intra-observer variability. Results Results show differences in alveolar and palatal shape in UCLP patients in comparison with healthy controls. Prior to cheiloplasty an increased width and alveolar length was observed while the palatal depth was decreased. After cheiloplasty the widths moved towards normal but were still significantly larger. Conclusion Infants with unilateral cleft lip and palate show a wider maxillary arch in comparison with the control population. Initial treatment has most influence on the width of the arch, which decreased towards normal.
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Affiliation(s)
- Robin Bruggink
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboudumc 3DLab, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank Baan
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboudumc 3DLab, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gem Kramer
- "Alkmaarse Orthodontisten", Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Colet Claessens
- Radboudumc 3DLab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, Groningen, The Netherlands.,Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland.,Faculity of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Ewald M Bronkhorst
- Department of Dentistry - Preventive and Restorative Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas J J Maal
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edwin Ongkosuwito
- Radboudumc 3DLab, Radboud University Medical Center, Nijmegen, The Netherlands.,Amalia Cleft and Craniofacial centre, Radboud University Medical Center, Nijmegen, The Netherlands
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Rezende Pucciarelli MG, de Lima Toyoshima GH, Marchini Oliveira T, Marques Honório H, Sforza C, Soares S. Assessment of dental arch stability after orthodontic treatment and oral rehabilitation in complete unilateral cleft lip and palate and non-clefts patients using 3D stereophotogrammetry. BMC Oral Health 2020; 20:154. [PMID: 32460814 PMCID: PMC7254638 DOI: 10.1186/s12903-020-01143-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although arch stability has been studied in patients without a cleft, evidence for patients with a cleft is sparse. Therefore, we compared the dimensions and stability of dental arches in cleft lip and palate patients and those without a cleft. METHODS Forty participants, 20 with a complete unilateral cleft lip and palate and 20 non-cleft patients aged from 18 to 30 years, with anterior and/or posterior crossbite and receiving orthodontic treatment were evaluated retrospectively. Eighty gypsum casts were digitized using a laser model scanner casts for both groups made immediately after the orthodontic treatment was completed (T1). Also, for the Cleft Lip and Palate group, casts were obtained and digitized 1 year after implant-supported rehabilitation (T2) and for the Non-Cleft Lip and Palate group, 1 year after the conclusion of the orthodontic treatment (T2). The formula: Δ = T2-T1 evaluated the stability of dental arches for inter-canine distances (C-C'), inter-molar distances (M-M'), arch length (I-M), palate surface and volume. The dimensions of the dental arches were measured digitally. The independent t test was used for statistical analysis (α = 0.05). RESULTS A statistical difference was found in the stability of the groups for inter-canine (cleft area) measurement. At the times T1 and T2, a statistically significant difference was found in the arch length, surface and volume. CONCLUSIONS This study concluded that in the Cleft Lip and Palate group, the maxillary dimensions were not stabilized after 1 year of orthodontic and prosthodontic treatment (mainly for the inter-canine linear measurement) and that the transverse arch dimensions were smaller compared with those of non-cleft patients.
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Affiliation(s)
- Maria Giulia Rezende Pucciarelli
- Bauru School of Dentistry/Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Thais Marchini Oliveira
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry and Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Heitor Marques Honório
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Chiarella Sforza
- Faculty of Medicine and Surgery, Department of Biomedical Sciences for Health, Functional Anatomy Research Center (FARC), Università degli Studi di Milano, Milan, Italy
| | - Simone Soares
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry and Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, São Paulo, 17012-901, Brazil.
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Three-dimensional development of the palate in bilateral orofacial cleft newborns 1 year after early neonatal cheiloplasty: Classic and geometric morphometric evaluation. J Craniomaxillofac Surg 2020; 48:383-390. [PMID: 32184075 DOI: 10.1016/j.jcms.2020.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/31/2020] [Accepted: 02/24/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess palatal growth in newborns with complete bilateral cleft lip and palate (cBCLP) and bilateral cleft lip and palate with tissue bridges (BCLP + B) 1 year after early neonatal cheiloplasty (ENC). MATERIAL AND METHODS The methodology was based on classic and morphometric analysis of dental models of newborns with cBCLP or BCLP + B. These analyses included metric analysis, coherent point drift-dense correspondence analysis, superprojection methods, and multivariate statistics. Dental casts were observed in two age categories, which were compared with each other. The first cast was obtained from each patient before ENC (T0, 5 ± 5 days) and the second one prior to palatoplasty (T1, 12 ± 6 months). RESULTS Fifty-two dental models obtained from 26 newborns with cBCLP and BCLP + B were evaluated. The results showed that over the 12-month period, alveolar clefts were narrowed in both cleft types due to anterior growth combined with the formative effect of suturing. This was confirmed by decreases in the dimensions of the right (T0 9.93 ± 2.80 mm, T1 6.64 ± 2.43 mm; p ≤ 0.003) and left (T0 10.71 ± 4.13 mm, T1 6.69 ± 4.29 mm; p ≤ 0.003) alveolar clefts in cBCLP patients. Similar reductions in alveolar cleft widths occurred on the left side (T0 11.69 ± 4.75 mm, T1 4.34 ± 2.97 mm; p ≤ 0.001) of BCLP + B patients, while on the right side, which was connected by a combined tissue bridge, there was non-significant narrowing of the alveolar cleft (T0 1.61 ± 1.34 mm, T1 1.04 ± 0.70 mm; p = 0.120). The ENC did not restrict posterior palatal growth, meaning that intertuberosity width was extended in cBCLP (T0 32.80 ± 3.15 mm, T1 35.86 ± 2.80 mm; p ≤ 0.001) and in BCLP + B neonates (T0 34.01 ± 2.15 mm, T1 36.21 ± 2.14 mm; p ≤ 0.004). Width and length measurements in the observed groups showed growth tendencies equivalent to those in noncleft or LOP patients. Palatal variability was greater in neonatal cBCLP, but was reduced during the monitored period, approximating that for BCLP + B. Regions with the most notable palatal growth were located primarily at the premaxilla and at the anterior and partially posterior ends of the maxillary segments. CONCLUSION Early neonatal cheiloplasty had no negative effect on palatal growth in any direction. There was no reduction in the length or width of the palate during the first year of life, nor was there narrowing of the dentoalveolar arch. The formative effect of the operated lip on the anterior part of the palate was confirmed. This, in combination with the favorable growth, lead to closure of the alveolar cleft.
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Monga N, Kharbanda OP, Balachandran R, Neelapu BC. Palatal volume estimation in operated unilateral and bilateral cleft lip and palate subjects using digital study models. Orthod Craniofac Res 2020; 23:284-290. [DOI: 10.1111/ocr.12368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Nitika Monga
- Indian Council of Medical Research (ICMR) New Delhi India
- Division of Orthodontics and Dentofacial Deformities Centre for Dental Education and Research All India Institute of Medical Sciences New Delhi India
| | - Om Prakash Kharbanda
- Division of Orthodontics and Dentofacial Deformities Centre for Dental Education and Research All India Institute of Medical Sciences New Delhi India
| | - Rajiv Balachandran
- Division of Orthodontics and Dentofacial Deformities Centre for Dental Education and Research All India Institute of Medical Sciences New Delhi India
| | - Bala Chakravarthy Neelapu
- Academy of Scientific & Innovative Research (AcSIR) CSIR‐Central Scientific Instruments Organisation Chandigarh India
- Koneru Lakshmaiah Education Foundation Vijayawada AP India
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Dindaroğlu F, Duran GS, Doğan S. Dental crown symmetry in unilateral cleft lip and palate patients: A three‐dimensional analysis on digital dental models. Orthod Craniofac Res 2019; 22:281-288. [DOI: 10.1111/ocr.12330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Furkan Dindaroğlu
- Ege University Faculty of Dentistry Department of Orthodontics İzmir Turkey
| | | | - Servet Doğan
- Ege University Faculty of Dentistry Department of Orthodontics İzmir Turkey
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Botticelli S, Küseler A, Mølsted K, Ovsenik M, Nørholt SE, Dalstra M, Cattaneo PM, Pedersen TK. Palatal morphology in unilateral cleft lip and palate patients: Association with infant cleft dimensions and timing of hard palate repair. Orthod Craniofac Res 2019; 22:270-280. [PMID: 31056824 DOI: 10.1111/ocr.12318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/05/2019] [Accepted: 04/26/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To assess the impact of cleft severity and timing of hard palate repair on palatal dimensions in unilateral cleft lip and palate (UCLP) children. SETTING AND SAMPLE POPULATION Single-centre analysis within a multicenter RCT of primary surgery; 122 UCLP randomized to early hard palate closure (EHPC) at 12 months or delayed hard palate closure (DHPC) at 36 months; 28 frequency-matched controls. METHODS Linear measurements of palatal height, width and length were performed on 116 digital models of UCLP subjects (8.21 years, SD = 0.53) and 28 models of non-cleft individuals (8.44 years SD = 0.72). Cleft dimensions at infancy (mean 1.8 months) were considered. In a pilot study, shell-to-shell distances between the 3D cleft palate objects and a reference mesh were calculated and differences between the groups assessed. Morphological differences were visualized using colour mapping. RESULTS Compared to controls, UCLP subjects presented a higher palate at the level of the anterior scar (P = 0.002), but generally a lower palate in the middle region (P < 0.001). Comparing UCLP subgroups, the DHPC subjects showed a flatter palate posteriorly (P = 0.048) and the EHPC group exhibited more transversal constriction (P = 0.003 at M1 level). 3D analysis revealed a shallower palate in the DHPC group both in the middle (P = 0.002) and the posterior part (P = 0.008). Anterior cleft severity correlated negatively with palatal height (P = 0.01). CONCLUSIONS Unilateral cleft lip and palate palates differ from controls in width and height. DHPC may represent an advantage for the transversal dimension, but a disadvantage for palatal height. Infant cleft dimensions partially explain differences in palatal height.
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Affiliation(s)
- Susanna Botticelli
- Section of Orthodontics, Aarhus University, Aarhus, Denmark.,Cleft Lip and Palate Department, Institut for Komunikation og Handikap (IKH), Aarhus, Denmark
| | - Annelise Küseler
- Section of Orthodontics, Aarhus University, Aarhus, Denmark.,Cleft Lip and Palate Department, Institut for Komunikation og Handikap (IKH), Aarhus, Denmark.,Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Mølsted
- Copenhagen Cleft Palate Center-University Hospital of Copenhagen, Copenhagen, Denmark
| | - Maja Ovsenik
- Department of Orthodontics and Dentofacial Orthopedics, University of Ljubljana, Ljubljana, Slovenia
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.,Section of Oral Surgery and Oral Pathology, Aarhus University, Aarhus, Denmark
| | - Michel Dalstra
- Section of Orthodontics, Aarhus University, Aarhus, Denmark
| | | | - Thomas Klit Pedersen
- Section of Orthodontics, Aarhus University, Aarhus, Denmark.,Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
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Girinon F, Ketoff S, Hennocq Q, Kogane N, Ullman N, Kadlub N, Galliani E, Neiva-Vaz C, Vazquez MP, Picard A, Khonsari RH. Maxillary shape after primary cleft closure and before alveolar bone graft in two different management protocols: A comparative morphometric study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:406-409. [PMID: 30763782 DOI: 10.1016/j.jormas.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/21/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
AIM AND SCOPE Result assessment in cleft surgery is a technical challenge and requires the development of dedicated morphometric tools. Two cohorts of patients managed according to two different protocols were assessed at similar ages and their palatal shape was compared using geometric morphometrics. MATERIAL AND METHODS Ten patients (protocol No. 1) benefited from early lip closure (1-3 months) and secondary combined soft and hard palate closure (6-9 months); 11 patients (protocol No. 2) benefited from later combined lip and soft palate closure (6 months) followed by hard palate closure (18 months). Cone-Beam Computed Tomography (CBCT) images were acquired at 5 years of age and palatal shapes were compared between protocols No. 1 and No. 2 using geometric morphometrics. RESULTS Protocols No. 1 and No. 2 had a significantly different timing in their surgical steps but were assessed at a similar age (5 years). The inter-canine distance was significantly narrower in protocol No. 1. Geometric morphometrics showed that the premaxillary region was located more inferiorly in protocol No. 1. CONCLUSION Functional approaches to cleft surgery (protocol No. 2) allow obtaining larger inter-canine distances and more anatomical premaxillary positions at 5 years of age when compared to protocols involving early lip closure (protocol No. 1). This is the first study comparing the intermediate results of two cleft management protocols using 3D CBCT data and geometric morphometrics. Similar assessments at the end of puberty are required in order to compare the long-term benefits of functional protocols.
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Affiliation(s)
- F Girinon
- Arts et métiers ParisTech, LBM, Paris, France
| | - S Ketoff
- Arts et métiers ParisTech, LBM, Paris, France; Assistance publique Hôpitaux de Paris, Hôpital Universitaire Necker - Enfants Malades, Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Centre de Référence des Malformations de la Face et de la Cavité Buccale (MAFACE), Filière Maladies Rares TeteCou, Université Paris Descartes, Université Sorbonne Paris Cité, Paris, France
| | - Q Hennocq
- Assistance publique Hôpitaux de Paris, Hôpital Universitaire Necker - Enfants Malades, Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Centre de Référence des Malformations de la Face et de la Cavité Buccale (MAFACE), Filière Maladies Rares TeteCou, Université Paris Descartes, Université Sorbonne Paris Cité, Paris, France
| | - N Kogane
- Assistance publique Hôpitaux de Paris, Hôpital Universitaire Necker - Enfants Malades, Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Centre de Référence des Malformations de la Face et de la Cavité Buccale (MAFACE), Filière Maladies Rares TeteCou, Université Paris Descartes, Université Sorbonne Paris Cité, Paris, France
| | - N Ullman
- Assistance publique Hôpitaux de Paris, Hôpital Universitaire Necker - Enfants Malades, Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Centre de Référence des Malformations de la Face et de la Cavité Buccale (MAFACE), Filière Maladies Rares TeteCou, Université Paris Descartes, Université Sorbonne Paris Cité, Paris, France
| | - N Kadlub
- Assistance publique Hôpitaux de Paris, Hôpital Universitaire Necker - Enfants Malades, Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Centre de Référence des Malformations de la Face et de la Cavité Buccale (MAFACE), Filière Maladies Rares TeteCou, Université Paris Descartes, Université Sorbonne Paris Cité, Paris, France
| | - E Galliani
- Assistance publique Hôpitaux de Paris, Hôpital Universitaire Necker - Enfants Malades, Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Centre de Référence des Malformations de la Face et de la Cavité Buccale (MAFACE), Filière Maladies Rares TeteCou, Université Paris Descartes, Université Sorbonne Paris Cité, Paris, France
| | - C Neiva-Vaz
- Assistance publique Hôpitaux de Paris, Hôpital Universitaire Necker - Enfants Malades, Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Centre de Référence des Malformations de la Face et de la Cavité Buccale (MAFACE), Filière Maladies Rares TeteCou, Université Paris Descartes, Université Sorbonne Paris Cité, Paris, France
| | - M P Vazquez
- Assistance publique Hôpitaux de Paris, Hôpital Universitaire Necker - Enfants Malades, Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Centre de Référence des Malformations de la Face et de la Cavité Buccale (MAFACE), Filière Maladies Rares TeteCou, Université Paris Descartes, Université Sorbonne Paris Cité, Paris, France
| | - A Picard
- Assistance publique Hôpitaux de Paris, Hôpital Universitaire Necker - Enfants Malades, Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Centre de Référence des Malformations de la Face et de la Cavité Buccale (MAFACE), Filière Maladies Rares TeteCou, Université Paris Descartes, Université Sorbonne Paris Cité, Paris, France
| | - R H Khonsari
- Assistance publique Hôpitaux de Paris, Hôpital Universitaire Necker - Enfants Malades, Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Centre de Référence des Malformations de la Face et de la Cavité Buccale (MAFACE), Filière Maladies Rares TeteCou, Université Paris Descartes, Université Sorbonne Paris Cité, Paris, France.
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15
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Ahmad Y, Starbuck JM. Disruption of symmetry: A quantitative assessment of facial skeleton anatomy in children born with unilateral cleft lip and palate. Clin Anat 2018; 31:1129-1136. [DOI: 10.1002/ca.23277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/20/2018] [Accepted: 09/07/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Yaser Ahmad
- Department of Biomedical SciencesUniversity of Central Florida Orlando Florida 32816
| | - John M. Starbuck
- Department of AnthropologyUniversity of Central Florida Orlando Florida 32816
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16
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Moslerová V, Dadáková M, Dupej J, Hoffmannova E, Borský J, Černý M, Bejda P, Kočandrlová K, Velemínská J. Three-dimensional assessment of facial asymmetry in preschool patients with orofacial clefts after neonatal cheiloplasty. Int J Pediatr Otorhinolaryngol 2018; 108:40-45. [PMID: 29605363 DOI: 10.1016/j.ijporl.2018.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/12/2018] [Accepted: 02/13/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate facial asymmetry changes in pre-school patients with orofacial clefts after neonatal cheiloplasty and to compare facial asymmetry with age-matched healthy controls. METHODS AND MATERIALS The sample consisted of patients with unilateral cleft lip (UCL), unilateral cleft lip and palate (UCLP), and bilateral cleft lip and palate (BCLP). The patients were divided in two age groups with a mean age of 3 years (n = 51) and 4.5 years (n = 45), respectively, and 78 age-matched individuals as controls. Three-dimensional (3D) facial scans were analyzed using geometric morphometry and multivariate statistics. RESULTS Geometric morphometry showed positive deviations from perfect symmetry on the right side of the forehead in the intervention groups and the controls. The UCL groups showed the greatest asymmetric nasolabial area on the cleft-side labia and the contralateral nasal tip. The UCLP group showed, moreover, asymmetry in buccal region due to typical maxillar hypoplasia, which was accentuated in the older group. The BCLP groups showed slightly similar but greater asymmetry than the control groups, except for the philtrum region. CONCLUSIONS Asymmetry of each of the cleft groups significantly differed from the controls. Except for the buccal region in the UCLP and BCLP groups, asymmetry did not significantly increase with age.
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Affiliation(s)
- Veronika Moslerová
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Vinicna 7, 128 44 Prague 2, Czech Republic; Department of Biology and Medical Genetics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 00 Prague 5, Czech Republic.
| | - Martina Dadáková
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Vinicna 7, 128 44 Prague 2, Czech Republic
| | - Ján Dupej
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Vinicna 7, 128 44 Prague 2, Czech Republic; Department of Software and Computer Science, Faculty of Mathematics and Physics, Charles University, Czech Republic
| | - Eva Hoffmannova
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Vinicna 7, 128 44 Prague 2, Czech Republic
| | - Jiří Borský
- Department of Otorhinolaryngology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 00 Prague 5, Czech Republic
| | - Miloš Černý
- Department of Neonatology and IRCU, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 00 Prague 5, Czech Republic
| | - Přemysl Bejda
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Sokolovská 83, 186 75 Prague 8, Czech Republic
| | - Karolína Kočandrlová
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Vinicna 7, 128 44 Prague 2, Czech Republic
| | - Jana Velemínská
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Vinicna 7, 128 44 Prague 2, Czech Republic
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17
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Aras I, Dogan S. Comparative Evaluation of the Pharyngeal Airways and Related Soft Tissues of Unilateral and Bilateral Cleft Lip and Palate Patients with the Noncleft Individuals. Cleft Palate Craniofac J 2017; 54:53-59. [PMID: 26247706 DOI: 10.1597/15-055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim This study is a comparison of pharyngeal airways and associated soft tissues of unilateral and bilateral cleft lip and palate patients with the noncleft individuals. Materials and Methods Twenty-four unilateral cleft lip and palate patients (UCLP), 21 bilateral cleft lip and palate patients (BCLP), and 26 noncleft patients (NC) between ages 15 to 17 were included in the study. Eleven linear, 1 angular, and 1 proportional measurements were carried out on pretreatment lateral cephalometric head films of these individuals. Results The nasopharyngeal depths were markedly reduced in BCLP when compared with the NC (P < .001) and UCLP (P < .01) with a significant difference (P < .01) also among UCLP and NC. Minimum space behind the tongue concerning BCLP and UCLP were significantly lower compared to the NC (P < .001 and P < .01, respectively). In pairwise comparison among the clefts, BCLP showed significant (P < .05) narrowing of this distance. Tongue heights and velar lengths were significantly (P < .001) lower in cleft groups compared to the controls. Similarly, the hyoid bone was positioned in a significantly (P < .01) anterior and inferior direction in cleft patients. Comparison of the mean ratio of velar length to nasopharyngeal depth of the three groups revealed significant (P < .001) inadequacies in cleft patients with significantly (P < .05) more severely reduced values in BCLP. Conclusion Pharyngeal airways and involved soft tissues of cleft patients show serious inadequacies compared to controls, with significant diversities among cleft types pertaining to some of the parameters investigated. It should be kept in mind that these variations can influence function in terms of respiration and phonation.
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Affiliation(s)
- Isil Aras
- Ege University, Faculty of Dentistry, Department of Orthodontics, Izmir, Turkey
| | - Servet Dogan
- Ege University, Faculty of Dentistry, Department of Orthodontics, Izmir, Turkey
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18
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Palatal growth in complete unilateral cleft lip and palate patients following neonatal cheiloplasty: Classic and geometric morphometric assessment. Int J Pediatr Otorhinolaryngol 2016; 90:71-76. [PMID: 27729158 DOI: 10.1016/j.ijporl.2016.08.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/27/2016] [Accepted: 08/29/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND A new method of early neonatal cheiloplasty has recently been employed on patients having complete unilateral cleft lip and palate (cUCLP). We aimed to investigate (1) their detailed palatal morphology before surgery and growth during the 10 months after neonatal cheiloplasty, (2) the growth of eight dimensions of the maxilla in these patients, (3) the development of these dimensions compared with published data on noncleft controls and on cUCLP patients operated using later operation protocol (LOP; 6 months of age). METHODS Sixty-six virtual dental models of 33 longitudinally evaluated cUCLP patients were analysed using metric analysis, a dense correspondence model, and multivariate statistics. We compared the palatal surfaces before neonatal cheiloplasty (mean age, 4 days) and before palatoplasty (mean age, 10 months). RESULTS The palatal form variability of 10-month-old children was considerably reduced during the observed period thanks to their undisturbed growth, that is, the palate underwent the same growth changes following neonatal cheiloplasty. A detailed colour-coded map identified the most marked growth at the anterior and posterior ends of both segments. The maxilla of cUCLP patients after neonatal cheiloplasty had a growth tendency similar to noncleft controls (unlike LOP). CONCLUSIONS Both methodological approaches showed that early neonatal cheiloplasty in cUCLP patients did not prevent forward growth of the upper jaw segments and did not reduce either the length or width of the maxilla during the first 10 months of life.
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19
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Three-dimensional evaluation of facial morphology in pre-school cleft patients following neonatal cheiloplasty. J Craniomaxillofac Surg 2016; 44:1109-16. [PMID: 27534972 DOI: 10.1016/j.jcms.2016.07.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/16/2016] [Accepted: 07/18/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the facial morphology of pre-school patients with various types of orofacial cleft after neonatal cheiloplasty in pre-school aged children; and to compare facial variability and mean shape with age-corresponding healthy controls. MATERIALS AND METHODS The sample included 40 patients with unilateral cleft lip (CL), 22 patients with unilateral cleft lip and palate (UCLP), and 10 patients with bilateral cleft lip and palate (BCLP). Patients were divided into two age categories, with a mean age of 3 years and 4.5 years, respectively. The group of healthy age-matched controls contained 60 individuals. Three-dimensional virtual facial models were evaluated using geometric morphometry and multivariate statistics methods. RESULTS Statistically significant differences were found between each of the cleft groups and the controls. Color-coded maps showed facial shape deviations, which were located mainly in the nasal area and philtrum in all groups examined, and also in the buccal region and the chin in patients with UCLP or BCLP. These differences became more apparent, but not significantly so, in the older age category. CONCLUSION Facial deviations typical of patients with clefts were observed in all of the patient groups examined. Although the analysis showed statistically significant differences in overall facial shape between patients and controls among all groups tested, the facial morphology in patients who have undergone only neonatal cheiloplasty (CL) is influenced to a small extent and may be considered satisfactory. More severe cleft types (UCLP, BCLP) together with palatoplasty, are reflected in more marked impairments in facial shape.
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