Protocols in the management of Cleft Lip and Palate: A Systematic Review

Morphological Changes in Maxillary Arch Post-Cheiloplasty in Cleft Lip and Palate Infants: A Case Series

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.

Perception, attitude, and opinion of parents of cleft lip and palate patients treated with nasoalveolar molding (NAM): A cross-sectional questionnaire study

BACKGROUND

The main goal of the nasoalveolar molding (NAM) is to mitigate the initial severity of the cleft, facilitating the subsequent surgical procedures. Nevertheless, the use of the appliance entails high stress levels for families.

AIM

The aim of this study was to assess the perceptions, attitudes, and opinions of parents whose cleft-affected children underwent treatment using the NAM technique.

DESIGN

A cross-sectional questionnaire study was conducted on a cohort of relatives of infants born with cleft lip and palate who were treated with the NAM appliance. The parents completed a 59-item questionnaire that had been previously validated.

RESULTS

The initial cohort consisted of 104 families. The level of satisfaction was high, and there was a direct correlation with early diagnosis. Satisfaction levels varied depending on the cleft type, with a decrease in cases of bilateral presentation. Satisfaction was influenced by the newborns' adaptation and the absence of complications. Parents who exhibited lower levels of satisfaction contemplated terminating the treatment.

CONCLUSIONS

Parents expressed high satisfaction with NAM treatment, due to effective management and understanding. Bilateral clefts and delayed diagnosis can significantly impact satisfaction. These results emphasize the importance of personalized approaches to address challenges in NAM treatment, particularly in instances of bilateral clefts and delayed diagnoses.

The nasoalveolar molding technique versus DynaCleft nasal elevator application in infants with unilateral cleft lip and palate

BACKGROUND

The introduction of presurgical nasoalveolar molding represented a significant departure from traditional molding methods. Developed by Grayson and colleagues in 1993, this technique combines an intraoral molding device with a nasal molding stent. This study aimed to compare the Grayson nasoalveolar molding appliance versus DynaCleft appliance as two methods of presurgical nasoalveolar molding.

METHODS

A single-blinded, randomized, parallel-arm clinical trial was conducted. Sixteen infants with complete unilateral cleft lip and palate were enrolled and divided into two groups of eight. Group 1 was treated with a modified Grayson nasoalveolar molding appliance that included a nasal stent, while group 2 was treated with DynaCleft elastic adhesive tape and an external nasal elevator. Standardized digital photographs of each infant were taken at baseline and post-treatment using a professional camera. Nine extraoral anthropometric measurements were obtained from each image using image measurement software.

RESULTS

The modified Grayson nasoalveolar appliance demonstrated a more significant improvement compared to DynaCleft in terms of alar length projection (on both sides), columella angle, and nasal tip projection. Symmetry ratios also showed enhancement, with significant improvements observed in nasal width, nasal basal width, and alar length projection (p< 0.05).

CONCLUSION

Both the modified Grayson nasoalveolar appliance and DynaCleft appear to be effective presurgical infant orthopedics treatment options, demonstrating improvements in nasolabial aesthetics. The modified Grayson appliance, equipped with a nasal stent, improved nasal symmetry more effectively than DynaCleft, resulting in a straighter columella and a more medially positioned nasal tip.

A systematic review of differences in outcome between one and two stage palate repair in cleft lip and palate

The aim of this systematic review was to determine whether one-stage palatoplasty for children born with cleft lip and palate shows overall advantages in outcome compared with two-stage palatoplasty. The included studies were controlled studies of syndromic and non-syndromic children born with unilateral cleft lip and palate, bilateral cleft lip and palate, or isolated cleft palate. The interventions studied were one-stage palatoplasty and two-stage palatoplasty starting with the soft palate. The outcomes were facial growth, speech, hearing, presence of fistulae, other complications related to surgery, health-related quality of life, and health economics. In total, 14 original studies were included. Results were dichotomized into showing advantage for one- or two-stage palatoplasty for the respective outcome and compared with the results from six included systematic reviews. No overall advantage for either surgical strategy was found for any of the outcome measures. The certainty of evidence was highest for the presence of fistulae, followed by facial growth and speech. For several outcomes, the quality of the existing evidence was too low to allow for any conclusions to be drawn. Neither one- nor two-stage palatoplasty showed significant advantages in clinical outcomes compared with the other. Other aspects such as ethics, economics, or surgeon's preference might hence be of more importance. Homogenous choices of outcome measures and defined minimal clinically important differences would facilitate further research.