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Agell Sogbe A, Mitiko Aseka Garcia M, Souza Lima Wan-Dall B, Sierra NE, da Silva Freitas R. Comparative Study of Maxillary Growth in Patients With Unilateral Cleft Treated With and Without Pre-Surgical Orthopedics. Cleft Palate Craniofac J 2024; 61:957-964. [PMID: 36655299 DOI: 10.1177/10556656221149784] [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: 01/20/2023] Open
Abstract
Compare the maxillary growth of patients with Unilateral Cleft treated with pre-surgical Functional Maxillary Orthopedic (FMO) and that of who underwent a surgical procedure with no previous use of appliances. Prospective study, the patients were divided into 2 groups. G1, was composed of 12 patients who received no pre-surgical intervention and cheilorhinoplasty at 6 months of age and G2, included 12 patients treated using Pre-Surgical Funtional Maxilary Orthopedic; they underwent no surgery during the study. Measurements were taken at three times: before the first month of life, at 6 months and between 9-12 months of age. Cleft distance (anterior, medium and posterior), maxillary width (anterior, medium and posterior) and minor and major segment width were analyzed. Alveolar Cleft decrease was 79.82% in G1 and 52% in G2. Posterior Cleft decrease was 24.1% in G1 and 41.77% in G2. Greater Segment Width increase was 24.53% for the patients in G1, and 37.47% for the patients in G2. As for Inter Canine Width, a decrease of 5.16% in G1 and an increase of 9.19% in G2 were found. Medium Arch Width only increased in a statistically significant manner in G2 9.02%. Surgery allowed for the closure of the alveolar cleft. FMO made it possible to close the anterior and the posterior clefts through the growth of the maxillary segments, increased the transverse growth of the maxilla and could prevent maxillary collapse. Each team must individually evaluate whether to indicate or not the use of preoperative orthopedics.
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Affiliation(s)
- Adriana Agell Sogbe
- Pediatric Oral and Maxillofacial Surgery Unit, Vall d´Hebron University Hospital, Barcelona, Spain
| | | | | | - Nicolas E Sierra
- Pediatric Oral and Maxillofacial Surgery Unit, Vall d´Hebron University Hospital, Barcelona, Spain
- Comprehensive Cleft Care Center, Mobile Surgery International, Oaxaca, Mexico
| | - Renato da Silva Freitas
- Plastic Surgery Unit, Department of Surgery, School of Medicine, Federal University of Parana (UFPR), Curitiba, Brazil
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Benitez BK, Brudnicki A, Tache A, Wieprzowski Ł, Surowiec Z, Nalabothu P, Lill Y, Mueller AA. Comparative study on cleft palate morphology after passive presurgical plate therapy in unilateral cleft lip and palate. J Plast Reconstr Aesthet Surg 2024; 92:198-206. [PMID: 38547553 DOI: 10.1016/j.bjps.2024.03.001] [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] [Received: 12/12/2023] [Accepted: 03/02/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Presurgical plate therapy has been widely accepted as a treatment prior to palatal cleft closure. The effects of passive presurgical plate therapy on cleft morphology prior to single-stage unilateral cleft lip and palate (UCLP) repair were quantified. PATIENTS AND METHODS We compared the dimensions of cleft width and cleft area (true cleft and palatal cleft) measured preoperatively at 2 European cleft centers. Center A performed single-stage UCLP repair in 8-month-old infants without any presurgical orthopedic treatment. Center B initiated passive presurgical plate therapy immediately after the birth of the neonates, followed by single-stage UCLP repair at 8 months of age. RESULTS We included 28 patients with complete UCLP from Center A and 12 patients from Center B. The average anterior width of the true cleft before surgery was significantly smaller in infants at Center B than that in Center A (p = 0.001) with 95% confidence interval of (1.8, 5.7) mm, but the average posterior width was similar in the 2 groups. The mean presurgical true cleft area amounted to 106.8 mm2 (SD = 42.4 mm2) at Center A and 71.9 mm2 (SD = 32.2 mm2) at Center B, with a confidence interval for the difference being (9.8, 60.1) mm2. This corresponded to a 32.7% reduction of the true cleft area when passive presurgical plate therapy was used for the first 8 months of the infants' life. CONCLUSION Passive presurgical plate therapy in UCLP significantly reduced the cleft area. Implications for the subsequent surgical outcome might depend on the surgical technique used.
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Affiliation(s)
- Benito K Benitez
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland.
| | - Andrzej Brudnicki
- Maxillofacial Department, Clinic of Pediatric Surgery, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211 Warsaw, Poland.
| | - Ana Tache
- Cleft & Craniofacial Team, GZA-ZNA, Ziekenhuizen, Antwerpen, Belgium.
| | - Łukasz Wieprzowski
- Maxillofacial Department, Clinic of Pediatric Surgery, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211 Warsaw, Poland.
| | - Zbigniew Surowiec
- Maxillofacial Department, Clinic of Pediatric Surgery, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211 Warsaw, Poland.
| | - Prasad Nalabothu
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland.
| | - Yoriko Lill
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland.
| | - Andreas A Mueller
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland.
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Delay A, Bellier A, Giot JP, Bettega G, Morand B. The influence of three different primary treatment protocols on 5-year-old maxillary growth in patients with complete unilateral cleft lip and palate. J Craniomaxillofac Surg 2024:S1010-5182(24)00169-0. [PMID: 38729845 DOI: 10.1016/j.jcms.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/13/2024] [Accepted: 04/27/2024] [Indexed: 05/12/2024] Open
Abstract
The study evaluated the effects of three different primary treatment protocols on maxillary growth in patients aged 5 years with complete unilateral cleft lip and palate (UCLP). The secondary objective was to assess the influence of initial cleft severity, family history of class III, and status of permanent lateral incisor on maxillary growth. In total, 54 patients with non-syndromic complete UCLP were included and grouped as follows: group An underwent lip adhesion, cheilorhinoplasty associated with tibial periosteal graft for hard palate repair, and finally veloplasty; group B underwent lip adhesion, then cheilorhinoplasty with intravelar veloplasty, and finally a hard-palate repair; group C underwent cheilorhinoplasty with intravelar veloplasty and then a hard-palate repair. Five-year maxillary growth was assessed on dental models, both clinically and digitally. No difference was found with GOSLON-Yardstick scoring. Five-year measurements showed that group C tended to have the best maxillary arch morphology (p = 0.012). Initial cleft severity did not impact maxillary growth, but status of permanent lateral incisor and family history of class III did (p = 0.019 and p = 0.004, respectively). In patients aged 5 years, the two-stage approach appeared to be the least detrimental to growth development. Predictive factors for growth retardation included the absence of lateral incisor and a family history of class III.
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Affiliation(s)
- Alexandra Delay
- Maxillo-facial and Plastic Surgery Department, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000, Grenoble, France.
| | - Alexandre Bellier
- Clinical Investigation Center, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000, Grenoble, France
| | - Jean-Philippe Giot
- Maxillo-facial and Plastic Surgery Department, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000, Grenoble, France
| | - Georges Bettega
- Maxillo-facial Surgery Department, Annecy Genevois Hospital, Annecy, France
| | - Beatrice Morand
- Maxillo-facial and Plastic Surgery Department, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000, Grenoble, France
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de Souza TM, Batista ST, de Souza RXS, Rezende SE, Alessi MS, Almeida TFA, Frazão DC, Pretti H, Freitas RDS, Macari S. The Effects of NAM on the Symmetry of the Face and Maxillary Arch in Babies With Unilateral Cleft. J Craniofac Surg 2023; 34:1618-1624. [PMID: 37307242 DOI: 10.1097/scs.0000000000009469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 06/14/2023] Open
Abstract
The study aimed to evaluate the effect of nasoalveolar molding (NAM) therapy through reverse engineering, or its absence, to obtain symmetry of the face and maxillary arch. Twenty-six babies with unilateral cleft lip and palate received treatment with NAM, and 12 babies with unilateral cleft lip and palate without presurgical orthopedics (control group). Patients were molded and photographed in 2-stages: the first month of life (T1/pre) and after the use of NAM/before the cheiloplasty (T2/post). In the digital models, the analyses performed were arch perimeter, arch length, and labial frenulum angle. The photographs allowed us to analyze nasal width, mouth width, columella angle, and nostril area. The results demonstrated that there was an increase in arch perimeter and arch length in control and NAM groups in the T2 period in comparison to T1. Labial frenulum angle was reduced in the NAM group compared to the NAM-T1 and control-T2 periods. Treatment with NAM yielded a reduction in nasal width in the period of T2 compared with T1. Columella angle was enhanced after NAM use in T2 and, was different from control group. The nostril area was reduced in the NAM group in T2 compared with control group. Nasoalveolar molding therapy reduced the labial frenulum angle, contributing to a reduction in the extension of the cleft. The NAM protocol improved facial symmetry, mainly through nasal effects, whereas the absence of orthopedic therapy yielded a commitment to the face and maxillary arch symmetry.
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Affiliation(s)
- Tânia Mara de Souza
- Department of Restorative Dentistry, Faculty of Dentistry, Federal University of Minas Gerais
| | - Sabrina Tailane Batista
- Department of Restorative Dentistry, Faculty of Dentistry, Federal University of Minas Gerais
| | | | - Sérgio Edriane Rezende
- Department of Head and Neck Surgeon and Skull-Maxillofacial Surgeon, Federal University of Minas Gerais, Belo Horizonte
- Plastic Surgery Service-CENTRARE-Hospital of Baleia
| | | | | | - Diogo Campos Frazão
- Department of Science and Technology Applied to Dentistry, Institute of Science/Technology, Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), São José dos Campos Campus, SP
| | - Henrique Pretti
- Department of Restorative Dentistry, Faculty of Dentistry, Federal University of Minas Gerais
| | - Renato da Silva Freitas
- Department of Surgery, Plastic Surgery Unit, School of Medicine, Federal University of Parana (UFPR), Curitiba, Brazil
| | - Soraia Macari
- Department of Restorative Dentistry, Faculty of Dentistry, Federal University of Minas Gerais
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