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Ogino S, Kawanabe H, Fukui K, Sone R, Oyama A. Effect of Pre-Surgical Orthopedic Treatment on Hard and Soft Tissue Morphology in Infants with Cleft Lip and Palate. Diagnostics (Basel) 2023; 13:diagnostics13081444. [PMID: 37189544 DOI: 10.3390/diagnostics13081444] [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: 03/24/2023] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023] Open
Abstract
The frequency of cleft lip and palate births in Japan is approximately 0.146%. The study aimed to compare the effects of NAM on restoring nasal morphology and improving extraoral nasal morphology in children with cleft lip and palate in the first stage of treatment using 3D imaging and oral model analysis. The subjects were five infants (37.6 ± 14.4 days old) with unilateral cleft lip and palate. The images taken with the 3D analyzer and oral model used for constructing the NAM at the first examination (baseline) and at the completion of the pre-surgical orthodontic treatment (157.8 ± 37.8 days old) were analyzed. The cleft distance was measured at the upper, middle, and lower points on the 3D images. On the model, the cleft jaw width at the maximum protrusion of the healthy and affected sides of the alveolar bone was measured. After the pre-surgical orthopedic treatment, the measured value on the model decreased significantly by a mean of 8.3 mm from baseline, and the cleft lip width narrowed by an average of 2.8 ± 2.2, 4.3 ± 2.3, and 3.0 ± 2.8 mm at the upper, middle, and lower points of the cleft, respectively. Pre-surgical orthopedic treatment using NAM can help narrow the width of the cleft jaw and lip. The sample size is stated at the study limit in the paper.
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Affiliation(s)
- Saki Ogino
- Department of Dentofacial Orthopedics, Graduate School of Dentistry, Ohu University, 31-1, Misumido, Tomitamachi, Koriyama-City 963-8611, Fukushima, Japan
| | - Hitoshi Kawanabe
- Division of Orthodontics and Dentofacial Orthopedics, Department of Oral Growth and Development, School of Dentistry, Ohu University, 31-1, Misumido, Tomitamachi, Koriyama-City 963-8611, Fukushima, Japan
| | - Kazunori Fukui
- Division of Orthodontics and Dentofacial Orthopedics, Department of Oral Growth and Development, School of Dentistry, Ohu University, 31-1, Misumido, Tomitamachi, Koriyama-City 963-8611, Fukushima, Japan
| | - Ryoko Sone
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1, Hikarigaoka, Fukushima-City 960-1295, Fukushima, Japan
| | - Akihiko Oyama
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1, Hikarigaoka, Fukushima-City 960-1295, Fukushima, Japan
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Dallaserra M, Pantoja T, Salazar J, Araya I, Yanine N, Villanueva J. Effectiveness of pre-surgical orthopedics on patients with cleft lip and palate: A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e506-e520. [PMID: 35151895 DOI: 10.1016/j.jormas.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Evaluate the effectiveness of pre-surgical orthopedics (PSO) in patients with cleft lip palate (CLP) in maxillary morphology (MM), facial growth and development (FGD), occlusal alterations (OA), parental satisfaction (PS), and side effects. DESIGN Systematic review and meta-analysis of randomized and controlled clinical trials. Searches was performed in CENTRAL, MEDLINE, and EMBASE. RESULTS From the eight studies included, three are randomized clinical trials, and five clinical trials are controlled. MM was evaluated by the intercanine width (Mean difference (MD) =1.44; CI95%= -0.30, 3.19; very low certainty), anteroposterior length (MD=1.32; CI95%= -0.59, 3.24; very low certainty) and intertuberocity width (MD=0.09; CI95%= -0.68, 0.49; certainty: very low). FGD was evaluated by SNA angle (MD: 1.29; P = 0.306; moderate certainty), SNB angle (MD: -0.79; P = 0.550; moderate certainty) and ANB angle (MD: 1; P = 0.362; moderate certainty). OA was evaluated by 5-years-old-index (MD= -0.09; P = 0.49; moderate certainty) and by Huddart score (MD=0.51; P = 0.736; moderate certainty). A valid questionnaire assessed PS only in one study (MD= -0.1; P = 0.199; moderate certainty). No studies reported side effects. CONCLUSION Due to the uncertainty of the effect of PSO on MM and the lack of clinically relevant effect on FGD, OA, or PS, it is not reasonable to include this intervention as a treatment until future studies clarify its effect.
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Affiliation(s)
- Matías Dallaserra
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile
| | - Tomás Pantoja
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 (8330023), Santiago de Chile
| | - Josefina Salazar
- Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile
| | - Ignacio Araya
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile
| | - Nicolás Yanine
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile
| | - Julio Villanueva
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Service of Maxillofacial Surgery. Hospital Clínico San Borja-Arriarán, Santiago de Chile. Av. Santa Rosa 1234 (8360160), Santiago de Chile.
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Burgaz MA, Cakan DG, Yılmaz RBN. Three-dimensional evaluation of alveolar changes induced by nasoalveolar molding in infants with unilateral cleft lip and palate: A case-control study. Korean J Orthod 2019; 49:286-298. [PMID: 31598485 PMCID: PMC6769263 DOI: 10.4041/kjod.2019.49.5.286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 12/02/2022] Open
Abstract
Objective The objectives of this study were to evaluate linear and volumetric alveolar changes induced by nasoalveolar molding (NAM) in infants with complete unilateral cleft lip and palate (UCLP) and compare the maxillary dimensions after NAM with the normal dimensions in infants without clefts. Methods A total of 26 infants with UCLP treated by NAM (mean age before and after NAM: 14.20 ± 8.09 days and 118.16 ± 10.06 days, respectively) comprised the treatment group, while 26 infants without clefts (mean age: 115.81 ± 8.71 days) comprised the control group. Changes in the maxillary dimensions following NAM were measured on three-dimensional models using Mimics software, version 17.0. Results During NAM, there was a decrease in the cleft widths, maxillary arch depths, and rotation of the greater segment. While the anterior alveolar arch width exhibited a significant decrease, the posterior arch width was mostly maintained. There were no changes in the anterior vertical deviations of the alveolar segments. The alveolar crest lengths, arch circumference, and bilateral posterior volumetric measures exhibited an increase. After NAM, the anterior arch width was comparable between the treatment and control groups, whereas the posterior arch width and anterior vertical deviations were greater in the treatment group than in the control group. The maxillary arch depths, alveolar crest lengths, and maxillary volumes were smaller in the NAM group than in the control group. Conclusions During NAM in infants with UCLP, the cleft width and anteroposterior and transverse alveolar dimensions exhibited a decrease while the vertical dimensions were maintained. Compared with infants without clefts, those with UCLP treated by NAM exhibited sagittal and vertical alveolar growth deficiencies and tissue insufficiency.
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Affiliation(s)
| | - Derya Germec Cakan
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - R Burcu Nur Yılmaz
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
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Trefný P, Smahel Z, Formánek P, Peterka M. Three-Dimensional Analysis of Maxillary Dental Casts Using Fourier Transform Profilometry: Precision and Reliability of the Measurement. Cleft Palate Craniofac J 2017; 41:20-6. [PMID: 14697074 DOI: 10.1597/02-097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Fourier transform profilometry was used for the three-dimensional measurement of maxillary dental casts to analyze the size and shape of the palate. The objective of this study was to test the accuracy of the measuring system and determine the precision and reliability of the measurement Methods Images of dental casts were analyzed using newly developed measuring software. Based on five landmarks located on the alveolar ridge, the measuring software constructed 10 transversal sections of the palate. In each section profile, the width, area, and 23 height variables were assessed. Subjects Maxillary dental stone casts of 25 healthy girls, 14.1 to 15.3 years of age, were studied. Results The technical error of measurement exceeded 5% of the size of the measurement only in variables with means less than approximately 3 mm. In fact, such small absolute dimensions were exhibited only by the palate height in anterior profile 2 and the palate height at the margins of other profiles. Reliability of the measurements was found to be very high for the width and area of the profiles. For height measurements, the coefficient of reliability was slightly lower at the profile margins than near the midline. Nevertheless, only three height variables showed a coefficient of reliability lower than 0.90. The coefficients of reliability of other height measurements of profiles 3 through 10 were only sporadically lower than 0.97. Conclusion With regard to the accuracy of the measuring system as well as the precision and reliability of the measurement, this method proved to be a suitable tool for studying palatal morphology.
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Affiliation(s)
- Pavel Trefný
- Institute of Dental Research, General Faculty Hospital, Prague, Czech Republic.
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Kuijpers-Jagtman AM, Long RE. The Influence of Surgery and Orthopedic Treatment on Maxillofacial Growth and Maxillary Arch Development in Patients Treated for Orofacial Clefts. Cleft Palate Craniofac J 2017. [DOI: 10.1597/1545-1569_2000_037_0527_tiosao_2.0.co_2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This paper describes maxillofacial growth and dental arch development in relation to different orthodontic and surgical interventions utilized in the management of orofacial clefts. It addresses presurgical orthopedic treatment in patients with unilateral cleft lip and palate, primary periosteoplasty, primary bone grafting, lip surgery, palatal surgery, pharyngeal flap surgery, maxillary protraction, and early secondary bone grafting. Difficulties associated with synthesizing previously published data and suggestions for approaching still unanswered questions in the next millennium are presented.
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Affiliation(s)
- Anne M. Kuijpers-Jagtman
- Department of Orthodontics and Oral Biology and Head of the Cleft Palate Craniofacial Unit of the University Hospital Sint Radboud, University of Nijmegen, The Netherlands
| | - Ross E. Long
- Lancaster Cleft Palate Clinic and Orthodontics and Research of the Lancaster Cleft/Craniofacial Program, Lancaster, Pennsylvania; Orthodontics, Albert Einstein Medical Center, Department of Orthodontics, Philadelphia, Pennsylvania; and Orthodontics, Department of Orthodontics, University of Maryland Dental School, Baltimore, Maryland
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Niranjane PP, Kamble RH, Diagavane SP, Shrivastav SS, Batra P, Vasudevan SD, Patil P. Current status of presurgical infant orthopaedic treatment for cleft lip and palate patients: A critical review. Indian J Plast Surg 2015; 47:293-302. [PMID: 25593413 PMCID: PMC4292105 DOI: 10.4103/0970-0358.146573] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Rehabilitation of cleft lip and palate (CLP) patients is a challenge for all the concerned members of the cleft team, and various treatment modalities have been attempted to obtain aesthetic results. Presurgical infant orthopaedics (PSIO) was introduced to reshape alveolar and nasal segments prior to surgical repair of cleft lip. However, literature reports lot of controversy regarding the use of PSIO in patients with CLP. Evaluation of long-term results of PSIO can provide scientific evidence on the efficacy and usefulness of PSIO in CLP patients. The aim was to assess the scientific evidence on the efficiency of PSIO appliances in patients with CLP and to critically analyse the current status of PSIO. A PubMed search was performed using the terms PSIO, presurgical nasoalveolar moulding and its long-term results and related articles were selected for the review. The documented studies report no beneficial effect of PSIO on maxillary arch dimensions, facial aesthetics and in the subsequent development of dentition and occlusion in CLP patients. Nasal moulding seems to be more beneficial and effective in unilateral cleft lip and palate patients with better long-term results.
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Affiliation(s)
- P Priyanka Niranjane
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
| | - R H Kamble
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
| | - S Pallavi Diagavane
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
| | - S Sunita Shrivastav
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
| | - Puneet Batra
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Modinagar, Kadrabad, Meerut, Uttar Pradesh, India
| | - S D Vasudevan
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
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Smahel Z, Trefný P, Formánek P, Müllerová Z, Peterka M. Three-dimensional morphology of the palate in subjects with isolated cleft palate at the stage of permanent dentition. Cleft Palate Craniofac J 2004; 40:577-84. [PMID: 14577820 DOI: 10.1597/1545-1569_2003_040_0577_tmotpi_2.0.co_2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Three-dimensional analysis of palate size and shape in patients with isolated cleft palate at the stage of permanent dentition. DESIGN Cross-sectional study using Fourier transform profilometry. SUBJECTS Twenty-nine randomly selected dental casts of approximately 15-year-old boys with isolated cleft palate and 28 dental casts of normal boys of the same age. INTERVENTIONS All patients were operated on by the same method (pushback and pharyngeal flap surgery) at a mean age of 4.5 years. MAIN OUTCOME MEASURES Data on the palate height in 210 defined locations (pixels). RESULTS The palate in isolated clefts is narrower throughout its whole extent and lower from the level of the first premolars. The difference, as compared with controls, increases in a posterior direction. At the level of the first molars, palatal height is reduced by one-quarter, the area of the transversal section by more than one-third. The shaping of the palate vault is, on average, symmetrical with a marked interindividual variability. Palatal height does not depend on the width of the dentoalveolar arch, and the height of the primary palate is not reduced. CONCLUSION The smaller width and reduced height from the level of the first premolars posteriorly confirm the substantially reduced space available for the tongue in patients with isolated cleft palate. Deviations are on the average symmetrical, and the anterior part of the palate is not shallower.
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Affiliation(s)
- Zbynek Smahel
- Faculty of Natural Sciences and Chairman of the Committee for Postgraduate Studies in Anthropology at Charles University, Prague, Czech Republic.
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Braumann B, Keilig L, Stellzig-Eisenhauer A, Bourauel C, Bergé S, Jäger A. Patterns of maxillary alveolar arch growth changes of infants with unilateral cleft lip and palate: preliminary findings. Cleft Palate Craniofac J 2003; 40:363-72. [PMID: 12846602 DOI: 10.1597/1545-1569_2003_040_0363_pomaag_2.0.co_2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Because of significant differences in pathomorphology at birth, it may be that a better treatment outcome prognosis exists for patients with incomplete versus complete cleft forms. Can reaction patterns be extracted from changes in maxillary dimensions of different cleft forms within the first year of life to support this hypothesis? SUBJECTS Chronologically consecutive casts of the maxilla (1 week and 3, 6, and 12 months of life) of 15 patients with complete unilateral cleft lip and palate (cUCLP) and 13 patients with incomplete unilateral cleft lip and palate (iUCLP). All patients were treated with passive palatal plates. Cheiloplasty was performed at 6 months of age. No primary osteoplastic surgery was carried out. INTERVENTIONS Following digitizing with a three-dimensional laser scanner, all cast surfaces were computer reconstructed, aligned, and superimposed. Distances between the surfaces were determined and expressed graphically. Computer-aided determination of defined maxillary dimensions was performed. The volumes of segmented surfaces were determined and compared. RESULTS Within the first year of life, decreased sagittal but increased transverse alveolar growth for patients with iUCLP was found. The increase in alveolar crest length in patients with iUCLP was 50% less within the first year of life than in patients with cUCLP. In the same patients, the volumes of the molar segments were, on average, larger at each registration stage and the increase in these volumes larger within the first year of life. CONCLUSION Conclusions regarding the direction and extent of growth cannot be drawn from the visible level of severity of the malformation.
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Affiliation(s)
- Bert Braumann
- Department of Orthodontics, Clinic for Oral and Maxillofacial Surgery, Center for Dentistry, University of Bonn, Bonn, Germany.
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Honda Y, Suzuki A, Nakamura N, Ohishi M. Relationship between primary palatal form and maxillofacial growth in Japanese children with unilateral cleft lip and palate: infancy to adolescence. Cleft Palate Craniofac J 2002; 39:527-34. [PMID: 12190341 DOI: 10.1597/1545-1569_2002_039_0527_rbppfa_2.0.co_2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this retrospective study was to evaluate the relationship between the severity of maxillary defects and maxillofacial growth from infancy to adolescence in children with complete unilateral cleft lip and palate (UCLP). SUBJECTS Thirty-one Japanese children with UCLP who had received cheiloplasty, palatoplasty, and orthodontic treatments at the Kyushu University Dental Hospital were selected. MATERIALS AND METHODS A three-dimensional laser scanner was used to measure maxillary dental casts taken at cheiloplasty. Surface areas and volumes of the palatal tissue were calculated. Lateral cephalographs that were taken both at cheiloplasty and 15 years of age or over (average age 16.5 years) were traced and digitized. Angular and linear measurements were calculated from the x, y-coordinates. Using correlation analyses, defects in the palatal tissue were compared with maxillofacial morphology both at cheiloplasty and in adolescence or maxillofacial growth during that time span. RESULTS (1) The surface areas or volumes of the palatal tissue were significantly correlated with the following maxillofacial measurements at infancy and adolescence: Or-depth; A-depth; PNS-height; ANS-height; N-Ba; S-N; S-Ba; N to P.P.; A'-Ptm'; Cd-Pog; Cd-Gn; Cd-G; and the N-S-Ba, S-N-A, and A-N-B angles. (2) They were also significantly correlated with the following maxillofacial growth measures from infancy to adolescence: A-depth, S-Ba, and the N-S-Ba and S-N-A angles. Only the N-S-Ba angle showed a negative correlation. CONCLUSION The patient who had more palatal tissue at cheiloplasty showed better maxillofacial growth.
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Affiliation(s)
- Yasuo Honda
- Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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Braumann B, Keilig L, Bourauel C, Jäger A. Three-dimensional analysis of morphological changes in the maxilla of patients with cleft lip and palate. Cleft Palate Craniofac J 2002; 39:1-11. [PMID: 11772163 DOI: 10.1597/1545-1569_2002_039_0001_tdaomc_2.0.co_2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Three-dimensional (3-D) morphological changes in the maxilla of patients with cleft lip and palate (CLP) have been recorded, mainly using two-dimensional cast analyses. Although these seem to be insufficient, no standardized 3-D method has been developed until now. In this study, accuracy, precision, and validity of a newly developed 3-D digital computer-aided procedure to visualize and metrically analyze the growth of the edentulous maxilla of infants with CLP have been evaluated. PATIENTS The method was applied to 10 infants with complete unilateral CLP. INTERVENTIONS Consecutive casts of the maxilla (1 week and 3, 6, and 12 months) of each patient were optically measured with a 3-D laser scanner. Following digitizing, the casts were computer reconstructed, aligned, and superimposed using specialized computer software. The distances between the surfaces were measured. Additionally, the surfaces were segmented perpendicular to the alveolar crest, the reference points being C1, C1', C2, C2', and I. The volumes of the resulting segments were determined and compared with one another. RESULTS The newly developed analysis enables a visualization of the extent and direction of morphological changes in the maxilla of infants with CLP. With this method it is possible to quantify these changes of the volume of defined alveolar segments. CONCLUSIONS The 3-D analysis developed is an ideal tool for the examination of 3-D morphological changes in the edentulous maxilla of patients with CLP. The results will serve as the starting point for a longitudinal study on the efficacy of different methods, not only of presurgical infant orthopedics but also of surgical procedures.
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Affiliation(s)
- Bert Braumann
- Department of Orthodontics, Center for Dentistry, University of Bonn, Bonn, Germany.
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Prahl C, Kuijpers-Jagtman AM, van't Hof MA, Prahl-Andersen B. A randomised prospective clinical trial into the effect of infant orthopaedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft). Eur J Oral Sci 2001; 109:297-305. [PMID: 11695749 DOI: 10.1034/j.1600-0722.2001.00056.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aim of the study was to evaluate the effect of infant orthopaedics (IO) on maxillary dimensions in infants with unilateral cleft lip and palate (UCLP). The study design was a prospective two-arm randomised controlled trial in parallel with three participating academic Cleft Palate Centres. Treatment was assigned by means of a computerised balanced allocation method. One group (IO+) wore passive maxillary plates during the first year of life, the other group (IO-) did not. Maxillary casts, made at birth, and at 15, 24, 48, 78 wk were digitised three-dimensionally. Before lip closure alveolar, midpalatal and posterior cleft width reduced significantly more in IO(+) than in IO(-). After lip closure, the alveolar cleft width reduced significantly more in IO(-). Until soft palate closure the slope of the palatal vault flattened significantly by IO. It is concluded that IO only has a temporary effect on maxillary arch dimensions that does not last beyond surgical soft palate closure. Therefore, infant orthopaedics as a tool to improve maxillary arch form could be abandoned. However, other outcome variables like facial and dental appearance, speech outcome, and cost-effectiveness need to be investigated further in order to assess the comprehensive effect of infant orthopaedics.
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Affiliation(s)
- C Prahl
- Department of Orthodontics, University of Nijmegen, The Netherlands
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Mishima K, Mori Y, Sugahara T, Sakuda M. Comparison between the palatal configurations in complete and incomplete unilateral cleft lip and palate infants under 18 months of age. Cleft Palate Craniofac J 2001; 38:49-54. [PMID: 11204682 DOI: 10.1597/1545-1569_2001_038_0049_cbtpci_2.0.co_2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the three-dimensional characteristics of the palatal configurations in incomplete unilateral cleft lip and palate (UCLP) patients and to determine whether there are differences in the effect of early orthopedic treatment between complete and incomplete UCLP patients. DESIGN Eight infants with incomplete UCLP and 12 infants with complete UCLP, selected at random, wore Hotz plates, and 8 other infants with complete UCLP did not. Palatal impressions were taken of these patients immediately after birth and at 1, 2, 3, 4 (just before cheiloplasty), 6, and 18 months of age (just before palatoplasty). Using our measuring system, the palatal casts were measured and compared three-dimensionally. RESULTS AND CONCLUSIONS The palate of the incomplete UCLP patients measured immediately after birth, compared with complete UCLP, showed: (1) smaller posterior arch width; (2) sagittal arch length did not differ; (3) incisal point was located more mesially; (4) the gap between the alveolar arch forms of the major and minor segments was smaller; and (5) the curvature of the palatal surface forward the nasal cavity in the minor segment was less. At 18 months of age, the following characteristics could be observed: (1) the difference observed at birth in the posterior arch width between the incomplete and complete UCLP infants vanished; (2) a significant difference in the location of the incisal point was observed only between the incomplete UCLP infants and the complete UCLP infants with a Hotz plate; and (3) the curvature was less in the incomplete UCLP infants than in the complete UCLP infants. Furthermore, the morphological change of the palatal surface was less in the incomplete UCLP infants than in the complete UCLP infants. This suggested that any influence of the Hotz appliance might be less in incomplete UCLP than in complete UCLP.
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Affiliation(s)
- K Mishima
- First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Okayama University, Okayama City, Japan
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Mishima K, Mori Y, Sugahara T, Minami K, Sakuda M. Comparison between palatal configurations in UCLP infants with and without a Hotz plate until four years of age. Cleft Palate Craniofac J 2000; 37:185-90. [PMID: 10749060 DOI: 10.1597/1545-1569_2000_037_0185_cbpciu_2.3.co_2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of presurgical orthopedic treatment three dimensionally, we previously developed a novel measuring system and described the efficacy of the treatment until 18 months of age. The aim of this study was to compare palatal configuration in complete unilateral cleft lip and palate (UCLP) infants fitted with a Hotz plate to those without it until four years of age using the same measuring system. PATIENTS Twenty complete UCLP infants were divided into two groups. A Hotz plate was used with 12 patients who first visited our clinic from January 1990 to March 1992 and was not used with an additional eight patients who first visited from April 1992 to July 1993. MAIN OUTCOME MEASURES Palatal casts taken from birth until four years of age were measured three dimensionally and were compared between the two groups. RESULTS AND CONCLUSIONS The width of the palate was larger in the group with a Hotz plate than in the group without it at four years of age. No difference was observed between the anteroposterior distance of the palate in the two groups at four years of age. Similarly, the alveolar arch form did not differ between the two groups. The degree of curvature of the palatal surface was smaller in the group with a Hotz plate than in the group without it. These data were similar to data obtained at 18 months of age.
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Affiliation(s)
- K Mishima
- First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Okayama University, Japan
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Mishima K, Sugahara T, Mori Y, Minami K, Sakuda M. Effects of presurgical orthopedic treatment in infants with complete bilateral cleft lip and palate. Cleft Palate Craniofac J 1998; 35:227-32. [PMID: 9603557 DOI: 10.1597/1545-1569_1998_035_0227_eopoti_2.3.co_2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To align the protruding premaxilla in infants with bilateral cleft lip and palate (BCLP), an intraoral appliance (i.e., Hotz plate) and an extraoral appliance consisting of a band covering the head and elastics are used as a presurgical orthopedic treatment in our clinic. The aim of this study was to analyze the configuration and position of the premaxilla and the vomer in infants with BCLP and to investigate the factors generating deviation and bending of the vomer and twisting of the premaxilla. PATIENTS Palatal casts were obtained serially from 10 infants with complete BCLP from 1 to 3 months of age. MEASUREMENTS These casts were automatically measured using a highly accurate contact-type measuring apparatus. After three-dimensional wire frame models generated from the serial casts were automatically superimposed, the magnitude and direction of the shift were calculated. A discriminant analysis was used for investigation of predictor variables generating the twisting or bending vomer. RESULTS AND CONCLUSIONS The vomer was found to be bent in two infants and the premaxilla was twisted in three infants. In the infants whose vomers were bent, the magnitude of the posterior shift of the premaxilla was greater than that of the inferior shift. A discriminant analysis indicated that at 1 month of age, a greater inclination and a smaller deviation of the vomer and a longer distance between the cleft edges of the lateral segments had a tendency to be associated with bending of the vomer or twisting of the premaxilla.
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Affiliation(s)
- K Mishima
- Second Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Osaka University, Suita, Japan
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Mishima K, Sugahara T, Mori Y, Sakuda M. Palatal configuration in complete bilateral cleft lip and palate infants before and after cheiloplasty. Cleft Palate Craniofac J 1997; 34:475-82. [PMID: 9431464 DOI: 10.1597/1545-1569_1997_034_0475_pcicbc_2.3.co_2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to analyze the three-dimensional configuration of the premaxilla, vomer, and lateral segments in bilateral cleft lip and palate (BCLP) infants and to investigate the early changes in the configuration following one- and two-stage cheiloplasty. METHODS This study consisted of 10 complete BCLP infants. One-stage operations were performed in five patients according to Manchester's method at 4 months of age. Two-stage operations were done for the remaining five patients using a triangular flap according to Tennison's method, at 4 and 8 months of age. Serial plaster models before and after the cheiloplasty were measured with a computer-controlled, highly accurate, contact-type measuring apparatus. Temporal changes in the configuration and form of the premaxilla were observed using an automatic superimposition method. The inclination and deviation of the vomer were evaluated using an approximation technique to a straight line with least squares. The distance between the lateral segments and a three-dimensional coordinate of the incisal point were also measured. RESULTS AND CONCLUSIONS The following differences in palatal configuration between the one- and two-stage cheiloplasties were observed: 1) In the two-stage group, the premaxilla shifted toward the cleft edge where the cheiloplasty was performed in both first- and second-stage operations. After the two-stage operation, the premaxilla did not shift greatly, and the premaxilla in cases 4 and 5 shifted downward and toward the cleft edge of the lateral segments where the first operation was performed. Protrusion of the premaxilla remained in the two-stage group. 2) In the one-stage group, the premaxilla in case 4 descended downward and backward without twisting or bending. The premaxilla of the other patients descended downward with twisting and bending. 3) Patients in the two-stage group had a stronger tendency toward medial collapse of the lateral segments than did those in the one-stage group.
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Affiliation(s)
- K Mishima
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Osaka University, Japan
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Mishima K, Sugahara T, Mori Y, Sakuda M. Three-dimensional comparison between the palatal forms in complete unilateral cleft lip and palate with and without Hotz plate from cheiloplasty to palatoplasty. Cleft Palate Craniofac J 1996; 33:312-7. [PMID: 8827388 DOI: 10.1597/1545-1569_1996_033_0312_tdcbtp_2.3.co_2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The palatal forms in 20 infants with a complete unilateral cleft lip, and palate (12 with a Hotz palate and 8 without, selected at random) were studied from birth until 18 months of age. Using techniques developed previously, the degree of curvature in the palate and the magnitude of migration of the maxillary segments were measured three-dimensionally. Furthermore, using a newly developed method to approximate a set of the points on the alveolar ridge to a circle in a plane, the form of the alveolar arch was evaluated. Results from the group with a Hotz plate revealed that the plate possesses four effects not seen in the group without a Hotz plate. The size of the palate was larger, and the sagittal gap between the two segments of the maxilla was smaller. These results suggest that the appliance could stimulate the growth of the segments and could prevent collapse of the maxillary arch from the force of lip closure. Third, the steepness of the segments toward the nasal cavity was smaller, possibly occurring because the appliance prevents tongue intrusion into the cleft. Fourth, the magnitude of migration of the lesser segment toward the cleft edge of the major segment was larger. This result suggests that the appliance could guide the growth of the maxillary segments to narrow the cleft width until 18 months of age.
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Affiliation(s)
- K Mishima
- Second Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Osaka University, Japan
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