Palatal asymmetry in cleft palate subjects

Arch Symmetry in Patients Without and With Cleft Lip and Palate After Orthodontic/Rehabilitative Treatment-A Stereophotogrammetry Study

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.

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

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.

Three-dimensional assessment of facial asymmetry in preschool patients with orofacial clefts after neonatal cheiloplasty

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.

Three-Dimensional Analysis of Maxillary Dental Casts Using Fourier Transform Profilometry: Precision and Reliability of the Measurement

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.

Three-dimensional imaging methods for quantitative analysis of facial soft tissues and skeletal morphology in patients with orofacial clefts: a systematic review

Background

Current guidelines for evaluating cleft palate treatments are mostly based on two-dimensional (2D) evaluation, but three-dimensional (3D) imaging methods to assess treatment outcome are steadily rising.

Objective

To identify 3D imaging methods for quantitative assessment of soft tissue and skeletal morphology in patients with cleft lip and palate.

Data sources

Literature was searched using PubMed (1948–2012), EMBASE (1980–2012), Scopus (2004–2012), Web of Science (1945–2012), and the Cochrane Library. The last search was performed September 30, 2012. Reference lists were hand searched for potentially eligible studies. There was no language restriction.

Study selection

We included publications using 3D imaging techniques to assess facial soft tissue or skeletal morphology in patients older than 5 years with a cleft lip with/or without cleft palate. We reviewed studies involving the facial region when at least 10 subjects in the sample size had at least one cleft type. Only primary publications were included.

Data extraction

Independent extraction of data and quality assessments were performed by two observers.

Results

Five hundred full text publications were retrieved, 144 met the inclusion criteria, with 63 high quality studies. There were differences in study designs, topics studied, patient characteristics, and success measurements; therefore, only a systematic review could be conducted. Main 3D-techniques that are used in cleft lip and palate patients are CT, CBCT, MRI, stereophotogrammetry, and laser surface scanning. These techniques are mainly used for soft tissue analysis, evaluation of bone grafting, and changes in the craniofacial skeleton. Digital dental casts are used to evaluate treatment and changes over time.

Conclusion

Available evidence implies that 3D imaging methods can be used for documentation of CLP patients. No data are available yet showing that 3D methods are more informative than conventional 2D methods. Further research is warranted to elucidate it.

Systematic review registration

International Prospective Register of Systematic Reviews, PROSPERO CRD42012002041

A preliminary study on the characteristics of the velopharyngeal structures in different-age patients with cleft palate

The purpose of this study was to investigate the developmental tendency of velopharyngeal structures in different-age patients with cleft palate (CP) to provide reference for selecting surgery in clinic. The investigators implemented a retrospective study, and 66 patients were selected, including 38 boys and 28 girls (average age, 15 years 5 months ± 7 years). These patients were divided into 3 groups (G1, G2, and G3) according to their ages and were taken lateral preoperative cephalograms at rest and during phonation of /i/. Twelve lengths and 3 ratios variables were defined in this study. All these measurements were analyzed by analysis of variance and post hoc test, whereas P value was set at 0.05. There were significant differences of velar thickness and height, vertical velar length, pharyngeal height and depth, uvular pharyngeal depth, and hard palate length and height. Except velar height and vertical velar length of which the differences were only significant between G1 and G2, the difference of the others was significant between G1 and G2, and G1 and G3. In conclusion, velar thickness and posterior velar length increased significantly before 20 years old, whereas the motility of velar muscles between 12 years old and 20 years old was weaker. Growths of maxilla in vertical and horizontal dimension were faster before 20 years old. Besides, height-depth ratio was increasing with increase in age.

Three-dimensional morphology of the palate in patients with bilateral complete cleft lip and palate at the stage of permanent dentition

OBJECTIVE

Three-dimensional analysis of palate size and shape in 30 patients with complete bilateral cleft lip and palate (BCLPc) at the stage of permanent dentition.

DESIGN

Cross-sectional study based on laser scanning.

SUBJECTS

Thirty dental casts of boys approximately 15 years old with BCLPc and 28 dental casts of healthy boys of the same age.

INTERVENTIONS

Arched-lip suture with periosteoplasty and push-back of the palate with pharyngeal-flap surgery.

MAIN OUTCOME MEASURES

Data on palate height in the 210 defined locations and on palate widths and profile area in 10 transverse sections.

RESULTS

The palate in patients with BCLPc was conical and narrower than in control study subjects, much more anteriorly than posteriorly. From the canines posteriorly, the palate was of almost constant height of 10 mm in the midline, being higher than in control study subjects at this location and lower more posteriorly (by 24% to 29% between molars). The area of transverse sections was reduced as compared with control study subjects from the first premolars posteriorly and reached more than 40% between molars. The length of the palate up to the first molars was not changed.

CONCLUSION

BCLPc subjects exhibited narrow, low, and flat palate. Palate size and shape differences indicate a substantial reduction of the space for the tongue.

Three-dimensional morphology of the palate in subjects with unilateral complete cleft lip and palate at the stage of permanent dentition

OBJECTIVE

Three-dimensional analysis of palate size and shape in patients with complete unilateral cleft lip and palate (UCLP) at the stage of permanent dentition.

SUBJECTS

Thirty randomly selected dental casts of boys approximately 15 years old with complete UCLP and 28 dental casts of normal boys of the same age.

INTERVENTIONS

All patients underwent lip repair according to Tennison with primary periosteoplasty (mean age 8.5 months) and palate repair by pushback and pharyngeal flap surgery (mean age 4.9 years).

MAIN OUTCOME MEASURES

Data on the palate height in 210 defined locations.

RESULTS

The palate in patients with UCLP was narrower throughout its whole extent, more anteriorly than posteriorly. From the canines posteriorly, it was also lower, and the difference as compared with controls increased in a posterior direction up to the level of second premolars (up to 30%) and then slightly diminished (to 21% between the first molars). The reduction of area of transverse sections reached 45% between premolars and 39% between first molars. The palate in the anterior portion was highest on the cleft side and in a posterior direction the maximum height of the palate shifted toward the midline and even beyond that line toward the noncleft side. Palatal height did not depend on dentoalveolar arch width.

CONCLUSION

The smaller width and height of the palate confirm the substantially reduced space for the tongue in patients with UCLP. The reduction is only slightly larger than in previously examined patients with isolated cleft palate. Palatal vault is asymmetrical, highest anteriorly on the cleft side and posteriorly on the noncleft side.

Three-dimensional morphology of the palate in subjects with isolated cleft palate at the stage of permanent dentition

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.