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Sijmons WJL, Krijt LL, Bruggink R, Ongkosuwito EM, Kuijpers MAR. Impact of Unilateral Alveolar Bone Grafting on Nasal Volume and Nasolabial Surface: A 3D Analysis. Cleft Palate Craniofac J 2023:10556656231221658. [PMID: 38128908 DOI: 10.1177/10556656231221658] [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: 12/23/2023] Open
Abstract
OBJECTIVE To determine possible effects of unilateral alveolar cleft closure on internal nasal volume and external nasolabial surface. DESIGN Retrospective, single-arm, cohort study. SETTING Institutional, tertiary care. PATIENTS Patients with complete unilateral cleft lip, alveolus, and palate (CUCLAP), who underwent closure of the alveolar cleft with autologous bone graft (ABG) at the age of 9-11 years, with cone beam computed tomography (CBCT) and/or three-dimensional (3D) stereophotogrammetry images taken before and one year after the ABG procedure. INTERVENTIONS ABG-pocedure in patients with CUCLAP. MAIN OUTCOME MEASURES The influence of ABG on the internal and external nasal morphology. RESULTS A total of 28 patients (21M/7F, 14R/14L) were divided into internal (CBCT) and external (3D-stereophotogrammetry) measurement subgroups. The external nasolabial surface showed a significant decrease of the angle alar curvature right-subnasale-alar curvature left (-1.99°; P = .02; 95% CI -2.61, -0.36) and an increase of the linear measurement between these points (+1.01 mm; P = .03; 95% CI: 0.11, 1.91). No significant differences were found when comparing the distance maps of the affected side with the non-affected side (P = .50, 95% CI: -0.20, 0.29). CONCLUSIONS Closure of the alveolar cleft in CUCLAP patients with ABG did not affect the internal nasal volume, but significantly affected the external nasal surface. The procedure resulted in the nose becoming wider because both alar curvatures moved caudally and laterally relative to the subnasale.
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Affiliation(s)
- W J L Sijmons
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - L L Krijt
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - R Bruggink
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands
- 3DLAB The Netherlands, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - E M Ongkosuwito
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - M A R Kuijpers
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands
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Najar Chalien M, Mark H, Lilja J, Rizell S. Long-term Outcome for Two-Stage Palatal Closure With Different Timings for Hard Palate Surgery: Craniofacial Growth and Dental Arch Relation. Cleft Palate Craniofac J 2023; 60:1140-1148. [PMID: 36597376 PMCID: PMC10467013 DOI: 10.1177/10556656221140676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim was to evaluate dental arch relation and craniofacial growth for individuals born with unilateral cleft lip and palate (UCLP), who had two-stage palatal surgery, with hard palate closure (HPC) at the ages of 3 or 8 years. DESIGN Longitudinal cohort study. SETTING Ceft lip and palate team in Gothenburg, Sweden. PATIENTS The inclusion criteria were nonsyndromic individuals born with complete UCLP who were consecutively operated according to two different surgical protocols; soft palate closure at 6 months followed by hard palate closure at the age of 3 years (HPC3) or at the age of 8 years (HPC8). In this evaluation, 28 individuals had HPC3 and 59 individuals had HPC8. INTERNVENTIONS The main outcome, longitudinal series of dental casts and lateral radiographs from the ages of 5, 10, 16, and 19 years, were evaluated using GOSLON Yardstick and cephalometric analysis. RESULTS At the age of 10 years, 78% of the individuals with HPC3 demonstrated GOSLON scores of 1 and 2 and 86% in HPC8. At the age of 19 years, 54% of the individuals exhibited GOSLON scores of 1or 2 when compared with 74% in HPC8. A statistical significant difference for SNA was observed at the age of 5 years (P = .004), with a lower SNA in HPC3, but not at the ages of 10, 16 and 19 years. At the final age, SNA was 75.2° for HPC3 and 76.8° for HPC8. CONCLUSIONS The decrease in age for HPC did not have an adverse effect on long-term dental arch relationship or craniofacial growth.
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Affiliation(s)
- Midia Najar Chalien
- Clinic of Orthodontics, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
- Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Mark
- Department of Plastic Surgery, Sahlgrenska University Hospital and Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Lilja
- Department of Plastic Surgery, Sahlgrenska University Hospital and Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sara Rizell
- Clinic of Orthodontics, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
- Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Palikaraki G, Makrygiannakis MA, Zafeiriadis AA, Benetou V, Sanoudos M, Bitsanis I, Tsolakis AI. The effect of facemask in patients with unilateral cleft lip and palate: a systematic review and meta-analysis. Eur J Orthod 2021; 43:69-79. [PMID: 32274494 DOI: 10.1093/ejo/cjaa027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with cleft lip and palate usually present a Class III skeletal pattern. Facemask (FM) is one of the conventional orthodontic treatment modalities used to address the skeletal discrepancy in cleft patients. OBJECTIVE To investigate the potential effectiveness of FM in unilateral cleft lip and palate (UCLP) patients. SEARCH METHODS Search without restrictions except language in seven databases since inception and hand searching until January 2019 was conducted. Detailed search strategies were developed for each database which were based on the PubMed strategy and adapted accordingly. SELECTION CRITERIA Controlled studies assessing the effect of FM in UCLP patients were to be included. DATA COLLECTION AND ANALYSIS After retrieval and selection of the studies, data extraction was performed. Both angular and linear cephalometric measurements were collected. Weighted mean differences (WMDs) and 95% confidence intervals (CΙs) between treated and untreated UCLP patients concerning the pre- and post-treatment angular measurements of each group were calculated using a random-effects meta-analysis model. The risk of bias in individual studies was assessed using the ROBINS-I tool. RESULTS From nine eligible studies, five were included in the meta-analysis investigating the use of FM in patients and controls with UCLP (with and without maxillary expansion). Statistically significant differences were evident for SNA/S-N-ss, SNB/S-N-sm, ANB/ss-N-sm, and SN-MP. FM was found to induce an increase of SNA (WMD = 2.12 degrees, 95% CI: 1.58 to 2.66), ANB (WMD = 4.17 degrees, 95% CI: 3.60 to 4.74), and SN-MP angles (WMD = 2.60 degrees, 95% CI: 1.10 to 4.10) and a decrease of SNB angle (WMD = -1.94 degrees, 95% CI: -2.48 to -1.40) in UCLP patients. Low to moderate heterogeneity was observed. LIMITATIONS They emerge due to risk of bias, exclusion of non-English papers and methodological characteristics of the included papers. CONCLUSIONS According to the available data, FM seems to improve the sagittal skeletal relationships in UCLP patients, increasing the SNA and ANB angles and decreasing the SNB angle. Moreover, in the vertical dimension, FM increases the SN-MP angle. Regarding dental measurements, there are controversial results. More high-quality studies need to be conducted in order to further clarify the impact of FM on UCLP patients. REGISTRATION NUMBER PROSPERO: CRD42019131619.
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Affiliation(s)
| | - Miltiadis A Makrygiannakis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios A Zafeiriadis
- Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassiliki Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Mattheos Sanoudos
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilias Bitsanis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Apostolos I Tsolakis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.,Department of Orthodontics, School of Dental Medicine Case Western Reserve University, Cleveland, OH, USA
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Galassi TV, Souza-Brosco TV, Lopes LD, de Almeida AM, da Silva Dalben G, de Paiva JB, Neto JR, Ozawa TO. Does Infant Orthopedics and Neonate Lip Surgery Influence the Occlusal Relationship in Patients With Unilateral Cleft Lip and Palate (UCLP)? Cleft Palate Craniofac J 2021; 58:1265-1273. [PMID: 33486979 DOI: 10.1177/1055665620984352] [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: 11/15/2022] Open
Abstract
OBJECTIVE To compare occlusal relationship in patients undergoing neonate versus conventional lip surgery (LS) with and without infant orthopedics (IO) by assessment of dental arch relationship in individuals with complete unilateral cleft lip and palate. MATERIAL AND METHODS Three groups treated by different protocols; Group I: neonate LS (1-15 days) + IO and palatoplasty (13-31 months); Group II: LS (3-12 months) + IO and palatoplasty (15-35 months); and Group III: LS (3-6 months) without IO and palatoplasty (12-18 months). The 112 intraoral photographs of individuals of all groups, obtained between 6 and 12 years of age, were assessed by the occlusal index for intraoral photograph rating. The groups were compared by the χ2 test. The correlation between surgical timing and the scores was tested by the Spearman test (P < .05). RESULTS Group I presented the highest percentage of score 5, group II exhibited highest percentage of score 1, and group III presented the lowest percentage of score 5 according to the χ2 test (P = .029). The Spearman correlation test revealed statistically significant difference between timing of LS and the occlusal index. The earlier the surgical timing, the higher the occlusal index (P = .019). CONCLUSIONS Infant orthopedics has demonstrated the possibility of postponing primary plastic surgeries. Patients submitted to late lip and palate repair had the best prognosis, while patients undergoing lip repair from 1 to 15 days of life, even operating the palate later, had the worst prognosis. Neonate LS negatively influenced the occlusal relationships.
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Affiliation(s)
- Thalita V Galassi
- Department of Orthodontics and Pediatrics, Faculty of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Telma V Souza-Brosco
- Plastic Surgery Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
| | - Lucy D Lopes
- Department of Prosthodontics, Faculty of Dentistry, University of Sao Paulo, Brazil
| | - Araci Malagodi de Almeida
- Orthodontics Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
| | - Gisele da Silva Dalben
- Pediatric Dentistry Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
| | - Joao B de Paiva
- Department of Orthodontics and Pediatrics, Faculty of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - José Rino Neto
- Department of Orthodontics and Pediatrics, Faculty of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Terumi O Ozawa
- Orthodontics Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
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Haque S, Khamis MF, Alam MK, Wan Ahmad AWM. The Assessment of 3D Digital Models Using GOSLON Yardstick Index: Exploring Confounding Factors Responsible for Unfavourable Treatment Outcome in Multi-Population Children With UCLP. Front Pediatr 2021; 9:646830. [PMID: 34262887 PMCID: PMC8273310 DOI: 10.3389/fped.2021.646830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
To evaluate dental arch relationship (DAR) using GOSLON Yardstick and also to explore the association between multiple factors (age, gender, UCLP types, UCLP side, Family history of cleft, family history of Class III malocclusion, techniques of cheiloplasty, techniques of palatoplasty) and DAR in children unilateral cleft lip and palate (UCLP) in different populations. Two hundred fifty-five laser scanned 3D digital models (LS3DM) of UCLP children (5-12 years) from Malaysia, Bangladesh, and Pakistan were included. The intra- and inter-examiner agreements were evaluated by kappa statistics, to compare the GOSLON mean score between the populations and to explore the responsible factors that affect DAR, one way ANOVA, and crude logistic regression analysis was used, respectively. The mean GOSLON score was 2.97; 3.40 and 3.09 in Malaysia, Bangladesh, and Pakistan, respectively. Twenty seven, 40, and 30 subjects were in unfavourable (category rating 4 and 5) groups in Malaysia, Bangladesh, and Pakistan, respectively. A significant association was found between techniques of palatoplasty (p = 0.03; p = 0.04 and p = 0.04 in Malaysia, Bangladesh, and Pakistan, respectively) and unfavourable DAR. Different cheiloplasty techniques (p = 0.04) and gender (p = 0.03) also exhibited noteworthy associations with unfavourable DAR in the Bangladeshi population. Bardach techniques of palatoplasty were significantly associated with unfavourable DAR in all three populations. Moreover, male UCLP and modified Millard techniques of cheiloplasty were also associated with unfavourable DAR in the Bangladeshi population.
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Affiliation(s)
- Sanjida Haque
- Orthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Mohd Fadhli Khamis
- Oral Biology and Forensic Odontology Unit, School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.,Forensic Odontology Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
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Kimura E, Obata T, Kitai S, Ishii T, Sakamoto T, Watanabe M, Watanabe A, Narita M, Nakano Y, Takano N, Sueishi K, Nishii Y. Three-Dimensional Measurements of Pharyngeal Airway in Patients with Unilateral Cleft Lip and Palate. THE BULLETIN OF TOKYO DENTAL COLLEGE 2020; 61:213-219. [PMID: 33177272 DOI: 10.2209/tdcpublication.2020-0019] [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: 11/06/2022]
Abstract
The aim of this study was to investigate 3-dimensional (3D) airway volume in patients with unilateral cleft lip and palate (UCLP) using computed tomography (CT). The study population comprised 15 UCLP patients (UCLP group) scheduled to receive alveolar bone grafts and 15 with impacted teeth (control group). The clinical requirements for a CT scan were met in both groups. Measurements were recorded from 3D reconstructions of Digital Imaging and Communications in Medicine data obtained from the CT images. Airway volume, cross-sectional area, and linear and angular measurements were recorded. Airway volume and cross-sectional area showed no significant difference between the two groups. The narrowest section of the airway in the UCLP group was tighter than that in the control group, however (p=0.017). The results of this study suggest that this difference in the measurements of the narrowest section of the airway is involved in the particular maxillofacial morphology found in UCLP patients.
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Affiliation(s)
- Emiko Kimura
- Department of Orthodontics, Tokyo Dental College
| | - Tomoko Obata
- Department of Orthodontics, Tokyo Dental College
| | - Shuto Kitai
- Department of Orthodontics, Tokyo Dental College
| | | | | | - Miki Watanabe
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College
| | - Akira Watanabe
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College
| | - Masato Narita
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College
| | - Yoko Nakano
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College
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Abstract
OBJECTIVE The aim of this study is to describe the importance of osteodistraction with transpalatal distractors for treating transversal maxillary hypoplasia in patients with cleft and lip palate. METHODS The participants were 17 patients (9 females and 8 males) with cleft lip and palate. Among these, 10 presented unilateral cleft lip and palate, 4 bilateral cleft lip and palate, and 3 cleft palate only. RESULTS All patients experienced a satisfactory palatal expansion and crossbite correction. The mean lengthening was 12.7 mm. The average increase of intercanine distance, intermolar distance, maxillary transverse dimension (MTD), facial transverse dimension (FTD) was 12.16, 8.45, 1.77, and 1.67 mm, respectively. The clinical follow-up was 29.7 months (range: 6-61 months). CONCLUSION Palatal distraction is a safe and successful alternative for treating maxillary transversal alterations in patients with cleft lip and palate. This technique facilitates the establishment of an adequate transverse dimension of maxillary, and consequently a proper dental occlusion.
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8
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Al Rudainy D, Ju X, Mehendale F, Ayoub A. The effect of facial expression on facial symmetry in surgically managed unilateral cleft lip and palate patients (UCLP). J Plast Reconstr Aesthet Surg 2018; 72:273-280. [PMID: 30522896 DOI: 10.1016/j.bjps.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 09/18/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
Abstract
AIM To evaluate the symmetry of facial expression in surgically managed UCLP patients. MATERIALS AND METHODS The study was conducted on 13 four-year-old children. Facial images were captured at rest and at maximum smile using stereophotogrammetry. A generic mesh, which is a mathematical facial mask consisting of a fixed number of indexed vertices, was utilised for the assessment of facial asymmetry. This was quantified by measuring the disparity between the left- and right-hand sides of the face after superimposing the original 3D images on their mirror copies. RESULTS Residual asymmetries at rest were identified at the vermillion of the upper lip and at the nares with a deviation of the philtrum towards the scar tissue. Vertical and anteroposterior asymmetries were identified on the cleft side. At maximum smile, the asymmetry increased noticeably at the vermillion of the upper lip and at the alar base. In the mediolateral direction, the philtrum deviated towards the cleft side with a significant increase of the asymmetry scores. DISCUSSION Asymmetry of the upper lip has significantly increased at maximum smile as a result of the upward forces of all perioral lifting muscles, which affected the lip directly. CONCLUSIONS The innovation of this study is the measurement of facial asymmetry for the objective outcome measure of the surgical repair of UCLP. The philtrum was the main site of residual asymmetry, which indicates the need for refining the primary repair of the cleft lip. Further corrective surgery may be required.
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Affiliation(s)
- D Al Rudainy
- Glasgow Dental Hospital & School, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK; Orthodontic Department, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - X Ju
- Glasgow Dental Hospital & School, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK; Medical Device Unit, Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, 1055 Great Western Rd, Glasgow G12 0XH, UK
| | - F Mehendale
- Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh, EH9 1LF, Edinburgh, UK
| | - A Ayoub
- Glasgow Dental Hospital & School, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK.
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Siegenthaler M, Bettelini L, Brudnicki A, Rachwalski M, Fudalej PS. Early versus late alveolar bone grafting in unilateral cleft lip and palate: Dental arch relationships in pre-adolescent patients. J Craniomaxillofac Surg 2018; 46:2052-2057. [PMID: 30416034 DOI: 10.1016/j.jcms.2018.09.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/30/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To evaluate the dental arch relationship in preadolescent children with complete unilateral cleft lip and palate after early secondary alveolar bone grafting (E-ABG) by comparing to late bone grafting (L-ABG). MATERIAL AND METHODS Two raters blindly assessed the dental arch relationship with the modified Huddart-Bodenham (HB) Index for 2 groups: E-ABG group (36 children, mean age 9.6 years) and L-ABG group (56 children, mean age 11.1 years). The groups differed with respect to age at which alveolar bone grafting was performed: between 1.4 and 4.1 years (mean 2.2 years, E-ABG group) and after 8 years (L-ABG group). T-test was run to compare scores between 2 groups. Regression analysis was carried out to evaluate gender, age at cleft repair, age at ABG, and age at assessment with the HB index. RESULTS The overall HB scores were -6.77 and -4.25 in the E-ABG and L-ABG groups, respectively (p = 0.025). Regression analysis showed that only the age at cleft repair influenced the HB scores. CONCLUSION ABG carried out between 2 and 4 years of age does not seem to negatively affect the dental arch relationship at the age of 10 years in comparison to L-ABG.
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Affiliation(s)
| | - Lisa Bettelini
- Private Practice, Winkelstrasse 22, 1716 Plaffeien, Switzerland
| | - Andrzej Brudnicki
- Department of Paediatric Surgery (Head of the Department: Prof. Ewa Sawicka), Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Martin Rachwalski
- Department of Maxillofacial and Plastic Surgery (Head of the Department: Prof. Arnaud Picard), National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015 Paris, France
| | - Piotr S Fudalej
- Department of Orthodontics (Head of the Department: Doc. Milos Spidlen), Institute of Dentistry and Oral Sciences, Palacky University Olomouc, Palackeho 12, 771 00 Olomouc, Czech Republic; Department of Orthodontics and Dentofacial Orthopaedics (Head of the Department: Prof. Christos Katsaros), University of Bern, Freiburgstrasse 9, 3010 Bern, Switzerland.
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Titiz S, Aras I. Modifications in Presurgical Nasoalveolar Molding Treatment of Bilateral Cleft Lip and Palate Patients With Severely Malpositioned Premaxillae. Cleft Palate Craniofac J 2018; 55:1316-1320. [PMID: 29578804 DOI: 10.1177/1055665618765781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate a modified presurgical nasoalveolar molding (PNAM) treatment for patients with bilateral cleft lip and palate (BCLP) with severely malpositioned premaxillae. SETTING This study was conducted at the Faculty of Dentistry, Department of Orthodontics, Ege University, Bornova, Izmir, Turkey. METHOD Retention arms were manufactured using a mold that we developed, and prefabricated retraction apparatuses were applied to the plaster model obtained from the patient. During the acrylic curing process, the flanges of the appliances were elongated into the sulcus without including the premaxilla. The premaxilla was aligned with the midline with an elastic band system, and the lip hanger was constructed with 0.023-in stainless steel wire. Elastic bands were stretched between the retraction apparatuses and the lip hanger based on the desired force. Nasal stents were added to the retention arms when the cleft width was reduced to less than 6 mm. CONCLUSION The modified PNAM treatment enabled faster derotation of the premaxilla and earlier initiation of retraction. The prefabricated retraction apparatus and retention arm provided efficient PNAM for patients with BCLP.
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Affiliation(s)
- Serap Titiz
- 1 Discipline of Orthodontics, Private Practice, Izmir, Turkey
| | - Isil Aras
- 2 Faculty of Dentistry, Department of Orthodontics, Ege University, Izmir, Turkey
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Willadsen E, Boers M, Schöps A, Kisling-Møller M, Nielsen JB, Jørgensen LD, Andersen M, Bolund S, Andersen HS. Influence of timing of delayed hard palate closure on articulation skills in 3-year-old Danish children with unilateral cleft lip and palate. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:130-143. [PMID: 28741729 DOI: 10.1111/1460-6984.12331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 05/09/2017] [Accepted: 05/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. AIMS To assess the influence of different timing of hard palate closure in a two-stage procedure on articulation skills in 3-year-olds born with unilateral cleft lip and palate (UCLP). Secondary aims were to compare results with peers without CP, and to investigate if there are gender differences in articulation skills. Furthermore, burden of treatment was to be estimated in terms of secondary surgery, hearing and speech therapy. METHODS & PROCEDURES A randomized controlled trial (RCT). Early hard palate closure (EHPC) at 12 months versus late hard palate closure (LHPC) at 36 months in a two-stage procedure was tested in a cohort of 126 Danish-speaking children born with non-syndromic UCLP. All participants had the lip and soft palate closed around 4 months of age. Audio and video recordings of a naming test were available from 113 children (32 girls and 81 boys) and were transcribed phonetically. Recordings were obtained prior to hard palate closure in the LHPC group. The main outcome measures were percentage consonants correct adjusted (PCC-A) and consonant errors from blinded assessments. Results from 36 Danish-speaking children without CP obtained previously by Willadsen in 2012 were used for comparison. OUTCOMES & RESULTS Children with EHPC produced significantly more target consonants correctly (83%) than children with LHPC (48%; p < .001). In addition, children with LHPC produced significantly more active cleft speech characteristics than children with EHPC (p < .001). Boys achieved significantly lower PCC-A scores than girls (p = .04) and produced significantly more consonant errors than girls (p = .02). No significant differences were found between groups regarding burden of treatment. The control group performed significantly better than the EHPC and LHPC groups on all compared variables.
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Affiliation(s)
- Elisabeth Willadsen
- University of Copenhagen, Department of Nordic Studies and Linguistics, Njalsgade, Denmark
| | - Maria Boers
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Hellerup, Denmark
| | - Antje Schöps
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Hellerup, Denmark
| | | | | | - Line Dahl Jørgensen
- University of Copenhagen, Department of Nordic Studies and Linguistics, Njalsgade, Denmark
| | | | - Stig Bolund
- University Hospital of Copenhagen, Copenhagen, Denmark
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12
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Alam MK, Iida J, Sato Y, Kajii TS. Postnatal treatment factors affecting craniofacial morphology of unilateral cleft lip and palate (UCLP) patients in a Japanese population. Br J Oral Maxillofac Surg 2012; 51:e205-10. [PMID: 23099108 DOI: 10.1016/j.bjoms.2012.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 10/02/2012] [Indexed: 11/26/2022]
Abstract
We have evaluated the craniofacial morphology of Japanese patients with unilateral cleft lip and palate (UCLP) and assessed the various postnatal factors that affect it. Lateral cephalograms of 140 subjects (mean (SD) aged 7 (2) years) with UCLP were taken before orthodontic treatment. Surgeons from Hokkaido University Hospital had done the primary operations. The craniofacial morphology was assessed by angular and linear cephalometric measurements. Cheiloplasty, palatoplasty, and preoperative orthopaedic treatment were chosen as postnatal factors. To compare the assessments of the postnatal factors, we made angular and linear cephalometric measurements for each subject and converted them into Z scores in relation to the mean (SD) of the two variables. Subjects treated by the modified Millard cheiloplasty had larger sella-nasion-point A (SNA) and nasion-point A-pogonion (NA-POG) measurements than subjects treated by the modified Millard with a vomer flap cheiloplasty. Two-stage palatoplasty showed consistently better craniofacial morphology than the other palatoplasty. Subjects who had preoperative orthopaedic treatment with a Hotz plate had significantly larger upper incisor/sella-nasion (U1-SN) measurements than who had no preoperative orthopaedic treatment or an active plate. We conclude that in subjects treated by a modified Millard type of cheiloplasty, a two-stage palatoplasty, and a Hotz plate there were fewer adverse effects on craniofacial morphology.
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Affiliation(s)
- M K Alam
- Orthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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