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R V, Singhal R, Namdev R, Kumar A, Dayma C, Rani A. Treatment Outcomes of Lip Taping in Patients with Non-syndromic Cleft Lip and/or Palate: A Systematic Review and Meta-analysis. Cleft Palate Craniofac J 2024:10556656241249822. [PMID: 38711400 DOI: 10.1177/10556656241249822] [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: 05/08/2024] Open
Abstract
OBJECTIVE To conduct a systematic review of the data in peer-reviewed medical literature and evaluate the effectiveness of lip taping as a pre-surgical naso-alveolar molding (NAM) technique in infants with cleft lip and/or palate. DESIGN An electronic search of various databases for relevant studies, regardless of date, from inception to June 2023 was carried out and evaluated. After completing the electronic search and applying our inclusion/exclusion criteria, 6 studies-2 randomized control trials, 2 non-randomized studies, and 2 case series-were included. Data extraction of relevant articles was done independently by 2 authors. Quality assessment was done using the JBI prevalence critical appraisal tool and certainty of evidence was carried out by GRADE approach. MAIN OUTCOME MEASURES Nasolabial Aesthetics, Dentoalveolar Relationship. RESULTS A total of six studies were included in the current review. Meta-analysis was carried out, and forest plots were obtained for a single mean from the lip-taping group. 3 studies had a low risk of bias, while 3 studies displayed a serious risk of bias. Significant improvement in various outcome measures was noted with lip taping when compared with the control group although the certainty of evidence was very low. CONCLUSION When compared to no therapy, lip taping appears to ameliorate dentoalveolar measurements and nasolabial aesthetics. To increase our knowledge of lip taping, more research will be needed in the future, as there are not many studies to prove lip taping is better than other treatment approaches.
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Affiliation(s)
- Vignesh R
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Ruchi Singhal
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Ritu Namdev
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Adarsh Kumar
- Department of Public Health Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Charu Dayma
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Asha Rani
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
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Arslan C, Aksahin EC, Nur Yılmaz RB, Germec Cakan D. Does YouTube TM Offer High-Quality Information About Nasoalveolar Molding? Cleft Palate Craniofac J 2024; 61:5-11. [PMID: 35861787 DOI: 10.1177/10556656221115025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the content and quality of YouTubeTM videos concerning nasoalveolar molding (NAM). DESIGN YouTubeTM was searched for videos containing information relevant to NAM with the 2 keywords "nasoalveolar molding," and "presurgical infant orthopedics." A total of 24 out of 51 videos were found to be applicable to this study and rated for quality using the Global Quality Scale (GQS). To determine whether the contents of the selected 24 videos were useful or not, a content usefulness index consisting of 8 parameters was created. The videos were classified according to the usefulness index as low or high content videos. Spearman rank correlation analysis, Kolmogorov-Smirnov, Shapiro-Wilk, and Mann-Whitney U-tests were used for statistical analysis. RESULTS The mean GQS score of the 24 YouTubeTM videos on NAM was 2.3 ± 0.8, indicating overall poor quality. In terms of information, videos with high content (29.2%) were less in number than low content videos (70.8%). GQS values were found to be significantly higher in the high content group (P < .01). Regarding the source, video, and audio quality values were significantly higher in the expert group compared to the caregiver group (P < .01), whereas the usefulness index did not differ between groups (P > .05). A significant relationship was found between GQS and usefulness index, audio quality, and video quality (P < .001). CONCLUSIONS YouTube™ videos on NAM were generally inadequate in their content information and poor in quality. Expert videos, showing better audiovisual quality and flow compared to non-expert videos, did not offer higher quality information about NAM considering the usefulness index.
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Affiliation(s)
- Can Arslan
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - Elif Ceren Aksahin
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | | | - Derya Germec Cakan
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
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Taori KP, Niranjane PP, Daigavane P. Nasal Cartilage Molding in a Case of Unilateral Cleft Lip and Alveolus (Type D): A Case Report. Cureus 2023; 15:e50998. [PMID: 38259383 PMCID: PMC10802890 DOI: 10.7759/cureus.50998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Nasal cartilage is asymmetric in individuals with cleft lips and has a depressed nasal dome and medial and lateral crus of the nose on the affected cleft side which can be corrected before cheiloplasty by taking advantage of circulating maternal estrogen. This case report presents pre-surgical nasal cartilage molding in a patient with unilateral cleft lip and alveolus using the Sawangi Pre-surgical Nasal Cartilage Molder appliance. The appliance is made from 0.8 mm stainless-steel round wire and has three components, namely, a rectangular frame, a force-generating component, and a swan-shaped wire framework with a soft liner for nasal asymmetry correction.
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Affiliation(s)
- Kushal P Taori
- Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Priyanka P Niranjane
- Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Daigavane
- Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Torres PTIC, Luisa MSPPM, Peralta PPEC, Robertson PJP, Montalva MDFM, Figueroa DDSÁA, Mejía DDSML, Moreno MDAS, Martínez MSMD, Aguilera MDA, Arreguín MDJC, Dosal MDMRP, Saavedra MSMDLPA, Granados MSA. Developing core outcome set for anthropometric evaluation for presurgical infant orthopedics for unilateral cleft lip and palate: e- Delphi consensus. J Plast Reconstr Aesthet Surg 2022; 75:3795-3803. [DOI: 10.1016/j.bjps.2022.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 04/11/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
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Abid M, Al-Groosh D, Dziedzic A, Abed H. Mothers' knowledge and experience concerning presurgical orthopedic management for infants with cleft lip and palate. J Orthod Sci 2021; 10:8. [PMID: 34568204 PMCID: PMC8423153 DOI: 10.4103/jos.jos_47_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/30/2020] [Accepted: 11/22/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES: The present study aimed to assess the level of mothers’ knowledge toward cleft lip and palate and their experience concerning presurgical orthopedic management. MATERIALS AND METHODS: This was a cross-sectional study where the mothers were invited to complete a self-administered validated and reliable questionnaire. The questionnaire included questions that aimed to assess mother's knowledge related to the most prevalent aspects of cleft lip and palate anomaly itself and additionally, questions associated with presurgical orthopedic treatment as an adjunct therapy. Descriptive statistics were used to define the characteristics of the study variables. Chi-square test was utilized to assess relationships between categorical variables. RESULTS: Totally, 145 mothers completed the survey (response rate was 73%). Forty-six (46%) of the mothers provided an incomplete or improper definition of the anomaly and 35 (24%) claimed that they know the cause of the anomaly. The majority of mothers did not identify family history as a risk factor; consanguinity was identified in 29% (n = 42). Of the total, 58 mothers (40%) agreed that dental management of CLP requires teamwork and the majority (n = 126, 87%) recognized the plastic surgeon as the most important specialist. Mothers aged 20-30 years old (n = 42, 53%), and those who are university graduates (n = 38, 48%), as well as employed mothers (n = 52, 66%) have in general a higher degree of knowledge regarding cleft lip and palate (P < 0.001). More than half of the mothers (n = 70, 57%) reported that presurgical orthopedic treatment was useful and needed for their infants. CONCLUSIONS: Most of the mothers reported a high level of knowledge about cleft lip and palate and they experienced the usefulness of the orthopedic appliances for their infants. However, there was uncertainty in some parts such as definition, diagnosis, causes, and risk factors for cleft lip and palate. Therefore, understanding the causes of cleft lip and palate, as well as comprehensive education concerning the essential role of the orthopedic appliances to improve cleft lip and palate are crucial for mothers to improve their infants’ quality of life.
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Affiliation(s)
- Mushriq Abid
- Department of Orthodontic, Baghdad University, Iraq
| | | | - Arkadiusz Dziedzic
- Department of Conservative Dentistry with Endodontics, Medica University of Silesia, Katowice, Poland
| | - Hassan Abed
- Department of Basic and Clinical Oral Science, Faculty of Dentistry, Makkah, Saudi Arabia
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Batra P, Raghavan S, Gribel BF. Nasoalveolar molding appliances. Am J Orthod Dentofacial Orthop 2021; 159:e85. [PMID: 33546838 DOI: 10.1016/j.ajodo.2020.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Puneet Batra
- Uttar Pradesh India, and Belo Horizonte, Minas Gerais, Brazil
| | | | - Bruno F Gribel
- Uttar Pradesh India, and Belo Horizonte, Minas Gerais, Brazil
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Jodeh DS, Soni S, Cray JJ, Rottgers SA. Degree of Asymmetry Between Patients With Complete and Incomplete Cleft Lips. Cleft Palate Craniofac J 2020; 58:539-545. [PMID: 32996328 DOI: 10.1177/1055665620962365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Surgical outcomes for patients with complete cleft lips are not as ideal as those achieved for milder phenotypes. We hypothesized that in addition to the greater width of the cleft, patients with complete cleft lip and palate exhibit a greater degree of hypoplasia and asymmetry. METHODS Stereophotographs of 14 infants with unrepaired unilateral complete and 14 with incomplete cleft lips were measured using Vectra imaging software (Canfield Imaging). Unpaired t tests were used to compare measured asymmetry between groups. Measurements included nasion to endocathion, sn-sbal, subnasale to alare (sn-al), subnasale to crista philtra, subalare to crista philtra (sbal-cphi), chelion to crista philtra, lateral lip element fullness, medial lip element fullness (mef), and non-cleft lip fullness. Duplicate measurements allowed Pearson correlation to be used to determine intra-rater reliability. Statistical significance was set at P < .05. RESULTS Degree of asymmetry of the nasal base, sn-al, and sn-sbal was significantly greater for patients with complete clefts (P = .0001, P = .0001). Hypoplasia of the lateral lip element was seen when comparing lateral and mef (P = .04, P = .004) and lateral lip height (sbal-cphi''; P = .002). The degree of cupid's bow asymmetry did not differ between groups (P = .23). Intrarater reliability was high for all facial measures, ranging from 0.70 to 0.99. CONCLUSIONS More severe, complete cleft lips demonstrate statistically significant greater asymmetry in surgically relevant dimensions. There was greater width of the nasal base. Vertical asymmetry of cupid's bow was unaffected by cleft severity, but that asymmetry was greater in patients with complete clefts due to hypoplasia of the lateral lip element. This may contribute to the less favorable results in these patients.
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Affiliation(s)
- Diana S Jodeh
- Division of Plastic and Reconstructive Surgery, 7582Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Sara Soni
- Department of Plastic Surgery, 7831University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - James J Cray
- Department of Biomedical Education & Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH, USA
| | - S Alex Rottgers
- Division of Plastic and Reconstructive Surgery, 7582Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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Chung KH, Sato N, Chou PY, Lo LJ. An Intraoperative Rescue Procedure for the Protruding Premaxilla in the Repair of Complete Bilateral Cleft Lip: Rapid Premaxillary Molding. Cleft Palate Craniofac J 2020; 58:251-256. [PMID: 32648486 DOI: 10.1177/1055665620938480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Primary reconstruction of complete bilateral cleft lip and palate (BCLP) with protruding premaxilla in one-stage surgery is challenging because of the tension on muscle repair. Such patients are also common in the developing countries. For this condition, we have applied intraoperative "rapid premaxillary molding (RPM)" technique and obtained satisfactory results. METHODS We reviewed the data of patients with complete BCLP with protruding premaxilla applying intraoperative RPM including both our institution and cleft missions to developing countries in the past 20 years. Selection criteria were patients receiving either no or insufficient preoperative molding presenting with significant protruding premaxilla, had consecutive follow-ups after surgery. To perform this technique, the surgeon holds the patient's face with both hands and compresses the protruding premaxilla with both thumbs. An intermittent but stable backward pressure is applied to the premaxilla until the segment is gradually flexible. Repeated compression is performed prior to tying the muscle sutures, at which time the premaxilla is retro-positioned and aligned with the lateral maxillary segments. Pre- and postoperative data were evaluated. RESULTS We have treated a total of 60 patients with complete BCLP with protruding premaxilla applying intraoperative RPM. All patients tolerated the operations and there were no major intra- and postoperative complications including lip dehiscence and vomer fracture. All of them had satisfactory results such as adequate muscle repair and symmetry of the lip and nostrils. CONCLUSION The RPM is a reliable and valuable intraoperative adjunct procedure for patients with complete BCLP presenting the protrusive premaxilla.
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Affiliation(s)
- Kyung Hoon Chung
- Plastic & Reconstructive Surgery, and Craniofacial Research Center, 22386Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Nobuhiro Sato
- Plastic & Reconstructive Surgery, and Craniofacial Research Center, 22386Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Pang-Yun Chou
- Plastic & Reconstructive Surgery, and Craniofacial Research Center, 22386Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Lun-Jou Lo
- Plastic & Reconstructive Surgery, and Craniofacial Research Center, 22386Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
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The Use of Prophylactic Antibiotics before Primary Palatoplasty Is Not Associated with Lower Fistula Rates: An Outcome Study Using the Pediatric Health Information System Database. Plast Reconstr Surg 2019; 144:424-431. [PMID: 31348354 DOI: 10.1097/prs.0000000000005843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Previous attempts to study the effect of prophylactic antibiotics on the outcomes of cleft palate surgery have been hampered by the need for a very large sample size to provide adequate power to discern a potentially small therapeutic effect. This limitation can be overcome by querying large databases created by health care governing bodies. METHODS Data from the Pediatric Health Information System database were used for this analysis. Patients, aged 6 to 18 months, who had undergone primary palatoplasty (International Classification of Diseases, Ninth Revision, code 27.62) between 2004 and 2009 were included. Subsequent repair of an oronasal fistula between 2004 and 2015 was identified by International Classification of Diseases, Ninth Revision, procedure code 21.82. Pharmacy billing records were used to determine antibiotic administration. Associations between antibiotic administration and fistula repair were assessed using random-intercept logistic regression adjusting for age, sex, race, and cleft type. RESULTS Seven thousand one hundred sixty patients were available for analysis; of these, 460 (6.4 percent) had a subsequent repair of an oronasal fistula. Fistula rates were 5.9, 11.4, and 5.2 percent among patients given preoperative antibiotics, only postoperative antibiotics, and no antibiotics, respectively (p < 0.001). Multivariable analysis results showed that the odds of having an oronasal fistula among patients who were administered preoperative antibiotics did not differ significantly (statistically) from patients who did not receive antibiotics (OR, 0.88; 95 percent CI, 0.59 to 1.31). CONCLUSIONS The treatment goal of primary palatoplasty is the successful repair of the cleft without an oronasal fistula. Administration of preoperative antibiotics did not significantly reduce the odds of subsequent fistula repair within the same Pediatric Health Information System institution following primary palatoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Jodeh DS, Ruso S, Feldman R, Ruas E, Rottgers SA. Clinical Outcomes Utilizing a "Modified Latham" Appliance for Presurgical Infant Orthopedics in Patients With Unilateral Complete Cleft Lip and Palate. Cleft Palate Craniofac J 2018; 56:929-935. [PMID: 30526003 DOI: 10.1177/1055665618816892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Presurgical infant orthopedic manipulation is utilized prior to cleft lip/nasal repair to facilitate a gingivoperiosteoplasty (GPP) and primary nasolabial repairs. The Latham dentomaxillary advancement appliance uses a screw that must be tightened daily to approximate the cleft segments in unilateral complete clefts. Our cleft center has been utilizing a "modified Latham" appliance since 1987, including an orthodontic elastic power chain to close the gap in a shorter amount of time. We performed a retrospective chart review of all patients undergoing treatment at Johns Hopkins All Children's Hospital (JHACH) with a unilateral complete cleft lip and palate between 1987 and 2017. Patients were identified by the International Classification of Diseases, Ninth Revision code (749.21). The majority of the patients represent the experience of the senior authors (E.R. and R.F.). Two hundred and eighty-one patients with unilateral complete cleft lip/palate were identified. Seventy-five patients were treated with a "modified Latham" appliance prior to their lip repair. The "modified Latham" appliance remained in place on average 20.6 days (range: 4-82), and average hospital stay after placement was 1.18 days. Nearly 96% of patients underwent a successful GPP at the time of nasolabial repair. Modification of the Latham appliance by utilizing an elastic power chain and eliminating the screw allows rapid closure of the alveolar cleft with limited need for adjustments and outpatient visits. Direct approximation of the palatal segments allows successful completion of a GPP in 95.9% of patients with limited dissection.
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Affiliation(s)
- Diana S Jodeh
- 1 Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Stephen Ruso
- 2 Cleft and Craniofacial Team, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Randy Feldman
- 2 Cleft and Craniofacial Team, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Ernesto Ruas
- 1 Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA.,2 Cleft and Craniofacial Team, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - S Alex Rottgers
- 1 Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA.,2 Cleft and Craniofacial Team, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
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Jodeh DS, Buller M, Rottgers SA. The Impact of Presurgical Infant Orthopedics on Oronasal Fistula Rates Following Cleft Repair: A Meta-Analysis. Cleft Palate Craniofac J 2018; 56:576-585. [DOI: 10.1177/1055665618806104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Presurgical infant orthopedics (PSIO) techniques were introduced to improve the outcomes achieved when treating children with complete cleft lip and palate. The effect of PSIO on the incidence of postoperative fistulae has never been reliably demonstrated. We conducted a meta-analysis to assess the effectiveness of PSIO in reducing postoperative fistulas in patients with complete cleft lip and palate. Methods: A search of the PubMed and Embase databases was performed to identify relevant articles that included primary palate repairs of patients with unilateral or bilateral complete clefts, reported the incidence of postoperative fistulae, and explicitly stated if PSIO was used. Details including author, number of subjects, use of PSIO, and fistula rate were cataloged. Results: A review of the PubMed database yielded 1135 unique citations, and Embase yielded 507 articles. Review of these yielded 15 studies, comprising 1241 children, which met inclusion criteria. The overall rate of oronasal fistula development was 7.09%. The average fistula rate for studies using PSIO was 5.93% versus 9.71% in the non-PSIO group. This difference was not statistically significant ( P = .34). Conclusions: The use of PSIO prior to cleft lip and palate repair provides multiple benefits related to facial and nasal form and is supported by a body of literature. The effect of PSIO on the incidence of postoperative fistulae has received less attention in the literature. Our meta-analysis of the available literature does not provide evidence to support the premise that the use of PSIO affects the incidence of fistulae after cleft palate repair.
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Affiliation(s)
- Diana S. Jodeh
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - Mitchell Buller
- Department of Plastic Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - S. Alex Rottgers
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
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Stress Distribution Patterns within Viscero- and Neurocranium during Nasoalveolar Molding: a Finite Element Analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1832. [PMID: 30175012 PMCID: PMC6110680 DOI: 10.1097/gox.0000000000001832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/18/2018] [Indexed: 11/26/2022]
Abstract
Background The purpose of this study was to evaluate the stress distribution patterns within the viscero- and neurocranium of neonates during nasoalveolar molding. Methods Finite element models of 3 different healthy neonates at different times of life (date of birth, 4 weeks, and 3.5 months) were generated on the basis of computed tomography scans. A validated workflow, including segmentation, meshing, setting of boundary conditions, and implementation of a bone density-dependent material model, was carried out for each model. A small and a large unilateral alveolar and hard palatal cleft were virtually cut in each model. The stress distribution pattern in each model was then analyzed by using Ansys APDL. Results Convergence analysis validated the results. The virtual experiments at the date of birth showed a stress pattern above a previously defined threshold value of 30,000 Pa in the ipsilateral naso-orbital-complex, frontal sinus, and the anterior fossa of the base of the skull, with von Mises values > 35,000 Pa. Stress patterns at the age of 4 weeks and 3.5 months showed reduced von Mises values at < 15,000 Pa. Conclusions Nasoalveolar molding therapy is a safe presurgical treatment modality without significant influence on the viscero- and neurocranium of neonates. Treatment, considering the stress distribution at the naso-orbital-complex and anterior fossa of the base of the skull, should begin in the second week of life, and treatment initiation of preterm infants should be adapted respectively.
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Use of Nasal Conformer After Birth Effectively Improves Nostril Symmetry in Patients With Unilateral Incomplete Cleft Lip. J Oral Maxillofac Surg 2018; 76:2612-2617. [PMID: 29864433 DOI: 10.1016/j.joms.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the clinical effects of preoperative nasoalveolar molding (NAM) and nasal conformer use in patients with unilateral incomplete cleft lip on the basis of their medical records and images. PATIENTS AND METHODS Data and images of 16 patients born with unilateral incomplete cleft lip who were hospitalized between January 2015 and August 2017 were retrieved from the medical records. The primary outcome was the extent of improvement in columella height (CH) before cheiloplasty. Other outcome measurements included the CH, nostril width, and nostril height, which were measured by ImageJ image processing software (version 1.4; National Institutes of Health, Bethesda, MD) and presented as ratios. Mann-Whitney U tests were used to compare the non-normally distributed data. RESULTS Patients in the NAM group and those in the nasal conformer group showed significantly improved (P < .05) preoperative cleft-side CH-to-normal-side CH ratios compared with the corresponding ratios at birth. There was no significant difference in terms of the extent of improvement in CH between the groups. CONCLUSIONS Preoperative use of nasal conformers in patients with unilateral incomplete cleft lip not only corrects the deformed nasal cartilage but also increases the CH and improves the overall preoperative nasal symmetry. In addition, compared with NAM, this method costs less, is more straightforward, and requires fewer outpatient clinic visits.
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Bauer FX, Heinrich V, Grill FD, Wölfle F, Hedderich DM, Rau A, Wolff KD, Ritschl LM, Loeffelbein DJ. Establishment of a finite element model of a neonate's skull to evaluate the stress pattern distribution resulting during nasoalveolar molding therapy of cleft lip and palate patients. J Craniomaxillofac Surg 2018; 46:660-667. [PMID: 29545028 DOI: 10.1016/j.jcms.2018.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/09/2018] [Accepted: 01/25/2018] [Indexed: 10/18/2022] Open
Abstract
Nasoalveolar Molding (NAM) is associated with ambivalent acceptance regarding effectiveness and unknown long-term results. Our purpose was to analyze the stress distribution patterns within the viscero- and neurocranium of neonates during the first phase of NAM therapy. A finite element (FE) model of a healthy four-week-old neonate was generated, derived from a computed tomography scan allowing the implementation of a bone-density-dependent material model. The influence of dental germs with variable material properties, the cleft width and area of expected force application were analyzed in a worst-case scenario. The resulting stress distribution patterns for each situation were analyzed using the software Ansys APDL. The established FE model was verified with a convergence analysis. Overall, stress patterns at the age of four weeks showed von Mises stress values below 60.000 Pa in the viscero- and neurocranium. The influences of the allocation of material properties for the dental germs, the area of force application, and the cleft width were negligible. A workflow to simulate the stress distribution and deformation in neonates attributable to various areas of force application has been established. Further analyses of the skulls of younger and older neonates are needed to describe the stress distribution patterns during NAM therapy.
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Affiliation(s)
- Franz X Bauer
- Institute of Medical and Polymer Engineering, Technische Universität München, Germany
| | - Veronika Heinrich
- Institute of Medical and Polymer Engineering, Technische Universität München, Germany
| | - Florian D Grill
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Felix Wölfle
- Institute of Medical and Polymer Engineering, Technische Universität München, Germany
| | - Dennis M Hedderich
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Andrea Rau
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
| | - Denys J Loeffelbein
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
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Hosseini HR, Kaklamanos EG, Athanasiou AE. Treatment outcomes of pre-surgical infant orthopedics in patients with non-syndromic cleft lip and/or palate: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2017; 12:e0181768. [PMID: 28742129 PMCID: PMC5524403 DOI: 10.1371/journal.pone.0181768] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/05/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-syndromic clefts lip and/or palate (CL/P) defects may have manifold significant and detrimental consequences for the affected individuals and their family environment. Although the use of pre-surgical infant orthopedics (PSIO) was introduced as a means to improve management and treatment outcomes, there still remains a controversy. OBJECTIVE To investigate the effectiveness of PSIO in patients with non-syndromic CL/P and evaluate the quality of the available evidence. SEARCH METHODS Search without restrictions, together with hand searching, until May 2016. SELECTION CRITERIA Randomized clinical trials investigating the effects of pre-surgical infant orthopedic appliances. DATA COLLECTION AND ANALYSIS Following study retrieval and selection, data extraction and individual study risk of bias assessment using the Cochrane Risk of Bias Tool took place. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach. RESULTS Finally 20 papers (3 unique trials) were identified, involving a total of 118 patients with unilateral complete CL/P and 16 with cleft of the soft and at least two thirds of the hard palate. Eight publications were considered as being of low, four of unclear and eight of high risk of bias. In general, the investigated appliances did not present significant effects when compared to each other or to no treatment in terms of feeding and general body growth, facial esthetics, cephalometric variables, maxillary dentoalveolar variables and dental arch relationships, speech and language evaluation, caregiver-reported outcomes, economic evaluation, as well as, adverse effects and problems. Overall, the quality of the available evidence was considered low. CONCLUSIONS The aforementioned findings could provide initial guidance in the clinical setting. However, given the multitude of parameters, which may have affected the results, good practice would suggest further research, in order to reach more robust relevant recommendations for management decisions in individual cases.
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Affiliation(s)
- Hamid Reza Hosseini
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Eleftherios G. Kaklamanos
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Athanasios E. Athanasiou
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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18
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Chaudhary DC, Sharma R, Sharma V, Kaur S. Presurgical nasoalveolar moulding: A boon in the management of cleft lip and palate. Med J Armed Forces India 2017; 72:S164-S168. [PMID: 28050103 DOI: 10.1016/j.mjafi.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 09/19/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Dinesh Chander Chaudhary
- Classified Specialist (Orthodontics), Army Dental Centre (R&R), Delhi Cantt, New Delhi 110 010, India
| | - Rohit Sharma
- Associate Professor (Oral and Maxillofacial Surgery), Dept of Dental Surgery, Armed Forces Medical College, Pune 411040, India
| | - Vineet Sharma
- Commandant and Command Dental Adviser (Northern Command), C/O 56 APO, India
| | - Simrat Kaur
- Associate Professor (Prosthodontics), SGRD Institute of Dental Sciences & Research, Amritsar, Punjab, India
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Aravena PC, Brandt M, Klett F, Hernández M, Coronado C. Effect of presurgical orthopedics on oral-health related quality of life in Chilean children with cleft lip and palate. A pilot study. JOURNAL OF ORAL RESEARCH 2016. [DOI: 10.17126/joralres.2016.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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20
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Rodman RE, Tatum S. Controversies in the Management of Patients with Cleft Lip and Palate. Facial Plast Surg Clin North Am 2016; 24:255-64. [DOI: 10.1016/j.fsc.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Palatal fistula is a known complication of cleft lip-cleft palate repair. Fistulas anterior to the incisive foramen can be particularly difficult to repair because of the lack of available tissue. Adjacent tissue has inherent limitations, and multiple free-flap techniques have been described; however, there remains no single solution for this difficult problem. The authors present an alternative strategy of replacing "like with like" by using an osteocutaneous free tissue transfer of the second toe for anterior oronasal fistulas. Use of the osteocutaneous second-toe free flap provides skin lining to both the oral side and the nasal side to close oronasal fistulas. It also bridges the alveolar gap with vascularized bone. This flap can be considered as an elegant alternative for anterior oronasal fistulas.
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Ebadifar A, Hamedi R, Khorram Khorshid HR, Saliminejad K, Kamali K, Aghakhani Moghadam F, Esmaeili Anvar N, Ameli N. Association of Transforming Growth Factor Alpha Polymorphisms with Nonsyndromic Cleft Lip and Palate in Iranian Population. Avicenna J Med Biotechnol 2015; 7:168-72. [PMID: 26605011 PMCID: PMC4629459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Cleft lip with or without cleft palate (CL/P) is one of the most common congenital anomalies and the etiology of orofacial clefts is multifactorial. Transforming growth factor alpha (TGFA) is expressed at the medial edge epithelium of fusing palatal shelves during craniofacial development. In this study, the association of two important TGFA gene polymorphisms, BamHI (rs11466297) and RsaI (rs3732248), with CL/P was evaluated in an Iranian population. METHODS The frequencies of BamHI and RsaI variations were determined in 105 unrelated Iranian subjects with nonsyndromic CL/P and 218 control subjects using PCR and RFLP methods, and the results were compared with healthy controls. A p-value of <0.05 was considered statistically significant. RESULTS The BamHI AC genotype was significantly higher (p=0.016) in the patients (12.4%) than the control group (5.0%). The BamHI C allele was significantly higher (p=0.001; OR=3.4, 95% CI: 1.6-7.4) in the cases (8.0%) compared with the control group (2.5%). CONCLUSION Our study showed that there was an association between the TGFA BamHI variation and nonsyndromic CL/P in Iranian population.
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Affiliation(s)
- Asghar Ebadifar
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Department of Orthodontic, Faculty of Dentistry, Shahid Behehsti University of Medical Sciences, Tehran, Iran
| | - Roya Hamedi
- Department of Orthodontic, Dentofacial Deformities Research Center, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding author: Roya Hamedi, Ph.D., Department of Orthodontic, Dentofacial Deformity Research Center, Faculty of Dentistry, Shahid Behehsti University of Medical Sciences, Tehran, Iran, Tel: +98 9125576105, E-mail:
| | | | - Kioomars Saliminejad
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Koorosh Kamali
- Department of Public Health, Faculty of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Nazanin Esmaeili Anvar
- Genetic Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nazilla Ameli
- Department of Orthodontic, Faculty of Dentistry, Semnan University of Medical Sciences, Semnan, Iran
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