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Park JJ, Kalra A, Parsaei Y, Rochlin DH, Verzella A, Grayson BH, Cutting CB, Shetye PR, Flores RL. The Effects of Gingivoperiosteoplasty and Cleft Palate Repair on Facial Growth. Plast Reconstr Surg 2024; 153:1110-1119. [PMID: 37184473 DOI: 10.1097/prs.0000000000010681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Gingivoperiosteoplasty (GPP) can avoid secondary alveolar bone graft in up to 60% of patients. The effects of GPP on maxillary growth are a concern. However, palatoplasty can also negatively impact facial growth. This study quantifies the isolated effects of GPP and cleft palate repair on maxillary growth at the age of mixed dentition. METHODS A single-institution, retrospective study of all patients undergoing primary reconstruction for unilateral cleft lip and alveolus (CLA) or cleft lip and palate (CLP) was performed. Study patients had lateral cephalograms at the age of mixed dentition. Patients were stratified into four groups: CLA with GPP (CLA + GPP), CLA without GPP (CLA - GPP), CLP with GPP (CLP + GPP), and CLP without GPP (CLP - GPP). Cephalometric measurements included the following: sella-nasion-point A (SNA), sella-nasion-point B (SNB), and A point-nasion-B point. Landmarks were compared between patient groups and to Eurocleft center D data. RESULTS One hundred ten patients met inclusion criteria: seven CLA - GPP, 16 CLA + GPP, 24 CLP - GPP, and 63 CLP + GPP patients. There were no significant differences in SNA, SNB, and A point-nasion-B point between CLA + GPP and CLA - GPP, or between CLP + GPP and CLP - GPP groups. In patients who did not receive GPP, SNA was significantly lower in patients with a cleft palate compared with patients with an intact palate ( P < 0.05). There were no significant differences in SNA or SNB of CLP - GPP or CLP + GPP groups when compared with Eurocleft data. CONCLUSION When controlling for the effects of cleft palate repair, GPP does not appear to negatively affect midface growth at the age of mixed dentition. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Jenn J Park
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Aneesh Kalra
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Yassmin Parsaei
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Danielle H Rochlin
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Alexandra Verzella
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Barry H Grayson
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Court B Cutting
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Pradip R Shetye
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Roberto L Flores
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
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Benitez BK, Brudnicki A, Tache A, Wieprzowski Ł, Surowiec Z, Nalabothu P, Lill Y, Mueller AA. Comparative study on cleft palate morphology after passive presurgical plate therapy in unilateral cleft lip and palate. J Plast Reconstr Aesthet Surg 2024; 92:198-206. [PMID: 38547553 DOI: 10.1016/j.bjps.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/02/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Presurgical plate therapy has been widely accepted as a treatment prior to palatal cleft closure. The effects of passive presurgical plate therapy on cleft morphology prior to single-stage unilateral cleft lip and palate (UCLP) repair were quantified. PATIENTS AND METHODS We compared the dimensions of cleft width and cleft area (true cleft and palatal cleft) measured preoperatively at 2 European cleft centers. Center A performed single-stage UCLP repair in 8-month-old infants without any presurgical orthopedic treatment. Center B initiated passive presurgical plate therapy immediately after the birth of the neonates, followed by single-stage UCLP repair at 8 months of age. RESULTS We included 28 patients with complete UCLP from Center A and 12 patients from Center B. The average anterior width of the true cleft before surgery was significantly smaller in infants at Center B than that in Center A (p = 0.001) with 95% confidence interval of (1.8, 5.7) mm, but the average posterior width was similar in the 2 groups. The mean presurgical true cleft area amounted to 106.8 mm2 (SD = 42.4 mm2) at Center A and 71.9 mm2 (SD = 32.2 mm2) at Center B, with a confidence interval for the difference being (9.8, 60.1) mm2. This corresponded to a 32.7% reduction of the true cleft area when passive presurgical plate therapy was used for the first 8 months of the infants' life. CONCLUSION Passive presurgical plate therapy in UCLP significantly reduced the cleft area. Implications for the subsequent surgical outcome might depend on the surgical technique used.
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Affiliation(s)
- Benito K Benitez
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland.
| | - Andrzej Brudnicki
- Maxillofacial Department, Clinic of Pediatric Surgery, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211 Warsaw, Poland.
| | - Ana Tache
- Cleft & Craniofacial Team, GZA-ZNA, Ziekenhuizen, Antwerpen, Belgium.
| | - Łukasz Wieprzowski
- Maxillofacial Department, Clinic of Pediatric Surgery, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211 Warsaw, Poland.
| | - Zbigniew Surowiec
- Maxillofacial Department, Clinic of Pediatric Surgery, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211 Warsaw, Poland.
| | - Prasad Nalabothu
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland.
| | - Yoriko Lill
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland.
| | - Andreas A Mueller
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland.
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Pontell ME, Taylor JA. Discussion: The Effects of Gingivoperiosteoplasty and Cleft Palate Repair on Facial Growth. Plast Reconstr Surg 2024; 153:1120-1121. [PMID: 38657011 DOI: 10.1097/prs.0000000000010781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Matthew E Pontell
- From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia
| | - Jesse A Taylor
- From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia
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Pan X, Huang L, Yang L, Gong Y, Liang Z, Gu M, Hu Z. Three-dimensional nasal asymmetry analysis between adolescence and adulthood in postoperative patients with unilateral cleft lip and palate using computed tomography. Odontology 2024; 112:630-639. [PMID: 37814147 DOI: 10.1007/s10266-023-00855-4] [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] [Received: 02/21/2023] [Accepted: 09/07/2023] [Indexed: 10/11/2023]
Abstract
AIM To investigate the differences of the nasal soft and hard tissue asymmetry in postoperative patients with unilateral cleft lip and palate (UCLP) between adolescence and adulthood, and to explore the correlation of nasal soft and hard tissue asymmetry. METHODS CT data from 47 repaired UCLP patients were included and divided into two groups:1. adolescent group: 23 patients (15 males, 8 females; age: 10-12 years old). 2. adult group: 24 patients (16 males, 8 females; age:18-32 years old). The three-dimensional asymmetry in nasal soft and hard tissues was analyzed. Additionally, the correlation between nasal soft and hard tissue asymmetry was also analyzed. RESULTS Both the adolescent group and adult group showed asymmetries in nasal soft and hard tissues. Compared to the adolescent group, the adult group had a significantly increased horizontal asymmetry of nasal soft tissues Sbal (P < 0.05). Furthermore, the sagittal asymmetry of soft tissue Glat (P < 0.05), Sbal (P < 0.001), Sni (P < 0.001) and hard tissue LPA (P < 0.05) also increased significantly. In the adult group, there were more landmarks with a correlation between the asymmetry of nasal hard tissue and soft tissue compared to the adolescent group. There were moderate to strong correlations between nasal hard and soft tissue symmetries in the horizontal and sagittal directions (0.444 < r < 764), but no correlation in the vertical direction in the adult group (P > 0.05). CONCLUSIONS The asymmetry of nasal soft and hard tissues in patients with repaired UCLP becomes more apparent in the horizontal and sagittal dimensions from adolescence to adulthood. The correlation between the asymmetry of nasal hard tissue and soft tissue becomes stronger in the horizontal and sagittal dimensions. These factors should be taken into account when performing treatment for repaired UCLP patients in adolescence and adulthood.
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Affiliation(s)
- Xuhong Pan
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China
| | - Le Huang
- Department of Stomatology, Shenzhen Luohu Hospital Group Luohu People's Hospital, Shenzhen, China
| | - Liang Yang
- Department of Stomatology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yingyu Gong
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China
| | - Zhigang Liang
- Department of Stomatology, Shenzhen Second People's Hospital, Shenzhen, China.
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | - Ziyang Hu
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China.
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Gopalakrishna S, Rajmohan M, Thakkar R, Ramesh Kannur J, Kamadal N, Malhotra A, Tiwari RVC. Choice of Surgeons in Retractors used in Cleft Lip and Palate Surgery: An Original Research. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S261-S264. [PMID: 38595442 PMCID: PMC11000989 DOI: 10.4103/jpbs.jpbs_485_23] [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: 08/04/2023] [Revised: 08/12/2023] [Accepted: 08/20/2023] [Indexed: 04/11/2024] Open
Abstract
Background To ensure optimal exposure and enable precise tissue manipulation, cleft lip and palate abnormalities require surgical repair utilizing retractors. Different retractors may affect surgical outcomes; however, this is not yet evident. Examining surgeon preferences for retractors in cleft lip and palate surgery and assessing their impact on patient outcomes were the goals of this study. Materials and Methods The patients who underwent primary cleft lip and palate repair were retrospectively analyzed. This study evaluated three widely used retractors: the Langenbeck, Gelpi, and Moult Mouth Gag retractors. This study looked at demographic information, surgical results (including scarring, aesthetic outcomes, and wound healing issues), and surgeon preferences for retractors. Results The study identified differences in surgical outcomes related to various retractor types. Both Group A (Langenbeck retractor) and Group B (Gelpi retractor) demonstrated similar favorable results, such as little wound healing issues, less scarring, and pleasing cosmetic results. The wound healing issues, scarring, and cosmetic outcomes were all worse in Group C (Moult Mouth Gag retractor). Conclusion Retractors were not always preferred by surgeons doing cleft lip and palate surgery. The type of retractor had an impact on the surgical results; the Moult Mouth Gag retractor performed less well than the Langenbeck and Gelpi retractors. These results highlight the value of using evidence-based criteria to select retractors more effectively and enhance surgical methods for better patient outcomes in cleft lip and palate repair.
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Affiliation(s)
- Sagar Gopalakrishna
- Department of Dentistry, Kodagu Institute of Medical Sciences, Madikeri, Karnataka, India
| | - M. Rajmohan
- Department of Dental Surgery, KAPV Government Medical College and Hospital, Trichy, Tamil Nadu, India
| | - Radhika Thakkar
- BDS, Eastman Institute for Oral Health, University of Rochester, New York, United States
| | - Jnanesh Ramesh Kannur
- Department of Oral and Maxillofacial Surgery, Consultant, Harneshwar Multi-Speciality Hospital, Pune, Maharashtra, India
| | - Neelamma Kamadal
- Department of Oral and Maxillofacial Surgery, Al Ameen Dental College, Vijayapura, Karnataka, India
| | - Aayush Malhotra
- Department of Oral and Maxillofacial Surgery, M.M. College of Dental Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India
| | - Rahul V. C. Tiwari
- Consultant, Oral and Maxillofacial Surgeon, OMNI and Andhra Hospitals, Visakhapatnam, Andhra Pradesh, India
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Sinha SP, Bajracharya M, Huang CS, Ko EWC. Does cleft lip and palate affect the severity of malocclusion? Clin Oral Investig 2023; 27:7557-7567. [PMID: 37910241 DOI: 10.1007/s00784-023-05345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the 3D anatomical features of unilateral (UCLP) and bilateral (BCLP) complete cleft lip and palate with those of skeletal Class III dentofacial deformities. MATERIALS AND METHODS In total, 92 patients were divided into cleft and noncleft groups. The cleft group comprised 29 patients with UCLP and 17 patients with BCLP. The noncleft group comprised 46 patients with Class III dentofacial deformities. 3D anatomical landmarks were identified and the corresponding measurements were made on the cone-beam computed tomography (CBCT). RESULTS The differences between the affected and unaffected sides of the patients with UCLP were nonsignificant. The differences between the patients with UCLP and BCLP were nonsignificant except for the SNA angle. Significant differences between the patients with clefts and Class III malocclusion were identified for the SNA, A-N perpendicular, and A-N Pog line, indicating that the maxillae of the patients in the cleft group were more retrognathic and micrognathic. Relative to the noncleft group patients, the cleft group patients had a significantly smaller ramus height. CONCLUSION The affected and unaffected sides of the patients with UCLP did not exhibit significant differences. The maxillae of the patients with UCLP were significantly more retrognathic than those of the patients with BCLP. The maxillae and mandibles of the patients in the cleft group were more micrognathic and retropositioned relative to those of the noncleft Class III patients. CLINICAL RELEVANCE The maxillary and mandibular findings indicated greater deficiencies in the patients with UCLP or BCLP than in those with skeletal Class III malocclusion. Appropriate surgical design should be administered.
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Affiliation(s)
- Suraj Prasad Sinha
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Manish Bajracharya
- Orthodontic Unit, Dental Department, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Chiung-Shing Huang
- Graduate Institute of Craniofacial and Dental Science, Chang Gung University, Taoyuan, Taiwan
| | - Ellen Wen-Ching Ko
- Graduate Institute of Craniofacial and Dental Science, Chang Gung University, Taoyuan, Taiwan.
- Craniofacial Research Center, Chang Gung Memorial Hospital, 6F, 199, Tung Hwa North Road, Linkou, Taipei, 105, Taiwan.
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Lim J, Tanikawa C, Kogo M, Yamashiro T. Prognostic Factors for Orthognathic Surgery in Children With Cleft Lip and/or Palate: Dentition and Palatal Morphology. Cleft Palate Craniofac J 2023; 60:1556-1564. [PMID: 35748725 DOI: 10.1177/10556656221109425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To determine dental and palatal morphology in children with cleft lip and/or palate (CL/P) and identify morphological prognostic factors for orthognathic surgery (OGS). Retrospective cohort study. Orthodontic department of a university dental hospital. This study included 80 patients with bilateral and unilateral CL/P who had lateral cephalograms at the ages of 7 (T1), 15 (T2) years, and a dental plaster model at T1. Plaster models at T1 were scanned with a three-dimensional (3D) scanner. Morphological features were extracted from 3D models with geometric morphometrics software as principal components (PCs). The combinations of the PCs and other predictive factors (ie, the No. of clefts in the lip and alveolus, the palatal repair method, sex, cephalometric variables at T1, and the No. of missing teeth) were examined by logistic regression to determine the predictability for OGS. The need for OGS and skeletal and dental discrepancies at T2 were examined as outcomes. Shrinkage of the palate, including vertical shallowing and transverse narrowing of the posterior maxilla and cleft-side asymmetry of the anterior maxilla at T1, as well as the No. of clefts in the lip and alveolus, the palatal repair method, male sex, several cephalometric variables for the sagittal and vertical dimensions, and the No. of missing teeth, were found to be predictive factors for OGS. Morphological prognostic factors for OGS in children with CL/P were determined.
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Affiliation(s)
- Jaeyeon Lim
- Graduate School of Dentistry, Osaka University, Suita, Japan
| | - Chihiro Tanikawa
- Graduate School of Dentistry, Osaka University, Suita, Japan
- Center for Advanced Medical Engineering and Informatics, Osaka University, Suita, Japan
| | - Mikihiko Kogo
- Graduate School of Dentistry, Osaka University, Suita, Japan
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Segantin JDF, Bisson GB, Chihara LL, Ferreira Júnior O. Tomographic analysis of relationship of mandibular morphology and third molars eruption. BMC Oral Health 2023; 23:915. [PMID: 37996868 PMCID: PMC10668375 DOI: 10.1186/s12903-023-03653-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Lower third molars (L3M) are the last teeth to erupt in the oral cavity. Uneruption of these teeth still raises questions about its causes, in the literature (1) genetic factors, (2) dental lamina activity and, mainly, (3) insufficient growth and development of the bone bases are included. While the lack of space theory influenced by mandibular morphology and size of L3M was argued to be the main reason for L3M impaction, there is a limitation in the literature in examining such association using more accurate tomographic analysis obtained from CBCT. This work aimed to evaluate the relationship between mandibular morphology and the eruption of L3M. METHODS In this regard, 85 Cone Beam Computed Tomographies (CBCT), with 147 L3M, were selected from the archives of the Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, obtained using an Accuitomo® Morita device and using the Dolphin Imaging 11.9 software. L3M eruption was related to linear measurements of jaw length (Co-Gn), retromolar space dimension (D2R), mesiodistal width of the L3M crowns, mandibular first molars (L1M) and mandibular canines (LC) and the angle mandibular (Ar-Go-Me). Independent samples t-test, chi-square tests and logistic regression were performed adopting a significance level of 5%. RESULTS The average mandible length of 116.446 mm + 6.415 mm, retromolar space of 11.634 mm + 2.385 mm, mesiodistal size of the L3M of 10.054 mm + 0.941 mm, sum of the mesiodistal widths of the L1M and LC of 15.564 mm + 1.218 mm and mandibular angle of 127.23° + 6.109. There was no statistically significant association between these factors and the eruption. CONCLUSION With the results obtained in this study, we conclude that the length and angle of the mandible, teeth size and dimension of the retromolar space are not associated with the L3M eruption.
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Affiliation(s)
- Jéssica de Fátima Segantin
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry. University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Gabriela Barbosa Bisson
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry. University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil.
| | - Letícia Liana Chihara
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry. University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Osny Ferreira Júnior
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry. University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
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Weismann C, Lehmann M, Aretxabaleta M, Koos B, Schulz MC. Maxillary canine position of patients with non-syndromic craniofacial disorder: a retrospective evaluation of panoramic radiographs. Head Face Med 2023; 19:44. [PMID: 37814280 PMCID: PMC10561517 DOI: 10.1186/s13005-023-00390-1] [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] [Received: 10/24/2022] [Accepted: 09/29/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The study evaluates the position and displacement tendency of unerupted maxillary canines in orthodontic patients with non-syndromic craniofacial disorders (CD) compared to a control (C) group. METHODS Canine position and displacement tendency were evaluated using panoramic radiographs (PAN) examined with parameters such as sector classification (sectors 1-5) and inclination angles (α and β). The displacement tendency was defined as the positioning of the tip in sectors 1 or 2, as well as its combination with increased angles (α > 30° and β > 39°). In addition, the correlation of the tooth position and agenesis, cleft side, and sex was assessed. RESULTS A total of 116 pre-treatment PAN, divided into the CD group (n = 50; mean age 8.32 ± 2.27 years) and the C group (n = 66; mean age 10.80 ± 2.82 years), were evaluated in this study. The sector classification showed no displacement tendency in both groups. Inclination angles α/β showed a statistically significant higher displacement tendency (p = 0.01) of the CD group (n = 5) on the right side, compared to healthy subjects (n = 1). Male CD patients had a statistically significant higher displacement tendency on the right side (p = 0.03). A statistically significant correlation between cleft and non-cleft-side (p = 0.03) was found. CONCLUSION Patients with CD showed a statistically significant higher displacement tendency of the maxillary canine affected by the cleft side. The inclination angle was found to be the better predictor compared to the sector classification which should be considered in the orthodontic treatment planning.
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Affiliation(s)
- C. Weismann
- Department of Orthodontics, University Hospital Tübingen, Osianderstr, 2-8, 72076 Tübingen, Germany
| | - M. Lehmann
- Department of Orthodontics, University Hospital Tübingen, Osianderstr, 2-8, 72076 Tübingen, Germany
| | - M. Aretxabaleta
- Department of Orthodontics, University Hospital Tübingen, Osianderstr, 2-8, 72076 Tübingen, Germany
| | - B. Koos
- Department of Orthodontics, University Hospital Tübingen, Osianderstr, 2-8, 72076 Tübingen, Germany
| | - M. C. Schulz
- Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, Osianderstr, 2-8, 72076 Tübingen, Germany
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Schmidt M, Slavicek G, Slavicek F, Schulz MC, Aretxabaleta M, Effert J, Koos B, Weise C. Masticatory Efficiency in Orthodontic Patients with Craniofacial Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4324. [PMID: 36901330 PMCID: PMC10001527 DOI: 10.3390/ijerph20054324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
This study evaluates the masticatory efficiency in patients with craniofacial disorders (CD) compared to controls (C). A total of 119 participants (7-21 years), divided into CD group (n = 42, mean age 13.45 ± 5.2 years) and C group (n = 77, mean age 14.3 ± 3.27 years) under an orthodontic treatment were included. Masticatory efficiency was assessed using a standard food model test. The masticated food was examined according to its number of particles (n) and area (mm2), wherein a higher number of particles alongside a smaller area was an indication of better masticatory efficiency. Additionally, the influence of cleft formation, chewing side, dentition stage, age and sex were evaluated. Patients with CD chewed the standardized food in fewer particles (nCD = 61.76 vs. nC = 84.58), with a significantly higher amount of area than the controls (ACD = 192.91 mm2 vs. AC = 146.84 mm2; p = 0.04). In conclusion, patients with CD showed a significantly decreased mastication efficiency compared to healthy patients. Factors such as stage of cleft formation, chewing side, dentition stage and age showed an influence on masticatory efficiency, whereas no gender effect on the masticatory efficiency of CD patients was found.
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Affiliation(s)
- Maria Schmidt
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | | | | | - Matthias C. Schulz
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Maite Aretxabaleta
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Josephine Effert
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Bernd Koos
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Christina Weise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
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Viñas MJ, Galiotto-Barba F, Cortez-Lede MG, Rodríguez-González MÁ, Moral I, Delso E, González-Meli B, Lobo F, López-Cedrún JL, Neagu D, Garatea J, Garatea A, Berenguer B, Lorca-García C, Delgado MD, Martí E, Gutiérrez JM, Hernández C, Murillo-González J, Martínez-Álvarez C, Martínez-Sanz E. Craniofacial and three-dimensional palatal analysis in cleft lip and palate patients treated in Spain. Sci Rep 2022; 12:18837. [PMID: 36336749 PMCID: PMC9637697 DOI: 10.1038/s41598-022-23584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022] Open
Abstract
Growth alterations have been described in patients operated on for oral clefts. The purpose of this work was to analyze the craniofacial and palate morphology and dimensions of young adults operated on for oral clefts in early childhood in Spain. Eighty-three patients from eight different hospitals were divided into four groups based on their type of cleft: cleft lip (CL, n = 6), unilateral cleft lip and palate (UCLP, n = 37), bilateral cleft lip and palate (BCLP, n = 16), and cleft palate only (CPO, n = 24). A control group was formed of 71 individuals. Three-dimensional (3D) digital models were obtained from all groups with an intraoral scanner, together with cephalometries and frontal, lateral, and submental facial photographs. Measurements were obtained and analyzed statistically. Our results showed craniofacial alterations in the BCLP, UCLP, and CPO groups with an influence on the palate, maxilla, and mandible and a direct impact on facial appearance. This effect was more severe in the BCLP group. Measurements in the CL group were similar to those in the control group. Cleft characteristics and cleft type seem to be the main determining factors of long-term craniofacial growth alterations in these patients. Prospective research is needed to clearly delineate the effects of different treatments on the craniofacial appearance of adult cleft patients.
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Affiliation(s)
- María José Viñas
- grid.4795.f0000 0001 2157 7667Facultad de Odontología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Francesca Galiotto-Barba
- grid.4795.f0000 0001 2157 7667Facultad de Odontología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - María Gabriela Cortez-Lede
- grid.419058.10000 0000 8745 438XHospital Clínico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, 30120 Murcia, Spain
| | - María Ángeles Rodríguez-González
- grid.419058.10000 0000 8745 438XHospital Clínico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, 30120 Murcia, Spain
| | - Ignacio Moral
- grid.438293.70000 0001 1503 7816Hospital Universitario Miguel Servet, Servicio Aragonés de Salud, 50009 Zaragoza, Spain
| | - Elena Delso
- grid.438293.70000 0001 1503 7816Hospital Universitario Miguel Servet, Servicio Aragonés de Salud, 50009 Zaragoza, Spain
| | - Beatriz González-Meli
- grid.410361.10000 0004 0407 4306Hospital Universitario Infantil Niño Jesús, Servicio Madrileño de Salud, 28009 Madrid, Spain
| | - Fernando Lobo
- grid.410361.10000 0004 0407 4306Hospital Universitario Infantil Niño Jesús, Servicio Madrileño de Salud, 28009 Madrid, Spain
| | - José Luis López-Cedrún
- grid.420359.90000 0000 9403 4738Complejo Hospitalario Universitario A Coruña, Servizo Galego de Saúde, 15006 A Coruña, Spain
| | - David Neagu
- grid.420359.90000 0000 9403 4738Complejo Hospitalario Universitario A Coruña, Servizo Galego de Saúde, 15006 A Coruña, Spain
| | - Joaquín Garatea
- grid.419060.a0000 0004 0501 3644Complejo Hospitalario de Navarra, Servicio Navarro de Salud, 31008 Pamplona, Spain
| | - Amaia Garatea
- grid.419060.a0000 0004 0501 3644Complejo Hospitalario de Navarra, Servicio Navarro de Salud, 31008 Pamplona, Spain
| | - Beatriz Berenguer
- grid.410361.10000 0004 0407 4306Hospital General Universitario Gregorio Marañón, Servicio Madrileño de Salud, 28009 Madrid, Spain
| | - Concepción Lorca-García
- grid.410361.10000 0004 0407 4306Hospital General Universitario Gregorio Marañón, Servicio Madrileño de Salud, 28009 Madrid, Spain
| | - María Dolores Delgado
- grid.410361.10000 0004 0407 4306Hospital Universitario 12 de Octubre, Servicio Madrileño de Salud, 28041 Madrid, Spain
| | - Eunate Martí
- grid.410361.10000 0004 0407 4306Hospital Universitario 12 de Octubre, Servicio Madrileño de Salud, 28041 Madrid, Spain
| | - José Manuel Gutiérrez
- grid.459669.10000 0004 1771 1036Hospital Universitario de Burgos, Sanidad de Castilla y León, 09006 Burgos, Spain
| | - Carlos Hernández
- grid.459669.10000 0004 1771 1036Hospital Universitario de Burgos, Sanidad de Castilla y León, 09006 Burgos, Spain
| | - Jorge Murillo-González
- grid.4795.f0000 0001 2157 7667Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Concepción Martínez-Álvarez
- grid.4795.f0000 0001 2157 7667Facultad de Odontología, Universidad Complutense de Madrid, 28040 Madrid, Spain ,grid.4795.f0000 0001 2157 7667Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Elena Martínez-Sanz
- grid.4795.f0000 0001 2157 7667Facultad de Odontología, Universidad Complutense de Madrid, 28040 Madrid, Spain ,grid.4795.f0000 0001 2157 7667Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
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12
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Condylar Changes after Maxillary Expansion in Children with Cleft Lip and Palate—A Three-Dimensional Retrospective Study. Biomimetics (Basel) 2022; 7:biomimetics7020073. [PMID: 35735589 PMCID: PMC9221144 DOI: 10.3390/biomimetics7020073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/29/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022] Open
Abstract
Background: The presence of posterior crossbite can trigger aesthetic and functional changes as mandibular asymmetry in individuals, contributing to asymmetrical muscle function. Mandibular asymmetry and respective condyle adaptation may be an etiological factor in temporomandibular disorder. This study aims to evaluate the effects of maxillary expansion on the position and angulation of the condyles as well as the intercondylar distance in children with cleft lip and palate. Methods: Twenty-five individuals with cleft lip and palate who underwent maxillary expansion were selected. Condylar changes were evaluated by cone beam computed tomography using the Pullinger and Hollender formula. To determine the statistically significant differences between the variables, the Student t-test and the Benjamini–Hochberg correction method for multiple comparisons were used. Results: No statistically significant differences between angulation and condylar position before and after maxillary expansion were found. The intercondylar distance tended to increase in growing individuals with cleft lip and palate after maxillary expansion. Conclusions: Intercondylar distance shows a tendency to increase after expansion regardless of the cleft phenotype. No differences were found in angulation and condylar position with the changes in occlusion resulting from maxillary expansion.
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13
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Zygomaticomaxillary suture maturation evaluation in patients with and without cleft lip and palate. Am J Orthod Dentofacial Orthop 2022; 162:162-172. [DOI: 10.1016/j.ajodo.2021.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/24/2022]
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Yi C, Shah N, Costello B, Goldstein J, Kumar A, Losee J, Schuster L. Protraction Headgear Compliance and Orthognathic Surgery in Patients With Cleft Lip and Palate. Cleft Palate Craniofac J 2022; 60:608-615. [PMID: 35068230 DOI: 10.1177/10556656221074890] [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: 11/16/2022] Open
Abstract
Assess cephalometric parameters and the need for orthognathic surgery (OS) and its relationship with compliance in protraction headgear (PHG). Retrospective case series. Hospital cleft-craniofacial center. 23 patients with nonsyndromic cleft lip and palate and history of lip and palate repair. Patients received PHG and orthodontic treatment. Compliant patients were compared to patients that were not. Protraction was applied with 170-gram elastics and patients were instructed to wear for at least 12 hours daily. Cephalometric measurements at initial (T1), post-PHG (T2), and pre-surgical or post-orthodontic treatment (T3) of at least age 15 for females and 17 for males and the presence of OS were compared. 83% (19) of patients reported compliance with therapy. Of those compliant, 68% (13) had OS and 32% (6) did not (P = .99). Inter-group comparisons at T1 between compliant and noncompliant showed no significant differences and the non-OS patients started with larger nasolabial angles (P < .05). At T2, there were no significant cephalometric differences between groups. At T3, compliant patients showed significantly more upper incisor proclination than noncompliant patients. Between OS and non-OS, OS patients had significantly decreased ANB, Wits, convexity, overjet, and FMA and larger nasolabial angles (P < .05). Patients compliant with PHG showed no difference in the need for OS. However, after orthodontic treatment, compliant patients showed more upper incisor proclination and OS patients with decreased ANB, Wits, convexity, overjet, FMA, and larger nasolabial angles.
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Affiliation(s)
- Cleo Yi
- 6619UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Nilesh Shah
- 6614University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jesse Goldstein
- 6619UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Anand Kumar
- 159284UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Joseph Losee
- 6619UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Impact of Cleft Palate Anastomosis in Cleft Lip and Palate Patients with Coexisting Cleft Lip Anastomosis Scar Based on Cephalometric Measurements. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
(1) Background: This article focuses on examining components affecting the overbite, overjet, and the effect of palate surgery on craniofacial morphology with a concomitant cleft lip fusion scar, and a comparison of patients who had only a cleft lip fusion scar. Patients with unilateral cleft lip (UCL) and patients with unilateral cleft lip and palate (UCLP) were included in the study. We aimed to find if cephalometric parameters were significantly different in these groups. (2) Material and methods: The study group consisted of a lateral cranial radiograph of patients with UCLP (n = 30) and UCL (n = 30). Cephalometric radiographs were saved electronically, and cephalometric analysis was performed using a computer program. (3) Results: We observed that a statistically significant higher degree of maxillary prognathism occurred in the UCL than in the UCLP. We observed the anterior position of the upper lip in relation to E-line in patients with cleft lip. (4) Conclusions: The results present the effect of cleft palate surgery on further forward growth of the maxilla. There was a decreased ANB angle present in the skeletal class II in patients with UCL and UCLP. The SNB angle was not increased, and the reverse overjet was due to the rectroclination of the upper incisors and protruded lower incisors.
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Digital Volumetric Monitoring of Palate Growth in Children With Cleft Lip and Palate. J Craniofac Surg 2021; 33:e143-e145. [PMID: 34636766 DOI: 10.1097/scs.0000000000008137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT This study aimed to evaluate longitudinally the volume of the dental arches in children with unilateral cleft lip and palate before and after the rehabilitative plastic surgeries. This is a longitudinal retrospective study was composed by 102 digitized dental casts of children with unilateral complete cleft lip (G1) and cleft lip and palate (G2). The palate volume was evaluated at 3 periods: preoperative (T1), postoperative 1 (T2), and postoperative 2 (T3). The intra- and inter-examiner reliability was analyzed by Wilcoxon test/Dahlberg formula and interclass correlation coefficient, respectively. The intragroup comparison was analyzed by Wilcoxon test and Friedman test followed by post-hoc Dunn test. Mann-Whitney test was applied for the intergroup comparison (α = 5%). G1 had a significant growth at T2 (P = 0.031). G2 demonstrated a positive development at T2, but decreased at T3 (P = 0.003). The intergroup analysis revealed that G2 showed a greater volume at T1 and T2 (P < 0.0001 and P = 0.0024, respectively). T2-T1 exhibited no statistically significant difference (P = 0.262). In conclusion, there was a volumetric increase in the dental arches after cheiloplasty followed by a reduction after palatoplasty. Further investigations are necessary to validate the preliminary results of the present study.
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Sullivan ZC, Van Eeden S, May J, Flannigan N, Seshu M, Dominguez-Gonzalez S. Identifying associations between dental arch relationship scores, relative deprivation and other cleft audit outcomes. Part 2. Orthod Craniofac Res 2021; 25:103-111. [PMID: 34056824 DOI: 10.1111/ocr.12504] [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] [Received: 11/28/2020] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
Identify associations between dental arch relationship scores, oral health status and deprivation index in patients with complete unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). Ninety-two 5-year-old children with non-syndromic complete UCLP and thirty-nine 5-year-old children with non-syndromic complete BCLP from the United Kingdom. Data were collected from the 5-year audit outcomes submitted to the Cleft Registry and Audit Network (CRANE). The index of multiple deprivation (IMD) and Welsh index of deprivation were used to assess a relative measure of deprivation. Comparisons of 5-year-old index/BCLP Deciduous Dentition Yardstick outcome against IMD and dmft are performed using multivariable linear regression models. Both UCLP and BCLP had a high percentage of children with dmft >0 (47% and 49%, respectively). The mean dmft for the UCLP cohort was 2.8 and 2.6 for the BCLP cohort. In the UCLP group, a poorer 5-year-old index was associated with an increased dmft score (P = .023) and higher level of deprivation (P = .010). In the BCLP group, there was no significant associations between BCLP Deciduous Dentition Yardstick, dmft and IMD. A poorer dental arch relationship outcome may be associated with higher level of area deprivation and oral health status, in children with UCLP. Those with a poor outcome for the 5-year-old Index are more likely to have increased caries experience.
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Affiliation(s)
| | | | - Joanna May
- Alder Hey Hospital Children's Hospital, Liverpool, UK
| | - Norah Flannigan
- Orthodontic department, Liverpool University Dental Hospital, Liverpool, UK
| | - Madhavi Seshu
- Alder Hey Hospital Children's Hospital, Liverpool, UK
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18
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Lim J, Tanikawa C, Kogo M, Yamashiro T. Determination of prognostic factors for orthognathic surgery in children with cleft lip and/or palate. Orthod Craniofac Res 2021; 24 Suppl 2:153-162. [PMID: 33599070 DOI: 10.1111/ocr.12477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the prognostic factors for orthognathic surgery (OGS) in children with cleft lip and/or palate (CL/P) using artificial intelligence (AI) systems. DESIGN Retrospective cohort study. SETTING An orthodontic department at a university dental hospital. PARTICIPANTS This study included 126 patients with bilateral and unilateral CL/P for whom lateral cephalograms were obtained at three time points: 7 (T1), 10 (T2) and 15 (T3) years of age. MAIN OUTCOME MEASURES Cleft type, severity of lip separation at birth, number of missing teeth, sex, palatal repair methods and surgeons, cephalometric variables at T1 and T2, and the total duration of orthodontic treatment were examined as predictors. The need for OGS and skeletal and dental discrepancies at T3 was examined as outcomes. RESULTS A total of six models were developed, with a mean area under the receiver operating characteristic curve of 0.93. Multiple prognostic factors for OGS were identified. In particular, the number of clefts in the lip and alveolus showed relatively high odds ratios, as did anterior crossbite at T3. Achieving palatal closure with the push-back method, rather than Furlow's method, was also found to be a predictive factor for anterior crossbite at T3, with high odds ratios. CONCLUSIONS The prognostic factors for OGS determined by the AI systems were the number of clefts in the lip and alveolus, the palatal repair method, male sex, several cephalometric variables for the sagittal and vertical dimensions, growth patterns and the number of missing teeth.
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Affiliation(s)
- Jaeyeon Lim
- Graduate School of Dentistry, Osaka University, Suita, Japan
| | - Chihiro Tanikawa
- Graduate School of Dentistry, Osaka University, Suita, Japan.,Center for Advanced Medical Engineering and Informatics, Osaka University, Suita, Japan
| | - Mikihiko Kogo
- Graduate School of Dentistry, Osaka University, Suita, Japan
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Medeiros-Santana MNLD, Araújo BMAM, Fukushiro AP, Trindade IEK, Yamashita RP. Surgical maxillary advancement and speech resonance: comparison among cleft types. Codas 2020; 32:e20190152. [PMID: 32401996 DOI: 10.1590/2317-1782/20202019152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/09/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose This study investigated the influence of the cleft type on the appearance of hypernasality after surgical maxillary advancement (MA). Methods Nasality was determined by measurement of nasalance (acoustic correlate of nasality) by nasometry. The study involved analysis of the nasalance scores of 17 individuals with isolated cleft palate (CP), 118 with unilateral cleft lip and palate (UCLP) and 69 with bilateral cleft lip and palate (BCLP), of both sexes, aged 18 to 28 years, after MA. Only individuals with normal nasalance scores indicating balanced resonance before MA were included in this study. Nasometry was performed 3 days before and 15 months after MA, on average. The proportion of patients who presented nasalance scores indicating hypernasality after surgery was calculated by the ANOVA test, and comparison among the different cleft types was evaluated by the chi-square test (p < 0.05). Results No significant difference was found in the proportions of individuals with hypernasality among the cleft types. Conclusion Nasometry showed that the appearance of hypernasality after MA in individuals with cleft palate with or without cleft lip occurred in similar proportions, regardless of the cleft type.
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Affiliation(s)
| | | | - Ana Paula Fukushiro
- Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brasil
| | - Inge Elly Kiemle Trindade
- Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brasil
| | - Renata Paciello Yamashita
- Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brasil
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Craniofacial Analysis May Indicate Co-Occurrence of Skeletal Malocclusions and Associated Risks in Development of Cleft Lip and Palate. J Dev Biol 2020; 8:jdb8010002. [PMID: 32012961 PMCID: PMC7151201 DOI: 10.3390/jdb8010002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/22/2022] Open
Abstract
Non-syndromic orofacial clefts encompass a range of morphological changes affecting the oral cavity and the craniofacial skeleton, of which the genetic and epigenetic etiologic factors remain largely unknown. The objective of this study is to explore the contribution of underlying dentofacial deformities (also known as skeletal malocclusions) in the craniofacial morphology of non-syndromic cleft lip and palate patients (nsCLP). For that purpose, geometric morphometric analysis was performed using full skull cone beam computed tomography (CBCT) images of patients with nsCLP (n = 30), normocephalic controls (n = 60), as well as to sex- and ethnicity- matched patients with an equivalent dentofacial deformity (n = 30). Our outcome measures were shape differences among the groups quantified via principal component analysis and associated principal component loadings, as well as mean shape differences quantified via a Procrustes distance among groups. According to our results, despite the shape differences among all three groups, the nsCLP group shares many morphological similarities in the maxilla and mandible with the dentofacial deformity group. Therefore, the dentoskeletal phenotype in nsCLP could be the result of the cleft and the coexisting dentofacial deformity and not simply the impact of the cleft.
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21
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Analysis of Dental Arch in Children With Oral Cleft Before and After the Primary Surgeries. J Craniofac Surg 2020; 30:2456-2458. [PMID: 31369497 DOI: 10.1097/scs.0000000000005775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to evaluate longitudinally the alteration of the dental arch dimensions of children with different oral cleft types, before and after the primary surgeries. Three-dimensional images of the maxillary dental casts of children with unilateral complete cleft lip (G1), unilateral complete cleft lip and palate (G2), and cleft palate (G3). The children were evaluated at pre-cheiloplasty (T1), pre-palatoplasty (T2), and 1 year after palatoplasty (T3). The measurements obtained: intercanine (C-C') and intertuberosity (T-T') distances, anterior (I-CC') and total (I-TT') arch lengths. To analyze the intraexaminer error, paired t-test was applied and Dahlbergh formula. The intragroups comparisons were applied: paired t-test, ANOVA followed by Tukey, Wilcoxon test, and Kruskal-Wallis test followed by Dunn test. The intergroup comparisons were performed by independent t-test and Mann-Whitney test. In G1, the C-C', T-T', and the I-TT' distances revealed a significant increase of the maxilla. In G2, the C-C' distance statistically decreased from T1 to T3, T-T' distance showed statistical increase from T1 to T3. The I-TT' length increased with statistically significant differences between T1 and T3, T2 and T3. In G3, the C-C', T-T', and I-TT' distance increased was statistically significant. The longitudinal evaluation of the changes occurred in the dental arches with different oral cleft types showed that cheiloplasty and palatoplasty caused the most alterations in the development of the maxillary dimensions of children with complete cleft lip and palate.
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The Electrical Activity of Masseter and Anterior Temporal Muscles in Patients With Unilateral Cleft Lip and Palate. J Craniofac Surg 2019; 30:e547-e551. [PMID: 31022137 DOI: 10.1097/scs.0000000000005560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to determine the electrical activity of masseter and anterior temporal muscles in patients with unilateral cleft lip and palate (CLP) and compare it with healthy volunteers. The study involved 20 female patients (mean age 20 ± 4 years) with unilateral cleft lip and palate who had undergone lip and palate surgery in childhood and finished the first-phase orthodontic therapy with level and align teeth. Twenty age- and sex-matched volunteers with no cleft lip and palate were involved as controls. Electromyographic (EMG) signals of masseter and anterior temporal muscles were recorded at rest position, during swallowing and during maximum bite force (MBF). EMG signals at different test conditions were compared between the cleft and noncleft sides of CLP patients and between CLP patients and healthy individuals. The EMG potentials of masseter (rest, swallowing, MBF) and temporal (rest, MBF) muscles were significantly higher in the cleft than the noncleft side of CLP patients (P value <0.001). Generally, patients with unilateral cleft lip and palate experienced a significant increase in the electrical activity of the masseter and temporal muscles in both sides compared to the control group (P <0.05). In conclusion, patients with unilateral cleft lip and palate exhibit overall greater masticatory muscle activity compared to healthy individuals. The asymmetric masticatory function in subjects with unilateral cleft lip and palate may be associated with severe consequences such as asymmetric facial growth, implying the importance of early diagnosis and orthodontic treatment to achieve a favorable environment for balanced facial growth in CLP affected patients.
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Anthropometric Analysis of the Dental Arches of Five-Year-Old Children With Cleft Lip and Palate. J Craniofac Surg 2018; 29:1657-1660. [PMID: 30028406 DOI: 10.1097/scs.0000000000004806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to analyze the dimensional alterations of the dental arches of 5-year-old children with cleft lip and palate and to compare these dimensions with children without oral clefts. One hundred twenty children were divided into the following groups: unilateral cleft lip (UCL), unilateral cleft lip and palate (UCLP), cleft palate (CP), and control (C). A specific software was used to digitize the dental casts and perform the anthropometric analyses through the measurement of transversal linear intercanine and intermolar distances on the maxilla and mandible. The intergroup comparisons of the maxillary dimensions exhibited that the intercanine distances of groups C and UCL were statistically greater than that of groups UCLP and CP. The intermolar distance was significantly smaller in group UCLP than in the other groups. No statistically significant difference occurred in the mandibular intercanine and intermolar distance among groups. The analysis of the superposition of the maxillary over the mandibular transversal distances showed statistically significant differences among groups. This study showed that at 5-year old, the children with cleft involving the palate had more maxillary dimensional alterations than those without cleft palate.
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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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Al-Rudainy D, Ju X, Mehendale FV, Ayoub A. Longitudinal 3D Assessment of Facial Asymmetry in Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2018; 56:495-501. [PMID: 29870280 DOI: 10.1177/1055665618780108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Longitudinal evaluation of asymmetry of the surgically managed unilateral cleft lip and palate (UCLP) to assess the impact of facial growth on facial appearance. DESIGN Prospective study. SETTING Glasgow Dental Hospital and School, University of Glasgow, United Kingdom. PATIENTS Fifteen UCLP infants. METHOD The 3-D facial images were captured before surgery, 4 months after surgery, and at 4-year follow-up using stereophotogrammetry. A generic mesh which is a mathematical facial mask that consists of thousands of points (vertices) was conformed on the generated 3-D images. Using Procustean analysis, an average facial mesh was obtained for each age-group. A mirror image of each average mesh was mathematically obtained for the analysis of facial dysmorphology. Facial asymmetry was assessed by measuring the distances between the corresponding vertices of the original and the mirror copy of the conformed meshes, and this was displayed in color-coded map. RESULTS There was a clear improvement in the facial asymmetry following the primary repair of cleft lip. Residual asymmetry was detected around the nasolabial region. The nasolabial region was the most asymmetrical region of the face; the philtrum, columella, and the vermillion border of the upper lip showed the maximum asymmetry which was more than 5 mm. Facial growth accentuated the underlying facial asymmetry in 3 directions; the philtrum of the upper lip was deviated toward the scar tissue on the cleft side. The asymmetry of the nose was significantly worse at 4-year follow-up ( P < .05). CONCLUSION The residual asymmetry following the surgical repair of UCLP was more pronounced at 4 years following surgery. The conformed facial mesh provided a reliable and innovative tool for the comprehensive analysis of facial morphology in UCLP. The study highlights the need of refining the primary repair of the cleft and the potential necessity for further corrective surgery.
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Affiliation(s)
- Dhelal Al-Rudainy
- 1 Orthodontic Department, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,2 Orthodontic Department, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Xiangyang Ju
- 3 Medical Devices Unit, Department of Clinical Physics and Bioengineering, National Health Service of Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Felicity V Mehendale
- 4 Cleft and Plastic Surgeon, Royal Hospital of Sick Children, Edinburgh, United Kingdom
| | - Ashraf Ayoub
- 5 Oral and Maxillofacial Surgery, Scottish Craniofacial Research Group, Glasgow University Dental Hospital and School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Yun-Chia Ku M, Lo LJ, Chen MC, Wen-Ching Ko E. Predicting need for orthognathic surgery in early permanent dentition patients with unilateral cleft lip and palate using receiver operating characteristic analysis. Am J Orthod Dentofacial Orthop 2018; 153:405-414. [PMID: 29501116 DOI: 10.1016/j.ajodo.2017.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 07/01/2017] [Accepted: 07/01/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to predict the need for orthognathic surgery in patients with unilateral cleft lip and palate (UCLP) in the early permanent dentition. METHODS In this retrospective cohort study, we included 61 patients with complete UCLP (36 male, 25 female; mean age, 18.47 years; range, 16.92-26.17 years). The subjects were grouped into an orthognathic surgery group and a nonsurgery group at the time of growth completion. Lateral cephalograms obtained at the age of 11 years were analyzed to compare the 2 groups. The receiver operating characteristic analysis was applied to predict the probability of the need for orthognathic surgery in early adulthood by using the measurements obtained at the age of 11 years. RESULTS SNB, ANB, SN, overbite, overjet, maxillary length, mandibular body length, and L1-MP were found to be significantly different between the 2 groups. For a person with a score of 2 in the 3-variable-based criteria, the sensitivity and specificity for determining the need for surgical treatment were 90.0% and 83.9%, respectively (ANB, ≤-0.45°; overjet, ≤-2.00 mm; maxillary length, ≤47.25 mm). CONCLUSIONS Three cephalometric variables, the minimum number of discriminators required to obtain the optimum discriminant effectiveness, predicted the future need for orthognathic surgery with an accuracy of 86.9% in patients with UCLP.
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Affiliation(s)
- Michelle Yun-Chia Ku
- Department of Craniofacial Orthodontics, Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Min-Chi Chen
- Department of Public Health and Biostatistics Consulting Center, School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Ellen Wen-Ching Ko
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University; Department of Craniofacial Orthodontics, Craniofacial Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC.
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Craniofacial morphology in women with Class I occlusion and severe maxillary anterior crowding. Am J Orthod Dentofacial Orthop 2018; 153:36-45. [DOI: 10.1016/j.ajodo.2017.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/01/2017] [Accepted: 05/01/2017] [Indexed: 11/20/2022]
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Facial Anthropometric Evaluation of Unilateral Cleft Lip and Palate Patients: Infancy Through Adolescence. J Craniofac Surg 2017; 29:353-357. [PMID: 29194260 DOI: 10.1097/scs.0000000000004199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Craniofacial anthropometric studies measure the differences in humans' craniofacial dimensions. The aim of this study was to determine facial anthropometric dimensions of newborn to 12-year-old girls with nonsyndromic unilateral cleft lip and palate (UCLP). METHODS In this cross-sectional analytical study, data was collected from 65 infant to 12-year old girls with UCLP. Digital frontal and profile facial photographs were transferred to a computer and desired anthropometric landmarks were traced on each image. Fifteen anthropometric parameters were measured which were the angles of facial, nasofacial, nasomental, Z, nasolabial, inclination of nasal base and labial fissure, nasal deviation, mentocervical, facial convexity and also ratios of nasal prominence relative to nasal height, middle to lower facial third, upper lip to lower lip height, columellar length relative to upper lip, and incisal show relative to incisal width. Pearson coefficient and linear regression were used for statistical analysis. RESULTS Upper lip to lower lip height ratio and angles of nasofacial, nasolabial, and facial convexity decreased with the age of the patients. In contrast, nasomental angle and the ratios of columellar length to upper lip length, middle facial height to lower facial height, and incisal show relative to incisal width increased. Other parameters studied did not appear to have any significant correlation with age. CONCLUSION In the girls with UCLP, various craniofacial dimensions have different growth rates with some parts growing slower than others. Some of the parameters studied were significantly correlated with age, thus growth-related curves and equations were obtained and presented.
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Cephalometric evaluation after two-stage palatoplasty combined with a Hotz plate: a comparative study between the modified Furlow and Widmaier-Perko methods. Int J Oral Maxillofac Surg 2017; 46:539-547. [PMID: 28174062 DOI: 10.1016/j.ijom.2017.01.009] [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] [Received: 06/22/2016] [Revised: 10/07/2016] [Accepted: 01/10/2017] [Indexed: 11/21/2022]
Abstract
The effects on craniofacial growth of two different soft palate repair techniques in two-stage palatoplasty were investigated. This was a retrospective, cross-sectional cohort study of 68 children with non-syndromic, complete unilateral cleft lip and palate. Thirty-four patients were treated with the modified Furlow method (F-group) and the remaining 34 with the Widmaier-Perko method (P-group). Craniofacial growth was assessed by analyzing 12 angular and 12 linear measurements on lateral cephalograms. Composite facial diagrams from the two groups were compared with those of a control non-cleft group. Angular and linear measurements did not differ significantly between the two groups, implying that the craniofacial morphology was not affected by the difference in soft palate repair technique. However, small differences in anterior nasal spine and posterior nasal spine were found in cleft patients compared with controls. These findings suggest that the modified Furlow and Widmaier-Perko methods have a similar impact on craniofacial growth. Considering speech function, the modified Furlow method provides better craniofacial growth and speech function. However, the long-term effects of both methods on craniofacial growth after growth cessation remain to be determined.
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Tovani-Palone MR, Portinari-Beja GBS, Pérez-Faverani L, Ferreira GR. Expansão rápida da maxila assistida cirurgicamente no tratamento reabilitador das fissuras bilaterais completas de lábio e palato: particularidades técnicas. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1.54756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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