The treatment of facial asymmetry: Review

Some degree of congenital or acquired asymmetry is normal and universal. Significant facial asymmetry, however, causes both aesthetic, as well as functional problems. The comprehensive management of facial symmetry is scarcely addressed.1-5 Differing etiologies, heterogeneous material, and different ages of patients tend to produce fragmentary reports, the more so as evidence-based evaluation of outcomes is almost impossible. Therefore, a presentation of the general rules of treatment, illustrated by our own material collected from the Hospital and Clinic of Plastic Surgery in Polanica-Zdrój and from private surgical and orthodontic practice, could be regarded as useful and justified. Special attention has been given to both functional and cosmetic problems encountered in severe congenital and acquired asymmetries. The management of selected craniofacial malformations in so-called rare clefts, cleft lip and palate, and craniofacial microsomia (CFM), as well as large hemangiomas and neurofibromas, have been discussed. Additionally, the treatment of extensive and asymmetrical post-traumatic deformities and defects is discussed with particular attention given to problems related to ankylosis of the temporomandibular joints. Numerous examples of one-stage procedures, as well as combined, multidisciplinary treatments are presented.

Orthodontic treatment in children with cleft lip and palate repaired using a two-stage surgical correction - authors' experience

AIM

The purpose of this study was to present and evaluate orthodontic rules and methods in the treatment of children and adolescents with complete cleft lip and palate.

MATERIALS AND METHODS

The material consists of about 5500 primary clefts treated at the Hospital and Clinic of Plastic Surgery in Polanica-Zdrój in the years 1976-2008. The most common surgical procedure (>99%) consisted of two-stage repair of cleft lip and palate. In the years 1976-2008, surgical treatment was administered to 5,500 children with a cleft lip and palate. The efficiency of orthodontic procedures is discussed in relation to multidisciplinary cooperation, with a particular emphasis on surgery.

CONCLUSIONS

Apart from cleft morphology and the quality of primary surgery, the patients appearance, midface development and occlusal conditions depend on multidisciplinary cooperation, with special regard given to orthodontic treatment.

Palate Dimensions in Six-Year-Old Children with Unilateral Cleft Lip and Palate: A Six-Center Study on Dental Casts

Objective

To compare palatal dimensions in 6-year-old children with unilateral cleft lip and palate (UCLP) treated by different protocols with those of noncleft children.

Design

Retrospective intercenter outcome study.

Patients

Upper dental casts from 129 children with repaired UCLP and 30 controls were analyzed by the trigonometric method.

Setting

Six European cleft centers.

Main outcome measures

Sagittal, transverse, and vertical dimensions of the palate were observed.

Statistics

Palate variables were analyzed with descriptive methods and nonparametric tests. Regarding several various characteristics measured on a relatively small number of subjects, hierarchical, k-means clustering, and principal component analyses were used.

Results

Mean values of the observed dimensions for five cleft groups differed significantly from the control (p < .05). The group with one-stage closure of the cleft differed significantly from all other cleft groups in most variables (p < .05). Principal component analysis of all 159 cases identified three clusters with specific morphologic characteristics of the palate. A similar number of treated children were classified into each cluster, while all children without clefts were classified in the same cluster. The percentage of treated children from a particular group that fit this cluster ranged from 0% to 70% and increased with age at palatal closure and number of primary surgical procedures.

Conclusion

At 6 years of age, children with stepwise repair and hard palate closure after the age of two more frequently result in palatal dimensions of noncleft control than children with earlier palatal closure and one-stage cleft repair.