EVALUATING SINUS PATHOLOGIES IN CLEFT LIP AND PALATE PATIENTS: A CBCT ANALYSIS

Morphometric assessment of greater palatine canal and foramen variations in cleft lip and palate patients using CBCT.

Rehabilitation of cleft lip and palate (CLP) patients is a challenge for all the concerned members of the cleft team, and various treatment modalities have been attempted to obtain aesthetic results. Presurgical infant orthopaedics (PSIO) was introduced to reshape alveolar and nasal segments prior to surgical repair of cleft lip. However, literature reports lot of controversy regarding the use of PSIO in patients with CLP. Evaluation of long-term results of PSIO can provide scientific evidence on the efficacy and usefulness of PSIO in CLP patients. The aim was to assess the scientific evidence on the efficiency of PSIO appliances in patients with CLP and to critically analyse the current status of PSIO. A PubMed search was performed using the terms PSIO, presurgical nasoalveolar moulding and its long-term results and related articles were selected for the review. The documented studies report no beneficial effect of PSIO on maxillary arch dimensions, facial aesthetics and in the subsequent development of dentition and occlusion in CLP patients. Nasal moulding seems to be more beneficial and effective in unilateral cleft lip and palate patients with better long-term results.

The nasopalatine canal (NPC) is a critical anatomic structure in maxillofacial surgery. Variations in its morphology among individuals with cleft lip and palate (CLP) may increase the risk of neurovascular injury and adversely affect surgical outcomes. This study aimed to investigate the anatomic characteristics of the NPC in CLP patients using cone beam computed tomography (CBCT). This retrospective cross-sectional study was conducted at a Turkish university hospital, based on CBCT scan data collected between 2016 and 2024. The primary predictor variable was cleft status (yes/no), and the main outcome variables included NPC shape, number of canaliculi, canal length, diameters, and number of the incisive (IF) and nasopalatine foramen (NF), and buccal bone thickness. Appropriate statistics were computed using a significance threshold of P≤0.05. A total of 78 unilateral CLP patients (29 females and 49 males; mean age 16.23) and 78 matched controls were included. Tree-branch, needle-shaped, and funnel-shaped canals, as well as type 1 and 2 canaliculi, were significantly more common in the CLP group (P<0.001, P=0.012). CLP patients exhibited significantly fewer NF, shorter canal length, and smaller IF diameters (P<0.001). Buccal bone thickness differed by location, with the CLP group showing higher values at points B to D, and the control group at point A (P≤0.05). Anatomic variability of the nasopalatine canal in CLP patients underscores the importance of individualized radiographic assessment. Incorporating CBCT into preoperative planning can enhance procedural safety and improve outcomes in maxillofacial interventions such as Le Fort I osteotomy, implant placement, and orthodontic procedures involving anterior tooth movement.

Orofacial clefts: treatment based on a multidisciplinary approach

The ObjectiveThe aim of the study was evaluation of metal ions (nickel and chromium) released from orthodontic appliances in cleft lip and palate patients and the usefulness of non-invasive matrices (saliva and hair).Materials and MethodsThe material studied consisted of 100 individuals, including 59 females and 41 males of 5 to 16 years of age, which were divided into 3 groups: experimental–patients with cleft lip and palate (36 individuals, the average treatment time 5.74 years); control group–patients without cleft lip and palate, during orthodontic treatment (32 individuals, the average treatment time 1.78 years) and the control group patients without cleft lip and palate, without any orthodontic appliances (32 individuals). Samples (saliva, hair) were collected and subjects underwent a survey by questionnaire. Multi-elemental analyses of the composition of non-invasive matrices was conducted in an accredited laboratory by inductively coupled plasma spectrometry technique ICP-OES. The results were reported as mean contents of particular elements (Cd, Cr, Cu, Fe, Mn, Mo, Ni, Si) in hair and in saliva.ResultsThe concentration of Cr, Ni, Fe and Cu ions in saliva of cleft lip and palate patients were several times higher as compared with not treated orthodontically control groups and higher than in the group with orthodontic appliances. Among the assessed matrices, hair of cleft lip and palate patients seem to be not a meaningful biomarker.ConclusionIt was found that orthodontic appliances used in long-term treatment of cleft lip and palate patients do not release toxic levels of Cr and Ni ions.

This study aims to evaluate the dental dimension in cleft lip and palate patients presenting agenesis of at least an upper lateral incisor and to compare the results with those of two control groups. A control group consisted of general orthodontic patients without agenesis, while the other group consisted of orthodontic patients with agenesis of at least one upper lateral incisor. Records of 40 (30 male, 10 female) cleft lip and palate patients (Group A), 40 (17 male, 23 female) patients representing the control group of general orthodontic patients (Group B) and 40 patients (14 male, 26 female) with at least one missing lateral incisor (Group C) were collected and analysed. Mesiodistal tooth size of all teeth (except second and third molars) was measured on digital or plaster dental casts. Tooth size in cleft lip and palate patients (Group A) was similar to that of the control group (Group B) of general orthodontic patients without tooth agenesis, except for the upper central incisors and the second upper left bicuspids that presented a significant reduction in the mesiodistal dental width. Non-syndromic patients with at least one missing upper lateral incisor showed a significant reduction of mesiodistal tooth size compared to Group A and to Group B. Dental width of cleft lip and palate patients is similar to that of a normal orthodontic population, with the exception of the upper central incisor and upper premolars on one side.

Articulation-function-associated brain developmental changes in cleft lip and palate patients.

Dental pulp stem cells (DPSCs) can undergo several types of differentiation, including osteogenic differentiation. One osteogenesis-inducing factor that has been previously described is in vitro low-power laser irradiation of cells. Laser irradiation promotes the acceleration of bone matrix mineralization of the cell strain. However, no consensus exists regarding the dose and treatment time. We used DPSC strains from cleft lip and palate patients because new bone tissue engineering strategies have used DPSCs in preclinical and clinical trials for the rehabilitation of alveolar bone clefts. Optimizing bone tissue engineering techniques for cleft and lip palate patients by applying low-power laser therapy (LPLT) to DPSCs obtained from these patients can help improve current strategies to quickly close large alveolar clefts. The aim of this study was to investigate the effects of LPLT at different energy densities in DPSC strains obtained from cleft lip and palate patients during in vitro osteogenic differentiation. Ten DPSC strains were obtained from cleft lip and palate patients and then used in the following study groups: group 1: control, the strains underwent osteogenic differentiation for 21 days; and groups 2, 3, and 4: the strains were irradiated each day with a low-power red laser (660 nm) (5, 10, and 20 J) during 21 days of osteogenic differentiation. Using Bonferroni's test, a statistically significant difference in the mean values was found between the irradiated groups (2, 3, and 4) and the control group (p < 0.001). However, no significant difference in osteogenic potential was found among the irradiated groups. Our findings showed that the osteogenic potential of DPSCs increases with red laser irradiation at 5, 10, and 20 J, and this treatment could be considered a new approach for preconditioning these cells to be used in bone tissue engineering.

Background: One of the congenital malformation in the early phase of embryogenesis is cleft lip and/or palate that need multidisciplinary treatment in dentistry. Although surgery is performed in the first few months of life, advanced treatment is needed sometimes in the growth age, such as orthodontic, periodontic and esthetic treatment. Objective: To describe a gingivectomy procedure to support orthodontic treatment in bilateral cleft lip and palate patient. Case Report: A 13-year-old boy was referred from the orthodontic department with complaints of enlargement in maxillary anterior gingiva teeth, blocking the placement of the orthodontic device. Patient’s examination showed bilateral cleft lip and palate, plaque score 35%, bleeding on probing 73%, dental agenesis on teeth 12 and 22, and gingival enlargement on regions 13–23. The aim of gingivectomy, in this case, was to eliminate pockets, restore physiologic gingival contour and facilitate the placement of the orthodontic device. Results: Clinical evaluation after gingivectomy showed satisfying results in reducing the pocket depth. Conclusion: Gingivectomy is effective in supporting the orthodontic treatment for cleft lip and/or palate patient. Keywords: cleft lip, cleft palate, gingival enlargement, gingivectomy, orthodontic treatment

The length of the cervical spine in a series of 206 adult males with cleft lip and/or palate and 50 normal controls was measured. The patients were divided into five subgroups according to the type and extent of the cleft. The shortening of the spine was most marked in bilateral cleft lip and palate patients (complete), less marked in unilateral cleft lip and palate patients, and was slight in isolated cleft palate patients. Complete isolated cleft palate and cleft lip was not associated with a shortening of the spine. A shortening of the cervical spine in less extensive types of isolated cleft palate was suggestive of the participation of the spine in their development, while in cleft lip and palate a simultaneous exposure to a teratogenic agent or any other developmental error during early stages of embryogenesis could explain the concomitant occurrence of spine anomalies. Patients with cleft lip and palate associated with a short spine also had a shorter mandibular ramus, which could be suggestive of simultaneous damage to both structures during morphogenesis. This relationship was not demonstrated in isolated cleft palate that developed in later stages of embryogenesis. In these cases a short spine itself could not have impaired the growth potential of the mandible, yet it could have mechanically induced the development of cleft palate. These observations are in agreement with the present state of knowledge on the development of orofacial clefts as shown in experimental animals.

Introduction: Cleft lip and palate patients often present with unique anatomical challenges, making dental anomaly detection and numbering particularly complex. The accurate identification of teeth in these patients is crucial for effective treatment planning and long-term management. Artificial intelligence (AI) has emerged as a promising tool for enhancing diagnostic precision, yet its application in this specific patient population remains underexplored. Objectives: This study aimed to evaluate the performance of an AI-based software in detecting and numbering teeth in cleft lip and palate patients. The research focused on assessing the system's sensitivity, precision, and specificity, while identifying potential limitations in specific anatomical regions and demographic groups. Methods: A total of 100 panoramic radiographs (52 males, 48 females) from patients aged 6 to 15 years were analyzed using AI software. Sensitivity, precision, and specificity were calculated, with ground truth annotations provided by four experienced orthodontists. The AI system's performance was compared across age and gender groups, with particular attention to areas prone to misidentification. Results: The AI system demonstrated high overall sensitivity (0.98 ± 0.03) and precision (0.96 ± 0.04). No statistically significant differences were found between age groups (p > 0.05), but challenges were observed in the maxillary left region, which exhibited higher false positive and false negative rates. These findings were consistent with the prevalence of unilateral left clefts in the study population. Conclusions: The AI system was effective in detecting and numbering teeth in cleft lip and palate patients, but further refinement is required for improved accuracy in the cleft region, particularly on the left side. Addressing these limitations could enhance the clinical utility of AI in managing complex craniofacial cases.

The aim of the study was to elaborate the algorithm of orthodontic treatment of cleft lip and palate (CLP) patients. One hundred and twenty-six CLP patients after CLP plasty preparing for alveolar ridge reconstruction were divided into 3 groups according to their age: 47 (37%) patients aged 6 to 11 years; 50 (40%) aged 12 to 17 years; 29 (23%) patients aged 18-27. Eighty-four (66.7%) patients had unilateral CLP and 42 (33.3%) had bilateral CLP. Complex examination revealed typical dental and maxillofacial features for each group. Clinical and diagnostic imaging data allowed formulating rationale for complex treatment approach and algorithm of treatment option choice according to patients age at the time of alveolar ridge reconstruction.

Growth-related changes of skeletal and upper-airway features in bilateral cleft lip and palate patients

Cleft lip and palate patients can present with a maxillary retrusion with tendency to Class III malocclusion after cleft repair. Maxillary distraction osteogenesis is a technique that provides simultaneous skeletal advancement and expansion of the soft tissues. Six nonsyndromic cleft lip and palate patients, ages 12 to 16 years (mean, 13.8 years), underwent maxillary distraction; four had a unilateral and two a bilateral cleft lip and palate. After an incomplete LeFort I osteotomy; a latency period of 3 days was respected. On Postoperative Day 4, distraction was initiated through anterior traction on a Delaire facial mask using distraction forces of 900 gm. Photographs and lateral cephalometric radiographs were obtained preoperatively and 4 months after distraction. A cephalometric analysis was performed to compare the sagittal dentocraniofacial morphology before and after distraction. The aesthetic improvement obtained by maxillary distraction osteogenesis during the permanent dentition to correct maxillary retrusion in our cleft lip and palate patients was impressive. Skeletal advancement varying from 1 to 3.5 mm (mean, 1.7 mm) was found. However, significant dentoalveolar compensations occurred in three patients. This was due to the dental anchorage of the distraction device and can be avoided only by the use of skeletal fixation.

Aims and backgroundPresurgical nasoalveolar molding (PNAM) is a technique used in cleft lip and palate (CLP) patients to reshape the alveolus, lips, and nostrils before surgical intervention, thereby reducing cleft severity.Case descriptionThis case report presents a 2-month-old male diagnosed with bilateral CLP and provisional Patau syndrome, characterized by additional anomalies such as right hind limb hypomobility and polysyndactyly. Due to the patient's cardiac condition, conventional nasoalveolar molding (NAM) was contraindicated. Instead, a modified nasal hook named Bhatia's hook was designed and fabricated using stainless steel wire and cold-cure acrylic, designed to mold the nasal structures without alveolar manipulation. The treatment objectives included improving nasal projection, reducing alar width and cleft gap, retracting the premaxilla, and centering the premaxilla. Over a 4-month period, biweekly adjustments led to significant improvements in nasal tip elevation, reduced septal deviation, decreased premaxillary protrusion, and minimized cleft size. Cheiloplasty performed at 6 months resulted in more effective surgical outcomes, including enhanced columella length and external nasal morphology.ConclusionThe successful management of this case underscores the potential of customized nasal hooks in improving surgical results for CLP patients with complicating factors.Clinical significanceThis modified nasal hook approach offers a viable alternative for nasal molding in patients with complex medical conditions, providing ease of fabrication and consistent force application.How to cite this articleBhatia V, Afeefa P, Ratre RK, et al. Presurgical Nasal Molding in a Bilateral Cleft Lip and Palate Patient with Patau Syndrome Using a Novel Bhatia's Hook: A Case Report. Int J Clin Pediatr Dent 2025;18(5):587–590.