Palatal surface area measurement: comparisons among different cleft types.

Orofacial clefts: treatment based on a multidisciplinary approach

Backgroud: Timing of surgery in the patients with cleft lip palate is an important factor of prognosis. Delaying in surgical repair of cleft lip and palate patient may lead to difficulty. It may causes wide, extensive and difficult dissection. There are always chances of wound infection, wound dehiscence, complete wound disruption, fistula formation, even there is also chance of maxillary hypoplasia and failure to articulate lifelong. The purpose of this study to observe the effects of cleft lip repair in early age on cleft alveolar and cleft palatal gap thus helps during cleft hard palate repair in patients with unilateral complete cleft lip and palate (UCLP). Methods: A retrospective study was done from January 2008 to July 2013. Patients with unilateral complete cleft lip and palate included in this study, who under went cleft lip at first admission and then and after 3 months of cleft palate was repaired. Patients with previous cleft lip-palate surgery were excluded. The gaps of cleft alveolus and posterior border of the cleft hard palate were recorded during 1st and 2nd operations. Age, gender, side of the cleft, associated anomalies, family history of cleft, cleft alveolar and cleft palatal gap noted, postoperative complications were also recorded. All the data were Results: A total of 63 patients included in this study. Age ranged from 4 months to 8 years. 38 patients were male and 25 were female. Right side was involved in 20 and 43 patients involved in left side. Eight patients had positive family history. Nine had associated congenital anomalies. Cleft alveolar and palatal gap reduced more in the patients who were below the age of 18 months. Postoperative complications were mild respiratory distress, notching of vermilion border developed oronasal fistula.Conclusion: In unilateral complete cleft lip palate patient, early cleft lip repair results, reduction of gaps of alveolar cleft and that of hard palate remarkably, especially in the patients who came for cleft lip surgery in appropriate time.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i3.21023

To evaluate the effect of preoperative use of an orthopedic plate (OP) on postoperative articulatory function in children with cleft lip and palate. The subjects had complete unilateral or bilateral cleft lip and palate and were scheduled for a one-stage palatoplasty. Tongue movements during sucking were analyzed by ultrasonography. Postoperative articulatory behavior was also assessed at 5 years 4 months of age. There was an excessive downward excursion of the rear portion of the tongue during sucking regardless of the use or nonuse of the OP. This indicated that infants with cleft palate could not create negative pressure in the oral cavity, even with the OP. However, the OP appeared effective for preventing irregular movements of the tongue during sucking. The proportion of subjects obtaining excellent articulation was significantly higher in the group using the OP until palatoplasty than in the group who did not continue using the OP. The proportion of subjects with disturbed articulatory function in the latter group was comparable with that in the control group, who never used the OP. Continuous use of the OP up to the time of palatoplasty appeared to be effective for the postoperative articulatory function in children with complete cleft lip and palate. Inhibiting irregular movements of the tongue, the OP might assist in preventing "palatalized articulation."

High tension and tissue dislocation caused by wide maxillary clefts could prevent an optimal aesthetic and functional outcome in primary cheilognathoplasty. Many surgical techniques or conservative (orthodontic and orthopaedic) devices have been proposed for the initial management of infants with complete cleft lip and palate to achieve a tension-free repair of the lip. Adhesion converts a wide unilateral complete cleft into a lesser deformity anatomically similar to an incomplete cleft lip. This study aimed to measure the effect of lip adhesion on the width of maxillary clefts. Between 2000 and 2007 lip adhesion was used on 49 consecutive infants affected by complete unilateral (n = 35) and bilateral (n = 14) cleft lip and palate. The indication for lip adhesion was the presence of a wide alveolar cleft (gap > 7 mm) with severely malpositioned maxillary segments. Lip adhesion was done at about 48 days, followed by definitive cheilognathoplasty at 98 days. Photographs and impressions were obtained before any operation. The width of the maxillary clefts was reduced by 60% in unilateral clefts and 61% in bilateral clefts. By converting a complete wide cleft lip to an incomplete cleft in both unilateral and bilateral clefts, adhesion of the lip achieved a better position and stabilised the arch in a symmetrical platform that eased both definitive closure of the defect in the lip and the restoration of the maxillary gap by periosteoplasty during definitive cheilognathoplasty.

The purpose of this study was to quantitate preoperative osseous dysmorphology in a homogeneous group of 3-month-old infants with unilateral complete cleft lip and palate. High-resolution computed tomography scans of 28 infants with unilateral complete cleft lip and palate were the basis for study. Coordinate data from 43 landmarks on the skull were collected using surface-rendered reconstructions of scan data. Euclidean distance matrix analysis was used to assess the degree of asymmetry between the cleft and noncleft sides of the craniofacial skeleton. Linear distances involving primary and secondary landmarks (those that are located on or within the bony cleft and those that are near the cleft in the adjacent oronasal area, respectively) were highly asymmetric, with significantly greater distances on the cleft side. In addition, small (1 to 5 percent) but statistically significant asymmetries in linear distances were found involving tertiary landmarks (those that are not directly associated with the cleft or adjacent oronasal area). Most linear distances involving the nasion, zygomaxillare superius, and frontozygomatic junction were significantly greater on the cleft side, and certain linear distances in and around the middle cranial fossa were significantly smaller on the cleft side. The extreme asymmetry of primary and secondary landmarks is explained by the cleft itself and the obvious displacement of the premaxilla toward the noncleft side. The subtler, statistically significant asymmetry of the tertiary landmarks supports the idea that the unilateral cleft affects development of the entire face and possibly the cranial base. Euclidean distance matrix analysis of computed tomography landmark data is a useful methodology for the quantitative morphometry of children with untreated unilateral cleft lip and palate.

Patients with cleft lip and palate demonstrate a spectrum of maxillary growth deficiencies. The purpose of this study was to review the authors' experience in the treatment of midface hypoplasia in nonsyndromic cleft lip-cleft palate patients using rotation advancement of the midface with Le Fort III distraction. A retrospective chart review was conducted to include all patients with nonsyndromic cleft lip and/or cleft palate who underwent Le Fort III rotation advancement of the midface from 1999 to 2011. Along with standard outcome measures, Amira imaging software was used to perform surface analysis on the last five consecutive patients in this series. Forty-three consecutive patients met inclusion criteria. Diagnoses included unilateral complete cleft lip and palate (n = 25) and bilateral complete cleft lip and palate (n = 18). Average distraction distance measured 10.1 mm at the level of the zygoma (range, 6 to 15 mm). Preoperative and 6-month postoperative sella, nasion, A point angles measured 76.3 and 81.8 degrees; whereas sella, nasion, B point angles measured 79.9 and 78.7 degrees, respectively. Preoperative and 6-month postoperative overjet measured -5.4 and 3.2 mm, whereas overbite measured 1.9 and 1.1 mm, respectively. Six patients (13 percent) developed pseudorelapse, with five patients going on to have subsequent Le Fort I advancement at an average of 7 years after distraction (range, 2 to 11 years). Le Fort III rotation advancement of the midface addresses severe midface deficiencies in select patients. Whereas older techniques target occlusal correction alone, extending osteotomies to the Le Fort III level allows occlusal correction along with improvements in malar and nasal projection required to achieve facial harmony in this group of patients. Therapeutic, IV.

Natal/neonatal teeth are very common in children with complete unilateral and bilateral cleft lip and palate. The extraction of these teeth is the usual treatment in the Hospital for Rehabilitation of Craniofacial Anomalies. The objective of this study was to verify whether these teeth could be of the normal complement or whether they were supernumerary. The primary dentition of children with cleft lip and palate with and without natal/neonatal teeth was compared at the Hospital for Rehabilitation of Craniofacial Anomalies. The sample consisted of 55 children with complete unilateral and bilateral cleft lip and palate with natal/neonatal teeth and 54 without. No positive association between these groups and missing lateral incisor or supernumerary or complete dentition was found. The extraction of the natal/neonatal teeth did not alter the final complement of primary teeth, and these teeth could be the lateral incisor or supernumerary.

Objective: Natal/neonatal teeth are very common in children with complete unilateral and bilateral cleft lip and palate. The extraction of these teeth is the usual treatment in the Hospital for Rehabilitation of Craniofacial Anomalies. The objective of this study was to verify whether these teeth could be of the normal complement or whether they were supernumerary. Design: The primary dentition of children with cleft lip and palate with and without natal/neonatal teeth was compared at the Hospital for Rehabilitation of Craniofacial Anomalies. Subjects: The sample consisted of 55 children with complete unilateral and bilateral cleft lip and palate with natal/neonatal teeth and 54 without. Results: No positive association between these groups and missing lateral incisor or supernumerary or complete dentition was found. Conclusion: The extraction of the natal/neonatal teeth did not alter the final complement of primary teeth, and these teeth could be the lateral incisor or supernumerary.

Objective The purpose of this study is to evaluate the efficacy of using a heat-cured acrylic feeding appliance in comparison with soft vinyl feeding appliances in neonates with nonsyndromic complete unilateral cleft lip and palate. Patients and methods Twelve nonsyndromic newborn infants with unilateral complete cleft lip and palate were included in this study. The infants received a soft vinyl-feeding appliance from day 1 after birth until 2 weeks of age; the same infants received the heat-cured acrylic feeding appliance. With the same amount of milk (30 ml), the time taken by the infant to bottle feed was registered and recorded at two different situations; after waking up and at mid-day. The data were collected, tabulated, and statistically analyzed using SPSS software. Results There was a statistically significant difference between the use of the heat-cured appliances and the soft vinyl appliances in the rehabilitation of neonates with nonsyndromic complete unilateral cleft lip and palate regarding the time taken to feed a fixed amount of milk (30 ml) (P < 0.05). Conclusions The use of the heat-cured acrylic feeding appliance was more efficient regarding the time of feeding. On the other hand, parents preferred the soft vinyl feeding appliance for its ease of use.

This study aimed to evaluate the relationship between head posture and craniofacial morphology in nonsyndromic cleft lip and palate children with oronasal fistula. A total of 31 cleft lip and palate patients with a mean skeletal age of 7.59 (+/-2.11) years were involved. Fifteen had complete unilateral cleft lip and palate, 13 had complete bilateral cleft lip and palate, and three had complete cleft palate. Each of the cleft patients was matched with a noncleft Class I subject, on the basis of sex and skeletal age. Lateral cephalograms were taken of all subjects in the standardized upright posture and in orthoposition. Sixteen postural parameters and 44 morphological parameters were evaluated. The correlations with the cranio-cervical and mandibulo-cervical parameters indicated a trend of retrusion in the incisors with extention of the head. The positive nontopographical relationship between the nasolabial angle and some of the postural parameters supplemented the retrusion tendency in the upper incisors with head extension. Vertical skeletal morphological parameters correlated with the postural parameters. Cranio-cervical parameters seemed to be mostly related to mandibular position. Most of the cranio-cervical parameters measured confirmed an increased cranio-cervical angulation in the cleft sample when compared to controls. This head posture change was associated with alterations in tooth position and craniofacial morphology when comparisons were made to the control group.

The aim of this retrospective investigation was to qualify and quantify changes of the vertical skeletal morphology during puberty in cleft patients compared with an age-matched noncleft control. Patients with unilateral cleft lip and palate (UCLP; n = 12) and bilateral cleft lip and palate (BCLP; n = 11) who fulfilled strict inclusion criteria according to the Hanover treatment protocol were evaluated by means of cephalometric analysis. Lateral cephalograms were analyzed for each cleft patient at age 10 and 15 and compared with corresponding data of a noncleft control (n = 20). It was concluded that a vertical growth impairment of the maxilla is found in patients with cleft lip and palate. The maxilla of cleft patients shows a significant clockwise rotation, whereas the inclination of the mandible shows little difference. Consequently, there is a skeletal superposition of the jaws. The posterior height of the maxilla is significantly shorter in patients both with UCLP and BCLP at T(0) and T(1). An increase of the anterior height of the mandible is found in the cleft groups.

Cleft lip or the palate is the congenital birth defect with which is characterised by complete or partial cleft lip or palate. The congenital cleft involving the facial structures may vary from trace of notching of the lip to a complete non fusion of lip and the palate. This study was done to determine the incidence of cleft lip and palate. It is a single centered retrospective study. Data was collected from the patient record system used in a private dental institution and following parameters such as gender, type of cleft lip and palate, unilateral or bilateral was recorded. 86000 patient details were analysed between June 2019 to March 2020 out of which 74 patients who fulfilled the inclusion and exclusion criteria were included in the study. The data was statistically analysed using SPSS software. In this study, it was observed that cleft lip was most commonly seen in males and cleft palate in females. Unilateral cleft lip is common in both males and females. Incomplete cleft palate is more common followed by complete cleft palate. Orofacial defects are most commonly seen at the time of birth.

Objectives. The objective of this study is to compare the impact of early and late reconstruction of complete unilateral cleft lip and palate on the growth and development of the front of the dentoalveolar arch. Methods. This study was carried out in the years 2012–2015 at the Clinic of Plastic, Reconstructive and Aesthetic Surgery in Banska Bystrica. Infants with unilateral complete cleft lip and palate were divided into 2 groups according to the timing of lip reconstruction. Group A consisted of infants with early lip reconstruction–realised in the first 14 days of life. Group B consisted of infants with later lip reconstruction–realised in the third month of age. Maxillary dental casts were obtained for each child in four periods–in the first 14 days of life, in the third month, in the sixth month and in the age of one year. These were followed by the identification, measurement and evaluation of anthropometric parameters. Results. Significant differences were occurred after the reconstruction of the lips in linear and angle measurements between infants in the A and B groups. Conclusion. The early surgical reconstruction of the lips in the first 14 days of life has a positive effect on the growth and development of the anterior segment of the dentoalveolar arch. Early lip reconstruction forms a continuous pressure on the frontal segment, resulting in the earlier remedy of anatomical properties and creates appropriate conditions for the best development of this area.

Objectives. The objective of this study is to compare the impact of early and late reconstruction of complete unilateral cleft lip and palate on the growth and development of the front of the dentoalveolar arch. Methods. This study was carried out in the years 2012 - 2015 at the Clinic of Plastic, Reconstructive and Aesthetic Surgery in Banska Bystrica. Infants with unilateral complete cleft lip and palate were divided into 2 groups according to the timing of lip reconstruction. Group A consisted of infants with early lip reconstruction - realised in the first 14 days of life. Group B consisted of infants with later lip reconstruction - realised in the third month of age. Maxillary dental casts were obtained for each child in four periods – in the first 14 days of life, in the third month, in the sixth month and in the age of one year. These were followed by the identification, measurement and evaluation of anthropometric parameters. Results. Significant differences were occurred after the reconstruction of the lips in linear and angle measurements between infants in the A and B groups. Conclusion. The early surgical reconstruction of the lips in the first 14 days of life has a positive effect on the growth and development of the anterior segment of the dentoalveolar arch. Early lip reconstruction forms a continuous pressure on the frontal segment, resulting in the earlier remedy of anatomical properties and creates appropriate conditions for the best development of this area.

The objective of this study is to characterize and compare tooth agenesis codes and their prevalence in a population of Spanish patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP), and to determine if the extent of the cleft (BCLP or UCLP) was associated with the number of absent teeth. This retrospective cross-sectional human study included 118 patients with complete BCLP (29) or UCLP (89) and permanent dentition from first molar to first molar. Congenitally missing teeth were identified on panoramic radiographs using the tooth agenesis code (TAC) to identify agenesis codes. Agenesis prevalence was 50.6 and 51.7% for UCLP and BCLP patients, respectively. The lateral upper incisor was the most frequently absent tooth, especially in the cleft quadrant. Numbers of absent teeth ranged from 1 to 6. This study represents a different approach from previous agenesis investigations in cleft patients. These Spanish patients showed a high number of ageneses, presenting nineteen different tooth agenesis codes. A total of five TACs were unique, in other words, observed in a single patient in the sample. No statistically significant relationship was found between the extent of the cleft and the number of absent teeth. The TAC system makes it possible to identify agenesis codes with simultaneous absence of teeth not detected in general prevalence studies.