Maxillary protraction in patients with unilateral cleft lip and palate : Evaluation of soft and hard tissues using the Alt-RAMEC protocol

Orthodontic treatment protocols in patients with alveolar clefting: a survey of ACPA-approved cleft teams in the United States

OBJECTIVES

To describe pre- and post-alveolar bone graft (ABG) practice protocols of orthodontists associated with American Cleft Palate-Craniofacial Association-approved cleft and cleft/craniofacial teams.

MATERIALS AND METHODS

Electronic survey responses from team orthodontists were evaluated regarding pre-ABG orthodontic treatment type(s), timing of post-ABG imaging and post-ABG orthodontic treatment, and craniofacial orthodontic fellowship training status of the team orthodontists. A P value of <.05 was considered significant.

RESULTS

Of 31 responding orthodontists, 54.8% had fellowship training and 45.2% did not. Pre-ABG orthodontic preparation ranged from solely maxillary expansion for alveolar segment alignment (35.5%) to a combination of maxillary expansion for both alveolar segment alignment and posterior crossbite correction, anterior tooth alignment, and anterior crossbite correction (19.4%). Most captured post-ABG radiographs prior to orthodontic tooth movement (90.3%). Orthodontists began treatment at least 6 months (35.5%), 2-4 months (32.3%), or 4-6 months (29%) post-ABG. No significant differences were found when comparing fellowship subgroups. In addition, 47.1% of fellowship-trained orthodontists deferred post-ABG orthodontic treatment to at least 6 months post-operatively, vs 21.4% of non-fellowship trained orthodontists (P = .14).

CONCLUSIONS

A large variation in approaches is evident in pre-ABG orthodontic treatment types and timing of post-ABG treatment. Post-operative imaging is pursued by most orthodontists to assess graft status prior to initiating orthodontic treatment. Additional clinical research is needed to support providers in their decision-making with regard to evidence-based approaches.

Bite Force Changes in Bilateral Cleft Lip and Palate Patients Before and After ALT-RAMEC Protocol

To evaluate the bite force (BF) changes in bilateral cleft lip and palate (BCLP) in contrast to the non BCLP children after ALT-RAMEC Facemask therapy.

The prospective study was carried out on a total of 60 subjects of age 6 to 13 years in a tertiary care hospital; treatment group, 30 children with BCLP and control group, 30 children without cleft lip and palate. Each cleft patient was received ALT-RAMEC Facemask treatment and their BF assessed at 4 different stages. Bite force taken before treatment, immediately, 3 months and 6 months after treatment. Bite force of the control group was taken at baseline to compare with the treatment group to demonstrate the difference in BF values. Independent t test and analysis of variance were used to perform statistical analysis.

There was a significant difference in BF between the treatment group (BCLP) 122.53 ± 8.64 N and the control group (non BCLP) 181.38 ± 18.84 N at baseline. After the Alt RAMEC protocol, changes in BF recorded over 3 and 6 months of therapy showed significant improvement. The mean values of BF at 3months and 6 months were 106.7 ± 9.3 N and 137.4 ± 9.5 N, respectively.

Bite force was significantly improved after ALT-RAMEC protocol followed by facemask therapy in BCLP patients.

Preoperative analysis of upper lip in patients with upper cleft lip/palate before lip repair

Background

The postoperative morphological appearances vary widely patients with unilateral cleft lip with or without cleft palate (UCL/P), whether it is complete or incomplete cleft. The main reason of bilateral lip asymmetry after cleft lip surgery lies in the lack of personalized measurement and design before surgery. In this study, we aim to individually investigate areas of the upper lip on cleft and non-cleft sides in patients with unilateral cleft lip with or without cleft palate (UCL/P).

Methods

Ninety-two patients with UCL/P (group 1: <1 year, group 2: 1–2 years) were included in the study. Group 1 included 37 patients with incomplete UCL/P and 29 with complete UCL/P; group 2 included 11 and 15 patients, respectively. The total area of the upper lip on the cleft side (Q8) was divided into Q3, Q4, and Q5 (further divided into a1 and a2), and the upper lip on the non-cleft side (Q7) was divided into Q2 and Q1 (further divided into A1 and A2). Area ratios between the cleft and the non-cleft sides were calculated, and certain parameters were tested for correlations with these ratios.

Results

Values of Q8/Q7 were partially overlapped between patients with complete and incomplete UCL/P. Significant correlations were noted between differences in height of the philtrum column (a–h) and the prolabial area ratio between the cleft and the non-cleft side (Q3/Q2) (P=0.032). Moreover, a significant correlation was noted between a1/A1 and the ratio of the lateral labial area between the cleft and the non-cleft side (Q5/Q1) (P=0.001).

Conclusions

The conventional classification of unilateral cleft lip as incomplete and complete does not completely and accurately reflect individual malformations. Therefore, it is necessary to analyze unilateral cleft lips individually to determine the repair technique and to predict postoperative outcomes.