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Otsuki K, Yamanishi T, Enomoto A, Tanaka S, Kogo M, Tome W, Oonishi-Yamamoto Y, Seikai T. Maxillary Development and Dental Arch Relationships Following Early Two-Stage Palatoplasty: A Comparative Study. Cleft Palate Craniofac J 2024; 61:400-408. [PMID: 36259119 DOI: 10.1177/10556656221129751] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine skeletal morphology and dental arch relationships at 8 years of age following early 2-stage palatoplasty, which consists of soft palate plasty at 1 year of age and hard palate closure at 1.5 years of age, and to compare the results with those of conventional pushback palatoplasty. DESIGN Retrospective. SETTING Single institutional study. PATIENTS Eighty-six patients with nonsyndromic complete unilateral cleft lip and palate (UCLP) were selected. INTERVENTION The subjects were divided into 2 groups according to the palatoplasty protocols, as follows: 45 patients, who underwent early 2-stage palatoplasty (ETS group), and 41 patients, who underwent 1-stage pushback palatoplasty (PB group). MAIN OUTCOME MEASURES Skeletal morphology was assessed using lateral cephalometric analysis, and dental arch relationships were examined using the GOSLON yardstick. RESULTS Cephalometric analysis revealed that the anterior-posterior length of the maxilla, measured by PTM-A and PTM-ANS, both projected to the nasal floor (NF) plane, was longer in the ETS group than in the PB group (PTM-A/NF, p = .04; PTM-ANS/NF, p = .03, unpaired t-test), although no significant difference was observed in SNA (p = .09, unpaired t-test). Upper posterior facial height was shorter in the ETS group than in the PB group (p = .02, unpaired t). Assessments with the GOSLON yardstick showed that the ETS group presented better dental arch relationships than the PB group (p = 0.04, Mann-Whitney's U-test). CONCLUSIONS The present results suggested that the ETS protocol reduced the negative effects of palatal surgery on facial development and dental arch relationships in patients with complete UCLP at 8 years of age.
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Affiliation(s)
- Koichi Otsuki
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Tadashi Yamanishi
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Akifumi Enomoto
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kindai University Hospital, Osaka, Japan
| | - Susumu Tanaka
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Mikihiko Kogo
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Wakako Tome
- Department of Orthodontics, Oral Structure, Function, and Development, School of Dentistry, Asahi University, Gifu, Japan
| | - Yuri Oonishi-Yamamoto
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Tetsuya Seikai
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
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Najar Chalien M, Mark H, Lilja J, Rizell S. Long-term Outcome for Two-Stage Palatal Closure With Different Timings for Hard Palate Surgery: Craniofacial Growth and Dental Arch Relation. Cleft Palate Craniofac J 2023; 60:1140-1148. [PMID: 36597376 PMCID: PMC10467013 DOI: 10.1177/10556656221140676] [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] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim was to evaluate dental arch relation and craniofacial growth for individuals born with unilateral cleft lip and palate (UCLP), who had two-stage palatal surgery, with hard palate closure (HPC) at the ages of 3 or 8 years. DESIGN Longitudinal cohort study. SETTING Ceft lip and palate team in Gothenburg, Sweden. PATIENTS The inclusion criteria were nonsyndromic individuals born with complete UCLP who were consecutively operated according to two different surgical protocols; soft palate closure at 6 months followed by hard palate closure at the age of 3 years (HPC3) or at the age of 8 years (HPC8). In this evaluation, 28 individuals had HPC3 and 59 individuals had HPC8. INTERNVENTIONS The main outcome, longitudinal series of dental casts and lateral radiographs from the ages of 5, 10, 16, and 19 years, were evaluated using GOSLON Yardstick and cephalometric analysis. RESULTS At the age of 10 years, 78% of the individuals with HPC3 demonstrated GOSLON scores of 1 and 2 and 86% in HPC8. At the age of 19 years, 54% of the individuals exhibited GOSLON scores of 1or 2 when compared with 74% in HPC8. A statistical significant difference for SNA was observed at the age of 5 years (P = .004), with a lower SNA in HPC3, but not at the ages of 10, 16 and 19 years. At the final age, SNA was 75.2° for HPC3 and 76.8° for HPC8. CONCLUSIONS The decrease in age for HPC did not have an adverse effect on long-term dental arch relationship or craniofacial growth.
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Affiliation(s)
- Midia Najar Chalien
- Clinic of Orthodontics, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
- Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Mark
- Department of Plastic Surgery, Sahlgrenska University Hospital and Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Lilja
- Department of Plastic Surgery, Sahlgrenska University Hospital and Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sara Rizell
- Clinic of Orthodontics, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
- Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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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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Hao J, Wan Q, Liu J, Wu W, Liu J, Luo C, Gao Z, Li F, Chen Y, Lu Z. Modified presurgical nasoalveolar molding for patients with neonatal complete bilateral cleft lip and palate having a severely malpositioned premaxilla. Am J Transl Res 2022; 14:3988-3994. [PMID: 35836893 PMCID: PMC9274589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To develop a modified presurgical nasoalveolar molding (MPNAM) with a premaxillary appliance, connected with two stainless steel wires and evaluate its therapeutic efficacy in newborns with complete bilateral cleft lip and palate (BCLP). METHOD A total of 41 patients with neonatal complete BCLP having a severely protruded and deviated premaxilla were retrospectively selected from January 2017 to November 2019. All patients received the MPNAM device with a premaxillary appliance which was worn until cheilorrhaphy. Plaster casts from pre- and post-MPNAM treatments were scanned using a three-dimensional laser scanner, and the changes were recorded. Facial photographs of patients were taken during the treatment. RESULT The average MPNAM treatment duration was 59.8 days. In all cases, the protrusive and deviated premaxilla was rapidly retracted and set into a suitable position after MPNAM treatment. The relative deviation distance and alveolar cleft width were significantly reduced. Both mid-palatal arch width and posterior arch width were increased. In addition, none of the patients developed any complications during the MPNAM treatment. CONCLUSION Our MPNAM device was able to rapidly centralize the malpositioned premaxilla and reduce the alveolar cleft defect. This device can be applied in presurgical orthodontic treatments for patients with complete BCLP having a severely protruded and deviated premaxilla.
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Affiliation(s)
- Jiansuo Hao
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University Guangzhou, P. R. China
| | - Quan Wan
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University Guangzhou, P. R. China
| | - Jiayu Liu
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University Guangzhou, P. R. China
| | - Wenli Wu
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University Guangzhou, P. R. China
| | - Jiameng Liu
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University Guangzhou, P. R. China
| | - Chongdai Luo
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University Guangzhou, P. R. China
| | - Zijun Gao
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University Guangzhou, P. R. China
| | - Fan Li
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University Guangzhou, P. R. China
| | - Yiyang Chen
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University Guangzhou, P. R. China
| | - Zhiyuan Lu
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University Guangzhou, P. R. China
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5
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Gandhi KK, Rai A. Diagnostic efficacy of novel cephalometric parameters for the assessment of vertical skeletal dysplasia. J Dent Res Dent Clin Dent Prospects 2022; 16:164-169. [PMID: 36704182 PMCID: PMC9871168 DOI: 10.34172/joddd.2022.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 10/07/2022] [Indexed: 01/20/2023] Open
Abstract
Background. An accurate diagnosis of vertical skeletal abnormalities presents several challenges. Specific cephalometric parameters can be effectively used for this purpose; however, the diagnostic accuracy of these parameters has not been entirely ascertained. This study examines the effectiveness of two novel cephalometric parameters for diagnosing vertical dysplasia. Methods. In this retrospective study, orthodontic patients were distributed into three study groups: average growth (AGG), horizontal growth (HGG), and vertical growth (VGG). The efficacies of the sum of angles (maxillary, mandibular, and ramal) and the height ratio (lower anterior facial height [LAFH]/upper anterior facial height [UAFH]) in identifying different growth patterns were examined. Receiver operating characteristic (ROC) curves were employed to assess the diagnostic precision quantitatively. Results. A total of 150 patients were included and divided equally among the three study groups. The ramal and mandibular angles varied across AGG, HGG, and VGG; however, the maxillary angle and the sum of these three angles did not vary significantly. There was a substantial variance in LAHF, UAHF, and their ratio in the three groups. The height ratio had 88% and 92% sensitivity to diagnose VGG and HGG, with cut-off values of 46 and 34, respectively (P<0.001). Conclusion. Height ratio values varied considerably depending on the facial growth patterns, suggesting its efficacy as a diagnostic tool for skeletal dysplasia, with greater reliability for positive treatment outcomes.
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Affiliation(s)
- Kaveri Kranti Gandhi
- Department of Periodontology, Indiana University School of Dentistry, Indianapolis, USA,Corresponding author: Kaveri Kranti Gandhi,
| | - Anshu Rai
- Department of Orthodontics and Dentofacial Orthopedics, Rama Dental College-Hospital and Research Centre Kanpur, Uttar Pradesh, India
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6
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Wlodarczyk JR, Brannon B, Munabi NCO, Wolfswinkel EM, Nagengast ES, Yao CA, Magee W. A Meta-Analysis of Palatal Repair Timing. J Craniofac Surg 2021; 32:647-651. [PMID: 33705001 DOI: 10.1097/scs.0000000000007029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Developing midface hypoplasia is common after palatoplasty and has been hypothesized to be influenced by the timing of hard palate repair. This meta-analysis assesses the risk of developing midface hypoplasia based on age at hard palate repair. A Pubmed PRISMA systematic review and meta-analysis was completed for literature focused on palatoplasty and midface hypoplasia published between 1970 and 2019. Cephalometric data were extracted and categorized by age at hard palate repair: <6, 7 to 12, 13 to 18, 19 to 24, and 25 to 83 months. Analysis of these groups and a control were compared using independent T-tests and Spearman correlation coefficients. SNA angles for each group were 77.9 ± 3.1° (<6 months), 77.7 ± 4.2° (7-12 months), 78.7 ± 4.2° (13-18 months), 75.1 ± 4.2° (19-24 months), 75.5 ± 4.8° (25-83 months), and were statistically different than the control group 82.4 ± 3.5° (P < 0.0001). Hard palate repair at 13 to 18 months had a statistically significant greater SNA angle than all other groups except for the repair at <6 months group (P = 0.074). As age at hard palate closure increased beyond 18 months, the SNA decreased, corresponding to a more hypoplastic maxilla (Spearman's correlation coefficient -0.381, P = 0.015). Analysis suggests that younger age at the time of repair is less likely to create in midface hypoplasia in adulthood. Minimizing midface hypoplasia in cleft palate patients by optimizing algorithms of care is a practical way to decrease the burden of disease on patients, families and medical systems. Further studies are needed to evaluate the role of technique on outcomes.Level of Evidence: IV.
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Affiliation(s)
- Jordan R Wlodarczyk
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
| | - Brooke Brannon
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
| | - Naikhoba C O Munabi
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles.,Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles
| | - Erik M Wolfswinkel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles
| | - Eric S Nagengast
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles.,Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles
| | - Caroline A Yao
- Division of Plastic Surgery, Shriners Hospital for Children, Pasadena
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7
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Shetty V, Sreekumar C, Patteta NK, Bahl D, Sailer HF. Correlation between surgical protocols for palatoplasty and midfacial growth in cleft lip and palate patients: A long-term, single centre study. J Craniomaxillofac Surg 2021; 49:1010-1019. [PMID: 34238633 DOI: 10.1016/j.jcms.2021.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 05/26/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022] Open
Abstract
To evaluate and compare the outcomes of two different surgical protocols for palatoplasty for midfacial growth in patients with cleft lip and palate. A retrospective observational cohort study was conducted in 80 patients with cleft lip and palate, who were divided into two groups. Group 1 comprised patients who underwent operation between 9 and 11 months of age using the Bardach two-flap technique without a palatal pushback. Group 2 comprised patients who had undergone operation between 18 and 20 months of age using either a Bardach two-flap technique with a palatal pushback or a von Langenbeck technique. Patient follow-up was done between 8 and 9 years of age when they reported to the centre for secondary alveolar bone grafting. Post-surgical cephalometric measurements were taken for midfacial growth analysis. Group 1 underwent palatoplasty at significantly younger ages than Group 2 (p < 0.01). A statistically significant difference(p < 0.01) was found between the two groups of patients on comparison of cephalometric parameters such as SNA, ANB, CoA, NperpA ANS-PNS, N-ANS, N-Me, Witt's (AO-BO). Group 2 had more positive cephalometric values as compared to Group 1, thereby implying that there was less incidence of midfacial hypoplasia in patients treated at the age of 18-20 months. Between the types of palatoplasty techniques within Group 2, i.e., Bardach two-flap and von Langenbeck, there was no statistical difference found in the post-opertative cephalometric values, i.e., SNA, ANB, CoA, ANS-PNS, N-ANS, N-Me, Witt's (AO-BO) except for Nperp-A, which showed a statistical difference (p = 0.03). Within the limitations of the study which is only a single center experience it seems that palatal closure should be carried out at 18-20 months of age for better midfacial growth, leading to decreased incidence of maxillary hypoplasia at a later stage in life. Repair at less than 18 months of age is also associated with mid-facial hypoplasia.
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Affiliation(s)
- Vikram Shetty
- Nitte Meenakshi Institute of Craniofacial Surgery, Nitte Deemed to be University, India
| | - Chandni Sreekumar
- Dept. of Periodontics, Srinivas Inst. of Dental Sciences, RGUHS, India
| | - Nanda Kishore Patteta
- Dept. of Cleft and Craniofacial Orthodontics, Nitte Meenakshi Institute of Craniofacial Surgery, Nitte Deemed to be University, India.
| | - Devyani Bahl
- Dept. of Oral and Maxillofacial Surgery, A.B.Shetty Memorial Inst. of Dental Sciences, Nitte Deemed to be University, India
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8
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Kato J, Mikoya T, Ito Y, Sato Y, Uematsu S, Kodama Y, Susami T, Yamanishi T, Takagi R. Dental Arch Relationship Outcomes Following 2-Stage Palatoplasty for Japanese Patients With Complete Unilateral Cleft Lip and Palate: A 3-Center Study. Cleft Palate Craniofac J 2021; 59:355-364. [PMID: 33910394 DOI: 10.1177/10556656211010606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare dental arch relationship outcomes following 3 different 2-stage palatal repair protocols. DESIGN Retrospective, cross sectional. SETTING Three cleft palate centers (A, B, C) in Japan. PATIENTS Ninety (A: 39, B: 26, C: 25) consecutively treated Japanese patients with complete unilateral cleft lip and palate. INTERVENTIONS In A, the soft palate and the posterior half of the hard palate were repaired at a mean age of 1 year 7 months. In B, the soft palate and hard palate were closed separately at a mean age of 1 year 6 months and 5 years 8 months, respectively. In C, the soft palate and hard palate were closed at a mean age of 1 year and 1 year 5 months, respectively. MAIN OUTCOME MEASURES Dental arch relationships were assessed using the 5-Year-Olds' (5-Y) index by 5 raters and the Huddart/Bodenham (HB) index by 2 raters. RESULTS Intra- and inter-rater reliabilities showed substantial or almost perfect agreement for the 5-Y and HB ratings. No significant differences in mean values and distributions of 5-Y scores were found among the 3 centers. The mean HB index scores of molars on the minor segment were significantly smaller in C than those in A and B (P < .05). CONCLUSIONS There were no significant differences in dental arch relationships at 5 years among the times and techniques of hard palate closure. However, further analysis of the possible influence of infant cleft size as a covariable on a larger sample size is needed.
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Affiliation(s)
- Junya Kato
- Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Tadashi Mikoya
- Center for Advanced Oral Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Yumi Ito
- Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshiaki Sato
- Department of Orthodontics, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Setsuko Uematsu
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yasumitsu Kodama
- Division of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takafumi Susami
- Department of Oral-Maxillofacial Surgery, Dentistry and Orthodontics, University of Tokyo Hospital, Tokyo, Japan
| | - Tadashi Yamanishi
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Ritsuo Takagi
- Division of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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9
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Rizell S, Küseler A, Heliövaara A, Skaare P, Brinck E, Bellardie H, Mooney J, Mølsted K, Karsten A, Sæle P, Chalien MN, Marcusson A, Eyres P, Shaw W, Semb G. Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: impact of maxillary dental agenesis on craniofacial growth and dental arch relationship in 8 year olds. Eur J Orthod 2021; 43:381-386. [PMID: 33693582 DOI: 10.1093/ejo/cjab007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND It is suggested that dental agenesis affects maxillary protrusion and dental arch relationship in children with unilateral cleft lip and palate (UCLP). In addition, an association between the need for orthognathic surgery and dental agenesis is reported. AIM The aim was to study the impact of maxillary dental agenesis on craniofacial growth and dental arch relationship in 8-year-old children with UCLP. SUBJECTS AND METHODS The sample consisted of individuals with UCLP from Scandcleft randomized trials. The participants had available data from diagnosis of maxillary dental agenesis as well as cephalometric measurements (n = 399) and GOSLON assessment (n = 408) at 8 years of age. RESULTS A statistically significant difference was found for ANB between individuals with agenesis of two or more maxillary teeth (mean 1.52°) in comparison with those with no or only one missing maxillary tooth (mean 3.30° and 2.70°, respectively). Mean NSL/NL was lower among individuals with agenesis of two or more maxillary teeth (mean 9.90°), in comparison with individuals with no or one missing maxillary tooth (mean 11.46° and 11.45°, respectively). The number of individuals with GOSLON score 4-5 was 47.2% in the group with two or more missing maxillary teeth and 26.1% respectively 26.3% in the groups with no or one missing maxillary tooth. No statistically significant difference was found in the comparison between individuals with no agenesis or with agenesis solely of the cleft-side lateral. CONCLUSION Maxillary dental agenesis impacts on craniofacial growth as well as dental arch relationship and should be considered in orthodontic treatment planning.
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Affiliation(s)
- Sara Rizell
- Clinic of Orthodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Sweden
| | - Annelise Küseler
- Cleft Palate Centre and University Hospital Aarhus and University of Aarhus, Denmark
| | - Arja Heliövaara
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital, Finland
| | - Pål Skaare
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Norway
| | - Eli Brinck
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Norway
| | - Haydn Bellardie
- University of the Western Cape, South Africa.,Greater Manchester Cleft Lip and Palate Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Jeanette Mooney
- Greater Manchester Cleft Lip and Palate Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Kirsten Mølsted
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Denmark
| | - Agneta Karsten
- Section of Orthodontics, Division of Orthodontics and Pedodontics, Department of Dental Medicine, Karolinska Institutet, Stockholm Craniofacial Team, Stockholm, Sweden
| | - Paul Sæle
- Oral Health Centre of Expertise, Western Norway, Bergen, Norway
| | - Midia Najar Chalien
- Clinic of Orthodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Sweden
| | - Agneta Marcusson
- Maxillofacial Unit, and Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Philip Eyres
- Greater Manchester Cleft Lip and Palate Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - William Shaw
- Greater Manchester Cleft Lip and Palate Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Gunvor Semb
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Norway.,Greater Manchester Cleft Lip and Palate Unit, Royal Manchester Children's Hospital, Manchester, UK
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10
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Ozawa TO, Dutka JDCR, Garib D, Lauris RCMC, Almeida AM, Brosco TVDS, Lauris JRP, Dolce C, Pegoraro-Krook MI. Influence of surgical technique and timing of primary repair on interarch relationship in UCLP: A randomized clinical trial. Orthod Craniofac Res 2020; 24:288-295. [PMID: 33098171 DOI: 10.1111/ocr.12435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/17/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare dental arch relationships in children with unilateral cleft lip and palate (UCLP) between two surgical techniques for repair of cleft lip/palate and two ages of palate repair. SETTINGS AND SAMPLE Dental models were taken for a group of 448 subjects at a mean age of 7 years and were evaluated by means of the Goslon Yardstick. The patients studied consisted of an initial group of 673 infants with complete UCLP randomized into 8 study groups according to lip repair procedures (Millard versus Spina techniques); palate repair procedures (von Langenbeck versus Furlow techniques); and palate repair timing (early: 9 to 12 months versus late: 15-18 months). METHODS Four surgeons performed all surgeries. Dependent variables included the following: lip repair technique, palate repair technique, age at time of palate repair and surgeon; with sex as an independent variable. The data were analysed using a general linear model (P < .05). RESULTS There were no significant differences for occlusal index scores as a function of lip or palate surgical technique, palatal repair timing and sex. Significant differences were found for occlusal index scores as a function of the surgeon. CONCLUSION Dental arch relationships were not influenced by lip and palatal repair techniques or patient age at palatal repair. The surgeon was the major factor that influenced the dental arch relationship outcome.
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Affiliation(s)
- Terumi Okada Ozawa
- Department of Orthodontics, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Jeniffer de Cassia Rillo Dutka
- Department of Speech-Language and Audiology, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Daniela Garib
- Department of Orthodontics, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.,Department of Orthodontics, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Rita C M C Lauris
- Department of Orthodontics, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Araci Malagodi Almeida
- Department of Orthodontics, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Telma Vidotto de Sousa Brosco
- Department of Plastic Surgery, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - José Roberto P Lauris
- Department of Orthodontics, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.,Department of Public Health, Bauru Dental School, University of São Paulo, Bauru, Brazil
| | - Calogero Dolce
- University of Florida College of Dentistry, Gainesville, FL, USA
| | - Maria Inês Pegoraro-Krook
- Department of Speech-Language and Audiology, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
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11
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Kochhar AS, Sidhu MS, Prabhakar M, Bhasin R, Kochhar GK, Dadlani H, Spagnuolo G. Frontal and Axial Evaluation of Craniofacial Morphology in Repaired Unilateral Cleft Lip and Palate Patients Utilizing Cone Beam Computed Tomography; An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217786. [PMID: 33114340 PMCID: PMC7663310 DOI: 10.3390/ijerph17217786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/16/2022]
Abstract
The current study was conducted to assess the extent of maxillary arch collapse on the cleft vis-a-vis non-cleft sides in the same individual presenting withunilateral cleft lip and palate (UCLP), using cone-beam computed tomography (CBCT). Thirty-one children (eighteen boys andthirteen girls) with surgically repaired UCLP, who met the inclusion criteria, were selected. Following the acquisition of CBCT scans, fourteen bilateral landmarks were selected. The distance of the bilateral landmark was calculated from the midsagittal plane on the cleft and non-cleft sides for both frontal and axial views. Tracings were done;the data obtained was subjected to statistical analysis;and intra-observer variability was checked with intraclass correlation coefficient (ICC) and two-way ANOVA. Subsequently, the measurements were subjected to paired t-tests at the 95% level of significance with Bonferroni correction. A significant reduction of pyriforme and an alveolar crest above the maxillary 1st molar were discerned in frontal analysis on the cleft side. In the axial view, the zygomatic arch, malar, porion and alveolar crest at the molar region were non-significant, but the alveolar crest at the premolar region (p < 0.004)) was significantly decreased. In the frontal analysis, pyriforme and the alveolar crest above the maxillary 1st molar, and, in the axial view, premolar widths, showed significant reduction when comparing the cleft vis-a-vis non-cleft sides.
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Affiliation(s)
| | - Maninder Singh Sidhu
- Department of Orthodontics, Faculty of Dental Sciences, SGT University Gurugram, Haryana 122006, India; (M.S.S.); (M.P.)
| | - Mona Prabhakar
- Department of Orthodontics, Faculty of Dental Sciences, SGT University Gurugram, Haryana 122006, India; (M.S.S.); (M.P.)
| | - Ritasha Bhasin
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G1G6, Canada;
| | - Gulsheen Kaur Kochhar
- Department of Pediatric & Preventive Dentistry, National Dental College & Hospital, Punjab 140507, India;
| | - Himanshu Dadlani
- Department of Periodontology, Kalka Dental College & Hospital, Meerut 250006, India;
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy
- Correspondence:
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12
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Tache A, Mommaerts MY. The need for maxillary osteotomy after primary cleft surgery: A systematic review framing a retrospective study. J Craniomaxillofac Surg 2020; 48:919-927. [DOI: 10.1016/j.jcms.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 06/26/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022] Open
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13
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Difference in Degrees of Satisfaction with Orthognathic Surgery and Orthodontic Treatment between Skeletal Class III and Cleft Patients. J Craniofac Surg 2019; 30:985-991. [PMID: 30817507 DOI: 10.1097/scs.0000000000005425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the degrees of satisfaction with orthognathic surgery and orthodontic treatment between skeletal Class III and cleft patients. MATERIALS AND METHODS The samples consisted of Class III group (N = 25) and Cleft group (N = 16). The Modified Orthognathic Quality of Life Questionnaires, which had 5 domains (oral function [OF], awareness of dentofacial deformity [ADD], social relationship [SR], facial esthetics [FE], and nose/lip esthetics [NLE]), were evaluated with 5 rates (0 [very satisfactory] to 4 [very unsatisfactory]) at initial visit (T1), just before surgery (T2), 3 to 6 months after surgery (T3), and at debonding or 1 year after surgery (T4). The scores at each stage, amount of change between stages, and effect size (ES) in the 5 domains were investigated. RESULTS Compared to Class III group, Cleft group exhibited lower satisfaction scores of NLE domain during all stages (all P < 0.001) and of SR domain and total domains at T4 stage (P < 0.05, P < 0.01). Cleft group showed significant improvement of satisfaction scores in FE domain during T1-T2 (P < 0.01), in SR, FE, NLE, and total domains during T2-T3 (all P < 0.01), in OF, SR, and total domains during T3-T4 (P < 0.05, P < 0.01, P < 0.01), and in all domains during T1-T4 (ADD, P < 0.05; OF, SR, and NLE, P < 0.01; FE and total, P < 0.001). Cleft group exhibited large improvement of ES only at SR and FE domains during T2-T3 (-0.81 and -1.09, respectively). CONCLUSIONS Owing to lower satisfaction of NLE domain at all stages in cleft patients, clinicians should recommend adjunctive cosmetic surgery for nose and lip after completion of treatment.
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14
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15
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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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16
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Bittermann GK, de Ruiter AP, Bittermann AJN, Mink van de Molen AB, van Es RJJ, Koole R, Rosenberg AJWP. Midfacial growth and dental arch relationships in bilateral cleft palate following secondary alveolar bone grafting and orthodontic intervention: Factors predicting a Le Fort I osteotomy at age 18. J Craniomaxillofac Surg 2018; 46:1764-1771. [DOI: 10.1016/j.jcms.2018.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/03/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022] Open
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17
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Effects of Nasoalveolar Molding Therapy on Alveolar and Palatal Cleft Deformities in Unilateral and Bilateral Cleft Lip and Palate. J Craniofac Surg 2018; 29:e179-e184. [PMID: 29381641 DOI: 10.1097/scs.0000000000004243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate and compare the efficacy of nasoalveolar molding (NAM) therapy in the improvement of alveolar and palatal cleft deformity on unilateral (UCLP) versus bilateral (BCLP) cleft lip and palate. MATERIALS AND METHODS A total of 19 UCLP (14 boys and 5 girls) and 8 BCLP (7 boys and 1 girl) infants completed NAM therapy were included in this study. Standardized parameters of cleft width of alveol and palate were measured on photocopies taken from the pre- and post-treatment plaster casts. To assess the intragroup differences, paired-samples test in UCLP and Wilcoxon test in BCLP groups were used. Mann-Whitney U test was used to evaluate the differences between the groups. RESULTS Significant decreases in alveolar and palatal cleft gaps were achieved in an average period of 3.3 ± 1.9 and 3.7 ± 1.6 months in UCLP and BCLP patients, respectively. The alveolar cleft decreased 7.85 ± 4.59 mm in UCLP and 4.25 ± 3.13 and 3.81 ± 3.50 mm in right and left alveolar cleft sides in BCLP, respectively. The palatal clefts were decreased 4.63 ± 2.44 mm in medial and 3.72 ± 2.62 mm in posterior parts in UCLP. The decrements in BCLP were 3.00 ± 2.75 mm in medial and 2.88 ± 2.75 mm in posterior palatal cleft distances. No significant differences were determined in the amount of alveolar or palatal cleft closure between UCLP and BCLP groups. The only decrease in arch width was 1.39 mm in medial part of palate in UCLP. CONCLUSION The NAM device provides significant decreases in both alveolar and palatal cleft deformities in UCLP and BCLP infants, as compared with their birth status.
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18
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Long-term craniofacial morphology in young adults treated for a non-syndromal UCLP: A systematic review. J Plast Reconstr Aesthet Surg 2018; 71:504-517. [DOI: 10.1016/j.bjps.2017.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/28/2017] [Accepted: 12/05/2017] [Indexed: 01/10/2023]
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19
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Hearing sensitivity in adults with a unilateral cleft lip and palate after two-stage palatoplasty. Int J Pediatr Otorhinolaryngol 2017; 94:76-81. [PMID: 28167017 DOI: 10.1016/j.ijporl.2016.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/24/2016] [Accepted: 12/24/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate long-term hearing and middle ear status in patients treated for a unilateral complete cleft lip and palate (UCLP) by two-stage palatoplasty. METHODS Forty-nine UCLP patients aged 17 years and older were included in this retrospective study. Patients were invited for a multidisciplinary long-term follow-up of their treatment at a tertiary center for craniofacial surgery in the Netherlands. ENT assessment included tympanometry and pure-tone audiometry. Medical files were searched for medical and surgical history. RESULTS In total, 19.4% of the patients had significant long-term hearing loss (PTA > 20 dB), comprising conductive hearing loss in 21.5% of the patients. In the majority (70%), this hearing loss was more pronounced at higher frequencies. In 25% the high fletcher index showed hearing thresholds above 20 dB. Ventilation tubes were placed at least once in 78.7% of the patients. The frequency of tube insertion was positively correlated with the incidence of reduced tympanic compliance (tympanogram type B) and the need for a pharyngoplasty. CONCLUSION The present study reports long-term hearing outcomes in UCLP patients with hard palate closure at 3 years of age. Persistent hearing loss was observed in 19.4% of our patients (PTA > 20 dB), mainly at the higher frequencies. Ventilation tube placement was associated with reduced tympanic compliance and higher risk on hearing loss (PTA air conduction). Our high incidence of velopharyngeal incompetence during early childhood, which is likely associated with Eustachian tube dysfunction, might have contributed to these results.
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