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Zheng J, Sun Y, Yang Z, Guo D, Ren M, Jiang Y, Yuan W. Comparison of craniomaxillofacial morphology in children with unilateral cleft lip and palate treated with/without presurgical nasoalveolar molding - a retrospective study with a mean age of 5 years. Clin Oral Investig 2024; 28:326. [PMID: 38763957 DOI: 10.1007/s00784-024-05725-z] [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] [Received: 01/10/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES To three-dimensionally assess differences in craniomaxillofacial skeletal development in patients with operated unilateral cleft lip and palate (UCLP) treated with/without presurgical nasoalveolar molding (PNAM) with a mean age of 5 years. MATERIALS AND METHODS Cone-beam CT radiographs of 30 patients with UCLP who had undergone PNAM and 34 patients with UCLP who did not receive PNAM were analyzed. The data were stored in DICOM file format and were imported into the Dolphin Imaging program for 3D image reconstruction and landmark identification. 33 landmarks, 17 linear and three angular variables representing craniofacial morphology were analyzed and compared by using the Mann-Whitney U tests. RESULTS The vast majority of linear variables and 3D coordinates of landmark points reflecting craniofacial skeletal symmetry were not significantly different between the two groups. In terms of craniofacial skeletal development, the PNAM group had a significantly smaller anterior nasal spine offset in the midsagittal plane and a greater maxillary length compared to the non-PNAM group. CONCLUSIONS Evaluations performed in early childhood showed that treatment with/without PNAM in the neonatal period was not a major factor influencing craniomaxillofacial hard tissue development in patients with UCLP; moreover, PNAM treatment showed significant correction of skeletal deviation at the base of the nose. CLINICAL RELEVANCE Follow-up in early childhood has shown that PNAM treatment administered during the neonatal stage does not impede maxillary development and has benefits in correcting nasal floor deviation. It is a viable option for improving nasal deformity in children with unilateral cleft lip and palate.
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Affiliation(s)
- Jie Zheng
- Department of Orthodontics, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Hongshan District, Wuhan, Hubei, 430079, People's Republic of China
| | - Yangqi Sun
- Department of Orthodontics, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Hongshan District, Wuhan, Hubei, 430079, People's Republic of China
| | - Zhengkun Yang
- Department of Orthodontics, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Hongshan District, Wuhan, Hubei, 430079, People's Republic of China
| | - Di Guo
- Department of Orthodontics, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Hongshan District, Wuhan, Hubei, 430079, People's Republic of China
| | - Meiqing Ren
- Department of Orthodontics, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Hongshan District, Wuhan, Hubei, 430079, People's Republic of China
| | - Yanping Jiang
- Department of Gynaecology, Renmin Hospital of Wuhan University, #99 Zhangzhidong Road, Wuchang District, Wuhan, Hubei, 430060, People's Republic of China.
| | - Wenjun Yuan
- Department of Orthodontics, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Hongshan District, Wuhan, Hubei, 430079, People's Republic of China.
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Şibar S, Doruk M, Gülşen A, Özdemir A, Tosun G, Üçüncü N. Evaluation of Orbitomalar Region Projection in Patients With Operated Cleft Lip and Palate (Cephalometric Study). Cleft Palate Craniofac J 2024; 61:545-554. [PMID: 36278686 PMCID: PMC10955793 DOI: 10.1177/10556656221133426] [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: 02/18/2024] Open
Abstract
OBJECTIVE The aim of this study was to compare the orbitomalar region projection in patients with cleft lip and palate (CLP) with skeletal class 1 cases. DESIGN Retrospective. SETTING Single center. PATIENTS Cephalometric data of 52 cases with unilateral CLP, 25 cases with bilateral CLP, and 60 healthy participants in skeletal class 1 without CLP were included. MAIN OUTCOME MEASURE(S) A total of 5 parameters, 3 in the orbital and 2 in the suborbital region, that determine the projection of the orbitomalar region on lateral cephalograms, and 13 parameters of the craniofacial region were evaluated. RESULTS Lateral, inferior, and anterior orbital parameters were similar between groups, while suborbital parameters were in a retrusive position in the CLP groups compared to the control group (P < .05). No significant difference was found between the CLP groups in terms of suborbital parameters. A moderate positive correlation was found between orbitomalar parameters and the anteroposterior positions of the maxilla and mandible. The lateral orbital region had a moderate negative correlation with anterior maxillary height, and the suborbital region had a negative moderate correlation with maxillary inclination. CONCLUSION Suborbital projection was more retrusive in CLP compared to the control group, but no difference was found between the CLP groups. On the other hand, the correlation between orbitomalar projection and maxillary and mandibular development was significant. The results show that there is a need for alternative treatment modalities for the suborbital region in patients with CLP.
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Affiliation(s)
- Serhat Şibar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University Hospital, Ankara, Turkey
| | - Mert Doruk
- Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University Hospital, Ankara, Turkey
| | - Ayşe Gülşen
- Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University Hospital, Ankara, Turkey
| | - Alihan Özdemir
- Department of Dentistry, Gazi University Hospital, Ankara, Turkey
| | - Gülce Tosun
- Department of Dentistry, Gazi University Hospital, Ankara, Turkey
| | - Neslihan Üçüncü
- Department of Dentistry, Gazi University Hospital, Ankara, Turkey
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Fangueiro DG, Garib DG, Conti ACDCF, Largura L. Evaluation of facial pleasantness in patients with complete and unilateral cleft lip and palate rehabilitated and submitted to orofacial harmonization. Dental Press J Orthod 2024; 29:e2423115. [PMID: 38567921 PMCID: PMC10983844 DOI: 10.1590/2177-6709.29.1.e2423115.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/30/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The objective of the present prospective case control study was to evaluate the facial pleasantness of patients with complete and unilateral cleft lip and palate at the end of interdisciplinary rehabilitation, submitted to facial fillers based on hyaluronic acid. METHODS The study group consisted of 18 individuals with complete unilateral cleft lip and palate, aged between 18 and 40 years (mean age 29 years) of both sexes. The patients presented a concave profile with mild to moderate maxillary deficiency, with completed orthodontic treatment and conducted by means of dentoalveolar compensations without orthognathic surgery. Participants underwent facial filling procedures with hyaluronic acid (HA) in the midface, inserted by a single operator. Standard photographs in frontal norm at rest, right profile at rest, and left profile at rest were obtained from each patient at the following operative times: (T1) pre-filler and (T2) and one-month post-filler. The photographs in T1 and T2 were randomly placed on a page of a virtual album. A 5-point Likert scale was used to assess facial pleasantness. The photographs were evaluated by two groups of evaluators consisting of 18 individuals with cleft lip and palate (CLPG=18) and 18 orthodontists with experience in the treatment of clefts (OG=18). For comparison between phases T1 and T2, and between evaluators with orofacial clefts and orthodontists, the Wilcoxon test was used (p<0,05). RESULTS People with cleft lip and palate rated their face as more pleasant after the midface filling procedure. In the perception of the orthodontists, on the other hand, the facial pleasantness remained similar after the facial filling procedure. CONCLUSIONS The filling of the middle third of the face in patients with cleft lip and palate treated without orthognathic surgery increased the pleasantness of the face in the opinion of laypeople with cleft lip and palate.
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Affiliation(s)
- Daniel Giaretta Fangueiro
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais (Bauru/SP, Brazil)
- Universidade do Sagrado Coração, Faculdade de Odontologia (Bauru/SP, Brazil)
| | - Daniela Gamba Garib
- Universidade de São Paulo, Faculdade de Odontologia de Bauru (Bauru/SP, Brazil)
| | - Ana Cláudia de Castro Ferreira Conti
- Universidade do Sagrado Coração, Faculdade de Odontologia (Bauru/SP, Brazil)
- Universidade Norte do Paraná, Faculdade de Odontologia (Londrina/PR, Brazil)
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Tayyar RK, Khattab TZ. Correlation between Cleft Width and Adjacent Teeth Inclination in Patients with Unilateral Cleft Lip and Palate Using CBCT: A Retrospective Study. Cleft Palate Craniofac J 2024:10556656241236532. [PMID: 38419460 DOI: 10.1177/10556656241236532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES To evaluate buccolingual and mesiodistal inclination of cleft-adjacent maxillary permanent central incisors (U1) and canines (U3) in patients with unilateral cleft lip and palate (UCLP) in the late mixed dentition and to investigate the correlation between the alveolar cleft width and cleft-adjacent teeth inclination using cone beam computed tomography (CBCT). DESIGN Observational cross-sectional retrospective study. SETTING Department of Orthodontics, Hama University Dental School. PATIENTS 32 patients with UCLP (22 boys, 10 girls; mean age = 10.53 ± 1.51 years). MAIN OUTCOME MEASURE Buccolingual and mesiodistal inclination of maxillary central incisors and canines were measured on both sides. Then, the cleft and non-cleft sides were compared using the Wilcoxon signed-rank test. Pearson's correlation was used to explore the association between the alveolar cleft width and cleft-adjacent U1 and U3 buccolingual and mesiodistal inclination. RESULTS The cleft-adjacent central incisors were significantly inclined lingually and distally compared with their non-cleft antimeres (P = .003, P < .001, respectively). The cleft-adjacent canines were significantly inclined buccally and mesially compared with their non-cleft antimeres (P < .001, for both). A positive correlation was found between the buccolingual inclination of cleft-adjacent U1 and the alveolar cleft width (r = 0.49, P = .004). CONCLUSIONS Patients with UCLP demonstrated a significant lingual and distal inclination of cleft-adjacent U1 and a significant buccal and mesial inclination of cleft-adjacent U3. The buccolingual inclination of cleft-adjacent U1 tends to increase with increasing the alveolar cleft width; however, the correlation was weak.
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Affiliation(s)
- Reham Khaled Tayyar
- Department of Orthodontics and Dentofacial Orthopedics, Hama University, Hama, Syria
| | - Tarek Z Khattab
- Department of Orthodontics and Dentofacial Orthopedics, Hama University, Hama, Syria
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Zhang X, Qin N, Zhou Z, Chen S. Machine learning in 3D auto-filling alveolar cleft of CT images to assess the influence of alveolar bone grafting on the development of maxilla. BMC Oral Health 2023; 23:16. [PMID: 36631872 PMCID: PMC9835292 DOI: 10.1186/s12903-023-02706-8] [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: 09/25/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Machine learning based auto-segmentation of 3D images has been developed rapidly in recent years. However, the application of this new method in the research of patients with unilateral cleft lip and palate (UCLP) is very limited. In this study, a machine learning algorithm utilizing 3D U-net was used to automatically segment the maxilla, fill the cleft and evaluate the alveolar bone graft in UCLP patients. Cleft related factors and the surgery impact on the development of maxilla were analyzed. METHODS Preoperative and postoperative computed tomography images of 32 patients (64 images) were obtained. The deep-learning-based protocol was used to segment the maxilla and defect, followed by manual refinement. Paired t-tests and Mann-Whitney tests were performed to reveal the changes of the maxilla after surgery. Two-factor, two-level analysis for repeated measurement was used to examine the different trends of growth on the cleft and non-cleft sides of the maxilla. Pearson and Spearman correlations were used to explore the relationship between the defect and the changes of the maxillary cleft side. RESULTS One-year after the alveolar bone grafting surgery, different growth amount was found on the cleft and non-cleft sides of maxilla. The maxillary length (from 34.64 ± 2.48 to 35.67 ± 2.45 mm) and the alveolar length (from 36.58 ± 3.21 to 37.63 ± 2.94 mm) increased significantly only on the cleft side while the maxillary anterior width (from 11.61 ± 1.61 to 12.01 ± 1.41 mm) and posterior width (from 29.63 ± 2.25 to 30.74 ± 2.63 mm) increased significantly only on the non-cleft side after surgery. Morphology of the cleft was found to be related to the pre-surgical maxillary dimension on the cleft side, while its correlation with the change of the maxilla after surgery was low or not statistically significant. CONCLUSION The auto-segmentation of the maxilla and the cleft could be performed very efficiently and accurately with the machine learning method. Asymmetric growth was found on the cleft and non-cleft sides of the maxilla after alveolar bone graft in UCLP patients. The morphology of the cleft mainly contributed to the pre-operation variance of the maxilla but had little impact on the maxilla growth after surgery.
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Affiliation(s)
- Xin Zhang
- grid.11135.370000 0001 2256 9319Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People’s Republic of China
| | - Niu Qin
- grid.11135.370000 0001 2256 9319Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People’s Republic of China
| | - Zhibo Zhou
- grid.11135.370000 0001 2256 9319Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People’s Republic of China
| | - Si Chen
- grid.11135.370000 0001 2256 9319Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People’s Republic of China
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Xu Y, Zeng N, Li J, Zheng Q, Shi B. Growth patterns of the nasolabial region following unilateral cleft lip primary repair. Front Pediatr 2023; 11:1136467. [PMID: 36994436 PMCID: PMC10040551 DOI: 10.3389/fped.2023.1136467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/16/2023] [Indexed: 03/31/2023] Open
Abstract
Surgical correction is the optimal way of repairing a congenital cleft lip. Patients with this condition often undergo initial surgical treatment at an early age and achieve an acceptable outcome. However, their levels of satisfaction will decrease in later stages of life as facial growth and development will inevitably cause changes in long-term outcomes, especially in the nasolabial region. Therefore, it is important for surgeons to understand nasolabial development after primary treatment and tailor their surgical techniques appropriately. This review focuses on the growth patterns of the nasolabial region after primary repair, so as to provide references for operative strategy.
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Göksel S, Özcan İ. A CBCT Study for Anatomic Variations of Osteomeatal complex in Patients With Cleft Lip and Palate. Cleft Palate Craniofac J 2023; 60:13-20. [PMID: 34787479 DOI: 10.1177/10556656211053773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate the anatomy and variations of osteomeatal complex (OMC) by comparing patients with nonsyndromic cleft lip and palate (CLP) and control group. DESIGN This case-control study was retrospectively analyzed using cone-beam computed tomography data. SETTING Istanbul University Faculty of Dentistry Department of Dentomaxillofacial Radiology. PATIENTS The study was conducted with 100 patients (44 females, 56 males) with CLP and 100 patients in the control group, which matched gender and age (with a maximum difference of 3 years). VARIABLES OMC variations are grouped as follows: ethmoidal, conchal, uncinate process, and septal variations. Then, we evaluated the presence of these OMC variations and compared them between the two groups. STATISTICAL ANALYSIS The McNemar's test was used to determine any significant differences between the groups for all indices at the 95% confidence level. RESULTS The most common anatomic variation in this study was Agger nasi cell (97%) and concha bullosa (97%) in the patients with CLP, while Agger nasi cell was the most common variation (99%) in the controls. Moreover, the atelectatic uncinate process was the least observed variation in both groups (1%). The incidences of paradoxical concha (58%;42%), bifid concha (29%;11%), deviated nasal septum (92%;80%) were significantly higher in the CLP group (p < 0.05). CONCLUSIONS The statistically significant results found when comparing OMC anatomy between the two groups reveal the importance of three-dimensional evaluation before functional endoscopic sinus surgery in patients with CLP.
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Affiliation(s)
- Sevde Göksel
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, 566936Ankara Medipol University, Ankara, Turkey
| | - İlknur Özcan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, 37516Istanbul University, Istanbul, Turkey
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Tian T, Huang HY, Wang W, Shi B, Zheng Q, Li CH. Three-dimensional finite element analysis of the effect of alveolar cleft bone graft on the maxillofacial biomechanical stabilities of unilateral complete cleft lip and palate. Biomed Eng Online 2022; 21:31. [PMID: 35596229 PMCID: PMC9123812 DOI: 10.1186/s12938-022-01000-y] [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: 09/30/2021] [Accepted: 05/16/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The objective is to clarify the effect of alveolar cleft bone graft on maxillofacial biomechanical stabilities, the key areas when bone grafting and in which should be supplemented with bone graft once bone resorption occurred in UCCLP (unilateral complete cleft lip and palate). METHODS Maxillofacial CAD (computer aided design) models of non-bone graft and full maxilla cleft, full alveolar cleft bone graft, bone graft in other sites of the alveolar cleft were acquired by processing the UCCLP maxillofacial CT data in three-dimensional modeling software. The maxillofacial bone EQV (equivalent) stresses and bone suture EQV strains under occlusal states were obtained in the finite element analysis software. RESULTS Under corresponding occlusal states, the EQV stresses of maxilla, pterygoid process of sphenoid bone on the corresponding side and anterior alveolar arch on the non-cleft side were higher than other maxillofacial bones, the EQV strains of nasomaxillary, zygomaticomaxillary and pterygomaxillary suture on the corresponding side were higher than other maxillofacial bone sutures. The mean EQV strains of nasal raphe, the maximum EQV stresses of posterior alveolar arch on the non-cleft side, the mean and maximum EQV strains of nasomaxillary suture on the non-cleft side in full alveolar cleft bone graft model were all significantly lower than those in non-bone graft model. The mean EQV stresses of bilateral anterior alveolar arches, the maximum EQV stresses of maxilla and its alveolar arch on the cleft side in the model with bone graft in lower 1/3 of the alveolar cleft were significantly higher than those in full alveolar cleft bone graft model. CONCLUSIONS For UCCLP, bilateral maxillae, pterygoid processes of sphenoid bones and bilateral nasomaxillary, zygomaticomaxillary, pterygomaxillary sutures, anterior alveolar arch on the non-cleft side are the main occlusal load-bearing structures before and after alveolar cleft bone graft. Alveolar cleft bone graft mainly affects biomechanical stabilities of nasal raphe and posterior alveolar arch, nasomaxillary suture on the non-cleft side. The areas near nasal floor and in the middle of the alveolar cleft are the key sites when bone grafting, and should be supplemented with bone graft when the bone resorbed in these areas.
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Affiliation(s)
- Tao Tian
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China
| | - Han-Yao Huang
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China.,West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China
| | - Wei Wang
- Urumql DW Innovation InfoTech Co., Ltd., Urumqi, 830000, Xinjiang Uygur Autonomous Region, The People's Republic of China
| | - Bing Shi
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China.,West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China
| | - Qian Zheng
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China. .,West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China.
| | - Cheng-Hao Li
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China. .,West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China.
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Abstract
BACKGROUND Secondary cleft rhinoplasty presents some of the most challenging cases of both cosmetic and functional nasal deformities. Understanding the anatomy and growth abnormality seen with the cleft nasal deformity helps to tailor surgical management. This article seeks to expand on the application of current concepts in secondary rhinoplasty for unilateral cleft lip nasal deformity. METHODS The authors review nasal analysis in the cleft rhinoplasty patient and provide the surgical management for each aspect in the secondary cleft rhinoplasty. RESULTS The secondary rhinoplasty was divided into seven areas: piriform hypoplasia, septal reconstruction, dorsal reshaping, tip reshaping, tip projection, alar reshaping, and alar repositioning. Surgical management for each is provided. CONCLUSION Secondary cleft rhinoplasty requires an understanding of the structural dysmorphology, and the use of cosmetic, functional, and secondary rhinoplasty techniques for its successful management.
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Wang X, Pastewait M, Wu TH, Lian C, Tejera B, Lee YT, Lin FC, Wang L, Shen D, Li S, Ko CC. 3D morphometric quantification of maxillae and defects for patients with unilateral cleft palate via deep learning-based CBCT image auto-segmentation. Orthod Craniofac Res 2021; 24 Suppl 2:108-116. [PMID: 33711187 DOI: 10.1111/ocr.12482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to quantify the 3D asymmetry of the maxilla in patients with unilateral cleft lip and palate (UCP) and investigate the defect factors responsible for the variability of the maxilla on the cleft side using a deep-learning-based CBCT image segmentation protocol. SETTING AND SAMPLE POPULATION Cone beam computed tomography (CBCT) images of 60 patients with UCP were acquired. The samples in this study consisted of 39 males and 21 females, with a mean age of 11.52 years (SD = 3.27 years; range of 8-18 years). MATERIALS AND METHODS The deep-learning-based protocol was used to segment the maxilla and defect initially, followed by manual refinement. Paired t-tests were performed to characterize the maxillary asymmetry. A multiple linear regression was carried out to investigate the relationship between the defect parameters and those of the cleft side of the maxilla. RESULTS The cleft side of the maxilla demonstrated a significant decrease in maxillary volume and length as well as alveolar length, anterior width, posterior width, anterior height and posterior height. A significant increase in maxillary anterior width was demonstrated on the cleft side of the maxilla. There was a close relationship between the defect parameters and those of the cleft side of the maxilla. CONCLUSIONS Based on the 3D volumetric segmentations, significant hypoplasia of the maxilla on the cleft side existed in the pyriform aperture and alveolar crest area near the defect. The defect structures appeared to contribute to the variability of the maxilla on the cleft side.
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Affiliation(s)
- Xiaoyu Wang
- Department of Orthodontics, Beijing Stomatological Hospital, Capital Medical University, Beijing, China.,Department of Stomatology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | | | - Tai-Hsien Wu
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Chunfeng Lian
- School of Mathematics and Statistics, Xi'an Jiaotong University, Shaanxi, China
| | - Beatriz Tejera
- Orthodontics, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Yan-Ting Lee
- Oral and Craniofacial Health Sciences Research, Adam School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Li Wang
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Dinggang Shen
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China.,School of Biomedical Engineering, ShanghaiTech University, Shanghai, China.,Department of Artificial Intelligence, Korea University, Seoul, Korea
| | - Song Li
- Department of Orthodontics, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Ching-Chang Ko
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH, USA
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Kochhar AS, Nucci L, Sidhu MS, Prabhakar M, Grassia V, Perillo L, Kochhar GK, Bhasin R, Dadlani H, d’Apuzzo F. Reliability and Reproducibility of Landmark Identification in Unilateral Cleft Lip and Palate Patients: Digital Lateral Vis-A-Vis CBCT-Derived 3D Cephalograms. J Clin Med 2021; 10:jcm10030535. [PMID: 33540549 PMCID: PMC7867146 DOI: 10.3390/jcm10030535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of the retrospective observational study was to compare the precision of landmark identification and its reproducibility using cone beam computed tomography-derived 3D cephalograms and digital lateral cephalograms in unilateral cleft lip and palate patients. METHODS Cephalograms of thirty-one (31) North Indian children (18 boys and 13 girls) with a unilateral cleft lip and palate, who were recommended for orthodontic treatment, were selected. After a thorough analysis of peer-reviewed articles, 20 difficult-to-trace landmarks were selected, and their reliability and reproducibility were studied. These were subjected to landmark identification to evaluate interobserver variability; the coordinates for each point were traced separately by three different orthodontists (OBA, OBB, OBC). Statistical analysis was performed using descriptive and inferential statistics with paired t-tests to compare the differences measured by the two methods. Real-scale data are presented in mean ± SD. A p-value less than 0.05 was considered as significant at a 95% confidence level. RESULTS When comparing, the plotting of points posterior nasal spine (PNS) (p < 0.05), anterior nasal spine (ANS) (p < 0.01), upper 1 root tip (p < 0.05), lower 1 root tip (p < 0.05), malare (p < 0.05), pyriforme (p < 0.05), porion (p < 0.01), and basion (p < 0.05) was statistically significant. CONCLUSION In patients with a cleft lip and palate, the interobserver identification of cephalometric landmarks was significantly more precise and reproducible with cone beam computed tomography -derived cephalograms vis-a-vis digital lateral cephalograms.
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Affiliation(s)
- Anuraj Singh Kochhar
- Former Consultant Orthodontist Max Hospital Gurgaon, Haryana 122001, India
- Correspondence:
| | - Ludovica Nucci
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (L.N.); (V.G.); (L.P.); (F.d.)
| | - Maninder Singh Sidhu
- Department of Orthodontics & Dean, Research & Development Faculty of Dental Sciences, SGT University Gurugram, Haryana 122505, India; (M.S.S.); (M.P.)
| | - Mona Prabhakar
- Department of Orthodontics & Dean, Research & Development Faculty of Dental Sciences, SGT University Gurugram, Haryana 122505, India; (M.S.S.); (M.P.)
| | - Vincenzo Grassia
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (L.N.); (V.G.); (L.P.); (F.d.)
| | - Letizia Perillo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (L.N.); (V.G.); (L.P.); (F.d.)
| | - Gulsheen Kaur Kochhar
- Department of Pediatric & Preventive Dentistry, National Dental College & Hospital, Punjab 140507, India;
| | - Ritasha Bhasin
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G1G6, Canada;
| | - Himanshu Dadlani
- Senior Consultant Department of Dentistry (Periodontology), Max Hospital, Gurgaon, Haryana 122001, India;
| | - Fabrizia d’Apuzzo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (L.N.); (V.G.); (L.P.); (F.d.)
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Akarsu-Guven B, Atik E, Gorucu-Coskuner H, Aksu M. Vertical Facial Skeletal Asymmetry and Occlusal Cant Relationship in Patients With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2020; 58:943-950. [PMID: 33287569 DOI: 10.1177/1055665620974574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the maxillary and mandibular vertical skeletal asymmetries, and the correlation between these asymmetries and occlusal cant in patients with unilateral cleft lip-palate (UCLP). METHODS Anteroposterior radiographs of 25 patients with UCLP (UCLP group, mean age: 20.98 ± 4.88 years) and 25 subjects without cleft (control group, mean age: 19 ± 2.86 years) were included. Independent samples t test, Mann-Whitney U test and Pearson correlation analysis were performed based on linear and angular measurements. RESULTS Lower facial horizontal asymmetry did not show statistically significant difference between the UCLP and control groups. However, vertical asymmetry of (a) the lateral cranial base (P = .014), (b) the nasomaxillary region (P < .001), (c) the maxillary dentoalveolus (P = .001), and (d) the lower face (P = .038) were all found to be significantly greater in UCLP group. The occlusal cant angle was also significantly greater in patients with UCLP compared to the controls (P = .016). While the occlusal cant angle was found to be correlated with the vertical asymmetry of the occlusal cant (r = 0.931, P < .001), maxillary cant angle was found to be correlated with the vertical asymmetry of the maxillary dentoalveolus (r = 0.655, P < .001). CONCLUSIONS There was no correlation between the occlusal cant and the vertical and horizontal skeletal asymmetries. Vertical asymmetries of the lower face and the medial cranial base were negatively correlated with the horizontal lower facial asymmetry.
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Affiliation(s)
- Bengisu Akarsu-Guven
- Faculty of Dentistry, Department of Orthodontics, 37515Hacettepe University, Ankara, Turkey
| | - Ezgi Atik
- Faculty of Dentistry, Department of Orthodontics, 37515Hacettepe University, Ankara, Turkey
| | - Hande Gorucu-Coskuner
- Faculty of Dentistry, Department of Orthodontics, 37515Hacettepe University, Ankara, Turkey
| | - Muge Aksu
- Faculty of Dentistry, Department of Orthodontics, 37515Hacettepe University, Ankara, Turkey
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Akay G, Eren İ, Karadag Ö, Güngör K. Nasal septal deviation in the unilateral cleft lip and palate deformities: a three-dimensional analysis. Oral Radiol 2020; 37:567-572. [PMID: 33180266 DOI: 10.1007/s11282-020-00491-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Lip and palate deformities are an important craniofacial congenital anomaly that negatively affects the anatomy of the nasal cavity and maxilla. This study aimed to evaluate the nasal septum deviation in individuals with a unilateral cleft lip and palate. METHODS The sample consists of 22 unilateral cleft lip-palate patients and 20 controls with non-cleft skeletal Class III. Maximal septal deviation angle and linear dimension were measured on cone-beam computed tomography images. The localization of maximal septal deviation was determined. The data were analyzed and compared between unilateral cleft lip-palate patients and skeletal Class III individuals. RESULTS For septal deviation, a significant discrepancy between unilateral cleft patients and skeletal Class III subjects was detected at the anterior nasal spine (ANS) level, the posterior nasal spine (PNS) level and the ANS-PNS midpoint level (p < 0.05). The maximum septal deviation angle of individuals with a unilateral cleft was significantly greater than individuals with skeletal Class III (p < 0.05). No statistically significant differences were found in the localization of maximum septal deviation between the unilateral cleft patients and the Class III individuals. CONCLUSION Our results demonstrated that the maximum septal deviation angle and dimension had significant differences in individuals with a unilateral cleft, compared to a skeletal Class III control group. However, no statistically significant discrepancy was observed between three levels (ANS, PNS and ANS-PNS middle levels) in the unilateral cleft patients.
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Affiliation(s)
- Gülsün Akay
- Department of Oral and Dentomaxillofacial Radiology, Faculty of Dentistry, Gazi University, Bişkek street, 82. street No:4, Emek, Ankara, Turkey.
| | - İlkay Eren
- Ministry of Health, Osmanlı Oral and Dental Health Center, Ankara, Turkey
| | - Özge Karadag
- Department of Statistics, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Kahraman Güngör
- Department of Oral and Dentomaxillofacial Radiology, Faculty of Dentistry, Gazi University, Bişkek street, 82. street No:4, Emek, Ankara, Turkey
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14
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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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Veloso NC, Mordente CM, de Sousa AA, Palomo JM, Yatabe M, Oliveira DD, Souki BQ, Andrade I. Three-dimensional nasal septum and maxillary changes following rapid maxillary expansion in patients with cleft lip and palate. Angle Orthod 2020; 90:672-679. [PMID: 33378475 PMCID: PMC8032269 DOI: 10.2319/090719-583.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To determine the three-dimensional changes of the nasal septum (NS), alveolar width, alveolar cleft volume, and maxillary basal bone following rapid maxillary expansion (RME) in consecutive patients with unilateral cleft lip and palate (UCLP). MATERIALS AND METHODS A retrospective investigation was conducted based on the analysis of cone-beam computed tomography (CBCT) data of 40 consecutive patients with UCLP (mean age 11.1 ± 2.2 years). Scans were acquired prior to RME (T0) and after removal of the expander (T1) before graft surgery. A three-dimensional analysis of the effects of RME on the nasal septum, alveolar width, alveolar cleft volume, and maxillary basal bone was performed. RESULTS No changes in the NS deviation were observed following RME (P > .05). Significant increases of the alveolar transverse dimension were found in the anterior (14.2%; P < .001) and posterior (7.7%; P < .001) regions as well as in the volume of the alveolar cleft (19.6%; P < .001). No changes in the basal bone dimensions and morphology were observed (P > .05). CONCLUSIONS Following RME, no changes were observed in the NS and maxillary basal bones of patients with UCLP despite the significant gain in the anterior and posterior alveolar width and the increase of the alveolar cleft defect. Clinicians should be aware that maxillary changes following RME in patients with UCLP are restricted to the dentoalveolar region.
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Three-Dimensional Analysis of Craniofacial Structures of Individuals With Nonsyndromic Unilateral Complete Cleft Lip and Palate. J Craniofac Surg 2020; 32:e65-e69. [PMID: 32858617 DOI: 10.1097/scs.0000000000006933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Cleft lip and palate (CLP) is one of the most common congenital deformities. Primary surgeries at an early age result in scar formation, which may impede the growth of craniofacial structures of the maxilla. Orthodontist's role in the management of individuals with CLP is important and starts from the time of birth. The knowledge of craniofacial structures in individuals with a cleft is essential for treatment planning. The purpose of this study was to analyze and compare craniofacial structures of cleft and noncleft side of individuals with non-syndromic unilateral complete cleft lip and palate (NSUCCLP) using cone-beam computed tomography (CBCT). CBCT scans of individuals with NSUCCLP (n = 42) were retrieved from the databases of two cleft centers, which followed the same protocols for timing and type of primary surgeries and secondary alveolar bone grafting (SABG). DICOM files of CBCT scans were integrated into Dolphin 3D software, and analysis was carried out in multiplanar views. The craniofacial structures of individuals with NSUCCLP were analyzed using fourteen parameters. Measurements were also recorded between the cleft and noncleft sides for comparison. The volume of the maxilla was generated by isolating it from adjacent structures on a 3D reconstructed model. MAWC, MAWPM1, MAWPM2, MAWM1, and MV of the cleft side was less than noncleft side (P < 0.05). MHP @ N Aper is less on the noncleft side (P < 0.05). There is an asymmetry of structures around the dentoalveolar and nasal region; however, asymmetries were not affected at deeper structures of the craniofacial region of individuals with NSUCCLP.
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17
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Banari AS, Datana S, Agarwal SS, Bhandari SK. Evaluation of Nasal Patency Among Patients With Unilateral Cleft Lip and Palate: Cleft Versus Non-Cleft Side. Cleft Palate Craniofac J 2020; 58:340-346. [PMID: 32815388 DOI: 10.1177/1055665620948719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the nasal patency using acoustic rhinometry (AR) in patients with unilateral cleft lip and palate (UCLP) and to ascertain the rhinological importance of the same. METHODS Eccovision Acoustic Rhinometer system was used for assessment of nasal cross-sectional area (CSA) and volume in 15 patients with UCLP. The CSA1, CSA2, and CSA3, which represent the CSA at the nasal valve area and anterior end of the inferior turbinate, the anterior half of the inferior turbinate and the anterior end of the middle turbinate, and the region of middle portion of middle turbinate, respectively, were compared on the cleft and non-cleft side. RESULTS The mean ± SD of CSA1, CSA2, and CSA3 as well as the overall nasal CSA were significantly higher on non-cleft side compared to cleft side (P value < .001). The mean ± SD of nasal volume was also significantly higher in non-cleft side compared to cleft side (P value < .001). CONCLUSIONS The nasal patency among patients with UCLP demonstrates a range of impairments that can be objectively measured using acoustic rhinometry. The orthodontic, orthopedic, or orthosurgical management of maxillary deficiency in these patients can affect the nasal area and volume and can have an impact on breathing, speech, and sleep. The pretreatment assessment may be useful to identify patients who are at potential risk of deterioration of nasal patency and airway post-intervention. Taking into consideration the multiple diagnostic procedures in the course of long-term multidisciplinary treatment of patients with cleft lip and palate, a noninvasive investigation technique such as AR may be the preferred mode of investigation to ascertain nasal patency.
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Affiliation(s)
- Ashwina S Banari
- Department of Orthodontics and Dentofacial Orthopedics, 355441Armed Forces Medical College, Pune, India
| | - Sanjeev Datana
- Department of Orthodontics and Dentofacial Orthopedics, 355441Armed Forces Medical College, Pune, India
| | - S S Agarwal
- Department of Orthodontics and Dentofacial Orthopedics, 355441Armed Forces Medical College, Pune, India
| | - S K Bhandari
- Department of Dental surgery and Oral Health Sciences, 355441Armed Forces Medical College, Pune, India
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Wang X, Zhang M, Han J, Wang H, Li S. Three-dimensional evaluation of maxillary sinus and maxilla for adolescent patients with unilateral cleft lip and palate using cone-beam computed tomography. Int J Pediatr Otorhinolaryngol 2020; 135:110085. [PMID: 32442820 DOI: 10.1016/j.ijporl.2020.110085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Maxillary sinus disease is frequently observed in patients with unilateral cleft lip and palate (UCLP). The anatomical variations of maxillary sinus and maxilla may play a role in the high incidence of sinusitis. The aims of this study were to evaluate and compare the three-dimensional (3D) structural features of maxillary sinus and maxilla in UCLP adolescent patients between the defect and non-defect sides, and investigate the morphological relationship between the maxillary sinus and maxilla on the defect side by using cone-beam computed tomography (CBCT). METHODS CBCT images were acquired from 42 UCLP adolescent patients. Maxillary sinus and maxilla on the defect and non-defect sides were segmented respectively and assessed three dimensionally, and the comparison was performed by paired t-test. A multiple linear regression was conducted to investigate the morphological relationship between the maxillary sinus and maxilla on the defect side. RESULTS No statistically significant difference was observed in any parameter of the maxillary sinus between the defect and non-defect sides (P > 0.05). Significant differences were observed in the length, anterior width, anterior height, and volume of the maxilla between the defect side and non-defect sides (P < 0.05). The parameters of maxillary sinus were significant related to the posterior width and height of maxilla on the defect side. CONCLUSION Adolescent patients with UCLP present similar 3D structural features of the maxillary sinus on both sides. Significant differences of the maxilla between the defect and non-defect sides were displayed in the area adjacent to the defect but not showed in the posterior portion of maxilla. Certain structures of the posterior portion of maxilla contribute to the variability of maxillary sinus.
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Affiliation(s)
- Xiaoyu Wang
- Department of Stomatology, Beijing Tian Tan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, PR China; Department of Orthodontics, Beijing Stomatological Hospital, Capital Medical University, No.4 Tiantan Xili, Dongcheng District, Beijing, 100050, PR China.
| | - Manfei Zhang
- Department of Orthodontics, Beijing Stomatological Hospital, Capital Medical University, No.4 Tiantan Xili, Dongcheng District, Beijing, 100050, PR China.
| | - Jianhui Han
- Department of Radiology, Beijing Stomatological Hospital, Capital Medical University, No.4 Tiantan Xili, Dongcheng District, Beijing, 100050, PR China.
| | - Hao Wang
- Department of Stomatology, Beijing Tian Tan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, PR China.
| | - Song Li
- Department of Orthodontics, Beijing Stomatological Hospital, Capital Medical University, No.4 Tiantan Xili, Dongcheng District, Beijing, 100050, PR China.
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Gorucu-Coskuner H, Atik E, Akarsu-Guven B, Aksu M. Comparison of Transverse Craniofacial Dimensions Between Growing Individuals With Unilateral Cleft Lip and Palate and Age-and Sex-Matched Noncleft Controls. Cleft Palate Craniofac J 2020; 57:1308-1313. [PMID: 32462928 DOI: 10.1177/1055665620927584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The study aimed to assess the transverse craniofacial dimensions of patients (age, 7-14 years) with unilateral cleft lip and palate (UCLP), compare these dimensions with those of noncleft individuals, and identify the correlations between the nasal and maxillary transverse widths of patients with UCLP. DESIGN A cross-sectional study. PARTICIPANTS Eighty patients operated on for complete UCLP (UCLP group; 35 girls, 45 boys; median age: 10.7 [7.9-14] years) and 80 age- and sex-matched noncleft individuals (control group; 35 girls, 45 boys; median age: 10.7 [7.3-14] years). INTERVENTIONS Interorbital, bizygomatic, nasal, maxillary skeletal, maxillary molar, mandibular molar, and antegonial width measurements were performed using posteroanterior cephalometric radiographs. Intergroup comparisons were conducted by using the independent samples t-test and Mann-Whitney U test. Correlation between the variables was examined using Pearson correlation analysis. RESULTS The bizygomatic, maxillary skeletal and molar, mandibular molar, and antegonial widths in the UCLP group were significantly less than those in the control group (P < .05). A positive correlation was found between the maxillary skeletal and nasal widths (r = 0.550, P < .001) and between the maxillary molar and nasal widths (r = 0.560, P < .001). CONCLUSIONS In individuals with UCLP, the bizygomatic, maxillary skeletal and molar, mandibular molar, and antegonial widths were significantly less than those in noncleft individuals. As the maxillary skeletal and dental widths presented a positive correlation with the nasal width, a decrease in nasal width must be considered when maxillary constriction is noted.
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Affiliation(s)
- Hande Gorucu-Coskuner
- Department of Orthodontics, Faculty of Dentistry, 37515Hacettepe University, Ankara, Turkey
| | - Ezgi Atik
- Department of Orthodontics, Faculty of Dentistry, 37515Hacettepe University, Ankara, Turkey
| | - Bengisu Akarsu-Guven
- Department of Orthodontics, Faculty of Dentistry, 37515Hacettepe University, Ankara, Turkey
| | - Muge Aksu
- Department of Orthodontics, Faculty of Dentistry, 37515Hacettepe University, Ankara, Turkey
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Unilateral Cleft Lip Nasal Deformity: Three-Dimensional Analysis of the Primary Deformity and Longitudinal Changes following Primary Correction of the Nasal Foundation. Plast Reconstr Surg 2020; 145:185-199. [PMID: 31592947 DOI: 10.1097/prs.0000000000006389] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Objective assessment of the unilateral cleft lip nasal deformity and the longitudinal changes with treatment is critical for optimizing cleft care. METHODS Consecutive patients undergoing cleft lip repair and foundation-based rhinoplasty were included (n = 102). Three-dimensional images preoperatively, postoperatively, and at 5 years of age were assessed and compared to age-matched controls. Images were normalized to standard horizontal, craniocaudal, and anteroposterior axes. RESULTS Cleft subalare was similar in position relative to controls but was 1.6 mm retrodisplaced. Subnasale was deviated 4.6 mm lateral to midline and had the greatest displacement of any landmark. Noncleft subalare was displaced 2.3 mm laterally. Regression analysis with deviation of subnasale from the midline as a dependent variable revealed progressive lateral displacement of noncleft subalare, narrowing of noncleft nostril, and intercanthal widening. Surgery corrected nasal base displacements along all axes, resulting in landmark positions similar to controls. Symmetry of nasal base correction persisted at 5-year follow-up, with no recurrent cleft alar base retrusion, regardless of initial cleft type. CONCLUSIONS Unilateral cleft lip nasal deformity may be "driven" by displacement of the anterior nasal spine and caudal septum. The cleft alar base is normal in position but retruded, whereas the noncleft alar base is displaced laterally. Changes with surgery involve anterior movement of the cleft alar base but also include medial movement of the noncleft alar base and columella. Symmetry of correction, including alar base retrusion, was stable over time and did not rely on alveolar bone grafting.
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Moungkhom P, Nagar A, Tandon P, Singh G, Singh A, Patil R, Prasad V. Three-dimensional assessment of craniofacial parameters in subjects with cleft lip and palate: A cone-beam computed tomography study. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2020. [DOI: 10.4103/jclpca.jclpca_1_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Citron I, Lee C, Calabrese CE, Padwa BL. Schneiderian Membrane Thickness Is Increased in Patients With Cleft Lip and Palate. Cleft Palate Craniofac J 2019; 57:296-301. [PMID: 31648537 DOI: 10.1177/1055665619882569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Patients with cleft lip and palate (CLP) are more likely to have sinusitis. The purpose of this study is to determine whether patients with CLP have thickening of the Schneiderian membrane. Specific aims were to (1) compare Schneiderian membrane thickness in patients with CLP to noncleft controls, (2) evaluate whether membrane thickening is associated with cleft side in patients with unilateral cleft lip and palate (UCLP), and (3) evaluate if age and sex are predictors of mucosal thickening. DESIGN Case-control study. SETTING Tertiary care center. PATIENTS Patients with CLP and controls. MAIN OUTCOME MEASURE The primary outcome variable was maximum Schneiderian membrane thickness measured on cone beam computed tomography. The primary predictor variable was the presence of a cleft. Additional variables were cleft phenotype, age, and sex. RESULTS There were 225 patients with CLP and 93 controls. Median mucosal thickness was 2.4 mm in cleft group and 0.0 mm in controls (P = .006). In cleft group, 56.7% of sinuses had mucosal thickness >2.0 mm compared to 38.2% in controls (P = < .004). Pathologic membrane thickening (>4.0 mm) was significantly higher in cleft group (P = .005). No statistically significant difference in mucosal thickness between cleft and noncleft sides in patients with UCLP. Linear regression showed no association between age or sex and Schneiderian membrane thickness. CONCLUSION Schneiderian membrane thickening is more common in patients with CLP and is not associated with the side of the cleft in patients with UCLP.
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Affiliation(s)
- Isabelle Citron
- Department of Plastic and Oral Surgery, Boston Children's Hospital, MA, USA
| | - Christine Lee
- Resident in the Advanced Graduate Program in Prosthodontics, Harvard School of Dental Medicine, Boston, MA, USA
| | - Carly E Calabrese
- Department of Plastic and Oral Surgery, Boston Children's Hospital, MA, USA
| | - Bonnie L Padwa
- Harvard School of Dental Medicine, Oral Surgeon in Chief, Department of Plastic and Oral Surgery, Boston Children's Hospital, MA, USA
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Iwasaki T, Suga H, Minami-Yanagisawa A, Hashiguchi-Sato M, Sato H, Yamamoto Y, Shirazawa Y, Tsujii T, Kanomi R, Yamasaki Y. Upper airway in children with unilateral cleft lip and palate evaluated with computational fluid dynamics. Am J Orthod Dentofacial Orthop 2019; 156:257-265. [PMID: 31375236 DOI: 10.1016/j.ajodo.2018.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 09/01/2018] [Accepted: 09/01/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Children with unilateral cleft lip and palate (UCLP) exhibit snoring and mouth breathing. They are also reported to show obstructive sleep apnea syndrome. However, their upper airway ventilation condition is not clearly understood. Therefore, this study was performed to evaluate upper airway ventilation condition in children with UCLP with the use of computational fluid dynamics. METHODS Twenty-one children (12 boys, 9 girls; mean age 9.1 years) with UCLP and 25 children (13 boys, 12 girls; mean age 9.2 years) without UCLP who required orthodontic treatment underwent cone-beam computed tomography (CBCT). Nasal resistance and upper airway ventilation condition were evaluated with the use of computational fluid dynamics from CBCT data. The groups were compared with the use of Mann-Whitney U tests and Student t tests. RESULTS Nasal resistance of the UCLP group (0.97 Pa/cm3/s) was significantly higher than that of the control group (0.26 Pa/cm3/s; P < 0.001). Maximal pressure of the upper airway (335.02 Pa) was significantly higher in the UCLP group than in the control group (67.57 Pa; P < 0.001). Pharyngeal airway (from choanae to base of epiglottis) pressure in the UCLP group (140.46 Pa) was significantly higher than in the control group (15.92 Pa; P < 0.02). CONCLUSIONS Upper airway obstruction in children with UCLP resulted from both nasal and pharyngeal airway effects.
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Affiliation(s)
- Tomonori Iwasaki
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan.
| | - Hokuto Suga
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Ayaka Minami-Yanagisawa
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Makiko Hashiguchi-Sato
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Hideo Sato
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Yuushi Yamamoto
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Yoshito Shirazawa
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Toshiya Tsujii
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | | | - Youichi Yamasaki
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
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Iwasaki T, Yanagisawa-Minami A, Suga H, Shirazawa Y, Tsujii T, Yamamoto Y, Ban Y, Sato-Hashiguchi M, Sato H, Kanomi R, Yamasaki Y. Rapid maxillary expansion effects of nasal airway in children with cleft lip and palate using computational fluid dynamics. Orthod Craniofac Res 2019; 22:201-207. [PMID: 30912603 DOI: 10.1111/ocr.12311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/06/2019] [Accepted: 03/18/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Rapid maxillary expansion (RME) improves nasal airway ventilation in non-cleft palate children. Children with unilateral cleft lip and palate (UCLP) may have nasal obstruction and experience an increased risk of obstructive sleep apnoea. The effect of RME in UCLP children is unclear. This retrospective study evaluated RME-induced changes in ventilation parameters in children with UCLP using computational fluid dynamics. SETTING AND SAMPLE POPULATION Nineteen patients (10 boys, mean age 10.7 years) who required RME had cone-beam computed tomography images taken before and after RME. Twenty control participants (11 boys, mean age 11.1 years) received regular orthodontic treatment. METHODS Nasal airway ventilation parameters (air pressure, air velocity and airflow rate) were analysed via computational fluid dynamics, and nasal cross-sectional area (CSA) was measured. RESULTS Maximum pressure, velocity and nasal resistance were significantly reduced by RME in the UCLP group. Air flow rate and CSA on the cleft side significantly were increased by RME in the UCLP group. CONCLUSIONS In children with UCLP, increasing the quantity of airflow and CSA on the cleft side by RME substantially improved nasal ventilation.
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Affiliation(s)
- Tomonori Iwasaki
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Ayaka Yanagisawa-Minami
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Hokuto Suga
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Yoshito Shirazawa
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Toshiya Tsujii
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Yuushi Yamamoto
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Yuusuke Ban
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Makiko Sato-Hashiguchi
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Hideo Sato
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | | | - Youichi Yamasaki
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
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Functional stability analyses of maxillofacial skeleton bearing cleft deformities. Sci Rep 2019; 9:4261. [PMID: 30862870 PMCID: PMC6414651 DOI: 10.1038/s41598-019-40478-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/29/2019] [Indexed: 02/05/2023] Open
Abstract
The symmetrically stable craniofacial bony structure supports the complex functions and delicate contour of the face. Congenital craniofacial deformities are often accompanied by bony defects and have been repetitively correlated with compromised dento-maxillary stability, but neither the extent nor the pattern of cleft-related maxillary instability has been explored in detail. Furthermore, it is largely unknown if the bony defect and related instability are correlated with secondary maxillary deformity common among patients with orofacial clefts. With the aid of finite element modeling, we studied the detailed relationship between cleft-related bony defect and maxillary stability under occlusal loading. Craniofacial models were generated based on cone-beam computed tomography data and loaded with mimicked bite forces along the axial axis of each tooth. Our data showed that all cleft models exhibited more asymmetrical deformations under mastication compared with the normal. Models with palatal cleft demonstrated greater asymmetry, greater dental arch contraction, and less maxillary protrusion compared to models with alveolar cleft only. For unilateral cleft models, alveolus on non-cleft side tended to be more protruded and lifted than the cleft side. For bilateral cleft models, the most prominent feature was the seriously contracted alveolar arch and curved and pitched premaxillae. These findings indicated cleft type-specific pattern of maxillary instability, which were largely in accordance with dentoalveolar morphological features among patients. Collectively, our study elucidated the detailed relationship between cleft bony defect and the pattern of maxillary instability, and suggested a prototype for studying the abnormal maxillary and dental arch growth among patients with craniofacial deformities.
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Thierens LAM, De Roo NMC, De Pauw GAM, Brusselaers N. Quantifying Soft Tissue Changes in Cleft Lip and Palate Using Nonionizing Three-Dimensional Imaging: A Systematic Review. J Oral Maxillofac Surg 2018; 76:2210.e1-2210.e13. [PMID: 29932938 DOI: 10.1016/j.joms.2018.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE The use of nonionizing 3-dimensional (3D) imaging in cleft lip and palate (CLP) research is well-established; however, general guidelines concerning the assessment of these images are lacking. The aim of the present study was to review the methods for quantification of soft tissue changes on 3D surface images acquired before and after an orthopedic or surgical intervention in CLP patients. MATERIALS AND METHODS A systematic literature search was performed using the databases MEDLINE (through PubMed), CENTRAL, Web of Science, and EMBASE. The literature search and eligibility assessment were performed by 2 independent reviewers in a nonblinded standardized manner. Only longitudinal studies reporting the assessment of pre- and postoperative 3D surface images and at least 10 CLP patients were considered eligible. RESULTS Fifteen unique studies (reported from 1996 to 2017) were identified after an eligibility assessment. The assessment of the 3D images was performed with landmark-dependent analyses, mostly supported by superimposition of the pre- and postoperative images. A wide spectrum of superimposition techniques has been reported. The reliability of these assessment methods was often not reported or was insufficiently reported. CONCLUSIONS Soft tissue changes subsequent to a surgical or an orthopedic intervention can be quantified on 3D surface images using assessment methods that are primarily based on landmark identification, whether or not followed by superimposition. Operator bias is inherently enclosed in landmark-dependent analyses. The reliability of these methods has been insufficiently reported.
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Affiliation(s)
- Laurent A M Thierens
- Resident, Department of Orthodontics, Oral Health Sciences, Ghent University, Ghent, Belgium; and Centre for Congenital Facial Anomalies, Ghent University Hospital, Ghent, Belgium.
| | - Noëmi M C De Roo
- Resident, Department of Orthodontics, Oral Health Sciences, Ghent University, Ghent, Belgium
| | - Guy A M De Pauw
- Full Professor, Department of Orthodontics, Oral Health Sciences, Ghent University, Ghent, Belgium; and Centre for Congenital Facial Anomalies, Ghent University Hospital, Ghent, Belgium
| | - Nele Brusselaers
- Full Professor, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Centre for Translational Microbiome Research, Department of Microbiology, Cell and Tumor Biology, Karolinska Institutet, Stockholm, Sweden; and SciLifeLab, Stockholm, Sweden
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Suri S, Disthaporn S, Ross B, Tompson B, Baena D, Fisher D, Lou W. Permanent maxillary central incisor and first molar rotations in the mixed dentition in repaired complete unilateral cleft lip and palate and their relationship with absence of teeth in their vicinity. Angle Orthod 2018; 88:567-574. [PMID: 29799271 DOI: 10.2319/121117-856.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To describe qualitatively and quantitatively the directions and magnitudes of rotations of permanent maxillary central incisors and first molars in the mixed dentition in repaired complete unilateral cleft lip and palate (UCLP) and study their associations with absence of teeth in their vicinity. MATERIALS AND METHODS Dental casts and orthodontic records taken prior to orthodontic preparation for alveolar bone grafting of 74 children with repaired UCLP (53 male, 21 female; aged 8.9 ± 1.0 years) were studied. Directions and magnitudes of permanent maxillary central incisor and first molar rotations were recorded. Tooth absence was confirmed from longitudinal radiographic records. Incisor and molar rotations were analyzed in relation to the absence of teeth in their vicinity. RESULTS Distolabial rotation of the permanent maxillary central incisor was noted in 77.14% on the cleft side, while distopalatal rotation was noted in 82.19% on the noncleft side. Incisor rotation was greater when a permanent tooth was present distal to the cleft side central incisor, in the greater segment. The permanent maxillary first molar showed mesiopalatal rotation, which was greater on the cleft side and when there was absence of one or more teeth in the buccal segment. CONCLUSIONS Presence and absence of teeth were associated with the severity of incisor and molar rotations in UCLP. Crowding of anterior teeth in the greater segment was associated with a greater magnitude of rotation of the cleft side permanent central incisor. Absence of one or more buccal segment teeth was associated with greater magnitude of rotation of the molar.
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Patel DS, Jacobson R, Duan Y, Zhao L, Morris D, Cohen MN. Cleft Skeletal Asymmetry: Asymmetry Index, Classification and Application. Cleft Palate Craniofac J 2018; 55:348-355. [PMID: 29437505 DOI: 10.1177/1055665617732775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To quantitatively measure the extent of 3D asymmetry of the facial skeleton in patients with unilateral cleft lip and palate (UCLP) using an asymmetry index (AI) approach, and to illustrate the applicability of the index in guiding and measuring treatment outcome. METHOD Two groups of subjects between the ages of 15 and 20 who had archived CBCT scan were included in this study. Twenty-five patients with complete UCLP were compared with 50 age-matched noncleft subjects. The CBCT scans were segmented and landmarked for 3D anthropometric analysis. An AI was calculated as a quantitative measure of the extent of facial skeletal asymmetry. RESULTS For the control group, the AI ranged from 0.72 ± 0.47 at A point to 4.77 ± 1.59 at Gonion. The degree of asymmetry increased with the increasing laterality of the landmark from the midsagittal plane. In the UCLP group, the values of AI significantly increased compared to the control group at nearly all measured landmarks. The extent of the asymmetry to involve the upper, middle, and lower facial skeleton varied widely with the individual patient with UCLP. CONCLUSION The asymmetry index is capable of capturing the 3D facial asymmetry of subjects with UCLP and as a basis for classification of the extent of the asymmetry. We found the index to be applicable in surgical planning and in measuring the outcome in improving the symmetry in patients who have undergone orthognathic surgery.
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Affiliation(s)
- Delnaz S Patel
- 1 Division of Plastic, Reconstructive and Cosmetic Surgery, Department of Surgery, University of Illinois at Chicago, IL, USA
| | - Rachel Jacobson
- 1 Division of Plastic, Reconstructive and Cosmetic Surgery, Department of Surgery, University of Illinois at Chicago, IL, USA
| | - Yao Duan
- 1 Division of Plastic, Reconstructive and Cosmetic Surgery, Department of Surgery, University of Illinois at Chicago, IL, USA
| | - Linping Zhao
- 1 Division of Plastic, Reconstructive and Cosmetic Surgery, Department of Surgery, University of Illinois at Chicago, IL, USA
| | - David Morris
- 1 Division of Plastic, Reconstructive and Cosmetic Surgery, Department of Surgery, University of Illinois at Chicago, IL, USA
| | - Mimis N Cohen
- 1 Division of Plastic, Reconstructive and Cosmetic Surgery, Department of Surgery, University of Illinois at Chicago, IL, USA
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Yang L, Chen Z, Zhang X. A cone-beam computed tomography evaluation of facial asymmetry in unilateral cleft lip and palate individuals. J Oral Sci 2017; 58:109-15. [PMID: 27021547 DOI: 10.2334/josnusd.58.109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Our study aimed to examine facial asymmetry in patients with unilateral cleft lip and palates (UCLP) using cone-beam computed tomography (CBCT) and explore the factors responsible for lower facial asymmetry in these individuals. The experimental group included 21 adolescent patients with non-syndromic UCLP while the control group comprised 14 patients without any facial cleft defects. The maxillofacial regions of the patients in the two groups were scanned using CBCT, and the Mimics 10.01 software was used to analyze the images. Multiple linear stepwise regression analysis was used to explore the factors related to the deviation of the pogonion point (Pog). Comparison of the two groups showed that the position of the lateral point of the pyriform aperture and the length of the mandibular body exhibited significant asymmetry (P < 0.05). Pog in the UCLP group deviated to the cleft side (1.24 ± 2.28 mm), and was related to B6L(R) to Sagittal plane, CdL(R) to Sagittal plane, and U6L(R) to LS plane. We concluded that significant differences between the cleft and non-cleft sides existed only around the cleft, and not in the deeper regions of the maxillary complex. Functional adaption may be the main reason responsible for chin deviation in UCLP individuals. (J Oral Sci 58, 109-115, 2016).
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Affiliation(s)
- Li'an Yang
- Department of Orthodontics, School of Stomatology, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University
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Peroz R, Holmström M, Mani M. Can objective measurements of the nasal form and function represent the clinical picture in unilateral cleft lip and palate? J Plast Reconstr Aesthet Surg 2017; 70:653-658. [PMID: 28325563 DOI: 10.1016/j.bjps.2017.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The present study aimed to evaluate the potential correlations between objective measurements of nasal function and self-assessed nasal symptoms or clinical findings at nasal examination among adults treated for unilateral cleft lip and palate (UCLP), respectively. METHODS All UCLP patients born between 1960 and 1987 (n = 109) treated at a tertiary referring center were invited. Participation rate was 76% (n = 83) at a mean of 37 years after the initial surgery. All participants completed the same study protocol including acoustic rhinometry (AR), rhinomanometry (RM), anterior rhinoscopy, and questionnaires regarding self-experienced nasal symptoms. RESULTS A reduced volume of the anterior nasal cavity on the operated side (measured by AR) correlated to an expressed wish by the patient to change the function of the nose. A similar correlation was seen for the minimal cross-sectional area of anterior nasal cavity on the operated side. Furthermore, correlations were found between smaller volume and area of nasal cavity and a greater frequency of nasal obstruction. No further correlations were found. CONCLUSION Objective measurements partly correlate to the clinical picture among adults treated for UCLP. However, these need to be combined with findings at clinical examination and patient self-assessment to represent the complete clinical picture.
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Affiliation(s)
- Roshan Peroz
- Department of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Mats Holmström
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Mani
- Department of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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Disthaporn S, Suri S, Ross B, Tompson B, Baena D, Fisher D, Lou W. Incisor and molar overjet, arch contraction, and molar relationship in the mixed dentition in repaired complete unilateral cleft lip and palate: A qualitative and quantitative appraisal. Angle Orthod 2017; 87:603-609. [PMID: 28195497 DOI: 10.2319/091916-698.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare the mixed dentition incisor and molar overjet, severity of contraction of the dental arch, and the sagittal molar relationship on the cleft side vs the noncleft side in children with repaired complete unilateral cleft of the lip and palate (UCLP). MATERIALS AND METHODS Orthodontic records taken prior to orthodontic preparation for alveolar bone grafting were screened to select study casts from patients with nonsyndromic repaired complete UCLP who did not have mandibular skeletal or dental asymmetry. The study sample comprised dental casts from 74 children aged 8.9 ± 1 years. Standardized digital photographs were acquired at 1:1 magnification. A coordinate system was developed using digital image-processing software (Photoshop CS4 and Adobe Illustrator). Incisor and molar overjet, Angle's classification, and arch contraction were recorded. Descriptive statistics, paired t-tests, and kappa statistics were used to compare the cleft and noncleft sides. RESULTS A negative overjet of -1 to -5 mm was often present at the incisors, with greater frequency and magnitude on the cleft side. Class II molar relation was more frequent on the cleft side (61.1%) than on the noncleft side (47.2%). Significantly greater contraction of the cleft side deciduous canine and deciduous first molar was noted, while the difference was very minor at the first permanent molar. CONCLUSIONS Cleft side maxillary arch contraction was most severe in the deciduous canine and first deciduous molar region and progressively less severe in the posterior region of the arch. A greater frequency and severity of negative overjet and Class II molar relationship was seen on the cleft side.
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Wang YT, Yu JH, Lo LJ, Hsu PH, Lin CHL. Developing Customized Dental Miniscrew Surgical Template from Thermoplastic Polymer Material Using Image Superimposition, CAD System, and 3D Printing. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1906197. [PMID: 28280726 PMCID: PMC5322424 DOI: 10.1155/2017/1906197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/08/2017] [Accepted: 01/19/2017] [Indexed: 12/21/2022]
Abstract
This study integrates cone-beam computed tomography (CBCT)/laser scan image superposition, computer-aided design (CAD), and 3D printing (3DP) to develop a technology for producing customized dental (orthodontic) miniscrew surgical templates using polymer material. Maxillary bone solid models with the bone and teeth reconstructed using CBCT images and teeth and mucosa outer profile acquired using laser scanning were superimposed to allow miniscrew visual insertion planning and permit surgical template fabrication. The customized surgical template CAD model was fabricated offset based on the teeth/mucosa/bracket contour profiles in the superimposition model and exported to duplicate the plastic template using the 3DP technique and polymer material. An anterior retraction and intrusion clinical test for the maxillary canines/incisors showed that two miniscrews were placed safely and did not produce inflammation or other discomfort symptoms one week after surgery. The fitness between the mucosa and template indicated that the average gap sizes were found smaller than 0.5 mm and confirmed that the surgical template presented good holding power and well-fitting adaption. This study addressed integrating CBCT and laser scan image superposition; CAD and 3DP techniques can be applied to fabricate an accurate customized surgical template for dental orthodontic miniscrews.
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Affiliation(s)
- Yu-Tzu Wang
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Jian-Hong Yu
- School of Dentistry, College of Medicine, China Medical University, Taichung, Taiwan
| | - Lun-Jou Lo
- Plastic & Reconstructive Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taiwan
| | - Pin-Hsin Hsu
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - CHun-Li Lin
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
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Pietruski P, Majak M, Debski T, Antoszewski B. A novel computer system for the evaluation of nasolabial morphology, symmetry and aesthetics after cleft lip and palate treatment. Part 1: General concept and validation. J Craniomaxillofac Surg 2017; 45:491-504. [PMID: 28238558 DOI: 10.1016/j.jcms.2017.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 12/19/2016] [Accepted: 01/24/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The need for a widely accepted method suitable for a multicentre quantitative evaluation of facial aesthetics after surgical treatment of cleft lip and palate (CLP) has been emphasized for years. The aim of this study was to validate a novel computer system 'Analyse It Doc' (A.I.D.) as a tool for objective anthropometric analysis of the nasolabial region. MATERIALS AND METHODS An indirect anthropometric analysis of facial photographs was conducted with the A.I.D. system and Adobe Photoshop/ImageJ software. Intra-rater and inter-rater reliability and the time required for the analysis were estimated separately for each method and compared. RESULTS Analysis with A.I.D. system was nearly 10-fold faster than that with the reference evaluation method. The A.I.D. system provided strong inter-rater and intra-rater correlations for linear, angular and area measurements of the nasolabial region, as well as a significantly higher accuracy and reproducibility of angular measurements in submental view. No statistically significant inter-method differences were found for other measurements. CONCLUSIONS The hereby presented novel computer system is suitable for simple, time-efficient and reliable multicenter photogrammetric analyses of the nasolabial region in CLP patients and healthy subjects.
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Affiliation(s)
- Piotr Pietruski
- Department of Plastic and Reconstructive Surgery, Centre of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland.
| | - Marcin Majak
- Department of Systems and Computer Networks, Faculty of Electronics, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Tomasz Debski
- Department of Plastic and Reconstructive Surgery, Centre of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland
| | - Boguslaw Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Norbert Barlicki Memorial Hospital, Lodz, Poland
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Junqueira CHZ, Janson G, Junqueira MHZ, Mendes LM, Favilla EE, Garib DG. Comparison between full face and hemifacial CBCT cephalograms in clinically symmetrical patients: a pilot study. Dental Press J Orthod 2016; 20:83-9. [PMID: 25992992 PMCID: PMC4445230 DOI: 10.1590/2176-9451.20.2.083-089.oar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 09/02/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: One of the advantages of cone-beam computed tomography (CBCT) is the possibility
of obtaining images of conventional lateral cephalograms derived from partial or
complete reconstruction of facial images. OBJECTIVE: This study aimed at comparing full face, right and left hemifacial CBCT
cephalograms of orthodontic patients without clinical facial asymmetry. METHODS: The sample comprised nine clinically symmetrical patients who had pretreament
full face CBCT. The CBCTs were reconstructed so as to obtain full face, right and
left hemifacial cephalograms. Two observers, at two different times, obtained
linear and angular measurements for the images using Dolphin 3D software.
Dependent and independent t-tests were used to assess the reproducibility of
measurements. Analysis of Variance and Kruskal-Wallis tests were used to compare
the variables obtained in the CBCT derived cephalometric views. RESULTS: There was good reproducibility for CBCT scans and no statistically significant
differences between measurements of full face, right and left hemifacial CBCT
scans. CONCLUSIONS: Cephalometric measurements in full face, right and left hemifacial CBCT scans in
clinically symmetrical patients are similar.
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Affiliation(s)
| | - Guilherme Janson
- Department of Orthodontics, College of Dentistry, Universidade de São Paulo, Bauru, São Paulo, Brazil
| | | | | | | | - Daniela Gamba Garib
- Department of Orthodontics, College of Dentistry, Universidade de São Paulo, Bauru, São Paulo, Brazil
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Hongyi L, Hai K, Xiaomeng W, Dongshuang L. [Three-dimensional analysis of alveolar changes of complete unilateral cleft lip patients after presurgical nasoalveolar molding treatment]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2016; 34:375-380. [PMID: 28317355 DOI: 10.7518/hxkq.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study analyzed the alveolar changes of complete unilateral cleft lip (UCCL) patients after pre-surgical nasoalveolar molding (PNAM) treatment using a three-dimensional method. METHODS Palate impressions of thirty UCCL patients who underwent PNAM treatment in the Affiliated Stomatology Hospital of Guangxi Medical University were taken pre- and post-PNAM. The plaster impressions were scanned using cone beam computed tomography (CBCT). The DICOM files were exported and 3D models reconstructed in Mimics 15.0. The following parameters were analyzed in SPSS 17.0: cleft alveolar gap width, alveolar arch end width, upper lip frenulum-median plane distance, alveolar shift distance, and length of alveolar section. RESULTS After PNAM treatment, the cleft alveolar gap width and upper lip frenulum-median plane distance decreased significantly (P<0.05). No statistically significant change was observed in the alveolar arch end width (P>0.05). Alveolar shift distances for both sides increased significantly (P<0.05), and the shift distance of major alveolar sec-tion had a more significant increase than the minor alveolar section. The lengths of the alveolar section of both sides increased significantly (P<0.05) with the length of the major alveolar section increasing more significantly than the minor alveolar section. CONCLUSIONS The impression-CBCT method supply accurate three-dimensional data of the alveolar process. The PNAM treatment can significantly correct alveolar deformity and improve appearance.
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Affiliation(s)
- Li Hongyi
- Dept. of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangxi Medical University, Nanning 530021, China
| | - Kuang Hai
- Dept. of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangxi Medical University, Nanning 530021, China
| | - Wang Xiaomeng
- Dept. of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangxi Medical University, Nanning 530021, China
| | - Li Dongshuang
- Dept. of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangxi Medical University, Nanning 530021, China
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Oh TS, Park JS, Choi JW, Kwon SM, Koh KS. Risk factor analysis of bone resorption following secondary alveolar bone grafting using three-dimensional computed tomography. J Plast Reconstr Aesthet Surg 2015; 69:487-92. [PMID: 26718845 DOI: 10.1016/j.bjps.2015.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 09/15/2015] [Accepted: 11/04/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND/AIM The purpose of this study is to analyze the risk factors for bone resorption following secondary bone grafting in the alveolar cleft, using three-dimensional (3D) computed tomography (CT) based on surgical simulation software (SimPlant OMS, Materialise Dental, Leuven, Belgium). METHODS We reviewed the secondary alveolar bone grafts performed by a single surgeon between January 2005 and January 2014. A total of 40 patients with unilateral alveolar cleft were included in this study. The grafted alveolar bone was measured using surgical simulation software. In order to validate the measurement, each data set was measured by three different analysts and the inter- and intraobserver variabilities were calculated. A total of eight risk factors for grafted bone survival, including patient age, sex, body mass index (BMI), palatal fistula, amount of grafted bone, dental appliance, canine or incisor eruption, and preoperative upper respiratory tract infection, were evaluated using the linear mixed model and Mann-Whitney test. RESULTS The average alveolar defect size was 4.98 cc and the average graft survival was 67.5%. The inter- and intraobserver variabilities of simulation software were 0.758 and 0.915, respectively. Among the risk factors, only dental appliance (p = 0.02) and canine eruption (p = 0.041) were significantly correlated with graft survival. Other risk factors, including the amount of grafted bone, did not show a significant relationship with graft survival. CONCLUSION Measurement of an alveolar bone defect using a simulation program based on 3D CT is reliable and reproducible. Secondary bone grafting survival was significantly correlated with canine eruption and dental appliance in the alveolar cleft.
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Affiliation(s)
- Tae Suk Oh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Joo Seok Park
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | | | - Kyung S Koh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.
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Dentino KM, Sierra-Vasquez D, Padwa BL. Inferior Turbinate Asymmetry Is a Feature of the Unilateral Complete Cleft Lip and Palate Nasal Deformity. J Oral Maxillofac Surg 2015; 74:797-803. [PMID: 26604048 DOI: 10.1016/j.joms.2015.09.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Patients with unilateral complete cleft lip and palate (UCLP) have a characteristic bilateral septal deformity, and septal deviation can be associated with turbinate hyperplasia, leading to paradoxical nasal obstruction. The purpose of the present study was to measure and compare the bony and mucosal dimensions of the inferior turbinate on the cleft and non-cleft sides in patients with UCLP. PATIENTS AND METHODS We implemented a retrospective cohort study of patients with UCLP who had undergone computed tomography (CT) scan between 2002 to 2013. Subjects who had undergone nasal revision, septoplasty, turbinectomy, or Le Fort I osteotomy before the imaging date were excluded. The primary predictor variable was the subject side (cleft vs noncleft side), and the primary outcome variable was the turbinate cross-sectional area. The secondary predictor variables included the site of measurement along the sagittal axis of the turbinate (anterior, middle, posterior) and tissue type (turbinate whole, bone, mucosa). The Wilcoxon signed rank test for paired samples compared the turbinate dimensions on the cleft and noncleft sides, with statistical significance set at P ≤ .05. RESULTS The sample included 53 patients (32 females and 21 males). The inferior turbinates were measured bilaterally on CT images obtained at a mean age of 12.2 ± 0.8 years. The inferior turbinate on the noncleft side was significantly larger in both bone and mucosa (P = .003). This relationship did not change when controlling for age and gender. CONCLUSIONS The results of the present study have confirmed bony and mucosal enlargement of the inferior turbinate on the noncleft side in patients with UCLP. This might contribute to bilateral nasal obstruction and should be considered during treatment planning for nasopharyngeal and orthognathic surgery.
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Affiliation(s)
- Kelley M Dentino
- Clinical Research Fellow, Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Bonnie L Padwa
- Associate Professor, Harvard School of Dental Medicine, Oral Surgeon in Chief, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
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Lin Y, Chen G, Fu Z, Ma L, Li W. Cone-Beam Computed Tomography Assessment of Lower Facial Asymmetry in Unilateral Cleft Lip and Palate and Non-Cleft Patients with Class III Skeletal Relationship. PLoS One 2015; 10:e0130235. [PMID: 26237311 PMCID: PMC4523208 DOI: 10.1371/journal.pone.0130235] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 02/23/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction To evaluate, using cone-beam computed tomography (CBCT), both the condylar-fossa relationships and the mandibular and condylar asymmetries between unilateral cleft lip and palate (UCLP) patients and non-cleft patients with class III skeletal relationship, and to investigate the factors of asymmetry contributing to chin deviation. Methods The UCLP and non-cleft groups consisted of 30 and 40 subjects, respectively, in mixed dentition with class III skeletal relationships. Condylar-fossa relationships and the dimensional and positional asymmetries of the condyles and mandibles were examined using CBCT. Intra-group differences were compared between two sides in both groups using a paired t-test. Furthermore, correlations between each measurement and chin deviation were assessed. Results It was observed that 90% of UCLP and 67.5% of non-cleft subjects had both condyles centered, and no significant asymmetry was found. The axial angle and the condylar center distances to the midsagittal plane were significantly greater on the cleft side than on the non-cleft side (P=0.001 and P=0.028, respectively) and were positively correlated with chin deviation in the UCLP group. Except for a larger gonial angle on the cleft side, the two groups presented with consistent asymmetries showing shorter mandibular bodies and total mandibular lengths on the cleft (deviated) side. The average chin deviation was 1.63 mm to the cleft side, and the average absolute chin deviation was significantly greater in the UCLP group than in the non-cleft group (P=0.037). Conclusion Compared with non-cleft subjects with similar class III skeletal relationships, the subjects with UCLP showed more severe lower facial asymmetry. The subjects with UCLP presented with more asymmetrical positions and rotations of the condyles on axial slices, which were positively correlated with chin deviation.
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Affiliation(s)
- Yifan Lin
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Gui Chen
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhen Fu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Lian Ma
- Department of Oral Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Weiran Li
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- * E-mail:
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Yatabe MS, Ozawa TO, Janson G, Faco RADS, Garib DG. Are there bone dehiscences in maxillary canines orthodontically moved into the grafted alveolar cleft? Am J Orthod Dentofacial Orthop 2015; 147:205-13. [PMID: 25636554 DOI: 10.1016/j.ajodo.2014.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 10/01/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The aim of this study was to assess the bone morphology of teeth mesialized into the grafted region in patients with unilateral alveolar cleft. METHODS The sample comprised 30 patients with unilateral cleft lip and palate with a mean age of 20.5 years. High-resolution cone-beam computed tomography images of the maxilla were obtained 6 months to 2 years after comprehensive orthodontic treatment. The contralateral canines and lateral incisors were used as controls. Axial section was used to measure the bone thickness, and cross section was used to measure the alveolar crest height using the cementoenamel junction as a reference. Paired t tests and Wilcoxon tests were used to compare the cleft and noncleft sides (P <0.05). RESULTS High individual variability was found. In general, the canines in the cleft side had statistically thinner buccal bone plates than the contralateral teeth. No differences between the cleft and noncleft sides were found for the lingual bone plate thickness. The canine on the cleft side showed a slightly greater distance between the lingual alveolar crest and the cementoenamel junction than the lateral incisor in the noncleft side. CONCLUSIONS In patients with unilateral cleft lip and palate, mesial orthodontic movement of the maxillary canines into the grafted alveolar cleft results in acceptable buccal and lingual periodontal morphology.
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Affiliation(s)
- Marília Sayako Yatabe
- PhD student, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil.
| | - Terumi Okada Ozawa
- Chief, Dentistry Division, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Guilherme Janson
- Associate professor, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Renato André de Souza Faco
- Buccomaxillofacial surgeon, Hospital of Reahabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Daniela Gamba Garib
- Associate professor of orthodontics, Hospital of Rehabilitation of Craniofacial Anomalies, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
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Lin HH, Chuang YF, Weng JL, Lo LJ. Comparative validity and reproducibility study of various landmark-oriented reference planes in 3-dimensional computed tomographic analysis for patients receiving orthognathic surgery. PLoS One 2015; 10:e0117604. [PMID: 25668209 PMCID: PMC4323243 DOI: 10.1371/journal.pone.0117604] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/29/2014] [Indexed: 11/18/2022] Open
Abstract
Background Three-dimensional computed tomographic imaging has become popular in clinical evaluation, treatment planning, surgical simulation, and outcome assessment for maxillofacial intervention. The purposes of this study were to investigate whether there is any correlation among landmark-based horizontal reference planes and to validate the reproducibility and reliability of landmark identification. Materials and Methods Preoperative and postoperative cone-beam computed tomographic images of patients who had undergone orthognathic surgery were collected. Landmark-oriented reference planes including the Frankfort horizontal plane (FHP) and the lateral semicircular canal plane (LSP) were established. Four FHPs were defined by selecting 3 points from the orbitale, porion, or midpoint of paired points. The LSP passed through both the lateral semicircular canal points and nasion. The distances between the maxillary or mandibular teeth and the reference planes were measured, and the differences between the 2 sides were calculated and compared. The precision in locating the landmarks was evaluated by performing repeated tests, and the intraobserver reproducibility and interobserver reliability were assessed. Results A total of 30 patients with facial deformity and malocclusion—10 patients with facial symmetry, 10 patients with facial asymmetry, and 10 patients with cleft lip and palate—were recruited. Comparing the differences among the 5 reference planes showed no statistically significant difference among all patient groups. Regarding intraobserver reproducibility, the mean differences in the 3 coordinates varied from 0 to 0.35 mm, with correlation coefficients between 0.96 and 1.0, showing high correlation between repeated tests. Regarding interobserver reliability, the mean differences among the 3 coordinates varied from 0 to 0.47 mm, with correlation coefficients between 0.88 and 1.0, exhibiting high correlation between the different examiners. Conclusions The 5 horizontal reference planes were reliable and comparable for 3D craniomaxillofacial analysis. These reference planes were useful in standardizing the orientation of 3D skull models.
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Affiliation(s)
- Hsiu-Hsia Lin
- Assistant Research Fellow, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Fang Chuang
- Research Assistant, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Jing-Ling Weng
- Research Assistant, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Professor, Department of Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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Bettens K, Wuyts FL, Van Lierde KM. Instrumental assessment of velopharyngeal function and resonance: a review. JOURNAL OF COMMUNICATION DISORDERS 2014; 52:170-183. [PMID: 24909583 DOI: 10.1016/j.jcomdis.2014.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/14/2014] [Accepted: 05/16/2014] [Indexed: 06/03/2023]
Abstract
UNLABELLED The purpose of this literature review is to describe and discuss instrumental assessment techniques of the velopharyngeal function in order to diagnose velopharyngeal disorders and resonance characteristics. Both direct and indirect assessment techniques are addressed, in which successively nasopharyngoscopy, videofluoroscopy, magnetic resonance imaging (MRI), cephalometric radiographic analysis, computed tomography (CT), ultrasound, acoustic and aerodynamic measurements are considered. Despite the multiple instrumental assessments available to detect and define velopharyngeal dysfunction, the ideal technique is not yet accessible. Therefore, a combination of different quantitative parameters can possibly form a solution for a more reliable determination of resonance disorders. These multi-dimensional approaches will be described and discussed. The combination of quantitative measurement techniques and perceptual evaluation of nasality will probably remain necessary to provide sufficient information to make appropriate decisions concerning the diagnosis and treatment of resonance disorders. LEARNING OUTCOMES The reader will be able to describe and discuss currently available instrumental techniques to assess the velopharyngeal mechanism and its functioning in order to diagnose velopharyngeal disorders. Additionally, he will be able to explain the possible advantages of the combination of several types of complementary measurement techniques.
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Affiliation(s)
- Kim Bettens
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium.
| | - Floris L Wuyts
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Biomedical Physics, University of Antwerp, Antwerp, Belgium
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Starbuck JM, Friel MT, Ghoneima A, Flores RL, Tholpady S, Kula K. Nasal airway and septal variation in unilateral and bilateral cleft lip and palate. Clin Anat 2014; 27:999-1008. [PMID: 24976342 DOI: 10.1002/ca.22428] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 05/29/2014] [Accepted: 06/03/2014] [Indexed: 11/10/2022]
Abstract
Cleft lip and palate (CLP) affects the dentoalveolar and nasolabial facial regions. Internal and external nasal dysmorphology may persist in individuals born with CLP despite surgical interventions. 7-18 year old individuals born with unilateral and bilateral CLP (n = 50) were retrospectively assessed using cone beam computed tomography. Anterior, middle, and posterior nasal airway volumes were measured on each facial side. Septal deviation was measured at the anterior and posterior nasal spine, and the midpoint between these two locations. Data were evaluated using principal components analysis (PCA), multivariate analysis of variance (MANOVA), and post-hoc ANOVA tests. PCA results show partial separation in high dimensional space along PC1 (48.5% variance) based on age groups and partial separation along PC2 (29.8% variance) based on CLP type and septal deviation patterns. MANOVA results indicate that age (P = 0.007) and CLP type (P ≤ 0.001) significantly affect nasal airway volume and septal deviation. ANOVA results indicate that anterior nasal volume is significantly affected by age (P ≤ 0.001), whereas septal deviation patterns are significantly affected by CLP type (P ≤ 0.001). Age and CLP type affect nasal airway volume and septal deviation patterns. Nasal airway volumes tend to be reduced on the clefted sides of the face relative to non-clefted sides of the face. Nasal airway volumes tend to strongly increase with age, whereas septal deviation values tend to increase only slightly with age. These results suggest that functional nasal breathing may be impaired in individuals born with the unilateral and bilateral CLP deformity.
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Affiliation(s)
- John M Starbuck
- Department of Orthodontics and Oral Facial Genetics, School of Dentistry, Indiana University, Indianapolis, Indiana, 46202
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Kuijpers MAR, Chiu YT, Nada RM, Carels CEL, Fudalej PS. Three-dimensional imaging methods for quantitative analysis of facial soft tissues and skeletal morphology in patients with orofacial clefts: a systematic review. PLoS One 2014; 9:e93442. [PMID: 24710215 PMCID: PMC3977868 DOI: 10.1371/journal.pone.0093442] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/04/2014] [Indexed: 01/11/2023] Open
Abstract
Background Current guidelines for evaluating cleft palate treatments are mostly based on two-dimensional (2D) evaluation, but three-dimensional (3D) imaging methods to assess treatment outcome are steadily rising. Objective To identify 3D imaging methods for quantitative assessment of soft tissue and skeletal morphology in patients with cleft lip and palate. Data sources Literature was searched using PubMed (1948–2012), EMBASE (1980–2012), Scopus (2004–2012), Web of Science (1945–2012), and the Cochrane Library. The last search was performed September 30, 2012. Reference lists were hand searched for potentially eligible studies. There was no language restriction. Study selection We included publications using 3D imaging techniques to assess facial soft tissue or skeletal morphology in patients older than 5 years with a cleft lip with/or without cleft palate. We reviewed studies involving the facial region when at least 10 subjects in the sample size had at least one cleft type. Only primary publications were included. Data extraction Independent extraction of data and quality assessments were performed by two observers. Results Five hundred full text publications were retrieved, 144 met the inclusion criteria, with 63 high quality studies. There were differences in study designs, topics studied, patient characteristics, and success measurements; therefore, only a systematic review could be conducted. Main 3D-techniques that are used in cleft lip and palate patients are CT, CBCT, MRI, stereophotogrammetry, and laser surface scanning. These techniques are mainly used for soft tissue analysis, evaluation of bone grafting, and changes in the craniofacial skeleton. Digital dental casts are used to evaluate treatment and changes over time. Conclusion Available evidence implies that 3D imaging methods can be used for documentation of CLP patients. No data are available yet showing that 3D methods are more informative than conventional 2D methods. Further research is warranted to elucidate it. Systematic review registration International Prospective Register of Systematic Reviews, PROSPERO CRD42012002041
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Affiliation(s)
- Mette A. R. Kuijpers
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Cleft Palate Craniofacial Unit, Radboud University Medical Centre, Nijmegen, The Netherlands
- * E-mail:
| | - Yu-Ting Chiu
- Department of Dentistry and Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Rania M. Nada
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carine E. L. Carels
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Cleft Palate Craniofacial Unit, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Piotr S. Fudalej
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern Switzerland
- Department of Orthodontics, Palacky University Olomouc, Olomouc, Czech Republic
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Drake AF, Rosenthal LHS. Otolaryngologic Challenges in Cleft/Craniofacial Care. Cleft Palate Craniofac J 2013; 50:734-43. [DOI: 10.1597/09-202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
An otolaryngology evaluation is an important aspect of care for any patient with craniofacial conditions. Otolaryngologists are commonly involved in the care of these patients to treat chronic otitis media, which frequently requires placement of pressure equalization tubes; however, there are many other otorhinolaryngologic issues that are addressed. Patients with craniofacial conditions may struggle with nasal obstruction, airway compromise, obstructive sleep apnea, dysphonia, swallowing, chronic sinonasal disease, and otologic disease.
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Affiliation(s)
- Amelia F. Drake
- UNC Craniofacial Center (School of Dentistry), UNC School of Medicine, University of North Carolina Hospital, Chapel Hill, North Carolina
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Choi YK, Park SB, Kim YI, Son WS. Three-dimensional evaluation of midfacial asymmetry in patients with nonsyndromic unilateral cleft lip and palate by cone-beam computed tomography. Korean J Orthod 2013; 43:113-9. [PMID: 23814705 PMCID: PMC3694202 DOI: 10.4041/kjod.2013.43.3.113] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/13/2012] [Accepted: 11/14/2012] [Indexed: 11/16/2022] Open
Abstract
Objective To compare three-dimensionally the midfacial hard- and soft-tissue asymmetries between the affected and the unaffected sides and determine the relationship between the hard tissue and the overlying soft tissue in patients with nonsyndromic complete unilateral cleft lip and palate (UCLP) by cone-beam computed tomography (CBCT) analysis. Methods The maxillofacial regions of 26 adults (18 men, 8 women) with nonsyndromic UCLP were scanned by CBCT and reconstructed by three-dimensional dental imaging. The frontal-view midfacial analysis was based on a 3 × 3 grid of vertical and horizontal lines and their intersecting points. Two additional points were used for assessing the dentoalveolar area. Linear and surface measurements from three reference planes (Basion-perpendicular, midsagittal reference, and Frankfurt horizontal planes) to the intersecting points were used to evaluate the anteroposterior, transverse, and vertical asymmetries as well as convexity or concavity. Results Anteroposteriorly, the soft tissue in the nasolabial and dentoalveolar regions was significantly thicker and positioned more anteriorly on the affected side than on the unaffected side (p < 0.05). The hard tissue in the dentoalveolar region was significantly retruded on the affected side compared with the unaffected side (p < 0.05). The other midfacial regions showed no significant differences. Conclusions With the exception of the nasolabial and dentoalveolar regions, no distinctive midfacial hard- and soft-tissue asymmetries exist between the affected and the unaffected sides in patients with nonsyndromic UCLP.
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Affiliation(s)
- Youn-Kyung Choi
- Department of Orthodontics, Pusan National University Dental Hospital, Yangsan, Korea
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Morén S, Mani M, Lundberg K, Holmström M. Nasal symptoms and clinical findings in adult patients treated for unilateral cleft lip and palate. J Plast Surg Hand Surg 2013; 47:383-9. [PMID: 23639332 DOI: 10.3109/2000656x.2013.771583] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of the study was to investigate self-experienced nasal symptoms among adults treated for UCLP and the association to clinical findings, and to evaluate whether palate closure in one-stage or two-stages affected the symptoms or clinical findings. All people with UCLP born between 1960-1987, treated at Uppsala University Hospital, were considered for participation in this cross-sectional population study with long-term follow-up. Eighty-three patients (76% participation rate) participated, a mean of 37 years after the first operation. Fifty-two patients were treated with one-stage palate closure and 31 with two-stage palate closure. An age-matched group of 67 non-cleft controls completed the same study protocol, which included a questionnaire regarding nasal symptoms, nasal inspection, anterior rhinoscopy, and nasal endoscopy. Patients reported a higher frequency of nasal symptoms compared with the control group, e.g., nasal obstruction (81% compared with 60%) and mouth breathing (20% compared with 5%). Patients also rated their nasal symptoms as having a more negative impact on their daily life and physical activities than controls. Nasal examination revealed higher frequencies of nasal deformities among patients. No positive correlation was found between nasal symptoms and severity of findings at nasal examination. No differences were identified between patients treated with one-stage and two-stage palate closure regarding symptoms or nasal findings. Adult patients treated for UCLP suffer from more nasal symptoms than controls. However, symptoms are not associated with findings at clinical nasal examination or method of palate closure.
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Ren S, Ma L, Sun Z, Qian J. Relationship between palate-vomer development and maxillary growth in submucous cleft palate patients. Cleft Palate Craniofac J 2012; 51:314-9. [PMID: 22994963 DOI: 10.1597/12-051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : Experimental and clinical findings suggest that the vomer is involved in facial development and might contribute to the short and retrusive maxilla in cleft patients. The aim of this study was to investigate the relationship between vomer development and maxillary growth in unoperated submucous cleft palate (SMCP) patients. Design : Retrospective cohort study. Participants : Thirty unoperated SMCP patients were included. The criteria for clinical diagnosis were: bifid uvula, a translucent zone in the midline of the soft palate, and a touchable "V" notch on the posterior border of the bony palate. There were 19 female and 11 male patients, with an age range from 3 to 25 years. Interventions : All patients were imaged using spiral computed tomography (CT) while in centric occlusion before the surgeries. Main Outcome Measures : Three-dimensional (3D) reconstruction models were created, and dentoalveolar relationships were rated by three experienced doctors according to the GOSLON score principles. The patients then were divided into three groups: 1 - normal occlusion, 2 - edge-to-edge bite, and 3 - crossbite. The vomer-palate fusion rate was calculated on 3D CT images and represented the vomer development. Results : The sagittal extent of the palatal cleft and the malformation of vomer in SMCP were greatly varied. The vomer-palate fusion rate in the crossbite group (occlusal score = 3) was significantly lower than that in the normal occlusion group (P = .027). Conclusions : Our findings suggest that correlation exists between vomer development and sagittal maxillary growth in unoperated SMCP patients.
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Urbanova W, Brudnicki A, Strydom H, Bronkhorst EM, Katsaros C, Fudalej PS. Nasolabial aesthetics correlates poorly with skeletal symmetry in unilateral cleft lip and palate. J Plast Reconstr Aesthet Surg 2012; 66:e1-7. [PMID: 22985870 DOI: 10.1016/j.bjps.2012.08.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 05/08/2012] [Accepted: 08/27/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the correlation between symmetry of the craniofacial skeleton and aesthetics of the nose and upper lip in children with complete unilateral cleft lip and palate (CUCLP). MATERIAL AND METHODS Craniofacial symmetry was evaluated on postero-anterior (PA) cephalograms of 54 children (37 boys and 17 girls; mean age = 11.0 years, SD 1.6) with CUCLP repaired with a one-stage closure (Cleft group). Treated subjects were age- and gender-matched with 54 untreated subjects taken from the University of Michigan Growth Study (Control group). Fourteen coefficients of asymmetry (CAs) were calculated and four angles were measured. Four raters assessed the nasolabial appearance on cropped facial and profile photographs with the 5-grade aesthetic index of Asher-McDade (grade 1 means the most aesthetic and grade 5 the least aesthetical outcome) in the Cleft group only. Independent t-tests were used to evaluate the inter-group differences for CAs. Pearson's correlation coefficients were calculated to examine a relationship between particular components of the aesthetical index and CAs. Multiple regression analyses were carried out to explain the nasolabial aesthetics on the basis of craniofacial symmetry. RESULTS In the Cleft group, most cephalometric variables demonstrated asymmetry not exceeding 10%. The Cleft and Control groups differed regarding three angular measurements (Se, Ism, and ANS) and 1 CA (Mo-V). Three of the four nasolabial components demonstrated correlation with some cephalometric variables. However, the correlation coefficients were low (range: -0.309 to 0.305). CONCLUSIONS There is a weak correlation between craniofacial skeletal symmetry and aesthetics of the nose and upper lip in children with CUCLP.
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Affiliation(s)
- Wanda Urbanova
- Department of Orthodontics and Cleft Anomalies, 3rd Medical Faculty, Charles University, Prague, Czech Republic
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Menezes LMD, Azeredo F, Weissheimer A, Rizzato JL, Rizzatto SMD. Cone-Beam computed tomography evaluation of maxillary expansion in twins with cleft lip and palate. Dental Press J Orthod 2012. [DOI: 10.1590/s2176-94512012000200009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Yoshida S, Suga K, Nakano Y, Sakamoto T, Takaki T, Uchiyama T. Postoperative evaluation of grafted bone in alveolar cleft using three-dimensional computed tomography data. Cleft Palate Craniofac J 2012; 50:671-7. [PMID: 22316403 DOI: 10.1597/11-062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : Postoperative evaluation of bone formation in the alveolar cleft by computed tomography imaging has been reported. We quantitatively evaluated bone grafts in the alveolar cleft preoperatively and postoperatively using three-dimensional data and superimposition of images. Subjects : A total of 12 patients with complete unilateral cleft lip and palate (six left-sided and six right-sided) were studied. Methods : Helical computed tomography scans were taken immediately before surgery and at 6 months after surgery and the DICOM files obtained were processed using Mimics and 3-matic software for three-dimensional data analysis. The preoperative and postoperative computed tomography data were superimposed, and the position and length of the unerupted canines and width of the alveolar cleft measured. Results : Strong and significant correlations were observed between bone formation in the alveolar cleft bone graft region and preoperative canine position (r = -.766, p < .01) and canine length (r = .681, p < .05). Stepwise multiple regression analysis demonstrated that only the preoperative canine position was independently and significantly correlated with bone formation in the alveolar cleft. Conclusion : These results indicate that the optimal timing for surgery is when the canine cusp is close to the alveolar plane.
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