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Pan X, Huang L, Yang L, Gong Y, Liang Z, Gu M, Hu Z. Three-dimensional nasal asymmetry analysis between adolescence and adulthood in postoperative patients with unilateral cleft lip and palate using computed tomography. Odontology 2024; 112:630-639. [PMID: 37814147 DOI: 10.1007/s10266-023-00855-4] [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: 02/21/2023] [Accepted: 09/07/2023] [Indexed: 10/11/2023]
Abstract
AIM To investigate the differences of the nasal soft and hard tissue asymmetry in postoperative patients with unilateral cleft lip and palate (UCLP) between adolescence and adulthood, and to explore the correlation of nasal soft and hard tissue asymmetry. METHODS CT data from 47 repaired UCLP patients were included and divided into two groups:1. adolescent group: 23 patients (15 males, 8 females; age: 10-12 years old). 2. adult group: 24 patients (16 males, 8 females; age:18-32 years old). The three-dimensional asymmetry in nasal soft and hard tissues was analyzed. Additionally, the correlation between nasal soft and hard tissue asymmetry was also analyzed. RESULTS Both the adolescent group and adult group showed asymmetries in nasal soft and hard tissues. Compared to the adolescent group, the adult group had a significantly increased horizontal asymmetry of nasal soft tissues Sbal (P < 0.05). Furthermore, the sagittal asymmetry of soft tissue Glat (P < 0.05), Sbal (P < 0.001), Sni (P < 0.001) and hard tissue LPA (P < 0.05) also increased significantly. In the adult group, there were more landmarks with a correlation between the asymmetry of nasal hard tissue and soft tissue compared to the adolescent group. There were moderate to strong correlations between nasal hard and soft tissue symmetries in the horizontal and sagittal directions (0.444 < r < 764), but no correlation in the vertical direction in the adult group (P > 0.05). CONCLUSIONS The asymmetry of nasal soft and hard tissues in patients with repaired UCLP becomes more apparent in the horizontal and sagittal dimensions from adolescence to adulthood. The correlation between the asymmetry of nasal hard tissue and soft tissue becomes stronger in the horizontal and sagittal dimensions. These factors should be taken into account when performing treatment for repaired UCLP patients in adolescence and adulthood.
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Affiliation(s)
- Xuhong Pan
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China
| | - Le Huang
- Department of Stomatology, Shenzhen Luohu Hospital Group Luohu People's Hospital, Shenzhen, China
| | - Liang Yang
- Department of Stomatology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yingyu Gong
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China
| | - Zhigang Liang
- Department of Stomatology, Shenzhen Second People's Hospital, Shenzhen, China.
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | - Ziyang Hu
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China.
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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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Liao YF, Chen YF, Chang CS, Lu TC, Chen YA, Yao CF, Chen PKT, Chen YR. Surgery-First Orthognathic Approach for Correction of Dentofacial Deformity in Unilateral Cleft Lip and Palate. Plast Reconstr Surg 2024; 153:173-183. [PMID: 36946892 DOI: 10.1097/prs.0000000000010451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Although several studies have reported the advantages of the surgery-first approach for orthognathic correction of class III deformity, there is no report of the success of this approach for patients with cleft lip and palate. Therefore, the purpose of this study was to evaluate the stability and outcome of bimaxillary surgery for cleft-related dentofacial deformity using a surgery-first approach. METHODS Forty-one patients with unilateral cleft lip and palate who consecutively underwent Le Fort I and bilateral sagittal split osteotomies for skeletal class III deformity were included. Cone-beam computed tomographic scans before surgery, 1 week after surgery, and after orthodontic treatment were used to measure the surgical and postsurgical changes in jaw position by landmarks, and outcomes of jaw protrusion and relation, incisor angle and occlusion, and menton deviation after treatment. Self-report questionnaires regarding satisfaction with overall appearance of the face and seven facial regions were administered after treatment. RESULTS A clinically insignificant relapse was found in the maxilla (<1 mm) and mandible (<2 mm). There was a significant improvement in the jaw protrusion and relation, incisor angle and occlusion, and menton deviation. Responses from the self-report questionnaires completed after treatment indicated that patient satisfaction was high. CONCLUSION These findings demonstrate surgical-orthodontic treatment with a surgery-first approach can successfully improve cleft-related dentofacial deformity in patients with unilateral cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Yu-Fang Liao
- From the Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University
- Department of Craniofacial Orthodontics
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan
- Craniofacial Research Center
| | - Yun-Fang Chen
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan
- Craniofacial Research Center
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei
| | - Chun-Shin Chang
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan
- Craniofacial Research Center
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
| | - Ting-Chen Lu
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan
- Craniofacial Research Center
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
| | - Ying-An Chen
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan
- Craniofacial Research Center
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
| | - Chuan-Fong Yao
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan
- Craniofacial Research Center
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
| | | | - Yu-Ray Chen
- From the Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan
- Craniofacial Research Center
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
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Murugan C, Kailasam V. Cranial Base Angle in Patients With Cleft Lip and Palate-A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2023; 60:39-54. [PMID: 34787478 DOI: 10.1177/10556656211053545] [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
Background: Diverse findings have been reported for the cranial base angle (CBA) in patients with CLP (cleft lip and palate) and non-CLP controls. Objective: The aim of this study is to assess and evaluate the CBA in patients with CLP and non-CLP controls. Methods: Data from PubMed, OVID Technologies, Inc., Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus, Web of Science, and EMBASE for Excerpta Medica dataBASE (EMBASE) with relevant terms was extracted until December 31, 2020. Inclusion criteria were data of patients with non-syndromic unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). In the case of UCLP and BCLP, patients with craniofacial syndromes were excluded. The study proposal was registered with PROSPERO (Registration number: CRD42021228632). Results: Fifteen studies with a total of 2032 participants were included for the systematic review and 14 studies with a total of 1972 participants were included for the meta-analysis. The risk of bias was assessed using the Modified Newcastle Ottawa scale under seven domains by two authors. Thirteen studies were graded as "good" and two as "satisfactory." The CBA in patients with CLP were greater than the non CLP Class I controls in six of the 15 studies. CBA was greater in patients with CLP than non-CLP controls by 1.21° (95% CI of 0.19-2.22). Meta-analysis reported considerable heterogeneity (I2 = 86%). Anterior (ACB) and posterior cranial base (PCB) lengths were shorter in patients with CLP than in the non-cleft Class I controls by 2.14 mm (95% CI of 0.99-3.30) and 2.06 mm (95% CI of 1.52-2.60), respectively. Conclusion: Most studies were graded as good. Patients with CLP had greater CBA and shorter ACB and PCB lengths when compared to non-CLP controls.
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Affiliation(s)
- Chandnee Murugan
- Sri Ramachandra Faculty of Dental Sciences (SRIHER), Chennai, TN, India
| | - Vignesh Kailasam
- Sri Ramachandra Faculty of Dental Sciences (SRIHER), Chennai, TN, India
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Nachmani A, Masalha M, Biadsee A, Nageris B, Ben-Dov T, Kassem F. Differences in craniofacial morphology between platybasic and nonplatybasic patients with velopharyngeal dysfunction and control subjects. Am J Orthod Dentofacial Orthop 2022; 162:e5-e16. [PMID: 35491327 DOI: 10.1016/j.ajodo.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study aimed to identify the characteristics of cranial-base morphology in platybasic and nonplatybasic patients with palatal anomalies and velopharyngeal dysfunction (VPD) compared with control subjects to investigate structural factors related to craniofacial morphology that affect the nasopharyngeal space and may influence velopharyngeal function, and to develop precise treatments for specific patients with VPD. METHODS Three hundred eighty-six patients with VPD and various palatal anomalies were studied retrospectively. The control group included 126 healthy patients with normal speech. Lateral cephalometric images assessed craniofacial morphology. RESULTS Nonplatybasic patients and control subjects had larger SNA, S-Ba-Ptm, and N-Ba-PP angles (in the craniomaxillary complex), and platybasic patients had larger nasopharyngeal ANS-Ptm-Ve and Ba-S-Ptm angles and longer Ve-T and Ve-Ba distances than the nonplatybasic patients. All study patients had larger ANB, Gn-Go-Ar, and PP-MP angles (in the craniomandibular complex). Nonplatybasic patients had smaller Ba-SN angles than platybasic patients and controls because of more acute N-S-Ptm angle. Among the nonplatybasic patients, Ve-T length tended to be shorter (with no significant difference between groups) and located more inferiorly (because of the smallest ANS-Ptm-Ve angle) in relation to the maxilla. Thus, the nasopharynx was narrower horizontally but longer vertically than in patients with platybasia. CONCLUSIONS Cranial-base flexure influences the shape of the skull base and facial-skeletal structure and may alter the pharyngeal space between them. This finding should help improve preoperative planning regarding the effect of the pharyngeal flap height relative to the nasopharynx and oropharynx ratio that affects surgical outcomes, such as resonance and residual VPD. In patients with Class III malocclusion and maxillary constriction, careful planning of presurgical orthodontic treatment is needed in maxillary advancement procedures. Orthodontic and surgical collaboration can help prevent postoperative VPD, especially in platybasic patients.
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Affiliation(s)
- Ariela Nachmani
- Faculty of Communication Disorders, Hadassah Academic College, Jerusalem, Israel; Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Muhamed Masalha
- Department of Otolaryngology, Head and Neck Surgery, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport School of Medicine, The Technion Institute of Technology, Haifa, Israel
| | - Ameen Biadsee
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Nageris
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tom Ben-Dov
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Firas Kassem
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Huang L, Wang Z, Shan Z, Yeung AWK, Yang Y, Liang Z, Gu M. Nasal asymmetry changes during growth and development in 6- to 12-year-old children with repaired unilateral cleft lip and palate: A 3D computed tomography analysis. J Anat 2021; 240:155-165. [PMID: 34411284 PMCID: PMC8655196 DOI: 10.1111/joa.13538] [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: 01/30/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022] Open
Abstract
Repaired unilateral cleft lip and palate (UCLP) is often accompanied by the deformity and asymmetry of the nasal region. Three‐dimensional analysis was performed to investigate the relationship between nasal soft‐ and hard‐tissue asymmetries, as well as the changes in nasal asymmetry with age, among children with repaired UCLP (age: 6–12 years). Forty‐seven patients were included in this study. Their computed tomography records were retrieved for analysis of the 3D asymmetry of 10 landmarks of the nasal soft and hard tissues. We observed that asymmetry was more severe in nasal hard tissues than in soft tissues, particularly in the sagittal dimension. Compared with patients aged 6–9 years old, patients aged 10 to 12 years old had significantly increased vertical asymmetry at the base of the alar groove (Gbase, p = 0.027) and the lateral point of the piriform aperture (LPA), (p < 0.001). The correlation between the LPA and the alar region was weak to moderate (r = 0.290 to 0.488). In conclusion, we found no evidence of growth and development in nasal hard‐tissue asymmetry among 6‐ to 12‐year‐old children with repaired UCLP, except for the vertical dimension. Nasal soft tissue exhibited a more preferable symmetry than hard tissue, and this could be attributed to the compensatory growth of nasal soft tissue, particularly in the vertical and sagittal dimensions. The weak to moderate correlations between nasal soft‐tissue asymmetry and hard‐tissue asymmetry were observed in the three dimensions. Surgeons should consider these factors when repositioning the nasal alar and controlling the size of the nostrils.
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Affiliation(s)
- Le Huang
- Department of Stomatology, Shenzhen Luohu Hospital Group Luohu People's Hospital, Guangdong, P.R. China.,Department of Stomatology, Shenzhen Second People's Hospital, Guangdong, P.R. China
| | - Ziling Wang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Zhiyi Shan
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Andy Wai Kan Yeung
- Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Yanqi Yang
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Zhigang Liang
- Department of Stomatology, Shenzhen Second People's Hospital, Guangdong, P.R. China
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
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Jahanbin A, Eslami N, Layegh P, Saeidi M, Kazemi M, Shahabi M, Raisolsadat SMA. Fractional CO 2 laser treatment for post-surgical lip scars in cleft lip and palate patients. Lasers Med Sci 2019; 34:1699-1703. [PMID: 31187297 DOI: 10.1007/s10103-019-02819-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/24/2019] [Indexed: 11/24/2022]
Abstract
Post-surgical scars of cleft lip patients can lead to abnormal lip activity, which causes deficient maxillary growth. The aim of the present study was to assess the effect of laser therapy on the appearance and electrical activity of the upper lip in cleft lip and palate patients. Twelve patients with cleft lip and palate participated in this study. All patients had surgically repaired the cleft lip at the age of about 3-6 months. The lip scars underwent five fractional CO2 laser treatment sessions with a 4-week interval. Improvement of the quality of the skin texture was recorded according to quartile grading scale based on photographs taken before and 1 month after treatment. Patients' satisfaction survey was also recorded using Patient Scar Assessment Questionnaire (PSAQ) before and after laser therapy. Moreover, the EMG activity of the upper lip muscle was measured before and after treatment. According to dermatologists, the improvement of scar appearance ranged from 0.5 to 3, with a mean of 1.29 ± 0.86. Mean scores of the scar appearance (p < 0.001), symptoms (p = 0.003), and scar consciousness (p < 0.001) subscales of the PSAQ questionnaire had significantly increased after treatment. The EMG recording of the upper lip had decreased significantly after laser treatment at rest (p = 0.009) and maximum lip compression (p = 0.007). The fractional CO2 laser is an effective method for treating old scars of the cleft lip with a significant change in the opinion of patients about their scar appearance. Also, the therapy can help to reduce the EMG activity of the upper lip at rest.
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Affiliation(s)
- Arezoo Jahanbin
- Department of Orthodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Eslami
- Department of Orthodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.,Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pouran Layegh
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Morteza Saeidi
- Department of Neurology, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mostafa Shahabi
- Department of Orthodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
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Lateral cephalometric measurements of Iranians with surgically repaired unilateral cleft lips and palates. Int Orthod 2019; 17:304-311. [PMID: 31028018 DOI: 10.1016/j.ortho.2019.03.013] [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: 11/20/2022]
Abstract
OBJECTIVES Since results of surgical correction of unilateral cleft lip and palate (UCLP) are controversial, and there is no study in this regard among Iranians, this study was conducted to document lateral cephalometric measurements of such cases, with respect to age, gender, and cleft side. METHODS In this cross-sectional study, 45 lateral cephalographs of individuals with UCLP who had undergone surgery but not orthodontic treatment were traced and 30 skeletal, dental and soft-tissue cephalometric measurements were measured. Parameters were compared between patients with UCLP and cephalometric norms. They were also compared between males and females, two age groups (≤8 and>8 years), and sides of cleft using the Student's t-test. RESULTS Only S-N-Pog and U1-SN values were significantly different between this sample and cephalometric norms. The variables were not significantly different between males and females. However, the values of ANB, Wits appraisal, Go-Gn, Go-Pog, U1-SN, interincisal angle, distance of upper lip to Ricketts E-line, and nasopharyngeal depth were significantly different between patients≤8 and>8 years (P<0.05). The S-N-Pog angle, Wits appraisal, Go-Gn, Go-Pog, U1-SN, interincisal angle and hypopharyngeal depth were significantly different between patients with right- and left-side clefts (P<0.05). CONCLUSION Measurements of patients with repaired UCLP were similar to cephalometric norms except for two parameters.
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Akarsu-Guven B, Karakaya J, Ozgur F, Aksu M. Upper airway features of unilateral cleft lip and palate patients in different growth stages. Angle Orthod 2019; 89:575-582. [PMID: 30694706 DOI: 10.2319/022518-155.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To compare growth-related changes of skeletal and upper airway features of unilateral cleft lip and palate subjects (UCLP) with non-cleft control (NCC) subjects by using lateral cephalograms. MATERIALS AND METHODS The sample comprised 238 subjects, collected cross-sectionally, divided into 2 groups: 94 with UCLP, and 144 NCC, subdivided into 4 groups according to their growth stages by using cervical vertebral maturation stage (CVMS). The subgroups were defined as early childhood (stage 1), prepubertal (stage 2: CVMS I and II), pubertal (stage 3: CVMS III and IV), and postpubertal (stage 4: CVMS V and VI). RESULTS The maxilla was more retrognathic at stages 2, 3, and 4 in females with UCLP. The mandible was more retrognathic in UCLP at stage 1 in males, and stages 2 and 3 in females. ANB (angle between NA plane and NB plane) was significantly smaller in UCLP subjects at stage 4 for both sexes. A vertical growth pattern was seen in UCLP subjects except males at stages 2 and 3, and females at stage 2. Posterior airway space was significantly narrower at all stages in males and after stage 1 in females. Middle airway space was significantly wider at all stages in females and after stage 1 in males. Epiglottic airway space was significantly narrower in males at stage 3. CONCLUSIONS Age- and sex-dependent differences in skeletal morphology and upper-airway widths of the UCLP subjects were identified when compared with controls.
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Imaging study of midface growth with bone-borne trans-sutural distraction osteogenesis therapy in growing cleft lip and palate patients. Sci Rep 2019; 9:871. [PMID: 30696887 PMCID: PMC6351653 DOI: 10.1038/s41598-018-37326-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/04/2018] [Indexed: 02/06/2023] Open
Abstract
Trans-sutural distraction osteogenesis (TSDO) promotes midface growth in growing cleft lip and palate (CLP) patients with midfacial hypoplasia. The superficial skeletal changes after therapy revealed rotation advancement of the midfacial skeleton associated with differential displacement in each segment, but reports rarely focus on the changes of internal structures, including circummaxillary sutures, the maxillary tuberosity and the maxillary sinus, which may play a crucial role during this process. This study evaluated the computed tomographic (CT) images of 26 growing CLP patients who received bone-borne TSDO therapy. The results revealed that the most prominent new bone formation occurred in the pterygomaxillary suture and pushed the P-point forward. The maxillary first molar exhibited significantly greater advancement compared with the P-point due to the growth of the maxillary tuberosity. The contribution ratio values of the advancement of the maxillary tuberosity and P-point to the maxillary first molar were 26% and 74%, respectively, in UCLP and 25% and 75%, respectively, in BCLP. Furthermore, the maxillary sinus volume was also significantly increased. In conclusion, midface growth with bone-borne TSDO therapy depends on both secondary displacement promoted by sutural bone formation mainly in the pterygomaxillary suture and primary displacement by growth of the maxillary tuberosity and maxillary sinus volume.
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Ren Y, Steegman R, Dieters A, Jansma J, Stamatakis H. Bone-anchored maxillary protraction in patients with unilateral complete cleft lip and palate and Class III malocclusion. Clin Oral Investig 2018; 23:2429-2441. [PMID: 30306334 DOI: 10.1007/s00784-018-2627-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 09/10/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This prospective controlled study evaluated the effect of bone-anchored maxillary protraction therapy in cleft children with Class III malocclusion using CBCT-derived 3D surface models. MATERIALS AND SUBJECTS Eighteen cleft patients between 10 and 12 years old were included. Intermaxillary elastics were worn after the placement of four zygoma bone plates for 18 months. Uniquely, three age-matched untreated groups including both cleft subjects and non-cleft subjects with Class III malocclusion served as controls. Profile photos and CBCT scans for each patient were taken before (T0) and 18 months after the protraction (T1). 3D measurements were made on CBCT surface models from the treatment group using tomographic color mapping method. Cephalometric measurements were made on lateral cephalogram reconstructed from the CBCT scans and were compared with those obtained from the control groups. RESULTS Two thirds of the treatment subjects showed improved lip projection towards more convex facial profile. The most significant skeletal changes on 3D surface models were observed at the zygomatic regions (mean 1.5-mm forward, downward, and outward displacement) and at the maxillary complex (mean 1.5-mm forward displacement). Compared with the control groups, the treatment subjects showed significant increase in the SNA and ANB angles, increased Wits appraisal, a more forward movement of point A and overjet improvement (p < 0.05). CONCLUSIONS BAMP in cleft patients gives a significant forward displacement of the zygomaxillairy complex in favor of the Class III treatment. CLINICAL RELEVANCE This treatment method shows clearly favorable outcome in cleft patients after 1.5 years of BAMP.
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Affiliation(s)
- Yijin Ren
- Department of Orthodontics, W.J. Kolff Institute, University Medical Center Groningen, University of Groningen, BB72 300001, Hanzeplein 1, 9700RB, Groningen, The Netherlands.
| | - Ralph Steegman
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan Dieters
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johan Jansma
- Department of Oral Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry Stamatakis
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Akarsu-Guven B, Arisan A, Ozgur F, Aksu M. Influence of nasoalveolar molding on skeletal development in patients with unilateral cleft lip and palate at 5 years of age. Am J Orthod Dentofacial Orthop 2018; 153:489-495. [PMID: 29602340 DOI: 10.1016/j.ajodo.2017.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The aim of this retrospective study was to assess the influence of presurgical nasoalveolar molding (NAM) on skeletal development in patients with operated unilateral cleft lip and palate at 5 years of age. MATERIALS Lateral cephalometric radiographs of 26 unilateral cleft lip and palate patients who had undergone presurgical NAM (NAM group) and 20 unilateral cleft lip and palate patients who did not have any presurgical NAM (non-NAM group) were analyzed. The radiographs were digitally traced using Quick Ceph Studio software (version 3.5.1.r (1151); Quick Ceph Systems, San Diego, Calif). Independent samples t tests were performed for statistical analysis. RESULTS No significant differences were observed in sagittal and vertical skeletal measurements between the NAM and non-NAM groups. CONCLUSIONS NAM resulted in no significant difference in skeletal development in unilateral cleft lip and palate patients compared with those without NAM in early childhood.
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Affiliation(s)
- Bengisu Akarsu-Guven
- Department of Orthodontics, Faculty of Dentistry, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey
| | - Arda Arisan
- Department of Orthodontics, Faculty of Dentistry, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey
| | - Figen Ozgur
- Department of Plastic, Reconstructive and Esthetic Surgery, Faculty of Medicine, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey
| | - Muge Aksu
- Department of Orthodontics, Faculty of Dentistry, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey.
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López-Giménez A, Silvestre-Rangil J, Silvestre FJ, Paredes-Gallardo V. Craniofacial cephalometric morphologies in different cleft types: a retrospective cross-sectional study of 212 patients. Oral Radiol 2017; 34:127-135. [PMID: 30484129 DOI: 10.1007/s11282-017-0290-z] [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] [Received: 03/30/2017] [Accepted: 05/15/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate and compare the craniofacial cephalometric morphologies among different cleft types in a Spanish population. METHODS A retrospective cross-sectional study was carried out on 212 patients. The patients were subdivided into four groups according to their cleft types: unilateral cleft lip and palate; bilateral cleft lip and palate; cleft lip; and cleft palate. Angular and linear cephalometric measurements were taken on lateral radiographs. RESULTS Unilateral cleft lip and palate was associated with a dolichofacial growth pattern, skeletal Class III with correct maxillary position, and lingual incisor inclination. Bilateral cleft lip and palate was associated with a mesofacial growth pattern, skeletal Class I with protruded maxillary position, and lingual incisor inclination. Cleft palate was associated with a mesofacial growth pattern, skeletal Class III with correct maxillary position, and lingual incisor inclination. Cleft lip was associated with a brachyfacial growth pattern, skeletal Class I with protruded maxillary position, lingual upper incisor inclination, and corrects lower incisor inclination. Significant correlations were observed between cleft types and their craniofacial cephalometric measurements. CONCLUSIONS The present information can be used for the determination of orthodontic treatment and even future orthognathic surgery planning, a requirement in most cleft patients.
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Affiliation(s)
- Ana López-Giménez
- Nen Déu Hospital, Passeig de Maragall, 193-197, 08041, Barcelona, Spain
| | - Javier Silvestre-Rangil
- Stomatology Department, Special Care Dentistry, University of Valencia, C/ Gasco Oliag nº1, 46010, Valencia, Spain
| | - Francisco-Javier Silvestre
- Stomatology Department, Special Care Dentistry, University of Valencia, C/ Gasco Oliag nº1, 46010, Valencia, Spain
| | - Vanessa Paredes-Gallardo
- Stomatology Department, Orthodontics, University of Valencia, C/ Gasco Oliag nº1, 46010, Valencia, Spain.
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SAKODA KL, JORGE PK, CARRARA CFC, MACHADO MADAM, VALARELLI FP, PINZAN A, OLIVEIRA TM. 3D analysis of effects of primary surgeries in cleft lip/palate children during the first two years of life. Braz Oral Res 2017; 31:e46. [DOI: 10.1590/1807-3107bor-2017.vol31.0046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/27/2017] [Indexed: 11/22/2022] Open
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Cone-beam computed tomography–synthesized cephalometric study of operated unilateral cleft lip and palate and noncleft children with Class III skeletal relationship. Am J Orthod Dentofacial Orthop 2016; 150:802-810. [DOI: 10.1016/j.ajodo.2016.03.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/20/2022]
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Isolated Influences of Surgery Repair on Maxillofacial Growth in Complete Unilateral Cleft Lip and Palate. J Oral Maxillofac Surg 2016; 74:1649-57. [DOI: 10.1016/j.joms.2016.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/17/2016] [Accepted: 03/17/2016] [Indexed: 11/18/2022]
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Carrara CFC, Ambrosio ECP, Mello BZF, Jorge PK, Soares S, Machado MAAM, Oliveira TM. Three-dimensional evaluation of surgical techniques in neonates with orofacial cleft. Ann Maxillofac Surg 2016; 6:246-250. [PMID: 28299266 PMCID: PMC5343636 DOI: 10.4103/2231-0746.200350] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Individuals with cleft lip and palate have many anatomic and functional alterations compromising esthetics, hearing, speech, occlusion, and development/craniofacial growth. The rehabilitative treatment of these patients is very challenging and starts at birth aiming at the best treatment for all functional demands. This study aimed to evaluate the dimensional alterations of the dental arches of neonates with cleft lip and palate after two different primary surgical techniques. MATERIALS AND METHODS The sample comprised 114 digital models of children aged from 3 to 36 months, with unilateral complete cleft lip and palate divided into two groups. Two different phases were evaluated: precheiloplasty and 1 year after palatoplasty. The evaluation was performed through the digital models of each child obtained by scanning digitalization (3D Scanner). Dental arches measurements were accomplished through Appliance Designer software. The following measurements were assessed: dental arch area, anterior amplitude of the cleft, total length of dental arch, intercanine distance, and intertuberosity distance. t-test was applied to compare differences between groups. RESULTS No statistically significant differences were observed between groups at precheiloplasty phase. At 1 year after palatoplasty, the groups differed in the total length of dental arch (P = 0.002), with greater values for Group I. CONCLUSION This study suggests that the results of the different surgical techniques may alter the growth and development of the dental arches of neonates with cleft lip and palate.
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Affiliation(s)
| | - Eloá Cristina Passucci Ambrosio
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | - Bianca Zeponi Fernandes Mello
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | - Paula Karine Jorge
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | - Simone Soares
- Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Thais Marchini Oliveira
- Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
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A comparative cephalometric study for adult operated cleft palate and unoperated cleft palate patients. J Craniomaxillofac Surg 2015; 43:1218-23. [DOI: 10.1016/j.jcms.2015.04.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 03/24/2015] [Accepted: 04/22/2015] [Indexed: 11/18/2022] Open
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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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Platybasia in 22q11.2 deletion syndrome is not correlated with speech resonance. Arch Plast Surg 2014; 41:344-9. [PMID: 25075355 PMCID: PMC4113692 DOI: 10.5999/aps.2014.41.4.344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 02/19/2014] [Accepted: 02/26/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND An abnormally obtuse cranial base angle, also known as platybasia, is a common finding in patients with 22q11.2 deletion syndrome (22q11DS). Platybasia increases the depth of the velopharynx and is therefore postulated to contribute to velopharyngeal dysfunction. Our objective was to determine the clinical significance of platybasia in 22q11DS by exploring the relationship between cranial base angles and speech resonance. METHODS In this retrospective chart review at a tertiary hospital, 24 children (age, 4.0-13.1 years) with 22q11.2DS underwent speech assessments and lateral cephalograms, which allowed for the measurement of the cranial base angles. RESULTS One patient (4%) had hyponasal resonance, 8 (33%) had normal resonance, 10 (42%) had hypernasal resonance on vowels only, and 5 (21%) had hypernasal resonance on both vowels and consonants. The mean cranial base angle was 136.5° (standard deviation, 5.3°; range, 122.3-144.8°). The Kruskal-Wallis test showed no significant relationship between the resonance ratings and cranial base angles (P=0.242). Cranial base angles and speech ratings were not correlated (Spearman correlation=0.321, P=0.126). The group with hypernasal resonance had a significantly more obtuse mean cranial base angle (138° vs. 134°, P=0.049) but did not have a greater prevalence of platybasia (73% vs. 56%, P=0.412). CONCLUSIONS In this retrospective chart review of patients with 22q11DS, cranial base angles were not correlated with speech resonance. The clinical significance of platybasia remains unknown.
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Moreira I, Suri S, Ross B, Tompson B, Fisher D, Lou W. Soft-tissue profile growth in patients with repaired complete unilateral cleft lip and palate: A cephalometric comparison with normal controls at ages 7, 11, and 18 years. Am J Orthod Dentofacial Orthop 2014; 145:341-58. [PMID: 24582026 DOI: 10.1016/j.ajodo.2013.11.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In this retrospective longitudinal study, we aimed to study differences in the soft-tissue profiles in growing children with clefts in comparison with controls through the period of facial growth from 7 to 18 years. METHODS Lateral cephalometric measurements made at 7 years (T1), 11.1 years (T2), and 17.9 years (T3) of age of 70 white children (35 boys, 35 girls) with complete unilateral cleft lip and palate (UCLP) who received primary lip and palate repair surgeries at The Hospital for Sick Children, Toronto, were compared with those of a control group of similar ages, sexes, and racial backgrounds, and having skeletal Class I facial growth, selected from the Burlington Growth Study. None of the included subjects had received any surgeries other than the primary lip and palate repairs, and none had undergone nasal septum surgery or nasal molding during infancy. Between-group comparisons were made at each time point using generalized linear models adjusted for age and sex effects. Longitudinal comparisons across all time points were conducted using the mixed model approach, adjusting for these effects and their interactions with time. RESULTS Bimaxillary retrognathism, progressive maxillary retrognathism, and increasing lower anterior face height with downward and backward growth rotation of the mandible in the UCLP group were seen. Unlike the hard-tissue face height ratio, their soft-tissue face height ratio was not affected. The upper lips in the UCLP group were shorter by 1.81 mm at T2 (P <0.001) and by 1.16 mm at T3 (P = 0.018), whereas their lower lips were 2.21 mm longer at T3 (P = 0.003). A reduced upper lip to lower lip length ratio at T2 and T3 (P <0.001) resulted. Their upper lips were relatively retruded by 1.44 mm at T1, 1.66 mm at T2, and 1.86 mm at T3 (all, P <0.001), and their lower lips were relatively protruded by 1.07 mm at T1 (P = 0.003), 1.40 mm at T2 (P <0.001), and 1.62 mm at T3 (P <0.001). Nose depths in the UCLP group were shallower by at least 1 mm from T1 to T3, and columellar length was shorter by almost 2 mm (all, P <0.001). Their columellae and nose tips rotated downward with growth, with the most significant rotations experienced from T2 to T3, and progressive reductions in their soft-tissue profile convexity were seen from T1 to T3 (P <0.001). CONCLUSIONS Key attributes of the imbalance in the soft-tissue profile in children with repaired UCLP were identified in the lip and nose regions. Although many profile differences were visible as early as 7 years of age, they became more apparent by 11 years of age and increased in severity thereafter. The short upper lip combined with a long lower lip resulted in the characteristic lip length imbalance, whereas the progressively retruding upper lip and protruding lower lip led to developing a step relationship in the sagittal lip profile during the adolescent growth period. Their columellae and nose tips rotated downward during this time.
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Affiliation(s)
- Iris Moreira
- Research associate, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; former clinical orthodontic fellow, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunjay Suri
- Associate professor, Discipline of Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; staff orthodontist, Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Bruce Ross
- Professor, Discipline of Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; staff orthodontist, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bryan Tompson
- Associate professor and head, Discipline of Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; head, Division of Orthodontics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Fisher
- Medical director, Cleft Lip and Palate Program, Hospital for Sick Children, Toronto, Ontario, Canada; associate professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Wendy Lou
- Professor and head, Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Canada Research Chair in Statistical Methods for Health Care, Toronto, Ontario, Canada
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Influence of modified Furlow double opposing Z-plasty on mandibular growth in Oriental patients with cleft palate and/or lip. Ann Plast Surg 2014; 73:311-4. [PMID: 24374402 DOI: 10.1097/sap.0b013e31827aeb6c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to statistically analyze mandibular growth disturbance in the Oriental cleft population and compare this with that of non-cleft children through cephalometric analysis. Thirty-six children with cleft palates, repaired using a modification of Furlow double opposing Z-plasty, were chosen. Comparative analyses among 3 types of cleft were performed. Statistical analyses of 8 linear and angular measurements were performed in cleft patients and the non-cleft population using Fisher Z-transformation. Comparative analysis showed no significant difference among the 3 types of cleft. In the Oriental cleft group treated with modified double opposing Z-plasty, the spatial position of the mandible showed significant differences compared with the non-cleft group. A backward inclination of the anterior surface of the mandible and downward rotation of the mandibular body were identified. Some of our results regarding gonial angle and length of the mandibular body conflicted with previous Western studies.
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Maxillo-mandibular relationship in untreated and surgically treated patients with unilateral complete cleft lip and palate: A cephalometric evaluation. EUROPEAN JOURNAL OF PLASTIC SURGERY 2013. [DOI: 10.1007/s00238-013-0880-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Nachmani A, Aizenbud D, Berger G, Berger RL, Hazan-Molina H, Finkelstein Y. The Prevalence of Platybasia in Patients with Velopharyngeal Incompetence. Cleft Palate Craniofac J 2013; 50:528-34. [DOI: 10.1597/11-265] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives To estimate the prevalence of platybasia in patients with velopharyngeal incompetence (VPI) and its relation with palatal anomalies and syndromes. Design and Settings Retrospective case analysis. Setting A university-affiliated hospital. Patients The VPI patients (n =366) included five groups with either cleft lip and palate (CLP), cleft palate (CP) only, submucous cleft palate (SMCP), occult submucous cleft palate (OSMCP), or non-CP. The control group (n = 126) comprised healthy, normal-speech individuals. Outcome Measures The cranial-base angle was measured by lateral cephalometric radiography. The prevalence of platybasia (defined as cranial base angle > 137°) was estimated and the patient's syndromes were recorded. Results The prevalence of platybasia was significantly higher in the VPI group (28.7%) than in the normal controls (2.4%) (P < .001). A significant difference (P < .01) was found in the prevalence of platybasia among the five VPI groups: 16.7%, 20.3%, 28.8%, 33.7%, and 40.3% for CLP, CP only, SMCP, OSMCP, and non-CP, respectively. No significant difference was found between the cranial-base angle of VPI patients and of controls and between the cranial-base angle of the five VPI groups. The VPI nonplatybasic patients had a significantly smaller cranial-base angle than normal controls (P < .01). Platybasia was the highest among patients with velocardiofacial syndrome (50%), followed by those with Pierre Robin syndrome (27.3%). Conclusions Platybasia, which may cause enlargement of the nasopharyngeal space and difficulties in achieving velopharyngeal closure, can be found in high numbers of VPI patients with or without CP. This supports the belief that velopharyngeal anomaly may be part of a more complex craniofacial anomaly influenced by the cranial-base flexure.
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Affiliation(s)
- Ariela Nachmani
- The Center of Cleft Palate and Craniofacial Anomalies, Meir Medical Center, Kfar Saba, Israel
- The Communication Disorders faculty, Hadassah Academic College, Jerusalem, Israel
| | - Dror Aizenbud
- School of Graduate Dentistry, Rambam Health Care Campus and Rappaport Faculty of Medicine—Technion, Israel Institute of Technology, Haifa, Israel
| | - Gilead Berger
- Ear, Nose, and Throat Histopathologic Research Laboratory, Department of Otolaryngology—Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
| | - Rachel L. Berger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagai Hazan-Molina
- Orthodontic and Craniofacial Department, School of Graduate Dentistry, Rambam Health Care Campus and Rappaport Faculty of Medicine—Technion, Israel Institute of Technology, Haifa, Israel
| | - Yehuda Finkelstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology—Head and Neck Surgery Meir Medical Center, Kfar Saba, Israel
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Maxillary reaction patterns identified by three-dimensional analysis of casts from infants with unilateral cleft lip and palate. J Orofac Orthop 2013; 74:275-86. [DOI: 10.1007/s00056-013-0153-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 12/07/2012] [Indexed: 11/26/2022]
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Xu X, Zheng Q, Lu D, Huang N, Li J, Li S, Wang Y, Shi B. Timing of palate repair affecting growth in complete unilateral cleft lip and palate. J Craniomaxillofac Surg 2012; 40:e358-62. [PMID: 22484231 DOI: 10.1016/j.jcms.2012.01.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the facial morphology characteristics of patients with complete unilateral cleft lip and palate (UCCLPs) who had undergone cleft palate repair at different times. DESIGN This study included 46 nonsyndromic UCCLPs and 38 age and sex matched non-cleft patients. 35 cephalometric measurements were used to evaluate the facial morphology. Student's t-test, one-way ANOVA and rank sum tests were used for comparison. Significant difference was defined at 95% level. RESULTS The data showed that UCCLPs who had palatoplasty between 7 and 12 years had greater PMP-A, PMP-ANS, Ba-ANS, Ba-A, Ba-N-ANS than those operated on before 4 years of age, and UCCLPs who had palatoplasty at 4-12 years had smaller Y-axis angle than those operated on before 4 years of age. CONCLUSIONS The maxillary sagittal length increased gradually as von Langenbeck repair was delayed. UCCLPs who underwent palate repair using von Langenbeck technique at 4-12 years had a more protrusive maxilla and less clockwise rotated mandible than those repaired before 4 years. UCCLPs operated using the von Langenbeck technique at 4-12 years had better head-face morphology than those operated on before 4 years. There was no difference in facial morphology among UCCLPs with palate repair at 4-12 years.
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Affiliation(s)
- Xue Xu
- Department of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
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Reiser E, Skoog V, Andlin-Sobocki A. Early dimensional changes in maxillary cleft size and arch dimensions of children with cleft lip and palate and cleft palate. Cleft Palate Craniofac J 2011; 50:481-90. [PMID: 22122198 DOI: 10.1597/11-003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : To study early changes in cleft size and maxillary arch dimensions and to evaluate these changes in relation to performed surgical procedures. Design : Retrospective longitudinal study. Setting : The Cleft Lip and Palate Center, Uppsala University Hospital, Sweden. Patients : Dental study models of 79 consecutive children (28 with unilateral cleft lip and palate, 39 with cleft palate, and 12 with Pierre Robin sequence) were analyzed. Interventions : Lip repair at 3 to 4 months, soft palate repair at 6 to 10 months, and hard palate repair at 25 to 26 months of age. Main Outcome Measures : Cleft size was measured before each surgical intervention up to 2 years and arch dimensions were measured before each surgical intervention and at 5 years. Results : Cleft widths decreased from infancy up to 2 years, but the anteroposterior cleft length in cleft palate was unchanged. Arch widths between cuspid points (C-C1) and tuberosity points (T-T1) and also the change over time in C-C1 and T-T1 differed significantly between the groups from infancy up to 5 years. Conclusions : Cleft widths decreased after lip closure and/or soft palate closure. The children with unilateral cleft lip and palate had wider maxillary arch dimensions than the children with cleft palate or Pierre Robin sequence during the first years of life, but after hard palate closure the transverse growth was reduced in the children with unilateral cleft lip and palate. At 5 years the children with unilateral cleft lip and palate had similar maxillary widths as the children with cleft palate and/or Pierre Robin sequence.
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Liu R, Lu D, Wamalwa P, Li C, Hu H, Zou S. Craniofacial morphology characteristics of operated unilateral complete cleft lip and palate patients in mixed dentition. ACTA ACUST UNITED AC 2011; 112:e16-25. [PMID: 21831675 DOI: 10.1016/j.tripleo.2011.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 04/04/2011] [Accepted: 04/12/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to analyze craniofacial morphologic characteristics at the stage of mixed dentition in Chinese children who had received surgery for unilateral complete cleft lip and palate (UCCLP) compared with the healthy population. MATERIAL AND METHODS Lateral cephalometric radiographs were taken for 2 groups of individuals: (1) 48 UCCLP patients who had been operated on before 2 years of age, and (2) 60 noncleft peers as controls. RESULTS The operated UCCLP groups differed from the control group as follows: reduced cranial base length, less maxillary length, more retrognathic maxilla, retusion of the entire maxilla, more incongruous intermaxillary relation, more concave skeletal profile, and more lingually inclined maxillary and mandibular incisors. CONCLUSIONS The operated UCCLP children at the mixed dentition stage showed serious craniofacial deformities and the craniofacial growth was influenced (especially in maxilla).
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Affiliation(s)
- Renkai Liu
- Department of Orthodontics, West China College of Stomatology, Sichuan University, Chengdu, China
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Rullo R, Laino G, Cataneo M, Mazzarella N, Festa VM, Gombos F. The effect of Delaire cheilorhinoplasty on midfacial growth in patients with unilateral cleft lip and palate. Eur J Orthod 2008; 31:64-7. [PMID: 18990680 DOI: 10.1093/ejo/cjn068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The aim of this research was to evaluate the effect of the Delaire surgical technique on the midfacial morphology in a group of subjects with a congenital unilateral cleft of lip and palate (UCLP), prior to orthodontic treatment. Thirty-five UCLP (15 left and 20 right) patients (16 males and 19 females, mean age 7.03+/-0.9 years; age range 8.7-5.0 years), treated for the correction of congenital malformation, were retrospectively selected. Analysis of midfacial growth was undertaken on lateral cephalograms, and the data were compared with reference values (Ricketts analysis). A Mann-Whitney ranked sum test was used to detect significant differences between the findings and reference values. P <or= 0.05 was considered as significant. The results demonstrated a retropositioning of both the maxilla and mandible (SNA and SNB P<0.01) and increased mandibular development (Go-Me distance). Vertically, there was a trend to a posterior rotation of the mandible (P<0.01), resulting in a hyperdivergent profile. This trend was confirmed by the increase in SpA-SpP/Go-Me (P<0.05). In agreement with previous studies, the effects of surgical closure of a cleft lip might be responsible for excessive maxillary retropositioning with a downward rotation.
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Affiliation(s)
- Rosario Rullo
- Department of Odontostomatological, Orthodontical and Surgical Sciences, Second University of Naples, Italy.
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Kim SM, Lee YJ, Lee SS, Kim YS, Lee SK, Kim IB, Chi JG. Abnormal maxillary trapezoid pattern in human fetal cleft lip and palate. Cleft Palate Craniofac J 2008; 45:131-40. [PMID: 18333644 DOI: 10.1597/06-077.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To elucidate abnormal growth patterns of human fetal maxillae with cleft lip and palate (CLP). SUBJECT A total of 71 fetal maxillae with CLP were obtained from aborted human fetuses. METHOD Dimensions of the maxillary trapezoid (MT), formed by the maxillary primary growth centers (MxPGC), were taken from radiographic images. The CLP dimensions were compared with maxillary trapezoid dimensions of normal fetuses from a previous study (Lee et al., 1992). MAIN OUTCOME MEASURES Cleft lip subjects without a cleft palate, unilateral cleft lip-alveolar cleft or cleft palate (UCL+A/UCLP), and bilateral cleft lip-alveolar cleft or cleft palate (BCL+A/BCLP) displayed abnormal MT patterns. MT abnormalities were most marked in the BCL+A/BCLP cohort. RESULTS The MT growth of prenatal CLP maxillae was severely arrested, resulting in abnormal MT shape on palatal radiograms. BCL+A/BCLP subjects had a more protruded nasal septum than subjects with other types of CLPs, while UCL+A/UCLP subjects showed severe deviation of the protruded nasal septum toward the noncleft side. Cleft lip-only subjects also exhibited abnormal MT growth. CONCLUSION MT is primarily involved in CLPs, so that the MT shape could be utilized as a sensitive indicator for the analysis of maxillary malformation in different types of CLPs.
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Affiliation(s)
- Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Kangnung National University, Gangeung, Korea
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Bibliography. Current world literature. Head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2006; 14:289-91. [PMID: 16832188 DOI: 10.1097/01.moo.0000233602.37541.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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