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Pendem S, Jayakumar NK, Gopalakrishnan S, Arakeri G. Systematic review and meta-analysis of surgical approaches for improving airway stability in infants with Robin sequence: evaluating complications and outcomes. Br J Oral Maxillofac Surg 2024; 62:511-522. [PMID: 38845304 DOI: 10.1016/j.bjoms.2024.04.003] [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: 10/07/2023] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 07/10/2024]
Abstract
The purpose of this systematic review and meta-analysis was to determine the most effective and least morbid surgical technique for relieving retroglossal airway obstruction in infants with Robin sequence (RS). The study adhered to PRISMA guidelines and included 25 studies (24 cohorts and one case series) that investigated interventions for airway improvement, including conservative measures, tongue-lip adhesion (TLA), mandibular distraction osteogenesis (MDO), and tracheostomy. The primary outcome variable was complication rate, while predictor variable was the use of interventions for airway improvement. Results showed that conservative measures were the preferred initial management strategy in most studies, while TLA was recommended for infants with mild obstruction, and MDO or tracheostomy was reserved for severe cases. Only complications could be analysed via meta-analysis due to data heterogeneity, revealing that tracheostomy had a summary odds ratio of 5.39 in favour of TLA, while MDO had a ratio of 2.8 over TLA, and the complication rates were similar between MDO and tracheostomy. If conservative measures fail, the study recommends mandibular distraction as the preferable technique for stable airway improvement. If the infant is unsuitable for distraction, tongue-lip adhesion may serve as an alternative, while tracheostomy should be reserved for cases of severe multi-level obstruction. The authors propose that large-scale, multicentre trials comparing long-term outcomes are required to establish definitive guidelines.
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Affiliation(s)
- Sneha Pendem
- Department of Oral and Maxillofacial surgery, Saveetha Dental College, Chennai, India
| | - Naveen Kumar Jayakumar
- Department of Oral and Maxillofacial Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai 600116, India.
| | - Sreejee Gopalakrishnan
- Department of Oral and Maxillofacial Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai 600116, India
| | - Gururaj Arakeri
- Department of Oral and Maxillofacial Surgery, HKDT Dental College and Hospital, Humnabad, Karnataka, India; Department of Head and Neck Oncology, HCG Cancer Centre, Bengaluru, Karnataka, India
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de Buys Roessingh A, Robert Y, Despars J, Zbinden-Trichet C, Herzog G, Broome M, El Ezzi O. Unilateral Cleft lip and Palate: Long-Term Results of the Malek Technique. Cleft Palate Craniofac J 2024; 61:219-230. [PMID: 36453758 PMCID: PMC10751977 DOI: 10.1177/10556656221139671] [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] [Indexed: 12/27/2023] Open
Abstract
To review at 18 years-old the results of surgery and follow-up of children born in our hospital with unilateral cleft lip and palate (uCLP). They were operated at the time by the same surgeon, following the same primary surgical procedure (Malek). Retrospective cohort study. Tertiary Children's Hospital. All children born with uCLP between 1996 and 2001 and operated in our hospital. Syndromic children were excluded. Results of the primary surgery, ear-nose-throat interventions, maxillo-facial surgery and final phonatory results. Seventy-nine files of children born with a cleft were reviewed: 34 were taken into consideration for uCLP: 15 right and 19 left. They were operated in two stages, following the inverse Malek procedure. Sixty per cent had a fistula. Eighty-eight percent had grommets. Ninety-seven percent had an alveolar graft at a median age of nine (5-10) and 22% underwent a Le Fort osteotomy. Seven percent were operated for a pharyngeal flap, 29% for a secondary lip surgery at a mean age of 12.8 and 29% for a late rhinoplasty at a mean age of 14.8 years. A median of 5.7 multidisciplinary consultations was realized with a median number of general anesthesia of 7.1 (4-13). This retrospective study shows that the Malek procedure for children born with uCLP is related to a high risk of fistula but good long-term phonatory results. Twenty percent of children were operated for a Le Fort procedure and one-third for a secondary lip procedure and rhinoplasty.
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Affiliation(s)
- Anthony de Buys Roessingh
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Yohann Robert
- Multidisciplinary consultations of facial cleft, CHUV, Lausanne, Switzerland
| | - Josée Despars
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Chantal Zbinden-Trichet
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Georges Herzog
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Martin Broome
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Oumama El Ezzi
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
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Huqh MZU, Abdullah JY, AL-Rawas M, Husein A, Ahmad WMAW, Jamayet NB, Genisa M, Yahya MRB. Development of Artificial Neural Network-Based Prediction Model for Evaluation of Maxillary Arch Growth in Children with Complete Unilateral Cleft Lip and Palate. Diagnostics (Basel) 2023; 13:3025. [PMID: 37835768 PMCID: PMC10572375 DOI: 10.3390/diagnostics13193025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Cleft lip and palate (CLP) are the most common congenital craniofacial deformities that can cause a variety of dental abnormalities in children. The purpose of this study was to predict the maxillary arch growth and to develop a neural network logistic regression model for both UCLP and non-UCLP individuals. METHODS This study utilizes a novel method incorporating many approaches, such as the bootstrap method, a multi-layer feed-forward neural network, and ordinal logistic regression. A dataset was created based on the following factors: socio-demographic characteristics such as age and gender, as well as cleft type and category of malocclusion associated with the cleft. Training data were used to create a model, whereas testing data were used to validate it. The study is separated into two phases: phase one involves the use of a multilayer neural network and phase two involves the use of an ordinal logistic regression model to analyze the underlying association between cleft and the factors chosen. RESULTS The findings of the hybrid technique using ordinal logistic regression are discussed, where category acts as both a dependent variable and as the study's output. The ordinal logistic regression was used to classify the dependent variables into three categories. The suggested technique performs exceptionally well, as evidenced by a Predicted Mean Square Error (PMSE) of 2.03%. CONCLUSION The outcome of the study suggests that there is a strong association between gender, age, and cleft. The difference in width and length of the maxillary arch in UCLP is mainly related to the severity of the cleft and facial growth pattern.
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Affiliation(s)
- Mohamed Zahoor Ul Huqh
- Orthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| | - Johari Yap Abdullah
- Craniofacial Imaging Lab, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia
| | - Matheel AL-Rawas
- Prosthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| | - Adam Husein
- Prosthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| | - Wan Muhamad Amir W Ahmad
- Department of Biostatistics, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| | - Nafij Bin Jamayet
- Division of Restorative Dentistry (Prosthodontics), School of Dentistry, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia;
| | - Maya Genisa
- Biomedical Programme, Faculty of Pascasarjana, YARSI University, Jakarta 10510, Indonesia;
| | - Mohd Rosli Bin Yahya
- Oral & Maxillofacial Department, Hospital Raja Perempuan Zainab II, Kota Bharu 15586, Malaysia;
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Kamata M, Sakamoto Y, Ogata H, Sakamoto T, Ishii T, Kishi K. Influence of Lip Revision Surgery on Facial Growth in Patients With A Cleft Lip. J Craniofac Surg 2023; 34:1203-1206. [PMID: 36727767 DOI: 10.1097/scs.0000000000009191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/10/2022] [Indexed: 02/03/2023] Open
Abstract
Although patients with cleft lip and palate often present with poor maxillary growth because of intrinsic and iatrogenic factors, the surgical influence of lip revision surgery, palatal fistula repair, and pharyngeal flap procedures remains uncertain in contrast to that of primary cleft lip repair and palatoplasty. Therefore, this study aimed to reveal factors inhibiting maxillary growth and inducing later orthognathic surgery. A retrospective analysis was conducted on the data of patients with cleft lip and palate who underwent a series of treatments at Keio University Hospital from 1990 to 2000. We collected data on patient sex, cleft type, number and timing of lip revision surgery, the incidence of palatal fistulae, history of pharyngeal flap procedures, and timing of a repeat bone graft, and reviewed whether these patients underwent orthognathic surgery later in life. Multivariate analysis was conducted using binary logistic regression to extract factors affecting later orthognathic surgery. A total of 52 patients were included in this study. Results showed that revision surgery conducted more than twice was the highest statistically significant predictor of later orthognathic surgery in patients with a cleft lip and palate ( P <0.05, odds ratio=43.3), followed by palatal fistula occurrence after cleft palate repair ( P <0.05, odds ratio=22.3). Therefore, primary surgical procedure is most important for these patients.
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Affiliation(s)
- Masafumi Kamata
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo , Japan
| | - Yoshiaki Sakamoto
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo , Japan
| | | | - Teruo Sakamoto
- Department of Orthodontics, Tokyo Dental College, Chiba, Japan
| | - Takenobu Ishii
- Department of Orthodontics, Tokyo Dental College, Chiba, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo , Japan
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Assessment of craniofacial and dental characteristics in individuals with treacher collins syndrome. A review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:511-515. [DOI: 10.1016/j.jormas.2020.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/24/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022]
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Wong KWF, Keeling A, Achal K, Khambay B. Using three-dimensional average facial meshes to determine nasolabial soft tissue deformity in adult UCLP patients. Surgeon 2018; 17:19-27. [PMID: 29880431 DOI: 10.1016/j.surge.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/21/2018] [Accepted: 04/30/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE There is limited literature discussing the residual nasolabial deformity of adult patients prior to undergoing orthognathic surgery. The purpose of this study is to determine the site and severity of the residual nasolabial soft tissue deformity between adult unilateral cleft lip and palate (UCLP) patients and a non-cleft reference group, prior to orthognathic surgery. MATERIAL AND METHODS Sixteen adult male UCLP patients, who all received primary lip and palate surgery according to a standardised Hong Kong protocol were recruited for this study. Facial images of each individual were captured using three-dimensional (3D) stereophotogrammetry and compared to a previous published Hong Kong non-cleft reference group of 48 male adults. Using two-sample t-tests differences in linear and angular measurements and asymmetry scores were evaluated between the two groups. In addition a "conformed" average UCLP facial template was superimposed and compared to conformed average non-cleft reference group facial template. Reproducibility of the measurements were assessed using Students paired t-tests and coefficients of reliability. MAIN FINDINGS Significant differences in linear and angular measurements and asymmetry scores were observed between the two groups (p < 0.05). Adult UCLP patients showed significantly narrower nostril floor widths, longer columella length on the unaffected side, a wider nose, shorter cutaneous lip height, shorter upper lip length and shorter philtrum length. Prior to orthognathic surgery adult UCLP patients showed significantly more facial asymmetry. Superimposition of the average facial meshes clearly showed the site and severity of the deficiency in the x, y and z-directions. CONCLUSIONS Many of the nasolabial characteristics reported to be present in children following primary UCLP repair continue into adulthood. The detrimental soft tissue effects of orthognathic surgery for UCLP patients may be different to non-cleft individuals; and as such the site and severity of the residual deformity should be assessed prior to surgery.
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Affiliation(s)
- Ka Wai Frank Wong
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong
| | - Andrew Keeling
- School of Dentistry, University of Leeds, Worsley Building, Leeds LS2 9NL, UK
| | - Kulraj Achal
- School of Dentistry, University of Leeds, Worsley Building, Leeds LS2 9NL, UK
| | - Balvinder Khambay
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong; Institute of Clinical Sciences, College of Medical and Dental Sciences, The School of Dentistry, University of Birmingham, 5 Mill Pool Way, Edgbaston, Birmingham, B5 7EG, UK.
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Cleft-Related Orthognathic Surgery Based on Maxillary Vertical Lengthening of the Anterior Facial Height. Plast Reconstr Surg 2018; 141:736-746. [DOI: 10.1097/prs.0000000000004172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cobb AR, Green B, Gill D, Ayliffe P, Lloyd TW, Bulstrode N, Dunaway DJ. The surgical management of Treacher Collins syndrome. Br J Oral Maxillofac Surg 2014; 52:581-9. [DOI: 10.1016/j.bjoms.2014.02.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 02/11/2014] [Indexed: 02/07/2023]
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Scopelliti D, Fatone FMG, Cipriani O, Papi P. Simultaneous options for cleft secondary deformities. Ann Maxillofac Surg 2014; 3:173-7. [PMID: 24205478 PMCID: PMC3814667 DOI: 10.4103/2231-0746.119229] [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] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION So much has been written by so many about secondary procedures in cleft surgery that testify not only the complexity and variable expression of cleft deformity itself but also the need to find methods of primary surgery that will reduce, if not avoid, adverse effects on all the structures and functions involved and affected. It must be the principal aim of cleft surgeon to restore the deformed and displaced regional anatomy to as close to normality as possible, whether or not true hypoplasia exists. The pathogenesis of secondary deformities is related to specific features as: the presence of scar tissues into the cleft basal bone area, that inhibits alveolar growth; scarring of palatal soft tissue, that inhibits growth and causes palatal orientation of dentoalveolar elements; and the exceeding lip tension, that may inhibits maxillary growth along dentoalveolar structures. MATERIALS AND METHODS From 2008 to 2011 at the Department of Cranio-Maxillo-Facial Surgery, Santo Spirito Hospital, Rome 25 patients (21 males and 4 females) who had undergone previous surgery for unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) were enrolled in our study. Diagnosis of deformity was made by means of a cephalometric and photographic analysis (Arnett), gipsometry and a radiological assessment (orthopantomography, lateral and frontal cephalometric X-rays). Moreover, every patient was studied with a temporomandibular joint (TMJ) tomography, TMJ magnetic resonance imaging (MRI) and a computerized gnatography to better evaluate potential TMJ dysfunctions. The surgical procedures adopted simultaneously were: Total or segmental maxillomandibular osteotomies, genioplasty, rhinoplasty, labioplasty, and application of facial prosthesis. Every patient received a postoperative questionnaire to evaluate his/her satisfaction with the surgery performed. RESULTS The surgical procedures adopted were Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) in 16 patients (65%) and only Le Fort I osteotomy in 9 patients (35%). A relapse of malformation occurred in 4.5% of cases. Concerning the patient questionnaire, 96% of patients were satisfied with the jaw surgery and favorable for combined surgery, 88% were satisfied with lip-nose surgery, and finally 76% would advise to a friend. CONCLUSIONS Simultaneous correction of the deformities is indicated as to avoid several surgical distresses for the patient, to improve facial aesthetic and function in one surgical step, and to reduce risk of psychological consequences.
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Affiliation(s)
- Domenico Scopelliti
- Department of Cranio-Maxillo-Facial Surgery, Santo Spirito Hospital, Rome, Italy
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Verzé L, Bianchi FA, Ramieri G. Three-dimensional laser scanner evaluation of facial soft tissue changes after LeFort I advancement and rhinoplasty surgery: patients with cleft lip and palate vs patients with nonclefted maxillary retrognathic dysplasia (control group). Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 117:416-23. [PMID: 24630160 DOI: 10.1016/j.oooo.2013.12.406] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 11/12/2013] [Accepted: 12/17/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the differences in facial soft tissue changes, despite the same extent of upper jaw forward movement, between patients with unilateral cleft lip and palate (uCLP) and those without, after LeFort I osteotomy and secondary rhinoplasty. STUDY DESIGN Twelve patients with maxillary retrognathic dysplasia and nose deformity were divided in 2 groups, A (uCLP) and B (control), and compared on the basis of the same maxillary advancement. Cephalometry and 3D mean facial model of groups A and B were obtained before and after surgery. Linear and angular measurements were calculated. RESULTS Upper vermilion and alar base remained unchanged in group A but increased in group B. In both groups, symmetry of the nasal base was improved, and an increase of the sagittal projection of the lips was observed. CONCLUSIONS 3D analysis showed that surgical procedures for uCLP can provide a satisfactory aesthetic outcome, but some differences are evident in comparison with the control group.
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Affiliation(s)
- Laura Verzé
- Department of Public and Pediatric Health Sciences, Legal Medicine Section, University of Turin, Turin, Italy.
| | - Francesca Antonella Bianchi
- Department of Surgical Sciences, Maxillofacial Surgery Section, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Guglielmo Ramieri
- Department of Surgical Sciences, Maxillofacial Surgery Section, San Giovanni Battista Hospital, University of Turin, Turin, Italy
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Influence of the Primary Cleft Palate Closure on the Future Need for Orthognathic Surgery in Unilateral Cleft Lip and Palate Patients. J Craniofac Surg 2010; 21:1615-8. [DOI: 10.1097/scs.0b013e3181ef2eed] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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