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Goel A, Goel A. Optimal timing for plastic surgical procedures for common congenital anomalies: A review. World J Clin Pediatr 2024; 13:90583. [DOI: 10.5409/wjcp.v13.i2.90583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 06/07/2024] Open
Abstract
Apart from listening to the cry of a healthy newborn, it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to parents. The global incidence of children born with congenital anomalies has been reported to be 3%-6% with more than 90% of these occurring in low- and middle-income group countries. The exact percentages/total numbers of children requiring surgical treatment cannot be estimated for several reasons. These children are operated under several surgical disciplines, viz, paediatric-, plastic reconstructive, neuro-, cardiothoracic-, orthopaedic surgery etc. These conditions may be life-threatening, e.g., trachea-oesophageal fistula, critical pulmonary stenosis, etc. and require immediate surgical intervention. Some, e.g., hydrocephalus, may need intervention as soon as the patient is fit for surgery. Some, e.g., patent ductus arteriosus need ‘wait and watch’ policy up to a certain age in the hope of spontaneous recovery. Another extremely important category is that of patients where the operative intervention is done based on their age. Almost all the congenital anomalies coming under care of a plastic surgeon are operated as elective surgery (many as multiple stages of correction) at appropriate ages. There are advantages and disadvantages of intervention at different ages. In this article, we present a review of optimal timings, along with reasoning, for surgery of many of the common congenital anomalies which are treated by plastic surgeons. Obstetricians, paediatricians and general practitioners/family physicians, who most often are the first ones to come across such children, must know to guide the parents appropriately and convincingly impress upon the them as to why their child should not be operated immediately and also the consequences of too soon or too late.
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Affiliation(s)
| | - Arun Goel
- Department of Plastic Surgery, Lok Nayak Hospital and Associated Maulana Azad Medical College, New Delhi 110002, India
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Villarreal-Martínez K, Fierro-Serna V, Rosales-Berber MA, Alejandri-Gamboa V, Torre-Delgadillo G, Ruiz-Rodríguez S, Pozos-Guillén A, Garrocho-Rangel A. Digital nasoalveolar molding through presurgical orthopedics in newborns/infants with cleft lip and palate: A comprehensive review and case study. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38468150 DOI: 10.1111/scd.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/14/2024] [Accepted: 02/21/2024] [Indexed: 03/13/2024]
Abstract
AIMS This study aims to provide a comprehensive review and case study about the advantages and disadvantages of the application of digital technologies in presurgical orthopedics in newborns/infants with cleft lip and palate (CLCP). Positive changes in the nasal anatomy, maxillary arch, and cleft width could be achieved. METHODS Three representative cases of newborns/infants with CLCP were managed using the presurgical newborn/infant orthopedics (PSIO) approach. The patients were diagnosed and treated. Detailed descriptions of the impression procedures and PSIO appliance construction and placement were provided for each case. RESULTS Case 1 utilized traditional impression techniques, Case 2 employed a semi-digitalized approach with intraoral digital scanning, and Case 3 utilized a completely digitalized method for appliance construction. Positive changes in maxillary arch dimensions and cleft width reduction were observed in all cases. CONCLUSIONS The management of CLCP in newborns and infants poses a complex challenge with profound implications. The PSIO approach not only facilitates reconstructive surgery but also enhances overall quality of life. Digital tools, like specialized optical scanners and 3D printing, revolutionize the PSIO process, making it more efficient and patient-friendly. Clinical benefits include improved facial morphology, esthetics, feeding, speech, and optimized future surgical results. Despite ongoing efficacy debates, global adoption as the initial surgical approach underscores its value. The integration of digital technologies offers new hope for patients and families, promising a brighter future for those affected by this congenital condition.
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Affiliation(s)
- Katia Villarreal-Martínez
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, San Luis Potosi, Mexico
| | - Victor Fierro-Serna
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, San Luis Potosi, Mexico
| | - Miguel A Rosales-Berber
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, San Luis Potosi, Mexico
| | - Vanessa Alejandri-Gamboa
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, San Luis Potosi, Mexico
| | - Gabriela Torre-Delgadillo
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, San Luis Potosi, Mexico
| | - Socorro Ruiz-Rodríguez
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, San Luis Potosi, Mexico
| | - Amaury Pozos-Guillén
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, San Luis Potosi, Mexico
| | - Arturo Garrocho-Rangel
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, San Luis Potosi, Mexico
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Liao D, Pereira N, Obayemi A, Sclafani AP. Secondary Cleft Rhinoplasty. Facial Plast Surg Clin North Am 2024; 32:43-54. [PMID: 37981415 DOI: 10.1016/j.fsc.2023.06.003] [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] [Indexed: 11/21/2023]
Abstract
Secondary cleft rhinoplasty remains a challenging operation that requires an understanding of the aberrant anatomy in cleft lip nasal deformity as well as the ability to adapt various techniques suited to the needs of each patient. In this article, we review some of the classically described approaches in cleft rhinoplasty and different strategies to address the nasal subunits. Presurgical adjuncts, surgical interventions before facial skeletal maturity, and patient reported outcome measures are also discussed.
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Affiliation(s)
- David Liao
- Department of Otolaryngology, Weill Cornell Medicine, 1305 York Avenue, 5th Floor, New York, NY 10021, USA
| | - Nicola Pereira
- Department of Otolaryngology, Weill Cornell Medicine, 1305 York Avenue, 5th Floor, New York, NY 10021, USA
| | - Adetokunbo Obayemi
- Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Anthony P Sclafani
- Department of Otolaryngology, Weill Cornell Medicine, 1305 York Avenue, 5th Floor, New York, NY 10021, USA.
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Destrez A, Colin E, Testelin S, Devauchelle B, Dakpé S, Naudot M. Evaluation of a Granular Bone Substitute for Bone Regeneration Using an Optimized In Vivo Alveolar Cleft Model. Bioengineering (Basel) 2023; 10:1035. [PMID: 37760137 PMCID: PMC10525109 DOI: 10.3390/bioengineering10091035] [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: 07/21/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Alveolar cleft is a common congenital deformity that requires surgical intervention, notably using autologous bone grafts in young children. Bone substitutes, in combination with mesenchymal stem cells (MSCs), have shown promise in the repair of these defects. This study aimed to evaluate the regenerative capabilities of a granular bone substitute using an optimized alveolar cleft model. Thirty-six rats underwent a surgical procedure for the creation of a defect filled with a fragment of silicone. After 5 weeks, the silicone was removed and the biomaterial, with or without Wharton's jelly MSCs, was put into the defect, except for the control group. The rats underwent μCT scans immediately and after 4 and 8 weeks. Analyses showed a statistically significant improvement in bone regeneration in the two treatment groups compared with control at weeks 4 and 8, both for bone volume (94.64% ± 10.71% and 91.33% ± 13.30%, vs. 76.09% ± 7.99%) and mineral density (96.13% ± 24.19% and 93.01% ± 27.04%, vs. 51.64% ± 16.51%), but without having fully healed. This study validates our optimized alveolar cleft model in rats, but further work is needed to allow for the use of this granular bone substitute in the treatment of bone defects.
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Affiliation(s)
- Alban Destrez
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France; (A.D.); (S.T.); (B.D.); (S.D.); (M.N.)
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
| | - Emilien Colin
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France; (A.D.); (S.T.); (B.D.); (S.D.); (M.N.)
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
- Institut Faire Faces, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
| | - Sylvie Testelin
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France; (A.D.); (S.T.); (B.D.); (S.D.); (M.N.)
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
- Institut Faire Faces, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
| | - Bernard Devauchelle
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France; (A.D.); (S.T.); (B.D.); (S.D.); (M.N.)
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
- Institut Faire Faces, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
| | - Stéphanie Dakpé
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France; (A.D.); (S.T.); (B.D.); (S.D.); (M.N.)
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
- Institut Faire Faces, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
| | - Marie Naudot
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France; (A.D.); (S.T.); (B.D.); (S.D.); (M.N.)
- Institut Faire Faces, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
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Carter CB, Gallardo FF, Colburn HE, Schlieder DW. Novel Digital Workflow for Nasoalveolar Molding and Postoperative Nasal Stent for Infants With Cleft Lip and Palate. Cleft Palate Craniofac J 2023; 60:1176-1181. [PMID: 35477311 DOI: 10.1177/10556656221095393] [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: 11/15/2022] Open
Abstract
OBJECTIVE We present a novel digital workflow to provide presurgical infant orthopedic (PSIO) treatment for a patient with a unilateral cleft lip/palate utilizing nasoalveolar molding (NAM) and a custom postsurgical nasal stent. SETTING Within the US military healthcare system, the Joint Base San Antonio Craniofacial Anomalies Team utilizes dental scanners, predictive 3D modeling software, and 3D printing technology in a digital workflow for NAM appliance fabrication. WORKFLOW Soft tissue facial scanning, peri-oral scanning, and dental putty impressions are used to facilitate fabrication and measure outcomes. Digital modeling software and 3D resin printing are utilized to manufacture the prescribed devices. MAIN OUTCOME MEASURES AND RESULTS Extra-oral facial scans and intra-oral impressions are compared between 3 timepoints: pre-treatment, posttreatment with NAM, and postsurgical treatment. CONCLUSIONS The ability to share workflows, establish outcome standards, and streamline patient care will continue to advance best practices in digital PSIO.
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Affiliation(s)
- Chad B Carter
- Air Force Postgraduate Dental School and Uniformed Services University of the Health Sciences, Postgraduate Dental College, Joint Base San Antonio, Lackland Air Force Base, TX, USA
| | - Francisco F Gallardo
- Uniformed Services University of Health Sciences, Nellis Air Force Base, NV, USA
| | - Hannah E Colburn
- Uniformed Services University of Health Sciences, Joint Base San Antonio, Lackland Air Force Base, TX, USA
| | - Daniel W Schlieder
- Uniformed Services University of Health Sciences, Brooke Army Medical Center, TX, USA
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Hughes EB, Tatum SA. Current trends in unilateral cleft lip repair. Curr Opin Otolaryngol Head Neck Surg 2023:00020840-990000000-00065. [PMID: 37144507 DOI: 10.1097/moo.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The purpose of this review is to provide an in-depth look at the current perioperative and intraoperative practices for unilateral cleft lip repair. The contemporary literature reveals trends towards incorporation of curvilinear and geometric hybrid lip repairs. Perioperative practices are trending in new directions as well with the use of enhanced recovery after surgery (ERAS) protocols to reduce morbidity and length of stay, continued use of nasoalveolar molding, and a tendency to favor outpatient repair with more utilization of same day surgery centers. There is much room for growth, with new and exciting technologies on the horizon to improve upon cosmesis, functionality, and the operative experience.
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Affiliation(s)
- Evan B Hughes
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
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Ji Q, Tang J, Hu H, Chen J, Cen Y. Botulinum toxin type A for preventing and treating cleft lip scarring—— A Systematic Review and Meta‐analysis. J Cosmet Dermatol 2022; 21:2331-2337. [PMID: 35347825 DOI: 10.1111/jocd.14941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Qiang Ji
- Department of Burn and Plastic Surgery West China Hospital Sichuan University Guoxue Alley, Wuhou District Chengdu 610041 China
| | - Jun Tang
- Department of Burn and Plastic Surgery West China Hospital Sichuan University Guoxue Alley, Wuhou District Chengdu 610041 China
| | - Hua Hu
- Department of Burn and Plastic Surgery West China Hospital Sichuan University Guoxue Alley, Wuhou District Chengdu 610041 China
| | - Junjie Chen
- Department of Burn and Plastic Surgery West China Hospital Sichuan University Guoxue Alley, Wuhou District Chengdu 610041 China
| | - Ying Cen
- Department of Burn and Plastic Surgery West China Hospital Sichuan University Guoxue Alley, Wuhou District Chengdu 610041 China
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Long-Term Comparison of the Aesthetic Outcomes between Nasoalveolar Molding- and Non-Nasoalveolar Molding-Treated Patients with Unilateral Cleft Lip and Palate. Plast Reconstr Surg 2021; 148:775e-784e. [PMID: 34705782 DOI: 10.1097/prs.0000000000008463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The cleft lip-nose deformity in unilateral cleft lip and palate is one of the most challenging problem for surgeons to correct. Although nasoalveolar molding has been shown to be effective in improving presurgical symmetry in patients with complete unilateral cleft lip and palate, there is need for better evidence regarding the long-term nasolabial aesthetics of patients who have received this therapy. METHODS Thirty-eight patients treated with nasoalveolar molding and 48 patients not treated with nasoalveolar molding (but otherwise treated similarly) with unilateral cleft lip and palate were studied to assess and compare the nasolabial aesthetics. The objective evaluation of the nasal symmetry was performed on the basal view of two-dimensional photographs and the subjective nasolabial aesthetic evaluation was performed using the Asher-McDade scale. RESULTS At 5-year postoperative follow-up, nasoalveolar molding group patients had better mean values on the objective scores; however, these were not statically significant. The nasoalveolar molding group of patients had a statistically significant improvement in the subjective evaluation in comparison to the non-nasoalveolar molding-treated patients. The number of lip revisions was also statistically higher in the non-nasoalveolar molding-treated group of patients. CONCLUSIONS In this retrospective, single-center study, the authors found that at 5-year postoperative follow-up, nasoalveolar molding-treated patients had improved nasolabial aesthetics and fewer revision operations. These are, however, preliminary results and the patients will be followed up until the end of growth to assess the longer term effects of nasoalveolar molding on the nasolabial aesthetics in unilateral cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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de Souza PTDR, Gonçalves-Wilhelmsen NCV, Rosa RT, Correia CDFKN, Pereira TM, Kitahara ABP, Ignácio SA, Azevedo-Alanis LR, Rosa EAR. Oral Colonization and Virulence Factors of Candida spp. in Babies With Cleft Palate. Cleft Palate Craniofac J 2021; 59:1056-1063. [PMID: 34259068 DOI: 10.1177/10556656211030437] [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 examine oral colonization and virulence factors of Candida spp. in patients aged from 0 to 18 months with cleft palate (CP). MATERIALS AND METHODS Sixty babies were allocated into 3 groups: CP, CP with orthodontic plate (CPwP), and control group (Ctrl) without CP. Information on feeding habits, hygiene, and history of candidosis was collected. The presence of Candida spp. was investigated in samples of saliva. Fungal hydrophobicity, protease, esterase, phospholipase, and hemolysin were evaluated in a semiquantitative manner. RESULTS Positive oral isolations of Candida spp. were detected in CP (89.5%), CPwP (100%), and Ctrl (44%) groups. Candidosis was more reported in the cleft groups than in the Ctrl group (P ≤ .023). There was a higher prevalence of Candida albicans, followed by Candida krusei, Candida tropicalis, and Candida parapsilosis in all groups. There was no uniformity of expression of virulence factors, either among different species or among different groups. CONCLUSION Candida spp. colonization occurred in all groups, being superior in CPwP group. Candidosis episodes were more reported in patients from CPwP than in other groups, although candidosis was also registered in other groups. Candida albicans was the predominant species and virulence factors did not exhibit any pattern for species or groups of patients.
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Affiliation(s)
| | | | - Rosimeire Takaki Rosa
- Pontifical Catholic University from Paraná, School of Life Sciences, Curitiba, Paraná, Brazil
| | | | - Thais Munhoz Pereira
- Pontifical Catholic University from Paraná, School of Life Sciences, Curitiba, Paraná, Brazil
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Osorio CC, Escobar LM, González MC, Gamboa LF, Chambrone L. Evaluation of density, volume, height and rate of bone resorption of substitutes of autologous bone grafts for the repair of alveolar clefts in humans: A systematic review. Heliyon 2020; 6:e04646. [PMID: 32954025 PMCID: PMC7484540 DOI: 10.1016/j.heliyon.2020.e04646] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/14/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To assess clinical studies that compare synthetic or enriched natural materials to autologous osseous grafts among individuals with cleft lip and palate to determine which would be the substitute to autologous bone graft for alveolar cleft repair in humans. Materials and methods Randomized and controlled clinical trials on alveolar clefts treated with synthetic bone substitutes and autogenous bone grafts combined with osteoinductive factors compared with autogenous bone grafts alone (with ≥4-month follow-up and reporting clinical/radiographic data) were considered eligible. MEDLINE, EMBASE, and Central databases were searched for articles published until February 2020. Results Of 73 eligible articles, 15 were included. Some inductive factors along with iliac crest bone decreased bone reabsorption, preserved the generated bone height/width, and reduced the required autologous bone graft volume. Bone morphogenetic protein (BMP2) as an autologous bone graft substitute, demonstrated satisfactory alveolar defect healing, by avoiding autograft use. Many materials did not yield better outcomes than did autologous grafts; however, hydroxyapatite and collagen complex, hydroxyapatite agarose composite gel, acellular dermal matrix film, fibrin glue, platelet-rich plasma, and deproteinized bovine bone showed similar bone healing outcomes, being an alternative alveolar defect treatment. Conclusions BMP2, as an osteoinductive factor along with a synthetic matrix, yields satisfactory bone healing and avoids the need for autologous bone grafts. However, high-quality RCTs are necessary to determine the most effective and safe concentration and protocol of BMP2 utilization as a substitute for the autologous iliac crest bone grafting.
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Affiliation(s)
- Catalina Colorado Osorio
- Unit of Integral Management of Craniofacial Anomalies (UMIMC), School of Dentistry, Universidad El Bosque, Colombia
| | - Lina María Escobar
- Unit of Integral Management of Craniofacial Anomalies (UMIMC), School of Dentistry, Universidad El Bosque, Colombia
| | - María Clara González
- Unit of Integral Management of Craniofacial Anomalies (UMIMC), School of Dentistry, Universidad El Bosque, Colombia
| | - Luis Fernamdo Gamboa
- Unit of Integral Management of Craniofacial Anomalies (UMIMC), School of Dentistry, Universidad El Bosque, Colombia
| | - Leandro Chambrone
- Unit of Integral Management of Craniofacial Anomalies (UMIMC), School of Dentistry, Universidad El Bosque, Colombia.,Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Colombia
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Dalessandri D, Tonni I, Laffranchi L, Migliorati M, Isola G, Bonetti S, Visconti L, Paganelli C. Evaluation of a Digital Protocol for Pre-Surgical Orthopedic Treatment of Cleft Lip and Palate in Newborn Patients: A Pilot Study. Dent J (Basel) 2019; 7:E111. [PMID: 31835442 PMCID: PMC6960660 DOI: 10.3390/dj7040111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to evaluate the accuracy, invasiveness and impact on clinical results of a digital oral impression protocol in the pre-surgical orthopedic treatment (PSOT) of newborn cleft lip and palate (CLP) patients undergoing primary alveolar surgical repair. Six patients were divided, according to impression technique used, into a digital (intraoral scanner (IOS)) and a non-digital (tray and putty (T&P)) group. Parents considered IOS impressions to be less invasive, compared to T&P impressions. The clinician that took all the impressions considered the IOS to be less stressful compared to the T&P method. In two T&P patients, the impression was repeated because some important anatomical details were missing, in one case due to patient regurgitation during the first attempt. No impression was repeated, and any adverse event was reported in the IOS group. There were no significant differences between these two protocols in pre-surgical alveolar gap reduction and surgical challenge. The study results indicate that this digital protocol can accelerate the production process of the passive molding plate with an instantaneous transmission of the digital impression to the dental lab, maintaining the same accuracy level and clinical outcomes of classical techniques and reducing the invasiveness of impression taking, avoiding any risk of impression material ingestion or inhalation.
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Affiliation(s)
- Domenico Dalessandri
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (I.T.); (L.L.); (S.B.); (L.V.); (C.P.)
| | - Ingrid Tonni
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (I.T.); (L.L.); (S.B.); (L.V.); (C.P.)
| | - Laura Laffranchi
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (I.T.); (L.L.); (S.B.); (L.V.); (C.P.)
| | - Marco Migliorati
- Department of Orthodontics, School of Dentistry, University of Genova, Largo Rossana Benzi 10, 16132 Genova, Italy;
| | - Gaetano Isola
- School of Dentistry, Department of General Surgery and Medical and Surgical Specialties, University of Catania, Via S. Sofia 78, 95123 Catania, Italy;
| | - Stefano Bonetti
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (I.T.); (L.L.); (S.B.); (L.V.); (C.P.)
| | - Luca Visconti
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (I.T.); (L.L.); (S.B.); (L.V.); (C.P.)
| | - Corrado Paganelli
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (I.T.); (L.L.); (S.B.); (L.V.); (C.P.)
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Abstract
Orofacial clefts are common congenital malformations with genetic and environmental risk factors. In the perinatal period, feeding and nutrition can be a challenge and the need for specialized feeders is common. Lip taping and nasoalveolar molding are early interventions that can be used to preoperatively modify cleft defects to enhance surgical outcomes. Multiple techniques are available for repair of orofacial clefts and choice of technique depends on cleft extent and surgeon preference. After definitive repair, children remain at increased risk for middle ear disease, velopharyngeal dysfunction, and malocclusion and require ongoing follow-up with a multidisciplinary team.
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Effects of Nasoalveolar Molding Therapy on Alveolar and Palatal Cleft Deformities in Unilateral and Bilateral Cleft Lip and Palate. J Craniofac Surg 2018; 29:e179-e184. [PMID: 29381641 DOI: 10.1097/scs.0000000000004243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate and compare the efficacy of nasoalveolar molding (NAM) therapy in the improvement of alveolar and palatal cleft deformity on unilateral (UCLP) versus bilateral (BCLP) cleft lip and palate. MATERIALS AND METHODS A total of 19 UCLP (14 boys and 5 girls) and 8 BCLP (7 boys and 1 girl) infants completed NAM therapy were included in this study. Standardized parameters of cleft width of alveol and palate were measured on photocopies taken from the pre- and post-treatment plaster casts. To assess the intragroup differences, paired-samples test in UCLP and Wilcoxon test in BCLP groups were used. Mann-Whitney U test was used to evaluate the differences between the groups. RESULTS Significant decreases in alveolar and palatal cleft gaps were achieved in an average period of 3.3 ± 1.9 and 3.7 ± 1.6 months in UCLP and BCLP patients, respectively. The alveolar cleft decreased 7.85 ± 4.59 mm in UCLP and 4.25 ± 3.13 and 3.81 ± 3.50 mm in right and left alveolar cleft sides in BCLP, respectively. The palatal clefts were decreased 4.63 ± 2.44 mm in medial and 3.72 ± 2.62 mm in posterior parts in UCLP. The decrements in BCLP were 3.00 ± 2.75 mm in medial and 2.88 ± 2.75 mm in posterior palatal cleft distances. No significant differences were determined in the amount of alveolar or palatal cleft closure between UCLP and BCLP groups. The only decrease in arch width was 1.39 mm in medial part of palate in UCLP. CONCLUSION The NAM device provides significant decreases in both alveolar and palatal cleft deformities in UCLP and BCLP infants, as compared with their birth status.
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