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Crins-de Koning M, Bruggink R, Nienhuijs M, Wagner T, Bronkhorst EM, Ongkosuwito EM. Three-dimensional analysis of facial morphology in nine-year-old children with different unilateral orofacial clefts compared to normative data. PeerJ 2025; 13:e18739. [PMID: 39866563 PMCID: PMC11758908 DOI: 10.7717/peerj.18739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 08/23/2024] [Accepted: 11/29/2024] [Indexed: 01/28/2025] Open
Abstract
Aim To compare three-dimensional (3D) facial morphology of various unilateral cleft subphenotypes at 9-years of age to normative data using a general face template and automatic landmarking. The secondary objective is to compare facial morphology of 9-year-old children with unilateral fusion to differentiation defects. Methods 3D facial stereophotogrammetric images of 9-year-old unilateral cleft patients were imported into 3DMedX® for processing. All images of patients with a right sided cleft were mirrored. A regionalized general facial template was used for standardization. This template was pre-aligned to each face using five automatically determined landmarks and fitted using MeshMonk. All cleft patients were compared to an age-and gender matched normative face using distance maps and inter-surface distances (mm). Average faces were created for five groups (unilateral cleft lip, alveolus, and/or palate (UCL/A/P), fusion and differentiation defects). The selected regions for the evaluation of facial morphology were: complete face, nose, upper lip, lower lip, chin, forehead, and cheeks. Results A total of 86 consecutive 3D-stereophotogrammetry images were acquired for examination. No statistically significant differences were observed among the UCL, UCLA, and UCLP groups for the complete face, cheeks, chin, forehead, lower lip, and nose. However, in the upper lip region a significant difference was observed between the UCLP and UCL groups (P = 0.004, CI [-2.93 to -0.48]). Further visual examination of the distance maps indicated that more severe clefts corresponded to increased retrusion in the midface and the tip of the nose, though these differences were not statistically significant across groups. For fusion vs differentiation defects, no statistically significant differences were observed, neither for the complete face nor for any of the individual regions. Conclusion The findings demonstrate statistically significant differences in the upper lip region between children with UCL and those with UCLP, particularly with greater upper lip retrusion in the UCLP group. The use of color-coded distance maps revealed local variations and a trend of asymmetry in the nasal region, with increasing retrusion of the nose tip, upper lip, and cheeks correlating with the severity of the cleft. Although these trends were not statistically significant, they suggest a progressive facial retrusion pattern as cleft severity increases. For the secondary objective, no statistical differences were found between the facial morphology of children with fusion and differentiation defects, although a similar progression of maxillary retrusion was observed in the distance maps.
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Affiliation(s)
- Marjolein Crins-de Koning
- Section of Orthodontics and Craniofacial Biology, Department of Dentistry, Radboud University Medical Center, Nijmegen, Netherlands
| | - Robin Bruggink
- Section of Orthodontics and Craniofacial Biology, Department of Dentistry, Radboud University Medical Center, Nijmegen, Netherlands
- Radboudumc 3D Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marloes Nienhuijs
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, Netherlands
- Amalia Cleft and Craniofacial Center, Radboud University Medical Center, Nijmegen, Netherlands
| | - Till Wagner
- Amalia Cleft and Craniofacial Center, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ewald M. Bronkhorst
- Department of Dentistry, Radboud University Medical Center, Nijmegen, Netherlands
| | - Edwin M. Ongkosuwito
- Section of Orthodontics and Craniofacial Biology, Department of Dentistry, Radboud University Medical Center, Nijmegen, Netherlands
- Amalia Cleft and Craniofacial Center, Radboud University Medical Center, Nijmegen, Netherlands
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Kauffmann P, Kolle J, Quast A, Wolfer S, Schminke B, Meyer-Marcotty P, Schliephake H. Effect of facial and nasolabial asymmetry on perceived facial esthetics in children with non-syndromic cleft lip and palate. Clin Oral Investig 2024; 28:449. [PMID: 39060480 PMCID: PMC11281991 DOI: 10.1007/s00784-024-05839-4] [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] [Academic Contribution Register] [Received: 11/02/2023] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE The aim of the present study was to objectively assess the degree of residual facial asymmetry after primary treatment of non-syndromic unilateral cleft lip and palate (UCLP) in children and to correlate it with subjective ratings of facial appearance. MATERIALS AND METHODS Stereophotometry was used to record the faces of 89 children with UCLP for comparison of cleft and non-cleft sides up to 5 years after primary cleft closure. Root mean square values were calculated to measure the difference between the shape of cleft and non-cleft sides of the face and were compared to controls without a cleft lip. The Asher-McDade Aesthetic Index (AMAI) was used for subjective rating of the nasolabial area through 12 laypersons. RESULTS Children with a cleft lip (CL) showed no significant difference in RMS values compared to controls. Significant differences occurred when the evaluation was limited to the nasolabial area, however only in patients with cleft lip alveolus (CLA) and cleft lip palate (CLAP)(p < 0.001). In contrast, subjective ratings showed significantly higher values for all three cleft severity groups (CL, CLA, CLAP) compared to controls (p < 0.001). There was a non-linear correlation between the RMS (root mean square) values and the AMAI score. CONCLUSIONS Even non-significant discrete objective deviations from facial symmetry in children after primary closure of UCLP are vigilantly registered in subjective ratings and implemented in the judgement of facial appearance. CLINICAL RELEVANCE 3D stereophotometry is a usefull tool in monitoring asymmetry in patients with a cleft.
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Affiliation(s)
- Philipp Kauffmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany.
| | - Johanna Kolle
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Anja Quast
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Susanne Wolfer
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Boris Schminke
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Meyer-Marcotty
- Department of Orthodontics, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Goettingen, Germany
| | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany
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Anishya D, Nagesh S. Assessment of Nasal Aesthetic Parameters in Patients with Unilateral Cleft Lip and Palate - A Retrospective Study. Cleft Palate Craniofac J 2024:10556656241261908. [PMID: 38860313 DOI: 10.1177/10556656241261908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES To assess and compare the deviating nasal cephalometric parameters of patients with unilateral cleft lip and palate (UCLP) with a control group. The study also aims to correlate the deviating cephalometric parameters with two aesthetic scoring systems. DESIGN A retrospective study. SETTING Dental college and hospital. PARTICIPANTS Pre-treatment lateral cephalograms and extra oral photographs of 20 adult patients with repaired UCLP presenting for orthodontic treatment. 20 patients with age and type of malocclusion matched control were selected. MAIN OUTCOME The nasal cephalometric parameters of patients with UCLP and a control group were compared. The nasolabial region of patients with cleft lip and palate (CLP) was scored using Asher McDade Aesthetic Index (AMAI) and Cleft Aesthetic Rating Scale (CARS). The scoring was done by six different groups assessors to study their perception of the nasolabial region. Correlation between cephalometric parameters and the aesthetic scores was done. RESULTS The study found significant differences in nasal length (P = .003) and depth (P < .001) between UCLP and the non-cleft control group. In the aesthetic assessment, orthodontist gave the least scores, while layman group scored the highest. The CARS nose aesthetic scores showed statistically significant high, negative correlation with the nasal length (P = .01). CONCLUSION The cephalometric parameters and the aesthetic indices can be aid the orthodontists in the assessment of nasolabial aesthetics and additionally refer for further definitive rhinoplasty to improve the patient's overall facial aesthetics.
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Affiliation(s)
- Daphane Anishya
- Department of Orthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Shweta Nagesh
- Department of Orthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
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Ongkosuwito EM, de Llano-Pérula MC, Dormaar T, Meazzini MC. Patient-centred oral cleft research. Orthod Craniofac Res 2024; 27 Suppl 1:4-5. [PMID: 38735026 DOI: 10.1111/ocr.12784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Edwin M Ongkosuwito
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands
- Expertise Center for Congenital Dental Malformations, Radboud University Medical Center, Nijmegen, The Netherlands
- Cleft and Craniofacial Anomalies, Radboud University Medical Center, Nijmegen, The Netherlands
- Orthodontics and Craniofacial Research
| | - Maria Cadenas de Llano-Pérula
- Service of Dentistry of University Hospitals Leuven, leuven, Belgium
- Department of Oral Health Sciences, Orthodontics of KU Leuven University, Belgium
- Research Unit of Orthodontics and Councillor of the Orthodontics Research Group of IADR
| | - Titiaan Dormaar
- Cleft and Craniofacial Anomalies, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria Costanza Meazzini
- Cleft Lip and Palate Regional Center, Smile House, Operation Smile, S.Paolo Hospital, Milano, Italy
- Department of Maxillo-Facial Surgery, S.Gerardo Hospital, Monza, Italy
- University of Milano, Italy
- European Society for Cleft Lip and Palate and Craniofacial Anomalies
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H AK, Batra P, Juneja A, Talwar A, Mohan S, Sood SC. 3-Dimensional Evaluation of Two PNAM Techniques (Modified Grayson & AlignerNAM) on Facial Soft Tissue Morphology: A Randomised Clinical Trial. Cleft Palate Craniofac J 2024:10556656241246923. [PMID: 38644766 DOI: 10.1177/10556656241246923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE Evaluate facial changes after Presurgical Naso-Alveolar Molding (PNAM) in unilateral cleft lip and palate (UCLP) patients treated with Modified Grayson Technique and AlignerNAM (with DynaCleft nasal elevator) using a 3D facial scan. DESIGN Randomised clinical trial. SETTING Institutional study. Participants: 20 UCLP patients allocated to two groups (10 patients each). INTERVENTIONS Group A patients underwent PNAM with Modified Grayson Technique and Group B patients underwent AlignerNAM (with DynaCleft nasal elevator). Their 3D facial scans were obtained by using an iOSbased application (Bellus3D FaceApp) mounted on a novel frame. These .stl files were analysed using 3D software (GOM INSPECT) at three-time intervals; before intervention (T0), after intervention (T1) and one month after lip repair surgery (T2). MAIN OUTCOME MEASURE(S) Changes in facial and nasolabial morphology. RESULTS Both techniques brought significant improvement in the columellar length, nasal tip projection, columella angle, nasal tip angle and a significant reduction in cleft width. At T1, a statistically significant difference in angular and linear measurements was present in both groups. At T2, no statistically significant difference in linear parameters was observed between the two groups except for the outer lateral height of the non-cleft side, basal lateral height of the non-cleft side, and philtrum width. Similar pattern was observed in angular measurements with no statistically significant difference between the two groups except in nasolabial angle, anterior nasal base triangle III, and anterior nasal root triangle. CONCLUSIONS Aligner NAM and Modified Grayson technique are equally effective PNAM methods with similar clinical results in nasolabial morphology after lip repair surgery.
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Affiliation(s)
- Alisha K H
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Puneet Batra
- Department of Orthodontics & Dentofacial Orthopaedics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Achint Juneja
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Aditya Talwar
- Department of Orthodontics & Dentofacial Orthopaedics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Stuti Mohan
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - S C Sood
- Smile Train Centre, Sant Paramanand Hospital, Delhi, Delhi, India
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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] [Academic Contribution 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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Chaikangwan I, Yodrabum N, Kusakunniran W, Tachavijijaru R, Aojanepong C. Utilization of images and three-dimensional custom-made nostril retainer fabricate for patients with cleft lip and cleft lip nose deformities at Siriraj Hospital: preliminary phase. Sci Rep 2023; 13:19109. [PMID: 37925587 PMCID: PMC10625571 DOI: 10.1038/s41598-023-46327-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 07/07/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023] Open
Abstract
A prospective study utilizing image analysis to assess nostril openings in post-operative patients with cleft lip and cleft lip nose deformities. This preliminary study seeks to employ two-dimensional (2D) images to fabricate a custom-made nostril retainer. This study was performed at Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand. This study included 30 healthy volunteers and 15 patients with cleft lip and cleft lip nose deformities. The nostril opening width and height for all participants were measured, and photographs were taken. An image analysis application was used to fabricate a three-dimensional (3D) custom-made nostril retainer. The mean differences between the direct measurements of the nostril aperture and the measurements obtained through the program did not exceed 2 mm in terms of nostril height, width, or columella. Two-dimensional photographs can be used to create a custom-made, three-dimensional nostril retainer. This retainer allows post-operative patients to maintain their nares without needing to visit the hospital, thereby reducing the cost of care.
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Affiliation(s)
- Irin Chaikangwan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Nutcha Yodrabum
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Worapan Kusakunniran
- Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Rachata Tachavijijaru
- Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Chongdee Aojanepong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
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Duggal I, Talwar A, Duggal R, Chaudhari PK, Samrit V. Comparative evaluation of nasolabial appearance of unilateral cleft lip and palate patients by professional, patient and layperson using 2 aesthetic scoring systems: A cross sectional study. Orthod Craniofac Res 2023; 26:660-666. [PMID: 37061872 DOI: 10.1111/ocr.12663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 11/23/2022] [Revised: 02/20/2023] [Accepted: 04/02/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVE To compare the perspective of healthcare providers (orthodontists), cleft patients and laypersons in judging nasolabial aesthetics in patients with complete unilateral cleft lip, with or without cleft palate (UCL ± P) using 2 scoring systems. DESIGN This cross-sectional study was conducted in a tertiary care government hospital. PATIENTS Photographic records of 100 patients with complete UCL ± P from the age group of 5-18 years (mean age-12.2 ± 3.93 years) were included in this study. METHOD Photographic records of 100 patients with complete UCL ± P from the age group of 5-18 years were included. A panel of 3 orthodontists, 3 laypersons and 3 cleft patients rated nasolabial aesthetics using 2 scoring systems i.e. Asher-McDade index (AMAI) and Cleft Aesthetic Rating Scale (CARS). Spearman's split-half reliability, Intra-class correlation coefficient and Cronbach's alpha were computed to measure internal consistency and reliability. Inter-panel agreement between pair of groups was determined by means of Spearman correlation coefficient. RESULTS Estimated reliability of CARS for 3 raters in each panel was in moderate agreement for orthodontists and cleft patients (0.849 and 0.810). Good repeatability and agreement were recorded with moderate to high intra-panel reliability for all parameters of both AMAI and CARS. Overall inter-panel agreement was moderate for both AMAI and CARS. Pair-wise inter-panel agreement showed a moderately positive correlation in both scales (AMAI and CARS) by cleft patients and professionals. CONCLUSION CARS index can be reliably used for assessment of nasolabial aesthetics by cleft patients, professionals and lay persons on 2D facial photographs. Patients were more critical than clinicians and laypersons using both indices (CARS and AMAI) as they are more self-aware and conscious. Thus, a clear communication between clinician and patient regarding expectations, perception and satisfaction with surgical results is strongly recommended.
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Affiliation(s)
- Isha Duggal
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Talwar
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Duggal
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Kumar Chaudhari
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vilas Samrit
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Kluge J, Bruggink R, Pandis N, Unkovskiy A, Jost-Brinkmann PG, Kuijpers-Jagtman AM, Bartzela T. Longitudinal Three-Dimensional Stereophotogrammetric Growth Analysis in Infants with Unilateral Cleft Lip and Palate from 3 to 12 Months of Age. J Clin Med 2023; 12:6432. [PMID: 37892569 PMCID: PMC10607132 DOI: 10.3390/jcm12206432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/09/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
This longitudinal study aimed to evaluate facial growth and soft tissue changes in infants with complete unilateral cleft lip, alveolus, and palate (CUCLAP) at ages 3, 9, and 12 months. Using 3D images of 22 CUCLAP infants, average faces and distance maps for the entire face and specific regions were created. Color-coded maps highlighted more significant soft tissue changes from 3 to 9 months than from 9 to 12 months. The first interval showed substantial growth in the entire face, particularly in the forehead, eyes, lower lip, chin, and cheeks (p < 0.001), while the second interval exhibited no significant growth. This study provides insights into facial soft tissue growth in CUCLAP infants during critical developmental stages, emphasizing substantial improvements between 3 and 9 months, mainly in the chin, lower lip, and forehead. However, uneven growth occurred in the upper lip, philtrum, and nostrils throughout both intervals, with an overall decline in growth from 9 to 12 months. These findings underscore the dynamic nature of soft tissue growth in CUCLAP patients, highlighting the need to consider these patterns in treatment planning. Future research should explore the underlying factors and develop customized treatment interventions for enhanced facial aesthetics and function in this population.
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Affiliation(s)
- Jennifer Kluge
- Department of Orthodontics and Dentofacial Orthopedics, Center for Oral Health Sciences CC3, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany; (A.U.); (P.-G.J.-B.)
| | - Robin Bruggink
- Radboudumc 3D Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, Medical Faculty, University of Bern, Freiburgstraße 7, 3010 Bern, Switzerland (A.M.K.-J.)
| | - Alexey Unkovskiy
- Department of Orthodontics and Dentofacial Orthopedics, Center for Oral Health Sciences CC3, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany; (A.U.); (P.-G.J.-B.)
- Department of Dental Surgery, Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya Street, 19c1, Moscow 119146, Russia
| | - Paul-Georg Jost-Brinkmann
- Department of Orthodontics and Dentofacial Orthopedics, Center for Oral Health Sciences CC3, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany; (A.U.); (P.-G.J.-B.)
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, Medical Faculty, University of Bern, Freiburgstraße 7, 3010 Bern, Switzerland (A.M.K.-J.)
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Faculty of Dentistry, Universitas Indonesia, Campus Salemba, Jalan Salemba Raya No. 4, Jakarta 10430, Indonesia
| | - Theodosia Bartzela
- Department of Orthodontics and Dentofacial Orthopedics, Center for Oral Health Sciences CC3, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany; (A.U.); (P.-G.J.-B.)
- Department of Orthodontics, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
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10
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Nicol M, de Boutray M, Captier G, Bigorre M. Primary cheilorhinoseptoplasty using the Talmant protocol in unilateral complete cleft lip: functional and aesthetic results on nasal correction and comparison with the Tennison-Malek protocol. Int J Oral Maxillofac Surg 2022; 51:1445-1453. [PMID: 35523693 DOI: 10.1016/j.ijom.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 10/14/2021] [Revised: 01/26/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
Many surgical procedures used to treat patients with unilateral complete cleft lip do not include a complete primary rhinoseptoplasty, which is delayed until the end of growth as part of secondary surgery. Primary cheilorhinoseptoplasty using the Talmant technique has been performed at Lapeyronie University Hospital, Montpellier for 15 years. This retrospective study evaluated and compared the functional and aesthetic results obtained in such patients at 4-6 years after surgery with those obtained without primary rhinoseptoplasty in patients undergoing the Tennison-Malek technique. This study included a cohort of 60 children who presented a unilateral complete cleft lip: 29 were operated on with the Tennison-Malek technique and 31 with the Talmant technique. Three functional and 14 aesthetic criteria were evaluated. All functional criteria showed better results in the Talmant group: nocturnal nasal breathing (P < 0.001), incidence of closed rhinolalia (P = 0.0019), and presence of asymmetric nasal breathing (P < 0.001). Concerning the aesthetic results, all criteria evaluated on the frontal and basal photographs of each patient showed significantly better results in the Talmant technique group. The rate of satisfactory results was> 75% for 12 of the 14 criteria in the Talmant group, compared with none of the 14 criteria in the Tennison-Malek group.
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Affiliation(s)
- Mickaël Nicol
- Department of Orthopaedic and Plastic Paediatric Surgery, Lapeyronie Hospital, Montpellier University School of Medicine, Montpellier, France.
| | - Marie de Boutray
- Department of Maxillofacial Surgery, Gui de Chauliac Hospital, Montpellier University School of Medicine, Montpellier, France
| | - Guillaume Captier
- Department of Orthopaedic and Plastic Paediatric Surgery, Lapeyronie Hospital, Montpellier University School of Medicine, Montpellier, France
| | - Michèle Bigorre
- Department of Orthopaedic and Plastic Paediatric Surgery, Lapeyronie Hospital, Montpellier University School of Medicine, Montpellier, France; Paediatric Plastic Surgery, Saint-Roch Private Clinic, Montpellier, France
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Stebel A, Urbanová W, Klimova I, Brudnicki A, Dubovska I, Polackova P, Kroupová D, Koťová M, Fudalej PS. The Slavcleft: a three-center study of the outcome of treatment of cleft lip and palate. Nasolabial appearance. PeerJ 2021; 9:e10631. [PMID: 33614265 PMCID: PMC7879938 DOI: 10.7717/peerj.10631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/02/2020] [Accepted: 12/01/2020] [Indexed: 11/20/2022] Open
Abstract
Background There is a multitude of protocols of treatment of cleft lip and palate (CLP) worldwide differing in number of operations, surgical techniques, and timings of surgeries. Despite, facial appearance in subjects with CLP is rarely ideal and residual stigmata are easy to notice in many patients irrespective of the protocol. The prospective controlled investigations are optimal for comparing effectiveness of treatment protocols. Because prospective studies are very challenging to perform in CLP field, it is reasonable to retrospectively assess different surgical protocols to identify the promising ones and then to test them in a prospective way. Methods Our objective was to assess the nasolabial appearance in a preadolescent Slavic population with unilateral cleft lip and palate (UCLP) by using the 0-200 numeric scale with reference photographs. Patients treated in Warsaw, Poland (n = 32), Prague, Czech Republic (n = 26) and Bratislava, Slovakia (n = 17) were included in this retrospective study. Each cleft center used a unique surgical protocol. Two panels of professional raters (n = 7) and laypeople (n = 10) scored blindly the nasolabial esthetics on cropped frontal and profile images with cropped reference photograph present on the same slide. Intra- and inter-rater agreement was assessed with Cronbach's alpha, intraclass correlation coefficients, t-tests, and Bland-Altman plots. Inter-group differences were evaluated with one-way ANOVA and regression analysis. Results The agreement within and between raters was acceptable. We found that patients treated in Warsaw, Prague, and Bratislava showed comparable nasolabial appearance on frontal and profile photographs when judged by both professional raters (p > 0.05) and laypeople (p > 0.05). Regression analysis did not identify influence of gender, group (i.e., Warsaw, Prague, and Bratislava), age at lip repair, surgeon, and age at photographic assessment on esthetic outcome (p > 0.05). Conclusion This study showed that none of the surgical protocols showed superiority to produce good nasolabial appearance.
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Affiliation(s)
- Adam Stebel
- Department of Maxillofacial Surgery, F. D. Roosevelt University Hospital, Banska Bystrica, Slovak Republic.,Department of Stomatology and Maxillofacial Surgery, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Wanda Urbanová
- Department of Orthodontics and Cleft Anomalies, Dental Clinic, 3rd Medical Faculty, Charles University, Faculty Hospital Royal Vineyard, Prague, Czech Republic
| | - Irena Klimova
- Clinic of Plastic and Reconstructive Surgery, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Andrzej Brudnicki
- Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland
| | - Ivana Dubovska
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Petra Polackova
- Department of Orthodontics and Cleft Anomalies, Dental Clinic, 3rd Medical Faculty, Charles University, Faculty Hospital Royal Vineyard, Prague, Czech Republic.,Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Daniela Kroupová
- Clinic of Plastic and Reconstructive Surgery, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Magdalena Koťová
- Department of Orthodontics and Cleft Anomalies, Dental Clinic, 3rd Medical Faculty, Charles University, Faculty Hospital Royal Vineyard, Prague, Czech Republic.,Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Piotr S Fudalej
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic.,Department of Orthodontics, Jagiellonian University Cracow, Krakow, Poland.,Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
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