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El Danaf AA, Al-Ahmady HH, Eldanaf HA, Soliman HA, Elhelw MH, Khalil MF, Rizk IA, Donia MS. Alveolar Oral Layer Repair by Periosteal Grafts versus Maxillary Flaps and Gingivoperiosteoplasty: Techniques and Follow-up to Adolescence. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5633. [PMID: 38415103 PMCID: PMC10898659 DOI: 10.1097/gox.0000000000005633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/09/2024] [Indexed: 02/29/2024]
Abstract
Background Alveolar periosteoplasty during primary repair of cleft lip is still a topic of debate due to the fear exacerbating maxillary retrusion. The authors present their experience with early closure of alveolar clefts. The study aims to analyze gingivoperiosteoplasty (GPP) by comparing the use of locoregional flaps versus distant grafts for reconstruction of the lower layer of the primary palate cleft. Methods Seventeen infants underwent 22 alveolar cleft repairs. After nasal floor repair by nasal mucoperiosteum, the oral layer was repaired by maxillary or gingival periosteal flaps in seven patients with alveolar clefts less than or equal to 6 mm wide, and tibial or pericranial periosteal grafts in 10 patients with wider clefts. At teenage years, crossbites in three flap-GPP and three graft-GPP patients were compared with nine older adolescents without primary GPP. Results Alveolar clefts were perfectly sealed. Radiographs during the early 3 postoperative years showed new bone formation more posteriorly extended in patients who underwent graft-GPP. Teeth eruption and alveolar rigidity at the mixed dentition age eliminated the need for secondary bone grafting. The anterior crossbites in adolescent patients ranged between -2 and -14 mm; crossing was relatively smaller in patients with a younger age and without cleft palate. The mean crossbite was 7.2 mm in the six teenagers and 9.6 mm in the control cases. Conclusions Graft-GPP may be a good alternative to flap-GPP, particularly for wide alveolar cleft repair. Maxillary retrusion is aggravated in patients with cleft palate and older age at assessment. GPP may not increase crossbite.
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Affiliation(s)
- Ahmed A. El Danaf
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Hatem H. Al-Ahmady
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Girls’ Branch, Al Azhar University, Cairo, Egypt
| | - Heba A. Eldanaf
- Restorative and Dental Materials Department, Oral and Dental Research Division, National Research Centre, Giza, Cairo, Egypt
| | - Helmy A. Soliman
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Moustafa H. Elhelw
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Maurice F. Khalil
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Ibrahim A. Rizk
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Mohamed S. Donia
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
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Chen X, Yu B, Wang Z, Li Q, Dai C, Wei J. Progress of Periosteal Osteogenesis: The Prospect of In Vivo Bioreactor. Orthop Surg 2022; 14:1930-1939. [PMID: 35794789 PMCID: PMC9483074 DOI: 10.1111/os.13325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/25/2022] [Accepted: 05/14/2022] [Indexed: 12/14/2022] Open
Abstract
Repairing large segment bone defects is still a clinical challenge. Bone tissue prefabrication shows great translational potentials and has been gradually accepted clinically. Existing bone reconstruction strategies, including autologous periosteal graft, allogeneic periosteal transplantation, xenogeneic periosteal transplantation, and periosteal cell tissue engineering, are all clinically valuable treatments and have made significant progress in research. Herein, we reviewed the research progress of these techniques and briefly explained the relationship among in vivo microenvironment, mechanical force, and periosteum osteogenesis. Moreover, we also highlighted the importance of the critical role of periosteum in osteogenesis and explained current challenges and future perspective.
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Affiliation(s)
- Xiaoxue Chen
- Department of Plastic and Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, Shanghai, China
| | - Baofu Yu
- Department of Plastic and Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, Shanghai, China
| | - Zi Wang
- Department of Plastic and Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, Shanghai, China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, Shanghai, China
| | - Chuanchang Dai
- Department of Plastic and Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, Shanghai, China
| | - Jiao Wei
- Department of Plastic and Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, Shanghai, China
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Functional Validation of a New Alginate-based Hydrogel Scaffold Combined with Mesenchymal Stem Cells in a Rat Hard Palate Cleft Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2743. [PMID: 32440413 PMCID: PMC7209877 DOI: 10.1097/gox.0000000000002743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/05/2020] [Indexed: 12/27/2022]
Abstract
Background: One of the major difficulties in cleft palate repair is the requirement for several surgical procedures and autologous bone grafting to form a bony bridge across the cleft defect. Engineered tissue, composed of a biomaterial scaffold and multipotent stem cells, may be a useful alternative for minimizing the non-negligible risk of donor site morbidity. The present study was designed to confirm the healing and osteogenic properties of a novel alginate-based hydrogel in palate repair. Methods: Matrix constructs, seeded with allogeneic bone marrow–derived mesenchymal stem cells (BM-MSCs) or not, were incorporated into a surgically created, critical-sized cleft palate defect in the rat. Control with no scaffold was also tested. Bone formation was assessed using microcomputed tomography at weeks 2, 4, 8, and 12 and a histologic analysis at week 12. Results: At 12 weeks, the proportion of bone filling associated with the use of hydrogel scaffold alone did not differ significantly from the values observed in the scaffold-free experiment (61.01% ± 5.288% versus 36.91% ± 5.132%; p = 0.1620). The addition of BM-MSCs stimulated bone formation not only at the margin of the defect but also in the center of the implant. Conclusions: In a relevant in vivo model of cleft palate in the rat, we confirmed the alginate-based hydrogel’s biocompatibility and real advantages for tissue healing. Addition of BM-MSCs stimulated bone formation in the center of the implant, demonstrating the new biomaterial’s potential for use as a bone substitute grafting material for cleft palate repair.
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Rieu-Chevreau C, Lavagen N, Gbaguidi C, Dakpé S, Klopp-Dutote N, Page C. Risk of occurrence and recurrence of otitis media with effusion in children suffering from cleft palate. Int J Pediatr Otorhinolaryngol 2019; 120:1-5. [PMID: 30735917 DOI: 10.1016/j.ijporl.2019.01.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Caroline Rieu-Chevreau
- Department of Otorhinolaryngology and Head & Neck Surgery, Amiens University Medical Center, Amiens, France
| | - Nolwenn Lavagen
- Department of Maxillofacial Surgery, Amiens University Medical Center, Amiens, France
| | - Cica Gbaguidi
- Department of Maxillofacial Surgery, Amiens University Medical Center, Amiens, France
| | - Stéphanie Dakpé
- Department of Maxillofacial Surgery, Amiens University Medical Center, Amiens, France
| | - Nathalie Klopp-Dutote
- Department of Otorhinolaryngology and Head & Neck Surgery, Amiens University Medical Center, Amiens, France
| | - Cyril Page
- Department of Otorhinolaryngology and Head & Neck Surgery, Amiens University Medical Center, Amiens, France.
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Electromyographic analysis of superior orbicularis oris muscle function in children surgically treated for unilateral complete cleft lip and palate. J Craniomaxillofac Surg 2017; 45:1547-1551. [PMID: 28736109 DOI: 10.1016/j.jcms.2017.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 05/17/2017] [Accepted: 06/27/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The aim of this study was to assess the electrical activity of the superior orbicularis oris muscle in children surgically treated for unilateral complete cleft lip and palate (UCCLP). MATERIAL AND METHODS The sample comprised 45 patients 6.38-12.68 years of age with UCCLP and 40 subjects 6.61-11.71 years of age with no clefts. Electromyographical (EMG) recordings were taken with a DAB-Bluetooth Instrument (Zebris Medical GmbH, Germany) in the rest position and during saliva swallowing, lip protrusion and reciprocal compression of the lips, as well as while producing the phonemes /p/, /b/, and /m/ combined with the vowel /a/. RESULTS The electrical activity of the upper lip during saliva swallowing and lip compression was significantly greater in the cleft group. Similar resting level activity was observed in both groups. During the production of the /p/, /b/, and /m/ phonemes combined with the vowel /a/ the results showed no significant differences in the EMG activity between children with UCCLP and noncleft subjects. CONCLUSION Patients with UCCLP have abnormal upper lip function characterized by increased activity of the superior orbicularis oris muscle during saliva swallowing and lip compression, and this may affect facial morphology.
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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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Xu X, Kwon HJ, Shi B, Zheng Q, Yin H, Li C. Influence of different palate repair protocols on facial growth in unilateral complete cleft lip and palate. J Craniomaxillofac Surg 2014; 43:43-7. [PMID: 25457468 DOI: 10.1016/j.jcms.2014.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/10/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To address the question of whether one- or two-stage palatal treatment protocol has fewer detrimental effects on craniofacial growth in patients aged 5 years with unilateral complete cleft lip and palate. MATERIALS AND METHODS Forty patients with non-syndromic unilateral complete cleft lip and palate (UCCLPs) who had received primary cleft lip repair at age 6-12 months and cleft palate repair at age 18-30 months were selected in this study. Eighteen UCCLP patients who received two-stage palate repair were selected as group 1, and 22 UCCLP patients who received one-stage palate repair were selected as group 2. The control group consisted of 20 patients with unilateral incomplete cleft lip (UICL patients) whose age and gender matched with UCCLP patients. A one-sample Kolmogorov-Smirnov test was used to analyze the nature of data distribution. Bonferroni test and Kruskal-Wallis H tests were used for multiple comparisons. RESULTS Both case groups showed reduced maxillary sagittal length (ANS-PMP, A-PM, p < 0.05) and retrusion of the maxilla (S-Ptm, p < 0.05), A point and ANS point (Ba-N-A, Ba-N-ANS, p < 0.05). Patients treated with two-stage palate repair had a reduced posterior maxillary vertical height (R-PMP, p < 0.05). CONCLUSIONS Our results indicated that maxillary sagittal length and position could be perturbed by both one- and two-stage palate repair. Vomer flap repair inhibited maxilla vertical growth. Delayed hard palate repair showed less detrimental effects on maxillary growth compared to early hard palate repair in UCCLP patients aged 5 years.
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Affiliation(s)
- Xue Xu
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, People's Republic of China.
| | - Hyuk-Jae Kwon
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, 120-752, Republic of Korea
| | - Bing Shi
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - Qian Zheng
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - Heng Yin
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - Chenghao Li
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, People's Republic of China.
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