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Pradubwong S, Paggasang Y, Pisek P, Winaikosol K, Jenwitheesuk K, Chowchuen B. Evaluation of nasolabial esthetics in 8- to 12-year-old patients with cleft lip and palate by healthcare professionals in Northeast Thailand. SAGE Open Med 2024; 12:20503121241260622. [PMID: 38887321 PMCID: PMC11181885 DOI: 10.1177/20503121241260622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024] Open
Abstract
Objective To assess the aesthetics of the nasolabial appearance of patients with cleft lip and palate aged 8-12 years by experienced and inexperienced professionals. Methods A cross-sectional study was conducted on 32 patients with cleft lip and palate, who underwent surgery and follow-up treatment at the Cleft Center. The research tools included a parent-completed survey providing GO graphic data and two-dimensional frontal view photographs of patients from both left and right sides. The aesthetic of the lip, nose, and nasolabial region was evaluated by an experienced and inexperienced medical professional team in groups of four individuals. In addition, data analysis was performed using descriptive statistics, mean values, standard deviations, Cronbach's alpha reliability coefficient, and the Wilcoxon signed-rank test. Results The average age of patients was 10.32 years, mainly male (65.63%), had unilateral cleft lip and palate (62.50%), and underwent bone grafting (96.88%). Regarding the assessment in three aspects, the aesthetic score assessed by experienced evaluators is fair level (2.64 ± 1.09) with an acceptable value of 0.73. In contrast, the inexperienced evaluator showed a high level (2.43 ± 0.83) with a high inter-rater reliability acceptable value of 0.60. Inexperienced evaluators showed higher scores for the lip and nasolabial region than experienced evaluators, which was statistically significant (p-values < 0.01). Conclusions The inexperienced evaluators showed significantly higher scores for appearance than experienced evaluators. This result can improve surgical techniques in future procedures to meet the needs of patients seeking lip and nasolabial appearance corrections across different age groups.
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Affiliation(s)
- Suteera Pradubwong
- Research Center of Cleft Lip-Cleft Palate and Craniofacial Deformities, Khon Kaen University in Association with Tawanchai Project, Khon Kaen University, Khon Kaen, Thailand
| | - Yupin Paggasang
- Division of Surgery, Faculty of Medicine, Surgical Nursing Department, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Poonsak Pisek
- Divisions of Orthodontics, Faculty of Dentistry, Department of Preventive Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Kengkart Winaikosol
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine, Department of Surgery, Khon Kaen University, Khon Kaen, Thailand
| | - Kamonwan Jenwitheesuk
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine, Department of Surgery, Khon Kaen University, Khon Kaen, Thailand
| | - Bowornsilp Chowchuen
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine, Department of Surgery, Khon Kaen University, Khon Kaen, Thailand
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Pan X, Huang L, Yang L, Gong Y, Liang Z, Gu M, Hu Z. Three-dimensional nasal asymmetry analysis between adolescence and adulthood in postoperative patients with unilateral cleft lip and palate using computed tomography. Odontology 2024; 112:630-639. [PMID: 37814147 DOI: 10.1007/s10266-023-00855-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/07/2023] [Indexed: 10/11/2023]
Abstract
AIM To investigate the differences of the nasal soft and hard tissue asymmetry in postoperative patients with unilateral cleft lip and palate (UCLP) between adolescence and adulthood, and to explore the correlation of nasal soft and hard tissue asymmetry. METHODS CT data from 47 repaired UCLP patients were included and divided into two groups:1. adolescent group: 23 patients (15 males, 8 females; age: 10-12 years old). 2. adult group: 24 patients (16 males, 8 females; age:18-32 years old). The three-dimensional asymmetry in nasal soft and hard tissues was analyzed. Additionally, the correlation between nasal soft and hard tissue asymmetry was also analyzed. RESULTS Both the adolescent group and adult group showed asymmetries in nasal soft and hard tissues. Compared to the adolescent group, the adult group had a significantly increased horizontal asymmetry of nasal soft tissues Sbal (P < 0.05). Furthermore, the sagittal asymmetry of soft tissue Glat (P < 0.05), Sbal (P < 0.001), Sni (P < 0.001) and hard tissue LPA (P < 0.05) also increased significantly. In the adult group, there were more landmarks with a correlation between the asymmetry of nasal hard tissue and soft tissue compared to the adolescent group. There were moderate to strong correlations between nasal hard and soft tissue symmetries in the horizontal and sagittal directions (0.444 < r < 764), but no correlation in the vertical direction in the adult group (P > 0.05). CONCLUSIONS The asymmetry of nasal soft and hard tissues in patients with repaired UCLP becomes more apparent in the horizontal and sagittal dimensions from adolescence to adulthood. The correlation between the asymmetry of nasal hard tissue and soft tissue becomes stronger in the horizontal and sagittal dimensions. These factors should be taken into account when performing treatment for repaired UCLP patients in adolescence and adulthood.
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Affiliation(s)
- Xuhong Pan
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China
| | - Le Huang
- Department of Stomatology, Shenzhen Luohu Hospital Group Luohu People's Hospital, Shenzhen, China
| | - Liang Yang
- Department of Stomatology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yingyu Gong
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China
| | - Zhigang Liang
- Department of Stomatology, Shenzhen Second People's Hospital, Shenzhen, China.
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | - Ziyang Hu
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China.
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Dindaroglu F, Dogan E, Dogan S. Is the Nasolabial Region Symmetric in Individuals With Cleft Lip and Palate? Cleft Palate Craniofac J 2024; 61:12-19. [PMID: 35912442 DOI: 10.1177/10556656221116535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the nasolabial symmetry in smile and resting position in individuals with nonsyndromic unilateral cleft lip and palate (UCLP) and compare with Class I individuals without cleft lip and palate (CLP). MATERIALS AND METHODS Frontal photographs of 40 individuals with UCLP (mean age 14.30 ± 0.25 years; 20 female, 20 male) and 40 skeletal Class I individuals without CLP (mean age 14.60 ± 0.34 years; 20 female and 20 male) were examined. Bland-Altman Levels of Agreements, Mann-Whitney U test, independent sample t-test were conducted, and intraclass correlation coefficients (ICCs) were calculated for statistical analysis. RESULTS Differences in the transverse lip distance (d-d') and vertical lip height at crista philtri (e-e') were lesser in the UCLP group at smile (P = .001; P = .005, respectively). When comparing the differences in these measurements at rest between control and UCLP groups, vertical lip height was longer at crista philtri (e-e') (P = .014), crista philtri was more laterally located (f-f') (P = .002), and the transverse lip distance was greater (d-d') (P = .004) in the UCLP group. Distance of the crista philtri to the midline of the face (f-f') (P = .007) were higher in the UCLP group during smiling compared to control group. CONCLUSIONS Nasolabial region asymmetry in smiling and rest position in individuals with UCLP was significantly different from the control group. However, the asymmetry in the nasolabial region, which is more evident in the resting position in individuals with UCLP, decreases during smiling.
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Affiliation(s)
- Furkan Dindaroglu
- Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey
| | - Ege Dogan
- Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey
| | - Servet Dogan
- Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey
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Peroz R, Hakelius M, Falk-Delgado A, Phua Y, Mani M. Patient Reported Outcome Following the Skoog Unilateral Cleft Lip Repair among Adults- a Long-Term Cohort Study and Comparison to a Non-cleft Population. Cleft Palate Craniofac J 2023:10556656231177139. [PMID: 37246371 DOI: 10.1177/10556656231177139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE The study primarily aimed to compare satisfaction with lip appearance among adults treated for unilateral cleft lip and palate (UCLP) with Skoog's primary lip repair procedure to those without clefts. The secondary aim was to determine whether satisfaction with lip appearance and the desire to change the lip/face appearance correlated with the number of secondary lip revisions performed. DESIGN Long-term follow-up. PATIENTS/SETTINGS All UCLP patients treated at the Uppsala University Hospital born between 1960- and 1987 (n = 109) were invited. At an average of 37 years following the primary lip repair, the participation rate was 76% (n = 83). A control group of adults without cleft (n = 67) completed the same study protocol for comparison. MAIN OUTCOME MEASURES Satisfaction with appearance was measured with The Satisfaction with Appearance Questionnaire (SWA) and a modified version of the Body Cathexis -Scale was used to assess the desire to change the lip and facial appearance. RESULTS UCLP patients were less satisfied with their lip, face, and overall appearance and reported a greater desire to change the appearance of their lips and face than non-cleft controls (p < 0.001). Dissatisfaction with lip appearance correlated to a greater willingness to change the appearance of the lip and face. No correlation was found between satisfaction with appearance and the number of the previously performed secondary lip revisions. CONCLUSION Adults treated for UCLP are less satisfied with the appearance of their lips compared to the non-cleft population. The number of secondary revisions does not necessarily correlate to greater satisfaction with lip appearance.
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Affiliation(s)
- Roshan Peroz
- Department of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Uppsala University and Uppsala university hospital, Uppsala, Sweden
| | - Malin Hakelius
- Department of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Uppsala University and Uppsala university hospital, Uppsala, Sweden
| | - Alberto Falk-Delgado
- Department of Plastic and Reconstructive Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Yun Phua
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, Brisbane, Australia
| | - Maria Mani
- Department of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Uppsala University and Uppsala university hospital, Uppsala, Sweden
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Guimarães LK, Gasparello GG, Pithon MM, Bark MJ, Mota Júnior SL, Tanaka OM. Visual perception of repaired cleft lip scarring face associated with different malocclusions via eye-tracking. J Dent Res Dent Clin Dent Prospects 2022; 16:45-52. [PMID: 35936939 PMCID: PMC9339742 DOI: 10.34172/joddd.2022.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/01/2022] [Indexed: 11/09/2022] Open
Abstract
Background. This study aimed to evaluate the visual facial perception in response to scars associated with repaired cleft lip (CL) on a male adolescent patient, as assessed via eye-tracking. Methods. Index of orthodontic treatment need (IOTN) malocclusions, grades 1, 5, and 8 were added to the frontal view facial image of an adolescent male model showing asymmetries of the nose and upper lip after CL surgery using the software Photoshop CS5® software. The eye movements of 91 laypeople observers were tracked by an Eye Tribe infrared sensor connected to OGAMA© software. A Kruskal–Wallis test was used to identify differences in total fixation time and time until the first fixation for the areas of interest. A visual analog scale (VAS) of attractiveness was also used in the study. Statistical analysis was performed adopting a significance level of P<0.05. Results. The area of interest (AOI) were found to be the mouth and teeth, which were more focused on gazed at than any other area, regardless of the grade of IOTN. For observers of different ages, there were significant differences in the time until the first fixation on the scar of the repaired CL region for IOTN grade 1 (P=0.007). Images showing IOTN grade 1 repaired CL regions received the highest VAS scores. The older the age, the greater the tendency to give a higher VAS score for the same malocclusion. Conclusion. The presence of a CL scar on the upper lip did not attract the eye of laypeople observers of different ages, regardless of the degree of malocclusion in the non-smile image. The age of the observers did influence the perception of attractiveness, with older observers giving higher scores than younger ones. As the severity of the malocclusion increased, they were found to be less attractive.
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Affiliation(s)
- Lara Karolina Guimarães
- Department of Orthodontics, Post-Graduation Program, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Gil Guilherme Gasparello
- Department of Orthodontics, Post-Graduation Program, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Matheus Melo Pithon
- Department of Orthodontics , Dental School, Southwest Bahia State University, Jequié, Bahia, Brazil
| | - Mohamad Jamal Bark
- Department of Orthodontics, Post-Graduation Program, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Sergio Luiz Mota Júnior
- Department of Orthodontics ,Dental School ,Juiz de Fora Federal University, Juiz de Fora, Minas Gerais, Brazil
| | - Orlando Motohiro Tanaka
- Department of Orthodontics, Post-Graduation Program, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Lips and noses in 10-year old patients with repaired complete unilateral clefts of lip, alveolus, and palate. A prospective three-centre study of the Baltic Cleft Network. J Craniomaxillofac Surg 2021; 50:246-253. [PMID: 34961665 DOI: 10.1016/j.jcms.2021.12.009] [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] [Received: 07/07/2020] [Revised: 11/06/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022] Open
Abstract
This multicenter study aimed at comparing different techniques of lip and nose repair with or without NAM and primary anterior rhinoplasty in pre-adolescent children. Patients with unilateral clefts of lip, alveolus, and palate who had undergone cleft lip and nose repair were evaluated in a prospective three-centre study using standardized monochromatic, cropped photographs. Four cleft surgeons evaluated the aesthetics of the central part of the face when the patients had reached age ten years. Seventy-six sets of photographs out of 87 patients were evaluated. The overall ratings of lips and noses did not differ much between centres. However, noses of centres 1 (mean 0.74; SD 0.57) and 2 (mean 0.76; SD 0.60) had been rated better than centre 3 (mean 1.32; SD 0.78; p = 0.0078), especially "Deformation of upper part of nostril rim or poor position of alar cartilage". Centre 3 had produced better looking scars (mean 0.33; SD 0.48); p = 0.0036. Within the limitations of the study it seems that NAM and primary anterior rhinoplasty including postoperative nasal stents should be performed whenever possible in order to achieve a favorable shape of the nose and to reduce the need for secondary corrective surgery.
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Molena K, Pinto LC, Dalben GS. The use of hyaluronic acid in individuals with cleft lip and palate: Literature review. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2021. [DOI: 10.4103/jclpca.jclpca_2_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Adetayo AM, Adetayo MO, Adeyemo WL, James OO, Adeyemi MO. Unilateral cleft lip: evaluation and comparison of treatment outcome with two surgical techniques based on qualitative (subject/guardian and professional) assessment. J Korean Assoc Oral Maxillofac Surg 2019; 45:141-151. [PMID: 31334102 PMCID: PMC6620301 DOI: 10.5125/jkaoms.2019.45.3.141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/25/2018] [Accepted: 10/16/2018] [Indexed: 11/07/2022] Open
Abstract
Objectives The outcomes of the treatment of unilateral cleft lip can vary considerably due to variations in repair techniques. The aim of this study was to evaluate and compare treatment outcomes of surgical repair of unilateral cleft lip using either the Tennison–Randall or Millard technique based on (qualitative) parent/subject and professional assessments. Materials and Methods This was a prospective, randomized, controlled study conducted at Lagos University Teaching Hospital between January 2013 and July 2014. A total of 56 subjects with unilateral cleft lip presenting for primary surgery who satisfied the inclusion criteria were recruited for the study. Subjects were randomly allocated to surgical groups A or B through balloting. Group A underwent cleft repair with the Tennison–Randall technique, while group B underwent cleft repair with the Millard rotation advancement technique. Surgical outcome was assessed using qualitative evaluation by the guardian/subject and independent assessors based on a modified form of the criteria described by Christofides and colleagues. Results Of the 56 subjects enrolled in this study, 32 were male, with a male to female ratio of 1.3:1. Fifteen of the guardians/subjects in the Tennison–Randall group were most bothered about the lower part of the residual lip scar, while 12 guardians/subjects in the in the Millard group were most bothered about the upper part of the scar. More noses were judged to be flattened in the Millard group than in the Tennison–Randall group. Assessors observed a striking disparity in scar transgression of the philtral ridges between the two groups. Conclusion Essentially, there were no major difference in the overall results between Millard rotation-advancement and Tennison–Randall repairs. Both Millard and Tennison–Randall's techniques require significant improvements to improve the appearance of the scar on the upper part and lower part of the lip, respectively.
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Affiliation(s)
- Adekunle Moses Adetayo
- Department of Surgery, Benjamin Carson School of Medicine, Babcock University, Ilishan-Remo, Nigeria.,Dental Unit, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | - Modupe Olushola Adetayo
- Department of Biochemistry, Benjamin Carson School of Medicine, Babcock University, Ilishan-Remo, Nigeria
| | - Wasiu Lanre Adeyemo
- Oral and Maxillofacial Surgery, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Olutayo O James
- Oral and Maxillofacial Surgery, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Michael O Adeyemi
- Oral and Maxillofacial Surgery, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Nigeria
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Nguyen VT, Nguyen T, Jagomägi T. Nasolabial aesthetics of patients with repaired unilateral cleft lip and palate: A comparison of three rating methods in two countries. J Craniomaxillofac Surg 2018; 46:1385-1389. [PMID: 29861405 DOI: 10.1016/j.jcms.2018.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/20/2018] [Accepted: 05/11/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The study aimed to compare nasolabial aesthetics of patients with unilateral cleft lip and palate (UCLP) treated in Vietnam and Estonia using three rating methods: five-point aesthetic index, a visual analogue scale (VAS), and reference scores method. METHODS A total of 56 patients with repaired UCLP (23 from Vietnam and 33 from Estonia) were included in this cross-sectional study. Patients' facial and profile photographs were cropped to reveal the nasolabial region and coded. Five examiners rated nasolabial aesthetics of the patients using three methods: five-point aesthetic index, 100 mm VAS, and reference scores method. Intraclass correlation coefficients were used to evaluate intrarater and interrater reliabilities. RESULTS The five-point aesthetic index had a higher reliability than VAS and reference scores method. The least aesthetic feature among Vietnamese and Estonian patients was nasal symmetry and nasolabial profile respectively. No differences in nasolabial aesthetics were found between Vietnamese and Estonian patients regardless of the rating methods (p > 0.05) except for nasal symmetry. CONCLUSIONS The five-point aesthetic index seems to produce more reproducible results. There were no significant differences in nasolabial aesthetics between the two countries. Overall average nasolabial appearance results were obtained using different treatment protocols in the two countries.
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Affiliation(s)
- Van Thai Nguyen
- Institute of Dentistry, University of Tartu, Raekoja Plats 6, Tartu, 51003, Estonia; Faculty of Odonto-Stomatology, Hue University of Medicine and Pharmacy, 6 Ngo Quyen, Hue, Viet Nam.
| | - Toai Nguyen
- Faculty of Odonto-Stomatology, Hue University of Medicine and Pharmacy, 6 Ngo Quyen, Hue, Viet Nam
| | - Triin Jagomägi
- Institute of Dentistry, University of Tartu, Raekoja Plats 6, Tartu, 51003, Estonia
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Ozawa TO, Reis LLS, Kato RM, Rocha DL, Sathler R, Garib DG. Facial and Nasolabial Aesthetics of Complete UCLP Submitted to 2-Stage Palate Repair With Vomer Flap. Cleft Palate Craniofac J 2018; 55:1211-1217. [PMID: 29652533 DOI: 10.1177/1055665618767418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the aesthetics of nasolabial appearance and facial profile of children with unilateral cleft lip and palate (UCLP) submitted to 2-stage palate repair with vomerine flap. DESIGN Retrospective. SETTING Single center. PATIENTS Forty patients with UCLP, mean age of 7.81 years of both sexes, rehabilitated at a single center by 1 plastic surgeon. INTERVENTIONS Lip and anterior palate repair with nasal alar repositioning was performed at 3 to 6 months of age by Millard technique and vomer flap, respectively. Posterior palate was repaired at 18 months by Von Langenbeck technique. MAIN OUTCOME MEASURE(S) Four cropped digital facial photographs of each patient were evaluated by 3 orthodontists to score the nasolabial aesthetics and profile. Frequencies of each score as well means and medians were calculated. Kappa test was used for evaluating inter- and intrarater reproducibility. RESULTS The nasal form and deviation was scored as good/very good in 70%, fair in 22.5%, and poor in 7.5% of the sample. The nasal-subnasal aesthetic was considered good/very good in 55%, fair in 30%, and poor in 15% of the sample. The lip vermilion border and the white part of surgical scar aesthetics were good/very good in 77.5% and 80%, fair in 17.5% for both categories, and poor in 5% and 2.5% of the cases, respectively. In all, 67.5% showed convex facial profile, 20% was straight, and 12.5% was concave profile. CONCLUSIONS Two-stage palatoplasty presented an adequate aesthetical results for the majority of patients with UCLP in the mixed dentition.
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Affiliation(s)
- Terumi Okada Ozawa
- 1 Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Luciana Lais Savero Reis
- 1 Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Renata Mayumi Kato
- 1 Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Diógenes Laercio Rocha
- 1 Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Renata Sathler
- 1 Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Daniela Gamba Garib
- 2 Department of Orthodontics, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
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Pietruski P, Majak M, Debski T, Antoszewski B. A novel computer system for the evaluation of nasolabial morphology, symmetry and aesthetics after cleft lip and palate treatment. Part 1: General concept and validation. J Craniomaxillofac Surg 2017; 45:491-504. [PMID: 28238558 DOI: 10.1016/j.jcms.2017.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 12/19/2016] [Accepted: 01/24/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The need for a widely accepted method suitable for a multicentre quantitative evaluation of facial aesthetics after surgical treatment of cleft lip and palate (CLP) has been emphasized for years. The aim of this study was to validate a novel computer system 'Analyse It Doc' (A.I.D.) as a tool for objective anthropometric analysis of the nasolabial region. MATERIALS AND METHODS An indirect anthropometric analysis of facial photographs was conducted with the A.I.D. system and Adobe Photoshop/ImageJ software. Intra-rater and inter-rater reliability and the time required for the analysis were estimated separately for each method and compared. RESULTS Analysis with A.I.D. system was nearly 10-fold faster than that with the reference evaluation method. The A.I.D. system provided strong inter-rater and intra-rater correlations for linear, angular and area measurements of the nasolabial region, as well as a significantly higher accuracy and reproducibility of angular measurements in submental view. No statistically significant inter-method differences were found for other measurements. CONCLUSIONS The hereby presented novel computer system is suitable for simple, time-efficient and reliable multicenter photogrammetric analyses of the nasolabial region in CLP patients and healthy subjects.
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Affiliation(s)
- Piotr Pietruski
- Department of Plastic and Reconstructive Surgery, Centre of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland.
| | - Marcin Majak
- Department of Systems and Computer Networks, Faculty of Electronics, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Tomasz Debski
- Department of Plastic and Reconstructive Surgery, Centre of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland
| | - Boguslaw Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Norbert Barlicki Memorial Hospital, Lodz, Poland
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Fudalej SA, Desmedt D, Bronkhorst E, Fudalej PS. Comparison of Three Methods of Rating Nasolabial Appearance in Cleft Lip and Palate. Cleft Palate Craniofac J 2017; 54:400-407. [PMID: 28140671 DOI: 10.1597/14-189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate which of three methods of rating nasolabial appearance-esthetic index, visual analogue scale (VAS), or numerical scale with reference photographs-is optimal. DESIGN Experimental study. SETTING Radboud University Medical Centre, The Netherlands and University of Bern, Switzerland. SUBJECTS AND METHODS Cropped photographs of 60 patients with complete unilateral cleft lip and palate (mean age = 10.8 years) were used for rating. A panel of eight raters rated four components of nasolabial morphology (nasal shape, nose deviation, vermillion border, and profile view) using three methods: 5-point esthetic index, 100 mm VAS, and 0 to 200 numerical scale with reference photographs (reference scores method). Method reliability was assessed by re-evaluation of 20 images after >1 month. Intraclass correlation coefficients were calculated to evaluate consistency of each method. RESULTS Overall reference scores method always produced more reproducible results (i.e., higher ICCs) than did VAS or the esthetic index. However, statistically significant differences were found between reference scores and esthetic index in rating nasal shape, nose deviation, and vermillion border only (P < 0.001, <0.001, and 0.012, respectively) and between reference scores and VAS in rating nose deviation and vermillion border (P < 0.001 and 0.017, respectively). CONCLUSION We recommend the use of reference photographs along with the VAS or numerical (from 0 to 200) semi-continuous scale. The esthetic index, based on a Likert-type scale, seems to produce the most variable results and, therefore, is not preferred.
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Li L, Liao L, Zhong Y, Li Y, Xiang L, Li W. Variation trends of the postoperative outcomes for unilateral cleft lip patients by modified Mohler and Tennison-Randall cheiloplasties. J Craniomaxillofac Surg 2016; 44:1786-1795. [PMID: 27720276 DOI: 10.1016/j.jcms.2016.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 07/18/2016] [Accepted: 08/31/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate postoperative variation trends of unilateral cleft lip by stages, and to analyze influential factors of nasolabial symmetry. MATERIALS AND METHODS A total of 145 patients with unilateral cleft lip were treated by the modified Mohler or Tennison-Randall technique, and received routine anti-scarring treatment postoperatively. Photogrammetry was applied to respectively measure 5 indices by stages preoperatively, the first week (1 w), the third month (3 m), the sixth month (6 m), and the first year (1 y) postoperatively. Then we calculated the symmetry ratio and drew line charts. Student t tests were used for any group differences; linear regression analysis was used to examine which postoperative stage correlated best with the preoperative stage; cluster analysis was used to classify the severity of the cleft according to preoperative SRsn-cphi, which was used to predict the operative difficulty and to select an appropriate technique. RESULTS The Mohler technique yielded a more symmetric result. With the Tennison-Randall technique, the alar base was more lateral and downward, and the lip height on cleft side seemed longer. A stable effect emerged around 1 year after surgery with both techniques. Conspicuous scars appeared at 3 months, most scars gradually fade at 6 months, and the total evolution took around 1 year. Scars from the Mohler technique fluctuated across a larger range. Preoperative SRsn-cphi of the two techniques had statistical significance and was adopted as the basis for cluster analysis. The critical value was 0.670. The Mohler technique attained an almost identical effect in each interval, whereas the Tennison-Randall technique was better in the interval that SRsn-cphi <0.670. CONCLUSIONS Preoperative SRsn-cphi can be the evaluation index of severity; the modified Mohler technique is more broadly applicable to differences in severity than is the Tennison-Randall technique.
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Affiliation(s)
- Liqi Li
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Lishu Liao
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Yuxiang Zhong
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Yuangui Li
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Li Xiang
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Wanshan Li
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China.
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Urbanova W, Klimova I, Brudnicki A, Polackova P, Kroupova D, Dubovska I, Rachwalski M, Fudalej PS. The Slav-cleft: A three-center study of the outcome of treatment of cleft lip and palate. Part 1: Craniofacial morphology. J Craniomaxillofac Surg 2016; 44:1767-1776. [PMID: 27663676 DOI: 10.1016/j.jcms.2016.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/25/2016] [Accepted: 06/10/2016] [Indexed: 11/26/2022] Open
Abstract
Results of a comparison of the outcomes of treatment of cleft lip and palate can be affected by growth characteristics of populations from which subjects with the clefts are derived. Moreover, conventional cephalometric techniques used in cleft studies for analysis of facial morphology provide only a partial description of shape and are confounded by biases regarding the reference structures. In this retrospective comparison, craniofacial morphology of preadolescent patients with unilateral cleft lip and palate treated in Warsaw (n = 35, age = 10.6 years, SD = 1.2), Prague (n = 38, age = 11.6 years, SD = 1.4), and Bratislava (n = 26, age = 10.5 years, SD = 1.6) were evaluated on cephalograms with the cephalometric method used in the Eurocleft study and geometric morphometrics. We found that patients treated in Warsaw showed slightly more favorable outcomes than in Prague and Bratislava. The differences were related primarily to the position of maxillary alveolar process, cranial base, mandibular angle, and soft tissues. Although no association between a component of treatment protocol and the outcome was found, it is possible that organizational factors such as participation of high-volume, experienced surgeons contributed to these results.
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Affiliation(s)
- Wanda Urbanova
- Department of Orthodontics and Cleft Anomalies, Dental Clinic, 3rd Medical Faculty, Charles University, Faculty Hospital Royal Vineard, Šrobárova 50, 100 34 Prague 10, Czech Republic
| | - Irena Klimova
- Cleft Center, Clinic of Plastic and Reconstructive Surgery, Comenius University, Pažítková ul. č. 4, 821 01 Bratislava, Slovakia
| | - Andrzej Brudnicki
- Department of Pediatric Surgery, Institute of Mother and Child, Kasprzaka Str. 17a, 01-211 Warsaw, Poland
| | - Petra Polackova
- Department of Orthodontics and Cleft Anomalies, Dental Clinic, 3rd Medical Faculty, Charles University, Faculty Hospital Royal Vineard, Šrobárova 50, 100 34 Prague 10, Czech Republic
| | - Daniela Kroupova
- Cleft Center, Clinic of Plastic and Reconstructive Surgery, Comenius University, Pažítková ul. č. 4, 821 01 Bratislava, Slovakia
| | - Ivana Dubovska
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacky University Olomouc, Palackého 12, 779 00 Olomouc, Czech Republic
| | - Martin Rachwalski
- Department of Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Straße 62, 50937 Köln, Germany
| | - Piotr Stanislaw Fudalej
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacky University Olomouc, Palackého 12, 779 00 Olomouc, Czech Republic; Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland.
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17
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Basal View Reference Photographs for Nasolabial Appearance Rating in Unilateral Cleft Lip and Palate. J Craniofac Surg 2016; 26:1548-50. [PMID: 26163840 DOI: 10.1097/scs.0000000000001846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The Asher-McDade system is a 5-point ordinal scale frequently used to rate the components of nasolabial appearance, including nasal form and nasal symmetry, in unilateral cleft lip and palate. Although reference photographs illustrating this scale have been identified for the frontal and right profile view, no reference photographs exist for the basal view. The aim of this study was to identify reference photographs for nasal form and nasal symmetry from the basal view to illustrate this scale and facilitate its use. Four raters assessed nasolabial appearance (form and symmetry) on basal view photographs of 50 children (average age 8 years) with a repaired cleft lip. Intraclass correlation coefficients show fair to moderate inter-rater reliability. Cronbach α indicated strong agreement between raters (0.77 nasal form; 0.78 nasal symmetry; 0.80 overall), along with low duplicate measurement error and strong internal consistency between the measures. The photographs with the highest agreement among raters were selected to illustrate each point on the 5-point scale for nasal form and for nasal symmetry, resulting in the selection of 10 reference photographs. The basal view reference photograph set developed from this study may complement existing reference photograph sets for other views and facilitate rating tasks.
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18
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Adeola AO, Oladimeji AA. Developing a visual rating chart for the esthetic outcome of unilateral cleft lip and palate repair. Ann Maxillofac Surg 2015; 5:55-61. [PMID: 26389035 PMCID: PMC4555950 DOI: 10.4103/2231-0746.161060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Aesthetic impairment is a major concern for the cleft lip/palate patient. Thus, auditing of postsurgical esthetic outcome needs to be further explored as till date no universally accepted protocol exists. The study objective was to propose a new visual rating chart (VRC) for the aesthetic outcome of cleft lip and palate (CLP) surgery. MATERIALS AND METHODS In a retrospective review of 200 repaired clefts, the common esthetic deficiencies were identified, categorized and ranked in the order of severity. A chart of the illustrative diagram with textual description of the defects was produced and used as a basis for rating outcome by two groups of raters (familiar raters and recruited raters). Intra- and inter-raters reliability was estimated using Cohen's kappa statistics and intra-class correlation coefficient (ICC). Comparison between mean group coefficient was achieved with Kendall's correlation coefficient of concordance. RESULTS The intra- and inter-rater reliability for familiar raters was found to be strong with kappa values range of 0.80-0.87 (P < 0.001). Similarly, inter-raters' reliability by recruited judges was very strong using ICC at both single (0.768) and average measures (0.982). CONCLUSION The VRC is a reliable tool for assessing the esthetic outcome of CLP repairs.
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Affiliation(s)
- A Olusanya Adeola
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
| | - A Akadiri Oladimeji
- Faculty of Dentistry, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
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19
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One-stage (Warsaw) and two-stage (Oslo) repair of unilateral cleft lip and palate: Craniofacial outcomes. J Craniomaxillofac Surg 2015; 43:1224-31. [DOI: 10.1016/j.jcms.2015.04.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/23/2022] Open
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Kocher K, Kowalski P, Kolokitha OE, Katsaros C, Fudalej PS. Judgment of Nasolabial Esthetics in Cleft Lip and Palate Is Not Influenced by Overall Facial Attractiveness. Cleft Palate Craniofac J 2015; 53:e45-52. [PMID: 25932752 DOI: 10.1597/14-019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine whether judgment of nasolabial esthetics in cleft lip and palate (CLP) is influenced by overall facial attractiveness. DESIGN Experimental study. SETTING University of Bern, Switzerland. SUBJECTS AND METHODS Seventy-two fused images (36 of boys, 36 of girls) were constructed. Each image comprised (1) the nasolabial region of a treated child with complete unilateral CLP (UCLP) and (2) the external facial features, i.e., the face with masked nasolabial region, of a noncleft child. Photographs of the nasolabial region of six boys and six girls with UCLP representing a wide range of esthetic outcomes, i.e., from very good to very poor appearance, were randomly chosen from a sample of 60 consecutively treated patients in whom nasolabial esthetics had been rated in a previous study. Photographs of external facial features of six boys and six girls without UCLP with various esthetics were randomly selected from patients' files. Eight lay raters evaluated the fused images using a 100-mm visual analogue scale. Method reliability was assessed by reevaluation of fused images after >1 month. A regression model was used to analyze which elements of facial esthetics influenced the perception of nasolabial appearance. RESULTS Method reliability was good. A regression analysis demonstrated that only the appearance of the nasolabial area affected the esthetic scores of fused images (coefficient = -11.44; P < .001; R(2) = 0.464). The appearance of the external facial features did not influence perceptions of fused images. CONCLUSION Cropping facial images for assessment of nasolabial appearance in CLP seems unnecessary. Instead, esthetic evaluation can be performed on images of full faces.
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Desmedt DJ, Maal TJ, Kuijpers MA, Bronkhorst EM, Kuijpers-Jagtman AM, Fudalej PS. Nasolabial symmetry and esthetics in cleft lip and palate: analysis of 3D facial images. Clin Oral Investig 2015; 19:1833-42. [PMID: 25802221 DOI: 10.1007/s00784-015-1445-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine the relationship between nasolabial symmetry and esthetics in subjects with orofacial clefts. MATERIAL AND METHODS Eighty-four subjects (mean age 10 years, standard deviation 1.5) with various types of nonsyndromic clefts were included: 11 had unilateral cleft lip (UCL); 30 had unilateral cleft lip and alveolus (UCLA); and 43 had unilateral cleft lip, alveolus, and palate (UCLAP). A 3D stereophotogrammetric image of the face was taken for each subject. Symmetry and esthetics were evaluated on cropped 3D facial images. The degree of asymmetry of the nasolabial area was calculated based on all 3D data points using a surface registration algorithm. Esthetic ratings of various elements of nasal morphology were performed by eight lay raters on a 100 mm visual analog scale. Statistical analysis included ANOVA tests and regression models. RESULTS Nasolabial asymmetry increased with growing severity of the cleft (p = 0.029). Overall, nasolabial appearance was affected by nasolabial asymmetry; subjects with more nasolabial asymmetry were judged as having a less esthetically pleasing nasolabial area (p < 0.001). However, the relationship between nasolabial symmetry and esthetics was relatively weak in subjects with UCLAP, in whom only vermilion border esthetics was associated with asymmetry. CONCLUSIONS Nasolabial symmetry assessed with 3D facial imaging can be used as an objective measure of treatment outcome in subjects with less severe cleft deformity. In subjects with more severe cleft types, other factors may play a decisive role. CLINICAL SIGNIFICANCE Assessment of nasolabial symmetry is a useful measure of treatment success in less severe cleft types.
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Affiliation(s)
- Dries J Desmedt
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas J Maal
- Department of Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mette A Kuijpers
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands.,Cleft Palate Craniofacial Unit, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department of Preventive and Curative Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands.,Cleft Palate Craniofacial Unit, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Piotr S Fudalej
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland. .,Department of Orthodontics, Palacky University Olomouc, Olomouc, Czech Republic.
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Ferrari Júnior FM, Ayub PV, Capelozza Filho L, Pereira Lauris JR, Garib DG. Esthetic evaluation of the facial profile in rehabilitated adults with complete bilateral cleft lip and palate. J Oral Maxillofac Surg 2014; 73:169.e1-6. [PMID: 25511967 DOI: 10.1016/j.joms.2014.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/16/2014] [Accepted: 09/16/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the facial esthetics of patients with complete bilateral cleft lip and palate, and to compare the judgment of raters related and unrelated to cleft care. MATERIALS AND METHODS The sample comprised 23 adult patients (7 women and 16 men) with a mean age of 26.1 years, rehabilitated at a single center. Standardized photographs of the right and left facial profile were taken of each patient and subjectively evaluated by 25 examiners: 5 orthodontists and 5 plastic surgeons with expertise in oral cleft rehabilitation, 5 orthodontists and 5 plastic surgeons without expertise in oral cleft rehabilitation, and 5 laypersons. The facial profiles were classified into 3 categories: esthetically unpleasant, esthetically acceptable, and esthetically pleasant. Intraexaminer and interexaminer agreements were evaluated with the Spearman correlation coefficient and Kendall coefficient of concordance. The differences between rater categories were analyzed using the Student-Newman-Keuls test (with P < .05 indicating a statistically significant difference). RESULTS Most of the sample was classified as esthetically acceptable. Orthodontists and plastic surgeons related to oral cleft rehabilitation gave the best scores to the facial profiles, followed by layperson examiners and by orthodontists and plastic surgeons unrelated to oral cleft rehabilitation. The middle third of the face, the nose, and the upper lip were frequently pointed out as contributors to the esthetic impairment. CONCLUSIONS The facial profile of rehabilitated adult patients with complete bilateral cleft lip and palate was considered esthetically acceptable because of morphologic limitations in the structures affected by the cleft. Laypersons and professionals unrelated to oral cleft rehabilitation seem to be more critical regarding facial esthetics than professionals involved with cleft rehabilitation.
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Affiliation(s)
- Flávio Mauro Ferrari Júnior
- Orthodontist, Private Practice, and Coordinator, Interceptive Orthodontics Course, Society for the Social Promotion of the Cleft Lip and Palate Patient, Bauru, São Paulo, Brazil.
| | - Priscila Vaz Ayub
- Masters Student, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | | | | | - Daniela Gamba Garib
- Associate Professor of Orthodontics, Hospital for Rehabilitation of Craniofacial Anomalies and Bauru Dental School, University of São Paulo, Bauru, Brazil
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23
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Paiva TS, Andre M, Paiva WS, Mattos BSC. Aesthetic evaluation of the nasolabial region in children with unilateral cleft lip and palate comparing expert versus nonexperience health professionals. BIOMED RESEARCH INTERNATIONAL 2014; 2014:460106. [PMID: 25126560 PMCID: PMC4122016 DOI: 10.1155/2014/460106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/26/2014] [Indexed: 11/26/2022]
Abstract
Esthetic evaluation of cleft lip and palate rehabilitation outcomes may assist in the determination of new surgical interventions and aid in reevaluation of treatment protocols. Our objective was to compare esthetics assessments of the nasolabial region in children with a unilateral cleft lip and palate between healthcare professionals who were experienced in the treatment of cleft lip and palate and those who were inexperienced. The study group included 55 patients between 6 and 12 years of age who had already undergone primary reconstructive surgery for unilateral cleft lip. Standardized digital photographs were obtained, and the esthetic features of the nose, lip, and nasolabial region were evaluated. We used only cropped photographic images in the assessments of healthcare professionals with and without experience in cleft lip and palate. Interrater analysis revealed highly reliable assessments made by both the experienced and inexperienced professionals. There was no statistically significant difference in the esthetic attractiveness of the lip and nose between the experienced and inexperienced professionals. Compared with the inexperienced professionals, the experienced professional evaluators showed higher satisfaction with the esthetic appearance of the nasolabial region; however, no difference was observed in the analysis of the lip or nose alone.
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Affiliation(s)
- Tatiana Saito Paiva
- Department of Maxillofacial Surgery, Prosthodontics, and Traumatology, Dentistry School, University of Sao Paulo, Alves Guimarães Street 470, 05410000 Sao Paulo, SP, Brazil
| | - Marcia Andre
- Department of Maxillofacial Surgery, Prosthodontics, and Traumatology, Dentistry School, University of Sao Paulo, Alves Guimarães Street 470, 05410000 Sao Paulo, SP, Brazil
| | - Wellingson Silva Paiva
- Department of Maxillofacial Surgery, Prosthodontics, and Traumatology, Dentistry School, University of Sao Paulo, Alves Guimarães Street 470, 05410000 Sao Paulo, SP, Brazil
| | - Beatriz Silva Camara Mattos
- Department of Maxillofacial Surgery, Prosthodontics, and Traumatology, Dentistry School, University of Sao Paulo, Alves Guimarães Street 470, 05410000 Sao Paulo, SP, Brazil
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Mercado AM, Phillips C, Vig KWL, Trotman CA. The effects of lip revision surgery on nasolabial esthetics in patients with cleft lip. Orthod Craniofac Res 2014; 17:216-25. [PMID: 24846148 DOI: 10.1111/ocr.12046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES 1) To determine the concordance among surgeons on subjective assessments of nasolabial esthetics in children with repaired cleft lip; and 2) to evaluate longitudinal changes in nasolabial esthetics in relation to cleft lip revision surgery. SETTING AND SAMPLE POPULATION School of Dentistry at University of North Carolina, Chapel Hill. Children with repaired unilateral cleft lip: 32 had lip revision surgery and 27 did not have surgery. MATERIALS AND METHODS Retrospective observational study from a non-randomized clinical trial. Ratings of nasolabial esthetics performed by six surgeons using the Asher-McDade scale at baseline and 12-month follow-up. RESULTS Concordance among surgeons ranged from poor to acceptable. Nasolabial ratings at follow-up were better in the Revision group than in the Non-Revision group, although differences were small. The most prevalent change in the Revision Group was improvement in one or more units on the scale, while 'no change' was most prevalent in the Non-Revision group. Participants in the Revision group were more likely to receive a 'no' in relation to the need for lip or nose revision at the follow-up visit. CONCLUSION There were mild esthetic improvements observed in relation to lip revision surgery, which should be interpreted with caution given the subjectivity of the rating method used.
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Affiliation(s)
- A M Mercado
- College of Dentistry, The Ohio State University, Columbus, OH, USA
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25
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Brudnicki A, Bronkhorst EM, Nada R, Dudkiewicz Z, Kaminek M, Katsaros C, Fudalej PS. Nasolabial appearance after two palatoplasty types in cleft lip and palate. Orthod Craniofac Res 2014; 17:124-31. [PMID: 24417872 DOI: 10.1111/ocr.12039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Facial appearance is important for normal psychosocial development in children with cleft lip and palate (CLP). There is conflicting evidence on how deficient maxillary growth may affect nasolabial esthetics. METHODS We retrospectively investigated nasolabial appearance in two groups, the Langenback (35 children; mean age 11.1 years; range: 7.9-13.6) and Vomerplasty (58 children; mean age 10.8 years; range: 7.8-14), who received unilateral CLP surgery by the same surgeon. The hard palate repair technique differed between the two groups. In the Langenback group, palatal bone on the non-cleft side only was left denuded, inducing scar formation and inhibiting maxillary growth. In the Vomerplasty group, a vomerplasty with tight closure of the soft tissues on the palate was applied. Thirteen lay judges rated nasolabial esthetics on photographs using a modified Asher-McDade's index. RESULTS Nasolabial esthetics in both groups was comparable (p > 0.1 for each nasolabial component). Inferior view was judged as the least esthetic component and demonstrated mean scores 3.18 (SD = 0.63) and 3.13 (SD = 0.47) in the Langenback and Vomerplasty groups, respectively. Mean scores for other components were from 2.52 (SD = 0.63) to 2.81 (SD = 0.62). Regression analysis showed that vomerplasty is related with slight improvement in the nasal profile only (coefficient B = -0.287; p = 0.043; R(2 ) = 0.096). CONCLUSIONS This study demonstrates that the use of vomerplasty instead of the Langenbeck technique is weakly associated with the nasolabial appearance among pre-adolescent patients with UCLP.
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Affiliation(s)
- A Brudnicki
- Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland
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26
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Chung EH, Borzabad-Farahani A, Yen SLK. Clinicians and laypeople assessment of facial attractiveness in patients with cleft lip and palate treated with LeFort I surgery or late maxillary protraction. Int J Pediatr Otorhinolaryngol 2013; 77:1446-50. [PMID: 23871270 PMCID: PMC3943337 DOI: 10.1016/j.ijporl.2013.05.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 05/28/2013] [Accepted: 05/31/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the changes in the facial attractiveness (FA) in two groups of cleft lip and palate patients with Class III malocclusions treated using LeFort I surgery or late maxillary protraction. MATERIALS AND METHODS Standardized pre- and post-treatment photographs were taken of 32 patients (17 corrected by orthognathic surgery and 17 by late maxillary protraction). The photographs were randomized and 42 clinicians and 121 laypeople rated them on a 10-point FA scale via a web-based survey. RESULTS Clinicians' mean FA values increased from 4.45 to 5.16 [95% CI of mean difference (MD), 0.59-0.82, p<0.001] in surgical cases and 4.84 to 5.30 (95% CI of MD, 0.35-0.56, p<0.001) in protraction cases. The laypeople mean FA values increased from 5.07 to 5.54 (95% CI of MD, 0.40-0.53, p<0.001) in surgical cases and 5.51 to 5.68 (95% CI of MD, 0.11-0.23, p<0.001) in protraction cases. When patients combined, laypeople rated FA 0.64 points higher (95% CI, 0.54-0.74, p<0.001) in pre-treatment and 0.38 points higher (95% CI, 0.27-0.48, p<0.05) in post-treatment relative to clinicians. CONCLUSION Both clinicians and laypeople perceived an improvement of FA after both treatments. Laypeople rated FA higher compared to clinicians.
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Affiliation(s)
- Eun Hee Chung
- Formerly, Pediatric Dentistry, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Ali Borzabad-Farahani
- Orthodontics, Warwick Dentistry, Warwick Medical School, University of Warwick, Coventry, UK; Formerly, Craniofacial Orthodontics, Children’s Hospital of Los Angeles; Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
| | - Stephen L-K Yen
- Craniofacial Orthodontics, Children’s Hospital of Los Angeles; Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
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Gkantidis N, Papamanou DA, Christou P, Topouzelis N. Aesthetic outcome of cleft lip and palate treatment. Perceptions of patients, families, and health professionals compared to the general public. J Craniomaxillofac Surg 2013; 41:e105-10. [PMID: 23287059 DOI: 10.1016/j.jcms.2012.11.034] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 11/20/2012] [Accepted: 11/21/2012] [Indexed: 10/27/2022] Open
Abstract
The aesthetic outcome of cleft treatment is of great importance due to its complex management and the psychosocial consequences of this defect. The aim of the study was to assess the aesthetic evaluations of patients following cleft surgery by various groups and investigate potential associations of the assessments with life quality parameters. Head photos of 12 adult patients with treated unilateral cleft lip and palate were evaluated by laypeople and professionals. A questionnaire was distributed and answered by the patients and their parents. Intra-panel agreement was high (α > 0.8) for laypeople and professionals. Between-groups agreement was high for both laypeople and professionals, but not when patients and/or parents were tested. Professionals, parents, and patients were more satisfied with patients' appearance than laypeople, although in general all groups were not highly satisfied. Low satisfaction with aesthetics correlated with increased self-reported influence of the cleft in the patients' social activity and professional life (0.56 < rho < 0.74, p < 0.05). These findings highlight the observed negative influence of the cleft on the patient's social activity and professional life and underline the need for the highest quality of surgical outcome for this group of patients.
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Affiliation(s)
- Nikolaos Gkantidis
- Department of Orthodontics and Dentofacial Orthopedics (Head: Prof. Dr. C. Katsaros), School of Dental Medicine, University of Bern, Switzerland.
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Mosmuller DGM, Griot JPWD, Bijnen CL, Niessen FB. Scoring systems of cleft-related facial deformities: a review of literature. Cleft Palate Craniofac J 2012; 50:286-96. [PMID: 23030761 DOI: 10.1597/11-207] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : There is a need for an internationally agreed objective method of assessing cleft-related deformities in order to compare the results of individual surgeons and different surgical techniques or to determine the optimal timing for primary lip closure. To assess the current methods, an overview of the recent developments in postoperative scoring systems of cleft-related deformities was made. Methods : A Medline search from June 2003 through July 2011 was conducted, and references in the selected articles were checked. This search yielded 428 articles, and after application of the inclusion and exclusion criteria, 40 articles were included in this review. Results : Twenty-five studies used two-dimensional (2D) photographs for the assessment of cleft-related deformities. Fourteen of these studies used a subjective method for the assessment and 11 performed anthropometric measurements. Good reliability has been found for subjective assessments and measurements from 2D photographs. Fifteen studies assessed three-dimensional (3D) imaging. Conclusions : Although there is a wide variety in study design, 3D imaging seems most reliable in assessing cleft-related facial deformities. However, scoring on 2D photographs is easier to perform and more applicable in daily practice because all cleft patients are photographed through the course of their treatment.
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Offert B, Janiszewska-Olszowska J, Dudkiewicz Z, Brudnicki A, Katsaros C, Fudalej PS. Facial esthetics in children with unilateral cleft lip and palate 3 years after alveolar bonegrafting combined with rhinoplasty between 2 and 4 years of age. Orthod Craniofac Res 2012; 16:36-43. [PMID: 23311658 DOI: 10.1111/ocr.12002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate facial esthetics in patients with unilateral cleft lip and palate (UCLP) after alveolar bone grafting combined with rhinoplasty between 2 and 4 years of age. DESIGN Retrospective case-control study. SETTING The Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland. MATERIAL AND METHODS Photographs of full faces and cropped images of five nasolabial components: nasal deviation, nasal form, nasal profile, vermillion border, and inferior view were assessed by 5 professional and 14 layraters in 29 children (23 boys and 6 girls; mean age = 5.3 years, SD 0.5; Early-grafted group) and 30 children (20 boys and 10 girls; mean age = 5.5 years, SD 1.0; Non-grafted group) with complete unilateral cleft lip and palate repaired with a one-stage closure. The groups differed regarding the timing of alveolar bone grafting: in the Early-grafted group, alveolar bone grafting in combination with rhinoplasty (ABG-R) was performed between 2 and 4 years of age (mean age = 2.3 years; SD 0.6); in the Non-grafted group, the alveolar defect was grafted after 9 years of age. No primary nose correction was carried out in any group. To rate esthetics, a modified five-grade esthetic index of Asher-McDade was used, where grade 1 means the most esthetic and grade 5 - the least esthetic outcome. RESULTS Esthetics of full faces and of all nasolabial elements in the Early-grafted group was significantly better than in Non-grafted group. The scores in the Early-grafted group ranged from 2.30 to 2.66 points, whereas in the Non-grafted group ranged from 2.66 to 3.17 points. All intergroup differences were statistically significant (p < 0.05). CONCLUSIONS Three years post-operatively, early alveolar bone grafting combined with rhinoplasty is favorable for facial esthetics in children with UCLP, but a longer follow-up is needed to assess whether the improvement was permanent.
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Affiliation(s)
- B Offert
- Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland
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Power SM, Matic DB. Critical analysis of consecutive unilateral cleft lip repairs: determining ideal sample size. Cleft Palate Craniofac J 2012; 50:144-9. [PMID: 22428541 DOI: 10.1597/11-104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : Cleft surgeons often show 10 consecutive lip repairs to reduce presentation bias, however the validity remains unknown. The purpose of this study is to determine the number of consecutive cases that represent average outcomes. Secondary objectives are to determine if outcomes correlate with cleft severity and to calculate interrater reliability. Design : Consecutive preoperative and 2-year postoperative photographs of the unilateral cleft lip-nose complex were randomized and evaluated by cleft surgeons. Parametric analysis was performed according to chronologic, consecutive order. The mean standard deviation over all raters enabled calculation of expected 95% confidence intervals around a mean tested for various sample sizes. Setting : Meeting of the American Cleft Palate-Craniofacial Association in 2009. Patients, Participants : Ten senior cleft surgeons evaluated 39 consecutive lip repairs. Main Outcome Measures : Preoperative severity and postoperative outcomes were evaluated using descriptive and quantitative scales. Results : Intraclass correlation coefficients for cleft severity and postoperative evaluations were 0.65 and 0.21, respectively. Outcomes did not correlate with cleft severity (P = .28). Calculations for 10 consecutive cases demonstrated wide 95% confidence intervals, spanning two points on both postoperative grading scales. Ninety-five percent confidence intervals narrowed within one qualitative grade (±0.30) and one point (±0.50) on the 10-point scale for 27 consecutive cases. Conclusions : Larger numbers of consecutive cases (n > 27) are increasingly representative of average results, but less practical in presentation format. Ten consecutive cases lack statistical support. Cleft surgeons showed low interrater reliability for postoperative assessments, which may reflect personal bias when evaluating another surgeon's results.
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Fudalej P, Katsaros C, Hozyasz K, Borstlap WA, Kuijpers-Jagtman AM. Nasolabial symmetry and aesthetics in children with complete unilateral cleft lip and palate. Br J Oral Maxillofac Surg 2012; 50:621-5. [PMID: 22245268 DOI: 10.1016/j.bjoms.2011.11.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 11/28/2011] [Indexed: 11/30/2022]
Abstract
The objective of this study was to evaluate the association between nasolabial symmetry and aesthetics in children with complete unilateral cleft lip and palate (CUCLP). Frontal and basal photographs of 60 consecutively treated children with CUCLP (cleft group: 41 boys and 19 girls, mean (SD) age 11 (2) years) and 44 children without clefts (control group: 16 boys and 28 girls, mean (SD) age 11(2) years), were used for evaluation of nasolabial symmetry and aesthetics. Nasal and labial measurements were made to calculate the coefficient of asymmetry (CA). The 5-grade aesthetic index described by Asher-McDade et al. was used to evaluate nasolabial appearance. Correlation and regression analysis were used to identify an association between aesthetics and CA, sex, and the presence of CUCLP. Ten measurements in the cleft, and 2 in the control, group differed significantly between the cleft and non-cleft (or right and left) sides, respectively. The significantly higher values of 9 of 11 CA in the children with CUCLP indicated that they had more asymmetrical nasolabial areas than children without clefts. However, the regression analyses showed that only a few CA were associated with nasolabial aesthetics. In conclusion, nasolabial aesthetics and nasolabial symmetry seem to be only weakly associated in patients with CUCLP.
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Affiliation(s)
- Piotr Fudalej
- Radboud University Nijmegen Medical Centre, Department of Orthodontics and Craniofacial Biology, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Paiva TS, Andre M. Evaluating aesthetics of the nasolabial region in children with cleft lip and palate: professional analysis and patient satisfaction. Patient Prefer Adherence 2012; 6:781-7. [PMID: 23152672 PMCID: PMC3496535 DOI: 10.2147/ppa.s36656] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cleft lip and palate is one of the most common deformities of the craniofacial region, and treatment of this deformity is essential for social reintegration. One of the major goals of surgery and treatment of craniofacial deformities is to improve the aesthetic appearance of the face, and thereby improve the patient's social acceptability. Here, we present a critical review of the criteria for aesthetic evaluation of the nasolabial region in cleft patients by assessing publications with the highest level of evidence, including professional evaluation, and patient satisfaction. The findings indicate treatment of this condition represents a major challenge for multidisciplinary team care.
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Affiliation(s)
- Tatiana Saito Paiva
- Correspondence: Tatiana Saito Paiva, Alves Guimaraes # 470, Apt 93, Sao Paulo, Brazil, 05410000, Tel +55 112 548 6900, Fax +55 112 548 6906, Email
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Fudalej P, Katsaros C, Dudkiewicz Z, Offert B, Piwowar W, Kuijpers M, Kuijpers-Jagtman AM. Dental arch relationships following palatoplasty for cleft lip and palate repair. J Dent Res 2011; 91:47-51. [PMID: 21984705 DOI: 10.1177/0022034511425674] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Palatal scarring is assumed to be a primary cause of facial growth derangement in cleft lip and palate. Evidence supporting this hypothesis is confounded by the clinical involvement of various surgeons, and therefore definitive conclusions are not possible. In this study, we investigated the dental arch relationship in two groups, Exposed (47 children; 11.2 yrs) and Unexposed (61 children; 11.2 yrs), with a unilateral cleft lip and palate operated on by the same surgeon. The technique of hard palate repair differed between the two groups. In the Exposed group, palatal bone of the non-cleft side only was left denuded, inducing scar formation. In the Unexposed group, a vomerplasty with tight closure of the soft tissues was applied. Three raters graded the dental arch relationship and palatal morphology using the EUROCRAN Index. The dental arch relationship in the Exposed group was less favorable than in the Unexposed group (p = 0.009). Palatal morphology in both groups was comparable (p = 0.323). This study demonstrates that reduction of denuded bony areas on the palate after palatal repair with a vomer flap had a favorable effect on the dental arch relationship. For palatal morphology, no effect of the type of palatal repair was found.
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Affiliation(s)
- P Fudalej
- Department of Orthodontics and Craniofacial Biology, Kasprzaka Str. 17a, Warsaw, Poland.
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Fudalej P, Janiszewska-Olszowska J, Wedrychowska-Szulc B, Katsaros C. Early alveolar bone grafting has a negative effect on maxillary dental arch dimensions of pre-school children with complete unilateral cleft lip and palate. Orthod Craniofac Res 2011; 14:51-7. [DOI: 10.1111/j.1601-6343.2011.01507.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Craniofacial morphology in complete unilateral cleft lip and palate patients consecutively treated with 1-stage repair of the cleft. J Craniofac Surg 2011; 21:1468-73. [PMID: 20856038 DOI: 10.1097/scs.0b013e3181ecc6c7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate the craniofacial morphology of children with a complete unilateral cleft lip and palate treated with a 1-stage simultaneous cleft repair performed in the first year of life. METHODS Cephalograms and extraoral profile photographs of 61 consecutively treated patients (42 boys, 19 girls) who had been operated on at 9.2 (SD, 2.0) months by a single experienced surgeon were analyzed at 11.4 (SD, 1.5) years. The noncleft control group comprised 81 children (43 boys and 38 girls) of the same ethnicity at the age of 10.4 (SD, 0.5) years. RESULTS In children with cleft, the maxilla and mandible were retrusive; the palatal and mandibular planes were more open, and sagittal maxillomandibular relationship was less favorable in comparison to noncleft control subjects. Soft tissues in patients with cleft reflected retrusive morphology of hard tissues--subnasal and supramental regions were less convex, profile was flatter, and nasolabial angle was more acute relative to those of the control subjects. CONCLUSIONS Craniofacial morphology after 1-stage repair was deviated in comparison with noncleft control subjects. However, the degree of deviation was comparable with that found after treatment with alternative surgical protocols.
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Mani MR, Semb G, Andlin-Sobocki A. Nasolabial appearance in adults with repaired unilateral cleft lip and palate: Relation between professional and lay rating and patients' satisfaction. J Plast Surg Hand Surg 2010; 44:191-8. [DOI: 10.3109/02844311.2010.499671] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gawrych E, Janiszewska-Olszowska J. Primary correction of nasal septal deformity in unilateral clefts during lip repair-a long-term study. Cleft Palate Craniofac J 2010; 48:293-300. [PMID: 20815730 DOI: 10.1597/09-112] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the long-term effect of primary septal correction carried out during lip closure on the nasal septum. MATERIALS, SUBJECTS, AND METHODS: Before primary septal correction was introduced, specimens from the septal cartilage and the anterior nasal spine of 10 deceased newborns and infants were analyzed with the aid of a light microscope to verify the presence of any growth zone. The study group comprised 91 children with unilateral clefts who had undergone primary lip repair with septal correction. The control group comprised 29 children with unilateral clefts operated on without primary septal correction. The appearance of the nasal septum was assessed on extraoral photographs in the second week of life and then 10 to 14 years postoperatively. RESULTS Morphologic examination revealed fibrous connective tissue with no signs of growth between the cartilaginous septum and bone. At long-term examination, the study group was found to have a nasal septum that was straight in 75 (83%), moderately deviated in 14 (15%), and severely deviated in two (2%) patients, whereas in the control group, the septum was considered straight in four (14%) children, moderately deviated in 11 (38%), and severely deviated in 14 (48%). CONCLUSIONS Primary septal correction may be considered safe because no growth zone exists between the septal cartilage and the anterior nasal spine. Careful primary nasal septal correction improves nose shape in a way that allows normal growth.
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