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Lundberg J, Al-Taai N, Levring Jäghagen E, Ransjö M, Sjöström M. Skeletal stability after maxillary distraction osteogenesis or conventional Le Fort I osteotomy in patients with cleft lip and palate: A superimposition-based cephalometric analysis. Oral Maxillofac Surg 2024; 28:925-934. [PMID: 38363518 PMCID: PMC11144679 DOI: 10.1007/s10006-024-01227-0] [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: 12/07/2023] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE The aim was to assess skeletal stability after maxillary advancement using either distraction osteogenesis (DO) or conventional Le Fort I osteotomy (CO) in patients with cleft lip and palate (CLP) or cleft palate (CP) utilising a new superimposition-based cephalometric method. METHOD This retrospective study included patients who were treated with DO (N = 12) or CO (N = 9). Sagittal and vertical changes after surgery, and skeletal stability at 18 months post-operatively were assessed with superimposition-based cephalometry, comparing lateral cephalograms performed pre-operatively (T0), post-operatively after CO or immediately after completed distraction in DO (T1), and at 18 months of follow-up (T2). RESULTS The mean sagittal movements from T0 to T2 in the DO and CO groups were 5.9 mm and 2.2 mm, respectively, with a skeletal relapse rate of 16% in the DO group and 15% in the CO group between T1 and T2. The vertical mean movement from T0 to T2 in the DO and CO groups was 2.8 mm and 2.0 mm, respectively, and the skeletal relapse rate between T1 and T2 was 36% in the DO group and 32% in the CO group. CONCLUSION Sagittal advancement of the maxilla was stable, in contrast to the vertical downward movement, which showed more-extensive relapse in both groups. Despite more-extensive maxillary advancement in the DO group, the rates of skeletal relapse were similar.
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Affiliation(s)
- Joakim Lundberg
- Oral and Maxillofacial Surgery, Department of Odontology, Umeå University, 90185, Umeå, Sweden.
| | - Nameer Al-Taai
- Orthodontics, Department of Odontology, Umeå University, SE-90185 Umeå, Sweden and Hamdan Bin Mohammed College of Dental Medicine, MBRU University, Dubai, UAE
| | - Eva Levring Jäghagen
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, 90185, Umeå, Sweden
| | - Maria Ransjö
- Orthodontics, Department of Odontology, Umeå University, 90185, Umeå, Sweden
| | - Mats Sjöström
- Oral and Maxillofacial Surgery, Department of Odontology, Umeå University, 90185, Umeå, Sweden
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Chen PR, Kwon SH, Lo LJ, Chou PY. Three-Dimensional Comparative Changes in the Pharyngeal Airway of Patients with Cleft after Two-Jaw Orthognathic Surgery. Plast Reconstr Surg 2024; 153:971e-983e. [PMID: 37257149 DOI: 10.1097/prs.0000000000010782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The present study evaluated the three-dimensional changes of the pharyngeal airway after orthognathic surgery (OGS) in patients with unilateral and bilateral clefts, and in unilateral cleft patients with and without pharyngeal flap (PF). METHODS Forty-five patients with unilateral or bilateral clefts undergoing OGS were enrolled. Cone-beam computed tomographic images were obtained before and after OGS. We measured the pharyngeal airway volumes, minimal cross-sectional area, and the horizontal displacement of facial landmarks. RESULTS The patients with bilateral cleft exhibited smaller initial velopharyngeal volume (unilateral, 8623 mm 3 ; bilateral, 7781 mm 3 ; P = 0.211), whereas the velopharyngeal volume increased significantly with a median of 744 mm 3 after OGS ( P = 0.031). The median horizontal displacement of A point was 2.9 and 2.6 mm among the patients with unilateral and bilateral clefts, respectively ( P = 0.276), and the median horizontal displacement of B point was -2.9 and -3.3 mm among patients with unilateral and bilateral clefts, respectively ( P = 0.618). The unilateral cleft patients with PF exhibited lower initial velopharyngeal volume (patients with a history of PF surgery, 7582 mm 3 ; patients without a history of PF surgery, 8756 mm 3 ; P = 0.129) and a lower increase in velopharyngeal volume (patients with a history of PF surgery, 437 mm 3 ; patients without a history of PF surgery, 627 mm 3 ; P = 0.739) after OGS. CONCLUSIONS Midface hypoplasia and the decrease in the velopharyngeal volume were more prominent among the bilateral cleft patients and the unilateral cleft patients with PF. After OGS, the velopharyngeal volume increased considerably among the bilateral cleft patients, but no considerable differences were noted among the unilateral cleft patients with PF. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Pin-Ru Chen
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Soo-Ha Kwon
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Lun-Jou Lo
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Pang-Yun Chou
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
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Zaroni FM, Sales PHDH, Maffìa F, Scariot R. Complications of orthognathic surgery in patients with cleft lip and palate: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101795. [PMID: 38340958 DOI: 10.1016/j.jormas.2024.101795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Determine the main complications of orthognathic surgery in patients with cleft lip and palate. METHODS PubMed, LILACS, Cochrane, Embase, Scopus, and Google Scholar were systematically reviewed. Studies addressing the complications of orthognathic surgery in patients with cleft lip and palate were included. For the search, the strategy was used with the descriptors extracted from MeSH "Cleft Palate", "Orthognathic Surgery" and "Complications". The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in the included studies. Patients of any sex, age, and ethnicity with cleft lip and palate submitted to orthognathic surgery were included in this systematic review. The study followed the PRISMA 2020 standards and was registered in PROSPERO with protocol CRD42020195927. RESULTS In the initial search, 1090 articles were found and after applying the inclusion and exclusion criteria, eleven studies were selected. The sample consisted of 629 patients who underwent Orthognathic Surgery, with an average age of 21.52 years. The majority of patients (390) presented unilateral transforamen proposals. In total, 150 complications were identified in the included studies, the most frequent being relapse of movement with 77 cases (51.3 %). Other reported, but less frequent, complications were gingival recession with root exposure, premaxillary mobility, intraoperative hemorrhage, fistulas and infection and velopharyngeal impairment. Most included studies did not have a control group, making meta-analysis unfeasible. Seven of the included studies presented a low risk of bias according to the NOS. CONCLUSIONS Orthognathic surgery in cleft patients is a safe procedure, however it presents particularities and more complications when compared to a non-cleft patient. In this study, the most common complication found was the relapse, and the surgeon must be aware of this complication and others, and try to minimize its negative effects on the patient. We strongly recommend further investigations with detailed methodologies, control groups, well-described criteria for reported complications, and comprehensive sample characteristics to provide higher-quality evidence.
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Affiliation(s)
| | | | - Francesco Maffìa
- MD. Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Rafaela Scariot
- Department of Stomatology, Dental School, Federal University of Paraná, Curitiba, Brazil
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Grillo R, Borba AM, da Silva YS, Brozoski MA, Miloro M, Naclério-Homem MDG. Exploring the relationship between the number of systematic reviews and quality of evidence: an orthognathic surgery-based study. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:101-112. [PMID: 38155010 DOI: 10.1016/j.oooo.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE We analyzed the quality and quantity of systematic reviews (SRs) of orthognathic surgery, the most frequently published topic in maxillofacial surgery. STUDY DESIGN We searched the PubMed database for SRs of orthognathic surgery with no restriction on the language of publication date. We assessed the certainty of evidence presented according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and the Leiden Manifesto using the Grading of Recommendations Assessment, Development, and Evaluation approach. We analyzed the data using descriptive statistics, Pearson´s correlation test, and linear regression. RESULTS Of the 171 SRs evaluated, approximately one fifth presented evidence with a high level of certainty. The number of orthognathic surgery SRs has been increasing, and many SRs were published after very similar topics had already been published. There is no relationship between the impact factor and the certainty of evidence. CONCLUSIONS An excessive number of SRs of orthognathic surgery are published, and many SRs are superfluous, simply reporting previous findings. Clinicians should not base treatment decisions solely on the evidence presented in SRs, and journal editors and reviewers should evaluate these SRs more critically, particularly when they address topics that have already been covered in the literature.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Alexandre Meireles Borba
- Research Program in Integrated Dental Sciences Department, Faculty of Dentistry of the University of Cuiabá, Cuiabá-MT, Brazil
| | | | - Mariana Aparecida Brozoski
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
| | - Michael Miloro
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria da Graça Naclério-Homem
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
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Patil S, Basavaraddi SM, Revankar AV, Naik RD, Desai A, Kumar N, Naik B. Comparative Evaluation of Relapse After LeFort 1 Osteotomy in Cleft Palate and Non-cleft Individuals: A Longitudinal Study. Cureus 2024; 16:e52298. [PMID: 38357082 PMCID: PMC10865924 DOI: 10.7759/cureus.52298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE The aim of this study was to assess and compare the likelihood of relapse one year after LeFort I advancement surgery in patients with and without cleft lip and palate. METHODS A retrospective observational study which included two groups of participants who underwent LeFort I maxillary advancement was performed. Group 1 included 10 non-cleft subjects and Group 2 included 21 subjects with cleft palate. These maxillary deficient patients were chosen and operated using a technique where only a sagittal displacement was intended. Patients who underwent additional mandibular surgery, significant vertical or transverse alterations, or both were excluded. Pre-operative (T1), immediately post-operative (T2), and minimum one-year follow-up (T3) lateral cephalograms were studied for each group. Skeletal stability and dental stability after LeFort I surgery at a minimum of one-year follow-up in cleft palate and non-cleft patients were evaluated. RESULTS For the given sample size, relapse tendencies showed statistically significant differences between cleft palate patients and non-cleft palate patients after maxillary advancement. The sella nasion angle and horizontal overlap of the maxillary and mandibular incisors (overjet) decreased by 2 degrees and 0.9 mm respectively in the cleft palate group while decreasing by 1.10 degrees and 0.40 mm in the non-cleft group. CONCLUSIONS After maxillary advancement with LeFort I osteotomy and miniplate fixation in patients with cleft palate and non-cleft patients, some degree of relapse was detected in both groups for the given sample size after one year post-operatively. The cleft palate group displayed additional relapse tendencies when compared to the non-cleft group.
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Affiliation(s)
- Shruti Patil
- Department of Orthodontics and Dentofacial Orthopedics, Shri Dharmasthala Manjunatheshwara (SDM) College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, IND
| | - Shrinivas M Basavaraddi
- Department of Orthodontics and Dentofacial Orthopedics, Shri Dharmasthala Manjunatheshwara (SDM) College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, IND
| | - Ameet V Revankar
- Department of Orthodontics and Dentofacial Orthopedics, Shri Dharmasthala Manjunatheshwara (SDM) College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, IND
| | - Roopak D Naik
- Department of Orthodontics and Dentofacial Orthopedics, Shri Dharmasthala Manjunatheshwara (SDM) College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, IND
| | - Anil Desai
- Department of Oral and Maxillofacial Surgery, Shri Dharmasthala Manjunatheshwara (SDM) College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, IND
| | - Niranjan Kumar
- Department of Plastic Surgery, Shri Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, IND
| | - Balaram Naik
- Department of Conservative Dentistry and Endodontics, Shri Dharmasthala Manjunatheshwara (SDM) College of Dental sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, IND
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Richardson S, Sinai Khandeparker RV, Krishna S, Diwaker M. Cleft Maxillary Hypoplasia: Comparison of Techniques and Proposal of a Novel Treatment Protocol for Management. J Craniofac Surg 2023:00001665-990000000-01201. [PMID: 37973037 DOI: 10.1097/scs.0000000000009844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/30/2023] [Indexed: 11/19/2023] Open
Abstract
This study was designed to compare different techniques of managing cleft maxillary hypoplasia and to propose a treatment protocol taking patient's age of presentation, amount of maxillary hypoplasia, and presence/absence of velopharyngeal insufficiency (VPI) into consideration. Five treatment modalities, viz. facemask therapy (Group I), anterior maxillary distraction (Group II), total maxillary distraction osteogenesis using rigid external distraction devices (Group III) and internal distraction devices (Group IV), and conventional orthognathic surgery (Group V), were assessed retrospectively using lateral cephalograms (taken at 3 intervals) and speech records (studied pre- and post-operatively). The results were subjected to statistical analysis. A P value of less than 0.05 was considered statistically significant. The mean advancement achieved in groups I, II, III, IV, and V was 4.2±1.54, 9.03±2.62, 11.82±1.18, 10.41±1.42, and 7.24±2.44 mm, respectively. The mean horizontal relapse noted in Groups I, II, III, IV, and V was 2.3 mm (n=8), 2.1 mm (n=14), 3.4 mm (n=10), 1.4 mm (n=5), and 2.4 mm (n=24), respectively. Compared to other groups, group II had fewer patients exhibiting relapse, a statistically significant observation. Similarly, statistically significant improvement in speech outcomes was found only in group II compared to other groups. Based on the results, a treatment protocol was proposed. The authors conclude that the proposed protocol would enable surgeons to decide the most appropriate treatment modality paying attention to not only the age of presentation and amount of advancement but also presence/absence of VPI which is instrumental in deciding upon the most appropriate treatment.
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Affiliation(s)
- Sunil Richardson
- Department of Oral and Maxillofacial Surgery Richardson's Dental and Craniofacial Hospital, Parvathipuram, Nagercoil, Tamil Nadu, India
| | - Rakshit Vijay Sinai Khandeparker
- Department of Oral and Maxillofacial Surgery Richardson's Dental and Craniofacial Hospital, Parvathipuram, Nagercoil, Tamil Nadu, India
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, Calapor, India
| | - Shreya Krishna
- Department of Oral and Maxillofacial Surgery Richardson's Dental and Craniofacial Hospital, Parvathipuram, Nagercoil, Tamil Nadu, India
- Department of Dentistry Vimhans Nayati Super Specialty Hospital, New Delhi, India
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Yang IH, Kim H, Chung JH, Choi JY, Lee JH, Kim MJ, Kim S, Baek SH. Classification of Skeletal Phenotypes of Adult Patients With Cleft Skeletal Class III Malocclusion Using Principal Component Analysis and Cluster Analysis. J Craniofac Surg 2023; 34:2297-2301. [PMID: 37449576 DOI: 10.1097/scs.0000000000009549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 05/21/2023] [Indexed: 07/18/2023] Open
Abstract
The purpose of this study was to classify the skeletal phenotypes of adult patients with skeletal class III (C-III) malocclusion and unilateral or bilateral cleft lip and palate using principal component analysis and cluster analysis. The samples consisted of 81 adult C-III patients with cleft lip and palate (CLP) who underwent orthognathic surgery (OGS) or distraction osteogenesis (59 males and 22 females; 50 unilateral cleft lip and palate and 31 bilateral cleft lip and palate; mean age when lateral cephalograms were taken, 22.2±4.6 y). Thirteen angular and one ratio cephalometric variables were measured. Using 4 representative variables obtained from principal component analysis (SNA, SNB, Gonial angle, and Bjork sum), K-means cluster analysis was performed to classify the phenotypes. Then, statistical analysis was conducted to characterize the differences in the variables among the clusters. Five clusters were obtained from 3 groups: severely retrusive maxilla and moderately retrusive mandible group: cluster-1 (23.5%, severely hyperdivergent pattern), cluster-4 (27.2%, moderately hyperdivergent pattern), and cluster-5 (11.1%, normodivergent pattern); moderately retrusive maxilla and normal mandible group: cluster-2 (30.9%, normodivergent pattern); normal maxilla and moderately protrusive mandible group: cluster-3 (7.4%, normodivergent pattern). Although skeletal phenotypes were diverse, distribution of sex and cleft type did not differ among 5 clusters ( P >0.05). Sixty-two percent of cleft patients showed a severely retrusive maxilla and moderately retrusive mandible (cluster-1, cluster-4, and cluster-5), which indicated that these are the main cause of skeletal C-III malocclusion in CLP patients who were treated with OGS. Therefore, it is necessary to consider presurgical orthodontic treatment and surgical planning based on the skeletal phenotypes of CLP patients.
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Affiliation(s)
- Il-Hyung Yang
- Department of Orthodontics, School of Dentistry, Seoul National University
| | - Haeddeuri Kim
- Department of Orthodontics, Seoul National University Dental Hospital
| | - Jee Hyeok Chung
- Department of Plastic and Reconstructive Surgery, Seoul National University Children's Hospital
| | - Jin-Young Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University
| | - Jong-Ho Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University
| | | | - Sukwha Kim
- Department of Plastic Surgery, CHA Bundang Medical Center, Yatap-ro, Bundang-gu, Seong-nam, Gyeonggi-do
| | - Seung-Hak Baek
- Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Republic of Korea
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Srivastav S, Tewari N, Antonarakis GS, Duggal R, Saji S, Lokade AK, Yadav R. Evidence Mapping and Quality Analysis of Systematic Reviews on Various Aspects Related to Cleft Lip and Palate. J Clin Med 2023; 12:6002. [PMID: 37762942 PMCID: PMC10532364 DOI: 10.3390/jcm12186002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/30/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Management of cleft lip and palate is interdisciplinary. An evidence-mapping approach was envisaged to highlight the existing gaps in this field, using only the highest level of evidence. OBJECTIVES To conduct evidence mapping and quality analysis of systematic reviews and meta-analyses related to any aspect of cleft lip and palate. SEARCH METHODS The cleft lip and palate field was divided into 9 domains and 50 subdomains and a method of categorization of systematic reviews was established. A comprehensive search strategy was carried out in seven databases along with the search of gray literature and references of included articles. SELECTION CRITERIA Systematic reviews related to any aspect of cleft lip and palate, conducted by a minimum of two reviewers, with a comprehensive search strategy and adequate quality analysis were included. DATA COLLECTION AND ANALYSIS A self-designed, pre-piloted data-extraction sheet was used to collect information that was analyzed through an expert group discussion. Quality analysis was performed using ROBIS-I, AMSTAR 2, and the PRISMA checklist. RESULTS A total of 144 systematic reviews published between 2008 and 2022 were included. The largest number of these could be categorized in the therapeutic domain (n = 58). A total of 27% of the studies were categorized as inconclusive, 40% as partially conclusive, and 33% as conclusive. As per ROBIS-I, 77% of reviews had high risk of bias while 58% were graded as critically low in quality as per AMSTAR 2. The majority of systematic reviews showed low reporting errors. CONCLUSIONS The majority of systematic reviews related to cleft lip and palate relate to therapeutic and prognostic domains and show high risk of bias and critically low quality regardless of the source journal. The results of this paper might serve as a starting point encouraging authors to carry out high-quality research where evidence is lacking. REGISTRATION A multidisciplinary expert-group formulated an a priori protocol, registered in Open Science Framework (DOI 10.17605/OSF.IO/NQDV2).
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Affiliation(s)
- Sukeshana Srivastav
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, 8000 Aarhus, Denmark
- Division of Paediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Nitesh Tewari
- Division of Paediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Gregory S. Antonarakis
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Ritu Duggal
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Seba Saji
- Division of Paediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Amol Kumar Lokade
- Division of Paediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rahul Yadav
- Division of Oral and Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India
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Nys M, Bempt MVD, Shaheen E, Dormaar JT, Politis C. Three-dimensional planning accuracy and follow-up of Le Fort I osteotomy in cleft lip/palate patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101421. [PMID: 36764580 DOI: 10.1016/j.jormas.2023.101421] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES Our aim was to determine the accuracy of the three-dimensional (3D) virtual planning and stability of LeFort I osteotomy in cleft lip and/or palate patients (CLP) using a validated 3D method. MATERIALS AND METHODS Eight patients with a history of cleft lip/palate treated with LeFort I osteotomy for maxillary hypoplasia between January 2016 and April 2020 were included in this retrospective study. Three-dimensional virtual planning was performed using Proplan software then transferred to the operation theater via 3D printed occlusal wafers. The accuracy of the 3D planning and the 1-year stability of the maxilla were evaluated by means of a validated semiautomatic stepwise module in Amira software resulting into 3 linear measurements: anterior/posterior, medial/lateral, superior/inferior and 3 rotational measurements: pitch, roll, yaw. RESULTS The largest mean absolute difference (MAD) for accuracy assessment was found in the A/P direction (2.75mm±2.25 mm) and in pitch (3.23°±2.11°). For A/P translation, an error of >2 mm was observed in 5(62.5%), for S/I translation an error of >2 mm was observed in 4(50.0%) of the 8 patients, whereas for pitch 3 patients(37,5%) showed an error >4° At one year follow-up, the largest linear and rotational MAD was found in the A/P direction (1.20mm±0.92 mm) and in pitch (3.31°±2.31°). CONCLUSIONS Findings of this study show that 3D virtual computer-assisted orthognathic surgery enables an accurate repositioning of the hypoplastic maxilla in CLP patients. However, A/P translations and pitch rotations remain challenging to achieve during surgery. These movements were also found to be least stable at one year follow-up.
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Affiliation(s)
- Margaux Nys
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Maxim Van Den Bempt
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Eman Shaheen
- Omfs Impath Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jakob Titiaan Dormaar
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Constantinus Politis
- Omfs Impath Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Yamagata K, Mohri T, Watanabe A, Bukawa M, Uchida F, Fukuzawa S, Ishibashi-Kanno N, Bukawa H. Anterior Maxillary Distraction Osteogenesis With Bone-borne Intraoral Buccal Devices for Maxillary Hypoplasia With Cleft Lip and Palate. J Craniofac Surg 2023; 34:1867-1871. [PMID: 37253151 DOI: 10.1097/scs.0000000000009412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/20/2023] [Indexed: 06/01/2023] Open
Abstract
Anterior maxillary distraction osteogenesis (AMDO) surgery for cleft lip and palate involves distraction of a segment of the anterior maxilla and advancement using 2 intraoral buccal bone-borne distraction devices. The anterior part of the maxilla is advanced anteriorly with less relapse which increases maxillary length and does not affect speech. We aimed to evaluate the effects of AMDO, including lateral cephalometric changes. Seventeen patients who had undergone this procedure were included in this retrospective study. The distractors were activated by 0.5 mm twice a day after a 3-day latency period. Lateral cephalometric radiographs were evaluated preoperatively, after distraction and removal of distractors, which were compared using the paired Student's t test. Anterior maxillary advancement was obtained in all patients with a median of 8.0 mm. Complications included nasal bleeding and loosening of distractors; however, there was no tooth damage or abnormal movement. The mean sella-nasion-A point (SNA) angle increased significantly, from 74.91° to 79.66°, the A point-nasion-B point angle from -0.38° to 4.34°, and the perpendicular line from nasion to Frankfort Horizontal (NV)-A point from -5.11 to 0.08 mm. The mean anterior nasal spine-posterior nasal spine length increased significantly from 50.74 to 55.10 mm, and the NV-Nose Tip from 23.59 to 26.27 mm. The mean relapse rate of NV-A was 11.1%. AMDO with bone-borne distractor resulted in less relapse and effectively corrected the maxillary retrusion.
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Affiliation(s)
- Kenji Yamagata
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tamaki Mohri
- Mohri Orthodontic Office, 2-2-7 Kasuga, Tsukuba, Ibaraki, 305-0821, Japan
| | - Atsushi Watanabe
- Mohri Orthodontic Office, 2-2-7 Kasuga, Tsukuba, Ibaraki, 305-0821, Japan
| | - Moeka Bukawa
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Fumihiko Uchida
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Satoshi Fukuzawa
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naomi Ishibashi-Kanno
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroki Bukawa
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
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Mafféïs J, Odri GA, Mercier JM, Loin J, Perrin JP, Joly A, Letelier C, Corre P, Bertin H. Stability of Le Fort 1 osteotomy in patients with bilateral cleft lip and palate: A retrospective study of 71 patients. J Craniomaxillofac Surg 2023; 51:407-415. [PMID: 37550117 DOI: 10.1016/j.jcms.2023.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/13/2023] [Accepted: 06/25/2023] [Indexed: 08/09/2023] Open
Abstract
The aim of this study was to evaluate the sagittal and vertical relapses after Le Fort 1 osteotomy in bilateral cleft lip and palate (BCLP) patients. Lateral cephalograms before surgery, immediately after the procedure, at one year, and at least two years (when available) after surgery were superimposed. The positions of five landmarks were studied in a coordinate system. Uni- and multivariate analyses investigated the effect of various factors on the relapse. Of the 71 patients included for a BCLP, 54 presented complete data at one year, and 30 patients were included for the long follow-up study (mean of 55 months). The mean maxillary advancement was 6.2 mm on the sub-spinal point (A). Sagittal relapse occurred at one year (mean of 1.1 mm on point A, 0.7 mm on point prosthion (P); p < 0.0001) and progressed by 0.5 mm and 1.0 mm, respectively, on the same points at the last follow-up. The mean vertical relapse was 0.5 mm on point A (p = 0.044), 0.6 mm on point P (p = 0.16) and 0.5 mm on incisor (I) (p = 0.056). The vertical relapse was correlated to the degree of vertical movement. Three factors were associated to the recurrence including a prior pharyngeal flap, an associated mandibular osteotomy and smoking habits.
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Affiliation(s)
- Julia Mafféïs
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-44000, Nantes, France.
| | - Guillaume Anthony Odri
- Service de chirurgie Orthopédique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 4, rue Ambroise-Paré, 75010, Paris, France; INSERM UMR 1132, Biologie de l'os et du Cartilage (BIOSCAR), Lariboisière Hospital, UFR de Médecine, Faculté de Santé, Université de Paris, 75010, Paris, France.
| | - Jacques-Marie Mercier
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-44000, Nantes, France.
| | - Justine Loin
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-44000, Nantes, France.
| | - Jean-Philippe Perrin
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-44000, Nantes, France.
| | - Aline Joly
- Service de Chirurgie Maxillo-Faciale, Plastique et Brulés, Hôpital Trousseau, CHU de Tours, Tours, France.
| | - Claudia Letelier
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Avenida Independencia 939, Santiago de Chile, Chile.
| | - Pierre Corre
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-44000, Nantes, France; Nantes Université, Oniris, UnivAngers, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, F-44000, Nantes, France.
| | - Hélios Bertin
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-44000, Nantes, France; Nantes Université, UnivAngers, CHU Nantes, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France.
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Kaur H, Grover S, Singaraju GS, Sidhu MS, Jaglan A, Dogra N. Effects of anterior maxillary distraction compared to LeFort-1 osteotomy and total maxillary distraction osteogenesis for treating hypoplastic maxilla in patients with cleft lip and palate- A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101308. [PMID: 36220549 DOI: 10.1016/j.jormas.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/21/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the treatment outcomes and effectiveness of Anterior Maxillary Distraction (AMD) with the LeFort I Osteotomy and Total Maxillary Distraction Osteogenesis (TMDO) to treat cleft maxillary hypoplasia. METHODS (PROSPERO CRD42020223345) Thorough electronic search of seven databases, unpublished gray literature, and a hand search of the relevant studies reference lists was done. Studies assessing mid-facial skeletal, dentoalveolar, and soft-tissue outcomes of AMD in patients >8 years of age, hypoplastic cleft maxilla, and with either TMDO/LeFort 1/ both as control groups were included. Seven included articles were assessed for the study characteristics and qualitative synthesis. Three studies were analyzed quantitatively using the RevMan 5.4 software. The quality of studies was assessed using Cochrane ROB2 and the overall certainty of evidence using GRADE. RESULTS AMD was performed in 241 subjects, LeFort 1 in 145 subjects, and TMDO in 42 subjects. Maxillary advancement for AMD and LeFort 1 groups showed no statistically significant difference (Mean Difference, MD -0.64°) while TMDO showed statistically significant advancement than AMD (MD -1.44°). Statistically significant upward rotation of anterior maxilla was noted with AMD (MD -6.15 degrees) than Lefort 1. Upper incisor inclination improved in both AMD and TMDO groups (MD 1.5°). Improvement in the maxilla-mandibular relationship, convexity of face, lip and nose, and marked dentoalveolar changes in overjet and upper incisor position were noted in all the three groups. Discernible airway alterations were noted in LeFort 1 and TMDOs. Total relapse was the least with AMD. CONCLUSION Distraction osteogenesis exhibited better dento-skeletal outcomes and minor skeletal relapse than LeFort 1. TMDO is a preferred modality in treating severe maxillary hypoplasia associated with CLP than AMD. Further long-term prospective comparative studies are required, possibly involving the patient-centric merits.
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Affiliation(s)
- Harneet Kaur
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi , India, 110025
| | - Seema Grover
- Department of Orthodontics, Faculty of Dental Sciences, SGT University Haryana, India, 122505
| | - Gowri Sankar Singaraju
- Department of Orthodontics and Dentofacial Orthopaedics, Narayana Dental College, Nellore, Andhra Pradesh, India, 524003
| | - M S Sidhu
- Department of Orthodontics, Faculty of Dental Sciences, SGT University Haryana, India, 122505
| | - Archana Jaglan
- Department of Orthodontics, Faculty of Dental Sciences, SGT University Haryana, India, 122505
| | - Namrata Dogra
- Department of Orthodontics, Faculty of Dental Sciences, SGT University Haryana, India, 122505.
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Simultaneous Le Fort III and Le Fort I Osteotomy: Surgical Outcomes and Clinical Parameters. J Craniofac Surg 2023; 34:222-226. [PMID: 36253918 DOI: 10.1097/scs.0000000000009066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Simultaneous Le Fort III/I (LF III/I) osteotomies are often performed when a differential advancement of the upper and lower midface is needed. This study aims to evaluate midface position preoperative and 1 week postoperative in patients with severe midface hypoplasia. In addition, this study aims to compare the planned surgical movements to the actual postoperative movements. MATERIALS AND METHODS A retrospective review was conducted using cephalometry for patients treated with a simultaneous LF III/I osteotomy at a single institution. Osteotomies were performed during 1980-2018 on skeletally mature patients with a craniofacial syndrome, with clinical and radiographic follow-up available. RESULTS Twelve patients met the inclusion criteria with a mean age of 20.2±6.4 years. Treatment resulted in statistically significant anterior movements related to Orbitale, anterior nasal spine, A Point, and the upper incisor tip, and inferior movements related to anterior nasal spine, A Point, upper and lower incisor tips, B point, and pogonion. Stability after 1 year showed only statistically significant changes at ANB. The predictable error for planned movements versus actual movements was greater in the vertical plane than the horizontal plane. CONCLUSIONS A simultaneous LF III/I osteotomy significantly improved the midface position and occlusal relationship in syndromic patients with midface hypoplasia in a predictable manner. Further multicenter studies with larger sample sizes are needed to validate the conclusions.
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Lee YH, Tsai CY, Wang LC, Lai UK, Lai JP, Lin SS, Chang YJ. Comparison of the Post-Surgical Position of the Temporomandibular Joint after Orthognathic Surgery in Skeletal Class III Patients and Patients with Cleft Lip and Palate. J Pers Med 2022; 12:jpm12091437. [PMID: 36143222 PMCID: PMC9506436 DOI: 10.3390/jpm12091437] [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: 08/17/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: The purpose of our research is to compare the post-surgical position of the temporomandibular joint in skeletal Class III patients and patients with cleft lip and palate treated with two-jaw orthognathic surgery using a three-dimensional computer tomography image. Materials and Methods: Twenty-three skeletal Class III patients with mandibular prognathism associated with maxillary retrognathism in group 1 and twenty cleft mid-face retrusion skeletal Class III patients in group 2 were enrolled in this study. All subjects were treated with two-jaw orthognathic surgery. Computed tomography scans were taken in all subjects at 3 weeks preoperatively and 6 months postoperatively. Three-dimensional craniofacial skeletal structures were build-up, and assessed the temporomandibular joint position changes before and after surgery. Results: Forty-three selected patients were separated into two groups. The mean age of patients was 22.39 ± 4.8 years in group 1 and 20.25 ± 3.8 years in group 2. The range of mean three-dimensional discrepancy of the selected condylar points was 0.95–1.23 mm in group 1 and 2.37–2.86 mm in group 2. The mean alteration of intercondylar angle was 2.33 ± 1.34° in group 1 and 6.30 ± 2.22° in group 2. The significant differences in the discrepancy of TMJ and changes in intercondylar angle were confirmed within the intra-group and between the two groups. Conclusions: Significant changes in postoperative TMJ position were present in both groups. Furthermore, the cleft group presented significantly more postoperative discrepancy of TMJ and more changes in intercondylar angle after surgery. This finding may be a reason leading to greater postoperative instability in cleft patients compared with skeletal Class III non-cleft patients. Clinical Trial Registration Number: IRB No: 202201108B0.
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Affiliation(s)
- Yi-Hao Lee
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Chi-Yu Tsai
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Ling-Chun Wang
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - U-Kei Lai
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Jui-Pin Lai
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Shiu-Shiung Lin
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yu-Jen Chang
- Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Correspondence: ; Tel.: +886-7-7317123 (ext. 8291)
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Relapse-related factors of Le Fort I osteotomy in cleft lip and palate patients: A systematic review and meta-analysis. J Craniomaxillofac Surg 2021; 49:879-890. [PMID: 34538538 DOI: 10.1016/j.jcms.2021.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 06/27/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
A systematic review search was based on the PICOS approach, as follows: population: cleft lip and palate patients; intervention: Le Fort I osteotomy; comparator: different surgical protocols; outcome: stability, recurrence or surgical complications; study designs: only case reports were excluded from the review. No restrictions were placed on language or year of publication. Risk of bias was analyzed, heterogeneity was assessed, and subgroup analysis was performed using a level of significance of 1% (p = 0.01). The search identified 248 citations, from which 29 studies were selected and a total of 797 patients enrolled. The level of agreement between the authors was considered excellent (k = 0.810 for study selection and k = 0.941 for study eligibility). Our results reported a mean maxillary advancement of 5.69 mm, a mean vertical downward/upward of 2.85/-2.02 mm and a mean clockwise rotation of 4.15°. Greater surgical relapse rates were reported for vertical downward movement (-1.13 mm, 39.6%), followed by clockwise rotation (-1.41°, 33.9%), sagittal (-0.99 mm, 17.4%) and vertical upward (0.11 mm, 5.4%) movements. No relevance was found regarding the type of cleft, the type of Le Fort I osteotomy, concomitant bone grafting, surgical overcorrection, postoperative rigid or elastic intermaxillary fixation, or retention splint. Study limitations were heterogeneity and the low number of high-quality studies. In spite of reported high relapse rates, Le Fort I osteotomy for maxillary reposition is the first-choice procedure for selected cleft lip and palate patients in whom extensive maxillary movements are not required, because of its safety and its three-dimensional movement versatility in one-step surgery. Otherwise, distraction osteogenesis should be considered as the gold standard treatment.
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Three-Dimensional Outcome Assessments of Surgical Correction in Cleft and Noncleft Patients with Class III Skeletal Relation: A Case-Control Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4572397. [PMID: 34435043 PMCID: PMC8380494 DOI: 10.1155/2021/4572397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/31/2021] [Indexed: 11/17/2022]
Abstract
Background The orthognathic strategies to treat patients with a concave profile but different tissue conditions remain controversial. The aim of this case-control study was to investigate the outcome predictability of orthognathic surgery in cleft lip and palate (CLP) patients and matched controls. Methods Fifty consecutive CLP and 45 matched non-CLP patients who received whole-piece Le Fort I and bilateral sagittal split osteotomy to correct class III skeletal relations were enrolled. The outcome discrepancies (ODs) from simulations among all groups were evaluated with consideration of the possible influences from planned surgical movements (PSM). Receiver operating characteristic curves were used to determine threshold values of PSMs that yielded clinically relevant OD. Results Unilateral CLP (UCLP) patients had comparable postsurgical OD to non-CLP patients in both jaws, whereas bilateral CLP (BCLP) patients had greater deviations from predicted results. Vertical movement of the A − point > 1.33 mm and yaw correction > 1.65° in the BCLP patients was associated with clinically relevant maxillary OD. Conclusions The OGS outcomes of BCLP patients were less predictable than those of the UCLP and noncleft patients. Vertical movements of the A − point > 1.33 mm and yaw correction > 1.65° in BCLP patients increased OD to a clinically relevant extent.
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Abstract
BACKGROUND In severe cases of maxillary hypoplasia, Le Fort I distraction may be required for treatment. This study describes our experience with internal distraction devices and assesses our outcomes in patients with a negative overjet on average >15 mm. METHODS A retrospective review of patients with a history of cleft lip and/or palate who underwent Le Fort I distraction at our institution from 11/2007-11/2017 was performed. Data regarding demographics, procedural details and outcomes were collected and analyzed. RESULTS Twenty patients, 13 (65.0%) male and 7 (30.0%) female, were included. All (100%) patients had a history of cleft lip and/or palate and 2 (10.0%) of them had associated syndromes. All 20 patients underwent internal distraction. The average age at surgery was 17.8 years (range 15.2-20.7, SD 1.6 years). The average preoperative negative overjet was 19.27 mm (range 10-30, SD 5.63 mm). The mean total distraction length was 15.3 mm (range 0-30, SD 6.72 mm). There were no intraoperative complications, however, there were a total of 4 (20.0%) postoperative complications, 2 of which required reoperation due to device malfunction or displacement. 14 (70.0%) patients had repeat procedures to complete occlusal correction or correct relapse. CONCLUSIONS Maxillary distraction alone was insufficient for correction of maxillary discrepancies averaging >15 mm. Instead, it's utility may be in positioning the maxilla for a more viable final advancement and fixation procedure, rather than being solely responsible for achieving normal occlusion during distraction.
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Abstract
ABSTRACT A series of skeletal and dentoalveolar/occlusal criteria were proposed for choosing the treatment modality for the management of midface hypoplasia in cleft lip/palate patients, focusing on functional improvement, aesthetics, and minimizing the risk of recurrence and secondary alterations. For which, 42 patients with nonsyndromic cleft lip/palate, all with previous primary lip/palate surgeries and without previous osteotomies, were analyzed. Orthognathic surgery (OS) (n = 24) and maxillary distraction osteogenesis (n = 18) with anterior segmental osteotomies (segmental distraction osteogenesis [SD]), alveolar transport disc (TD), and midface total distraction osteogenesis (TDO) by modified Le Fort III osteotomy was done.The average of maxillary advancement for OS was 5.58 ± 0.83 mm, for SD 9.4 ± 0.89 mm, for TD 8.00 ± 1.00 mm, and for TDO was 8.13 ± 1.55 mm.In the presence of infraorbital and/or zygomatic hypoplasia, TDO was performed using skeletal anchorage, with the requirement of occlusal stability in dental cast in occlusion. In short maxillary arch without dental cast feasibility in occlusion, hypodontia/agenesis or absence of premaxilla, TD and SD was performed. There was only 1 mm of recurrence in 1 patient of each group. Changes in speech were detected in 2 patients in the OS group (8.3%). Orthognathic surgery can be indicated for advancements ≤7 mm not requiring orbito-zygomatic advancement, whereas distraction osteogenesis can be indicated for advances >8 mm with or without the need for orbito-zygomatic advancement, in addition with other dentoalveolar factors and velopharyngeal function.
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One-Year Stability of LeFort I Advancement in Patients With Complete Cleft Lip and Palate Using a Standardized Clinical and Surgical Protocol. J Craniofac Surg 2021; 32:2491-2495. [PMID: 34260467 DOI: 10.1097/scs.0000000000007956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM To assess treatment outcome and 1-year stability of LeFort I advancement in patients with complete cleft lip and palate. METHODS Thirty-five patients (age 20.65 ± 2.20 years) with unilateral (n = 25) or bilateral (n = 10) complete cleft lip and palate who underwent LeFort I advancement were included.Lateral cephalograms before surgery (T1), immediately postsurgery (T2), and at 1-year follow-up (T3) were superimposed, and the position of anterior nasal spine (ANS), A-point, and U1 Tip assessed using an x, y coordinate system. Differences between landmark positions at the 3-time points were analyzed using paired sample t-tests, with a significance defined as α ≤ 0.05. RESULTS The mean surgical advancement in the horizontal direction (T2-T1) was 6.50 ± 2.62 mm at ANS (P < 0.001) and 7.05 ± 2.51 mm at A-point (P < 0.001). At a 1-year follow-up (T3-T2), the mean horizontal relapse at ANS was -1.41 ± 1.89 mm (P < 0.001) and -0.79 ± 1.48 mm at A-point (P 0.003). Mean horizontal relapse was 21.7% and 11% of surgical advancement when assessed at ANS and A-point, respectively. The central incisor tip position remained stable during the postsurgical period (0.12 ± 2.11 mm, P 0.732). At A-point, the mean vertical surgical change (T2-T1) was -0.96 ± 2.57 mm (P < 0.001). No significant post-treatment (T3-T2) vertical changes were detected at ANS or A-point. Phenotypic stability was excellent, with all patients maintaining positive overjet at 1-year follow-up. CONCLUSIONS LeFort I advancement in complete cleft lip and palate is stable, with less than a 2 mm relapse after 1-year. Surgical overcorrection by 10% to 20% is recommended to compensate for the expected skeletal relapse.
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Gibreel W, Wlodarczyk JR, Wolfswinkel EM, Yen S, Urata MM, Hammoudeh JA. Cleft Lip and Palate: Le Fort I Distraction Using an Internal Device. Clin Plast Surg 2021; 48:407-417. [PMID: 34051894 DOI: 10.1016/j.cps.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Maxillary hypoplasia is a commonly seen dentofacial anomaly in patients with cleft lip and palate after surgical repair of the cleft anomaly. To facilitate large horizontal movements of the maxilla, distraction osteogenesis is used to slowly stretch the soft tissue envelope with the skeletal advancement preventing tissue recoil and skeletal relapse. Internal distraction devices have the advantage of reducing the amount of physical and psychological stress placed on patients, families, and caregivers. The technique has been successful in producing stable results for large advancements of the facial skeleton when compared with conventional Le Fort I advancement and fixation of the maxilla.
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Affiliation(s)
- Waleed Gibreel
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA
| | - Jordan R Wlodarczyk
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA; Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
| | - Erik M Wolfswinkel
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA
| | - Stephen Yen
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA; Division of Dentistry and Orthodontics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Mark M Urata
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA; Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA; Division of Dentistry and Orthodontics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey A Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA; Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA; Division of Dentistry and Orthodontics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA.
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Gerbino G, Autorino U, Giaccone E, Novaresio A, Ramieri G. Virtual planning and CAD/CAM-assisted distraction for maxillary hypoplasia in cleft lip and palate patients: Accuracy evaluation and clinical outcome. J Craniomaxillofac Surg 2021; 49:799-808. [PMID: 33906808 DOI: 10.1016/j.jcms.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022] Open
Abstract
The aim of this prospective study was to report the experience with a specific guided distraction protocol for the treatment of CLP patients with severe midface hypoplasia. From January 2016 to April 2019, six consecutive, non-growing, CLP patients with maxillary hypoplasia underwent a specific distraction protocol based on the use of VSP, CAD/CAM-generated surgical splints, cutting guides, prebent internal maxillary distractors, early removal of distractors, and acute callus manipulation and fixation. STL files for VSP, using multislice CT scans taken preoperatively (T0) and 3 months after distractor removal (T1) were superimposed using the free software 3D Slicer and Geomagic Wrap to evaluate the accuracy of maxillary repositioning and assess 3D bone changes. Clinical outcome was evaluated at the 1-year follow-up (T2). The patients and surgeon were satisfied with the occlusal and aesthetic outcomes. A maximum difference of 2 mm between the VSP and the actual surgical outcome was chosen as the success criterion for accuracy. The average linear difference for selected points was <2 mm in four patients and >2 mm in two patients. The average distance of the postoperative maxilla from the VSP model was 2.28 mm (median 1.85), while the average forward movement of the maxilla was 10.18 mm The protocol used is effective and accurate in the correction of severe maxillary hypoplasia in CLP patients. Early removal of the distractor and stabilization with plates reduces patient discomfort and does not jeopardize stability. This protocol should be reserved for complex cases due to the costs of the procedure, which are not negligible.
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Affiliation(s)
- Giovanni Gerbino
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Italy
| | - Umberto Autorino
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Italy.
| | - Elena Giaccone
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Italy
| | - Andrea Novaresio
- Department of Surgical Sciences, University of Torino, Department of Management and Production Engineering, Politecnico of Torino, Italy
| | - Gugliemo Ramieri
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Torino, Italy
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22
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Esen A, Celik B, Dolanmaz D. Biomechanical evaluation of two miniplate fixations applied in the anterior region after Le Fort I osteotomy: an experimental study. Br J Oral Maxillofac Surg 2021; 60:152-156. [PMID: 34862066 DOI: 10.1016/j.bjoms.2021.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/30/2021] [Indexed: 10/22/2022]
Abstract
The aim of this experimental study was to evaluate the reliability of two-plate fixations applied to the anterior region of the maxilla after Le Fort I osteotomy in terms of stability. Twenty polyurethane-based skull models were used to evaluate two fixation techniques. Two groups consisting of four and two L-shaped titanium miniplates were tested. Each group was tested with the application of vertical forces in the anteroposterior direction using a servohydraulic testing unit. The displacement values in each group at each stage (from 10 N - 120 N) were compared using the Mann-Whitney U test. The displacement values for the two groups were not statistically significant up to 20 N, but differed significantly between 20 N and 120 N (p < 0.05). The results showed that the biomechanical behaviour of fixation with four miniplates was better than that of two after a load of 20 N. It can be concluded that when the amount of maxillary advancement is increased to 10 mm or more, fixation with only two plates does not provide sufficient stability experimentally.
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Affiliation(s)
- A Esen
- Necmettin Erbakan University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Beysehir Cd. Baglarbasi Sk., 42090 Meram, Konya, Turkey.
| | - B Celik
- Selcuk University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Alaeddin Keykubat Yerleskesi, 42250 Selcuklu, Konya, Turkey
| | - D Dolanmaz
- Bezmialem Vakif University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Adnan Menderes Bulvari, 34093, Fatih, Istanbul, Turkey
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What is the relapse after Le Fort I maxillary advancement in cleft lip and palate patients? A systematic review. Oral Maxillofac Surg 2020; 25:139-148. [PMID: 32940776 DOI: 10.1007/s10006-020-00906-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
Le Fort I osteotomy is the most common procedure for maxillary advancement in cleft patients, and a significant relapse is expected in the postoperative period. This study purpose is to evaluate the maxillary relapse and associated factors in cleft lip and palate (CLP) patients submitted to standard Le Fort I advancement. This systematic review sought studies in PubMed, SCOPUS, and Cochrane and included papers that evaluated the maxillary relapse with at least 1-year postoperative period. The quality assessment was adapted following PRISMA statement. The initial electronic search found 345 papers, and the final selection included 10 studies. In total, 275 CLP patients were evaluated 198 had unilateral CLP and 41 had bilateral CLP. Isolated maxillary advancement was performed in 166 patients, while 109 had bimaxillary surgery. The mean relapse in horizontal and vertical plane was 1.2 mm (19.7%) and 1.0 mm (29.4%), respectively. In conclusion, a relapse after maxillary advancement in patients with CLP is expected, being higher in vertical plane. Patients with UCLP and those who underwent bimaxillary surgery had a higher relapse rate. Due to the miscellaneous data and methodologies, future prospective clinical trials should apply rigorous selection of CLP patients sample and methods for variable analysis to obtain more accurate results.
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Thirty Years Later: What Has Craniofacial Distraction Osteogenesis Surgery Replaced? Plast Reconstr Surg 2020; 145:1073e-1088e. [DOI: 10.1097/prs.0000000000006821] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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25
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Susarla S, Ettinger R, Preston K, Kapadia H, Egbert M. Two-point nasomaxillary fixation of the Le Fort I osteotomy: assessment of stability at one year postoperative. Int J Oral Maxillofac Surg 2020; 49:466-470. [DOI: 10.1016/j.ijom.2019.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/29/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
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26
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Jiang L, Zheng Y, Li N, Chen X, Lu Z, Tong H, Yin N, Song T. Relapse rate after surgical treatment of maxillary hypoplasia in non-growing cleft patients: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2020; 49:421-431. [DOI: 10.1016/j.ijom.2019.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022]
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Virtual Surgical Planning Assisted Management for Cleft-Related Maxillary Hypoplasia. J Craniofac Surg 2020; 30:1745-1749. [PMID: 31449217 DOI: 10.1097/scs.0000000000005603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Maxillary hypoplasia is a common developmental deformity affecting patients with cleft lip and palate. Various surgical techniques including conventional orthognathic surgery, total maxillary distraction osteogenesis, and anterior maxillary segmental distraction have been applied to address the deformity. With the evolution of 3D computed tomography imaging, the visualization of skeletal complexities in different perspectives is greatly enhanced and comprehensive surgical planning is achieved. Intraoperative efficiency is also improved with the fabrication of 3D-printed templates. The study aims to present different surgical techniques with virtual surgical planning (VSP) and 3D-printed surgical templates and the solution of representative cases. From January 2014 to January 2019, VSP was transferred to actual surgery or distraction precisely in 80 adult patients with cleft-related maxillary hypoplasia. The accuracy was analyzed and the relapse was also estimated and observed in 18 patients after 1-year follow-up. Based on our experience, VSP provides a more reliable and effective option to conventional model surgery. It facilitates the preoperative planning and accurately transfers the virtual plan to correct the cleft-related maxillary hypoplasia.
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Wang Y, Li J, Xu Y, Huang N, Shi B, Li J. Accuracy of virtual surgical planning-assisted management for maxillary hypoplasia in adult patients with cleft lip and palate. J Plast Reconstr Aesthet Surg 2020; 73:134-140. [DOI: 10.1016/j.bjps.2019.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/26/2019] [Accepted: 07/27/2019] [Indexed: 11/15/2022]
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MIRANDA CM, SOUZA RMD, VENEZIAN GC, FRANZINI C, CUSTODIO W. Immediate and late follow-up effects of class III early correction in cleft lip and palate patients treated with maxillary protraction. REVISTA DE ODONTOLOGIA DA UNESP 2020. [DOI: 10.1590/1807-2577.04920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction There is no consensus about the immediate and latte follow-up effects of maxillary protraction in cleft lip and palate patients. Objective To evaluate the stability of Class III early treatment in cleft lip and palate patients through maxillary expansion and protraction. Material and method The sample consists in three lateral cephalometric radiographs of 28 patients (mean pre-treatment age of 6.7±1.8 years) who presented cleft lip and palate and were treated with maxillary expansion and Petit facial mask. The angular (SNA, SNB, ANB, SN.GoGn, FMA, Z Angle) and linear (overjet, Co-A, Co-Gn, Nperp-A, Nperp-Pg, AO-BO) cephalometric measures were evaluated through the Dolphin® software, in three moments: T0 (initial), T1 (after treatment), and T2 (follow-up). Data were submitted to the analysis of variance (ANOVA) and Tukey-Kramer test. The correlation between cephalometric measures and patient’s age was determined by Pearson’s chi-squared test. Result The SNA, ANB, and AO-BO measures increased considerably (p<0.05), and they did not present any differences compared to the initial ones after the follow-up time. The overjet measure increased (p<0.05) after treatment and, even with its decrease at the follow-up time, it was still higher than at the beginning (p<0.05). The Z angle showed improvement with treatment and remained stable at the follow-up time. Conclusion After treatment (maxillary expansion associated with protraction), there was a skeletal pattern improvement. During the follow-up period, those alterations decreased to a measure close to the beginning. There was an improvement in the dental pattern and facial profile that continued in the follow-up period.
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30
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Haas Junior O, Guijarro-Martínez R, de Sousa Gil A, da Silva Meirelles L, Scolari N, Muñoz-Pereira M, Hernández-Alfaro F, de Oliveira R. Hierarchy of surgical stability in orthognathic surgery: overview of systematic reviews. Int J Oral Maxillofac Surg 2019; 48:1415-1433. [DOI: 10.1016/j.ijom.2019.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 03/03/2019] [Accepted: 03/06/2019] [Indexed: 12/26/2022]
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31
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Hwang DS, Choi HS, Kim UK, Song JM. Complications Following Orthognathic Surgery for Patients With Cleft Lip/Palate. J Craniofac Surg 2019; 30:1815-1819. [DOI: 10.1097/scs.0000000000005536] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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32
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Three-Dimensional Outcome Assessments of Cleft Lip and Palate Patients Undergoing Maxillary Advancement. Plast Reconstr Surg 2019; 143:1255e-1265e. [PMID: 31136492 DOI: 10.1097/prs.0000000000005646] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this retrospective case series study was to compare three-dimensional postsurgical outcomes of patients with cleft lip and palate following maxillary advancement. METHODS Fifty consecutive cleft lip and palate patients who underwent whole-pieced Le Fort I advancements were assigned to the major (advancement ≥ 5 mm) or minor (advancement < 5 mm) groups. Three-dimensional surgical simulation was used for presurgical evaluation and planning. Virtual triangles of the presurgical, simulated, and 6-month postoperative stages were used for comparison. Translational and angular changes of each endpoint (A-point, MxR, and MxL) on the virtual triangles and reference planes were recorded and analyzed. Relationships between possible related variables and outcome discrepancies from simulations among all subgroups were also investigated. RESULTS Analysis of covariance and the least significant difference test revealed that the outcome discrepancy measurements were affected by different combinations of independent variables. The reliability test showed high consistency of the authors' method for three-dimensional measurements. CONCLUSIONS The actual surgical outcomes of cleft lip and palate patients differed from the virtual simulations. The outcome discrepancies are impacted by multiple factors. The outcome discrepancies of all rotational surgical corrections (roll, yaw, and pitch) were positively correlated to the degree of planned surgical movement. Meanwhile, bilateral cleft lip and palate patients are more likely to incur outcome discrepancies in yaw correction with major maxillary advancement. However, a maxillary advancement cutoff value of 5 mm would not necessarily lead to significant translational outcome discrepancies among cleft lip and palate patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Marion F, Mercier JM, Odri GA, Perrin JP, Longis J, Kün-Darbois JD, Corre P, Bertin H. Associated relaps factors in Le Fort I osteotomy. A retrospective study of 54 cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:419-427. [PMID: 30648606 DOI: 10.1016/j.jormas.2018.11.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/23/2018] [Accepted: 11/25/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The Le Fort I osteotomy (LFI) procedure is commonly used to restore morpho-functional balance. The goal of maxillofacial surgeons with this procedure is to achieve occlusal stability. To identify factors associated with relapse after maxillary advancement in cleft lip and palate patients, the one-year post-operative stability of Le Fort I osteotomy was evaluated. METHODS Horizontal and vertical relapse were analysed on lateral cephalograms by retrospectively using tracing paper in an orthonormal landmark in 54 patients undergoing unilateral cleft lip and palate surgery who were monitored at Nantes University Hospital. The lateral cephalograms were performed pre-operatively, immediately post-operatively, and after one year. Several variables were studied such as population data, intra-operative and post-operative surgical treatment, and surgical movement. RESULTS At point A, the subspinale point, the mean advancement during surgery was 4.2 mm, with a relapse of 0.8 mm (20.1%). The mean downward movement was 2.0 mm in 26 patients who had a clockwise rotation of the maxilla, with a relapse of 0.6 mm (28.4%). The mean upward movement was 2.3 mm in 27 patients who had a counterclockwise rotation, with a deterioration of 0.2 mm (7%). A 7-millimetre surgical advancement corresponded to the threshold value beyond which relapse appeared to be significantly greater but still less than two millimetres in 75% of cases. CONCLUSION The degree of advancement appears to be the only variable correlated with the amplitude of the relapse.
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Affiliation(s)
- F Marion
- Department of maxillo-facial surgery and stomatology, Nantes university hospital, 44000 Nantes, France.
| | - J M Mercier
- Department of maxillo-facial surgery and stomatology, Nantes university hospital, 44000 Nantes, France
| | - G-A Odri
- Department of orthopaedic surgery, Lariboisière hospital, 75010 Paris, France
| | - J P Perrin
- Department of maxillo-facial surgery and stomatology, Nantes university hospital, 44000 Nantes, France
| | - J Longis
- Department of maxillo-facial surgery and stomatology, Nantes university hospital, 44000 Nantes, France
| | - J-D Kün-Darbois
- Department of Maxillo-Facial Surgery and stomatology, Angers university Hospital, France
| | - P Corre
- Department of maxillo-facial surgery and stomatology, Nantes university hospital, 44000 Nantes, France
| | - H Bertin
- Department of maxillo-facial surgery and stomatology, Nantes university hospital, 44000 Nantes, France
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Impieri D, Tønseth KA, Hide Ø, Brinck EL, Høgevold HE, Filip C. Impact of orthognathic surgery on velopharyngeal function by evaluating speech and cephalometric radiographs. J Plast Reconstr Aesthet Surg 2018; 71:1786-1795. [DOI: 10.1016/j.bjps.2018.07.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/07/2018] [Accepted: 07/28/2018] [Indexed: 11/29/2022]
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35
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Turri de Castro Ribeiro T, Petri Feitosa MC, Almeida Penhavel R, Zanda RS, Janson G, Mazzottini R, Garib DG. Extreme maxillomandibular discrepancy in unilateral cleft lip and palate: Longitudinal follow-up in a patient with mandibular prognathism. Am J Orthod Dentofacial Orthop 2018; 154:294-304. [PMID: 30075931 DOI: 10.1016/j.ajodo.2017.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 10/28/2022]
Abstract
Growth deficiency of the maxilla is a frequent finding in patients with complete unilateral cleft lip and palate. When the sagittal discrepancy is severe, orthodontic treatment combined with orthognathic surgery is required. This article reports the treatment of a girl born with unilateral cleft lip and palate who had lip and palate repair at 3 and 12 months of age, respectively. At 3 years of age, she already showed a severe anteroposterior maxillary deficiency with an anterior crossbite in the deciduous dentition. A Class III skeletal pattern progressively increased during the mixed dentition period. Mandibular prognathism coupled with an extremely hyperdivergent growth pattern was observed. An alveolar bone graft was performed at 10 years of age. At 16 years of age, the ANB angle was -13.7° with a negative overjet of -9.8 mm. Comprehensive orthodontic treatment was conducted with extraction of the mandibular first premolars and maxillary lateral incisors due to dental crowding. Orthognathic surgery was performed at 18.9 years of age involving maxillary advancement of 7.4 mm and mandibular setback of 6.6 mm. Facial and occlusal changes were dramatic. Final nose repair was conducted at 19.7 years of age. At 22 years of age and 3 years after debonding, stability of the occlusal and skeletal results was observed, clearly demonstrating that the objectives established for the rehabilitation have been achieved.
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Affiliation(s)
- Tiago Turri de Castro Ribeiro
- Dental Division, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Mariana Chaves Petri Feitosa
- Dental Division, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil.
| | - Rogério Almeida Penhavel
- Dental Division, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Renata Sathler Zanda
- Dental Division, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Reinaldo Mazzottini
- Department of Stomatology, Bauru Dental School and Dental Division of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Daniela G Garib
- 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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36
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Kloukos D, Fudalej P, Sequeira‐Byron P, Katsaros C. Maxillary distraction osteogenesis versus orthognathic surgery for cleft lip and palate patients. Cochrane Database Syst Rev 2018; 8:CD010403. [PMID: 30095853 PMCID: PMC6513261 DOI: 10.1002/14651858.cd010403.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cleft lip and palate is one of the most common birth defects and can cause difficulties with feeding, speech and hearing, as well as psychosocial problems. Treatment of orofacial clefts is prolonged; it typically commences after birth and lasts until the child reaches adulthood or even into adulthood. Residual deformities, functional disturbances, or both, are frequently seen in adults with a repaired cleft. Conventional orthognathic surgery, such as Le Fort I osteotomy, is often performed for the correction of maxillary hypoplasia. An alternative intervention is distraction osteogenesis, which achieves bone lengthening by gradual mechanical distraction. This review is an update of the original version that was published in 2016. OBJECTIVES To provide evidence regarding the effects and long-term results of maxillary distraction osteogenesis compared to orthognathic surgery for the treatment of hypoplastic maxilla in people with cleft lip and palate. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 May 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2018, Issue 4), MEDLINE Ovid (1946 to 15 May 2018), Embase Ovid (1980 to 15 May 2018), and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; from 1982 to 15 May 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing maxillary distraction osteogenesis to conventional Le Fort I osteotomy for the correction of cleft lip and palate maxillary hypoplasia in non-syndromic cleft patients aged 15 years or older. DATA COLLECTION AND ANALYSIS Two review authors assessed studies for eligibility. Two review authors independently extracted data and assessed the risk of bias in the included studies. We contacted trial authors for clarification or missing information whenever possible. All standard methodological procedures expected by Cochrane were used. MAIN RESULTS We found six publications involving a total of 47 participants requiring maxillary advancement of 4 mm to 10 mm. All of them related to a single trial performed between 2002 and 2008 at the University of Hong Kong, but not all of the publications reported outcomes from all 47 participants. The study compared maxillary distraction osteogenesis with orthognathic surgery, and included participants from 13 to 45 years of age.Results and conclusions should be interpreted with caution given the fact that this was a single trial at high risk of bias, with a small sample size.The main outcomes assessed were hard and soft tissue changes, skeletal relapse, effects on speech and velopharyngeal function, psychological status, and clinical morbidities.Both interventions produced notable hard and soft tissue improvements. Nevertheless, the distraction group demonstrated a greater maxillary advancement, evaluated as the advancement of Subspinale A-point: a mean difference of 4.40 mm (95% CI 0.24 to 8.56) was recorded two years postoperatively.Horizontal relapse of the maxilla was significantly less in the distraction osteogenesis group five years after surgery. A total forward movement of A-point of 2.27 mm was noted for the distraction group, whereas a backward movement of 2.53 mm was recorded for the osteotomy group (mean difference 4.8 mm, 95% CI 0.41 to 9.19).No statistically significant differences could be detected between the groups in speech outcomes, when evaluated through resonance (hypernasality) at 17 months postoperatively (RR 0.11, 95% CI 0.01 to 1.85) and nasal emissions at 17 months postoperatively (RR 3.00, 95% CI 0.14 to 66.53), or in velopharyngeal function at the same time point (RR 1.28, 95% CI 0.65 to 2.52).Maxillary distraction initially lowered social self-esteem at least until the distractors were removed, at three months postoperatively, compared to the osteotomy group, but this improved over time and the distraction group had higher satisfaction with life in the long term (two years after surgery) (MD 2.95, 95% CI 014 to 5.76).Adverse effects, in terms of clinical morbidities, included mainly occlusal relapse and mucosal infection, with the frequency being similar between groups (3/15 participants in the distraction osteogenesis group and 3/14 participants in the osteotomy group). There was no severe harm to any participant. AUTHORS' CONCLUSIONS This review found only one small randomised controlled trial concerning the effectiveness of distraction osteogenesis compared to conventional orthognathic surgery. The available evidence is of very low quality, which indicates that further research is likely to change the estimate of the effect. Based on measured outcomes, distraction osteogenesis may produce more satisfactory results; however, further prospective research comprising assessment of a larger sample size with participants with different facial characteristics is required to confirm possible true differences between interventions.
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Affiliation(s)
- Dimitrios Kloukos
- University of BernDepartment of Orthodontics and Dentofacial Orthopedics, School of Dental MedicineFreiburgstrasse 7BernSwitzerland3010
| | - Piotr Fudalej
- University of BernDepartment of Orthodontics and Dentofacial Orthopedics, School of Dental MedicineFreiburgstrasse 7BernSwitzerland3010
- Palacky University OlomoucDepartment of Orthodontics, Institute of Dentistry and Oral Sciences, Faculty of Medicine and DentistryPalackého 12OlomoucCzech Republic772 00
| | - Patrick Sequeira‐Byron
- University of BernDepartment of Preventive, Restorative and Paediatric Dentistry, School of Dental MedicineFreiburgstrasse 7BernBernSwitzerlandCH‐3010
| | - Christos Katsaros
- University of BernDepartment of Orthodontics and Dentofacial Orthopedics, School of Dental MedicineFreiburgstrasse 7BernSwitzerland3010
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Hagberg E, Flodin S, Granqvist S, Karsten A, Neovius E, Lohmander A. The Impact of Maxillary Advancement on Consonant Proficiency in Patients With Cleft Lip and Palate, Lay Listeners’ Opinion, and Patients’ Satisfaction With Speech. Cleft Palate Craniofac J 2018; 56:454-461. [DOI: 10.1177/1055665618784804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Emilie Hagberg
- Stockholm Craniofacial Team, Department of Reconstructive Plastic Surgery and Functional Area Speech Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Stina Flodin
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Svante Granqvist
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Unit of Basic Science, School of Technology and Health, KTH Royal Institute of Technology, Huddinge, Sweden
| | - Agneta Karsten
- Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
- Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erik Neovius
- Department of Reconstructive Plastic Surgery, Stockholms Craniofacial Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Functional Area Speech Language Pathology and Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
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Tanikawa C, Hirata K, Aikawa T, Maeda J, Kogo M, Iida S, Yamashiro T. Efficacy of Maxillary Anterior Segmental Distraction Osteogenesis in Patients With Cleft Lip and Palate. Cleft Palate Craniofac J 2018. [PMID: 29533696 DOI: 10.1177/1055665618758692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the effects of maxillary anterior segmental distraction osteogenesis (MASDO) in patients with cleft lip and palate (CLP) and to identify risk factors for increased relapse. DESIGN A retrospective study. PATIENTS Thirty-one Japanese patients with CLP who underwent MASDO were eligible for study inclusion. MAIN OUTCOME MEASURES We evaluated lateral cephalograms obtained before (T1), at 3 months (T2), and at 1 year (T3) after MASDO, and measured changes from T1 to T2 (δT1T2), from T2 to T3 (δT2T3), and from T1 to T3 (δT1T3). We also evaluated the risk factors associated with an increased relapse. RESULTS Overall (δT1T3), MASDO improved retrusion of the maxilla. We measured a significant advancement (6.1 mm) of the anterior maxillary segment in δT1T2 (A-McNamara classification) and increases in the overjet and the SNA, ANB, and nasolabial angles. However, skeletal relapse was evident in δT2T3, and the median percentage of relapse was 10%. To explore the risk factors, we subdivided patients with a δT1T2 of >5 mm into 2 groups based on the percentage of relapse (>15% vs ≤15%). There were significant differences between these groups in the vertical positions of the anterior nasal spine and point A, and the angle formed by the SN and palatal planes (SNPP), suggestive of intraoperative counterclockwise rotation of the maxilla. CONCLUSIONS MASDO is effective for correcting midfacial deficiencies, but counterclockwise rotation of the maxilla during surgery may cause relapse.
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Affiliation(s)
- Chihiro Tanikawa
- 1 Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Kae Hirata
- 1 Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Tomonao Aikawa
- 2 The First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Jun Maeda
- 1 Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Mikihiko Kogo
- 2 The First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Seiji Iida
- 3 Department of Oral and Maxillofacial Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Yamashiro
- 1 Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Osaka, Japan
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da Silva WS, de Almeida ALPF, Pucciarelli MGR, Neppelenbroek KH, da Silva de Menezes JD, Yaedú RYF, Oliveira TM, Cintra FMRN, Soares S. Relapse after Le Fort I surgery in oral cleft patients: a 2-year follow-up using digitized and 3D models. Odontology 2018; 106:445-453. [PMID: 29497867 DOI: 10.1007/s10266-018-0351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 02/11/2018] [Indexed: 11/25/2022]
Abstract
This retrospective observational study aimed to evaluate and identify the relapse rate after orthognathic surgery for maxillary advancement (Le Fort I maxillary osteotomy) in oral cleft patients through digitized cephalograms and 3D dental models, following 2 years. Lateral cephalograms and dental casts of 17 individuals, enrolled in Orthodontics Department in Hospital of Rehabilitation of Craniofacial Anomalies, were carried out. The digital cephalometric tracings were evaluated in: T1-before surgery, T2-immediate after surgery, T3-6-month to 1-year after surgery. The dental study casts were digitized and evaluated in: F1-before surgery; F2-3-month to 1-year after surgery; F3-1 to 2 years after surgery. The analyses of the dental arches were performed directly on the scanned images. A single examiner previously trained and calibrated performed all the assessments. Repeated measures ANOVA was applied to study the variables and compare the periods, followed by Tukey test to evaluate the statistically significant differences, with level of significance of 5%. The digital cephalogram results showed that the vertical movement statistically differed from T2 to T3 (p = 0.002). The right and left premolar relationship in digitized models revealed that at F2 the individuals exhibited ¼ Class II and Class I, in 29.4 and 23.5% of the cases, respectively; and at F3, Class I, 58.8 and 70.6% of the cases, respectively. The cephalometry showed the relapse in the vertical movement after orthognathic surgery for maxillary advancement, but no relapse in the other evaluated parameters.
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Affiliation(s)
- Willian Saranholi da Silva
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Ana Lúcia Pompéia Fraga de Almeida
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Maria Giulia Rezende Pucciarelli
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Karin Hermana Neppelenbroek
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Juliana Dreyer da Silva de Menezes
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Renato Yassutaka Faria Yaedú
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Thais Marchini Oliveira
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Flavia M R N Cintra
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Simone Soares
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil.
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Fahradyan A, Wolfswinkel EM, Clarke N, Park S, Tsuha M, Urata MM, Hammoudeh JA, Yamashita DDR. Impact of the Distance of Maxillary Advancement on Horizontal Relapse After Orthognathic Surgery. Cleft Palate Craniofac J 2018; 55:546-553. [DOI: 10.1177/1055665617739731] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The maxillary horizontal relapse following Le Fort I advancement has been estimated to be 10% to 50%. This retrospective review examines the direct association between the amounts of maxillary advancement and relapse. We hypothesize that the greater the advancement, the greater the relapse amount. Method: Patients with class III skeletal malocclusion underwent maxillary advancement with either a Le Fort I or a Le Fort I with simultaneous mandibular setback (bimaxillary surgery) from 2008 to 2015. Patients were assessed for a history of cleft lip or cleft palate. Patients with known syndromes were excluded. Cephalometric analysis was performed to compare surgical and postsurgical changes. Results: Of 136 patients, 47.1% were males and 61.8% had a history of cleft. The mean surgery age was 18.9 (13.8-23) years and 53.7% underwent a bimaxillary procedure. A representative subgroup of 35 patients had preoperative, immediate postoperative, and an average of 1-year postoperative lateral cephalograms taken. The mean maxillary advancement was 6.3 mm and the horizontal relapse was 1.8 mm, indicating a 28.6% relapse. A history of cleft and amount of maxillary advancement were directly correlated, whereas bone grafting of the maxillary osteotomy sites was inversely correlated with the amount of relapse ( P < .05). Conclusions: Our data suggest positive correlation between amount of maxillary advancement and horizontal relapse as well as a positive correlation between history of cleft and horizontal relapse. Bone grafting of the maxillary osteotomy sites has a protective effect on the relapse.
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Affiliation(s)
- Artur Fahradyan
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Erik M. Wolfswinkel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Noreen Clarke
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Stephen Park
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Michaela Tsuha
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Mark M. Urata
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
- Division of Oral and Maxillofacial Surgery, Ostrow School of Dentistry of USC, Los Angeles, CA, USA
| | - Jeffrey A. Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Dennis-Duke R. Yamashita
- Division of Oral and Maxillofacial Surgery, Ostrow School of Dentistry of USC, Los Angeles, CA, USA
- Division of Oral and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA
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Watts GD, Antonarakis GS, Forrest CR, Tompson BD, Phillips JH. Is Linear Advancement Related to Relapse in Unilateral Cleft Lip and Palate Orthognathic Surgery? Cleft Palate Craniofac J 2018; 52:717-23. [DOI: 10.1597/14-061.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the stability of major versus minor Le Fort I maxillary advancements in unilateral cleft lip and palate (UCLP) patients. Design A retrospective longitudinal study was undertaken on 30 nonsyndromic UCLP patients treated with the same protocol at The Hospital for Sick Children, Toronto, Canada. Patients were grouped into major and minor movement groups based on planned surgical advancement. Standard lateral cephalometric radiographs were taken preoperatively (T1), immediately postoperatively (T2), and at least 1 year postoperatively (T3). Skeletal and dental variables were measured using cephalometric analysis. Stability was compared between groups using repeated-measures analysis of variance. Linear regression analysis was used to assess the relationship between advancement and relapse for the entire study population. Results A mean maxillary advancement of 9.8 mm and 4.9 mm was seen for the major (n = 10) and minor (n = 20) movement groups, respectively. The mean skeletal horizontal relapse was 1.8 mm (18%) for the major advancement group and 1.5 mm (31%) for the minor advancement group. There was no significant difference in skeletal horizontal relapse between the groups ( P > .05). The correlation coefficient ( r) between linear horizontal advancement and relapse was calculated to be .31 ( P > .05). Dental horizontal relapse was not significant for either the major or minor groups, and no significant difference was found between the groups ( P > .05) Conclusion Skeletal and dental relapse was found to be unrelated to the amount of maxillary linear advancement using conventional Le Fort I osteotomies in UCLP.
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Affiliation(s)
- Guy D. Watts
- Craniofacial Surgery, The Centre for Craniofacial Care and Research, Division of Plastic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gregory S. Antonarakis
- Division of Orthodontics, Department of Dentistry, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christopher R. Forrest
- Division of Plastic and Reconstructive Surgery, HSC Centre for Craniofacial Care and Research, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, The Centre for Craniofacial Care and Research, Division of Plastic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Bryan D. Tompson
- Division of Orthodontics, Department of Dentistry, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - John H. Phillips
- Division of Orthodontics, Department of Dentistry, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Cakarer S, Keskin B, Isler S, Cansiz E, Uzun A, Keskin C. Complications associated with surgically assisted rapid palatal expansion without pterygomaxillary separation. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017. [DOI: 10.1016/j.jormas.2017.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Alves MLM, Scarelli Lopes JF, de Almeida ALPF, Neppelenbroek KH, de Oliveira TM, Soares S. Orthognathic Surgery or Overlay Prosthesis: Quality of Life in Bilateral Cleft Lip and Palate Patients. Ann Maxillofac Surg 2017; 7:176-179. [PMID: 29264282 PMCID: PMC5717891 DOI: 10.4103/ams.ams_135_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The concern to restore and evaluate bilateral cleft lip and palate (BCLP) patients' quality of life, after rehabilitation, is an issue that has been discussed in the literature because it is the ultimate goal of any proposed treatment. OBJECTIVE To evaluate the overall and oral quality of life of BCLP patients who had completed their treatment with orthognathic surgery (OrSg) compared to those who completed theirs with prosthetic rehabilitation in the form of overlay prosthesis (OP). MATERIALS AND METHODS The study comprised 40 patients, 20 in OrSg group and 20 in OP group. Epidemiological survey and application of two questionnaires (World Health Organization Quality of Life-brief [WHOQOL-bref] and Oral Health Impact Profile-14 [OHIP-14]) were done. The final results were evaluated statistically by the Mann-Whitney test. RESULTS Regarding the comparison with the WHOQOL-bref, no significant statistical differences between groups were found. In the analysis of the OHIP-14, only in "psychological limitation" field difference could be observed, where OrSg group showed more negative impact when compared to the OP group. CONCLUSION Both rehabilitations provide a satisfactory quality of life for patients.
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Affiliation(s)
- Michelly Lima Moro Alves
- Hospital for Rehabilitation of Craniofacial Anomalies, Prosthetic Dentistry Sector, Bauru, São Paulo, Brazil
| | | | - Ana Lúcia Pompéia Fraga de Almeida
- Hospital for Rehabilitation of Craniofacial Anomalies, Prosthetic Dentistry Sector, Bauru, São Paulo, Brazil
- Department of Prosthetic Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Karin Hermana Neppelenbroek
- Department of Prosthetic Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Thais Marchini de Oliveira
- Hospital for Rehabilitation of Craniofacial Anomalies, Prosthetic Dentistry Sector, Bauru, São Paulo, Brazil
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Simone Soares
- Hospital for Rehabilitation of Craniofacial Anomalies, Prosthetic Dentistry Sector, Bauru, São Paulo, Brazil
- Department of Prosthetic Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
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What Are the Contributing Factors for Postsurgical Relapse After Two-Jaw Surgery in Patients With Cleft Lip and Palate. J Craniofac Surg 2017; 28:1071-1077. [DOI: 10.1097/scs.0000000000003514] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Skeletal stability of maxillary advancement with and without a mandibular reduction in the cleft lip and palate patient. Int J Oral Maxillofac Surg 2016; 45:1501-1507. [DOI: 10.1016/j.ijom.2016.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 06/05/2016] [Accepted: 08/10/2016] [Indexed: 11/19/2022]
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Kloukos D, Fudalej P, Sequeira‐Byron P, Katsaros C. Maxillary distraction osteogenesis versus orthognathic surgery for cleft lip and palate patients. Cochrane Database Syst Rev 2016; 9:CD010403. [PMID: 27689965 PMCID: PMC6452788 DOI: 10.1002/14651858.cd010403.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cleft lip and palate is one of the most common birth defects and can cause difficulties with feeding, speech and hearing, as well as psychosocial problems. Treatment of orofacial clefts is prolonged; it typically commences after birth and lasts until the child reaches adulthood or even into adulthood. Residual deformities, functional disturbances, or both, are frequently seen in adults with a repaired cleft. Conventional orthognathic surgery, such as Le Fort I osteotomy, is often performed for the correction of maxillary hypoplasia. An alternative intervention is distraction osteogenesis, which achieves bone lengthening by gradual mechanical distraction. OBJECTIVES To provide evidence regarding the effects and long-term results of maxillary distraction osteogenesis compared to orthognathic surgery for the treatment of hypoplastic maxilla in people with cleft lip and palate. SEARCH METHODS We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 16 February 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 1), MEDLINE Ovid (1946 to 16 February 2016), Embase Ovid (1980 to 16 February 2016), LILACS BIREME (1982 to 16 February 2016), the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) (to 16 February 2016), and the World Health Organization (WHO) International Clinical Trials Registry Platform (to 16 February 2016). There were no restrictions regarding language or date of publication in the electronic searches. We performed handsearching of six speciality journals and we checked the reference lists of all trials identified for further studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing maxillary distraction osteogenesis to conventional Le Fort I osteotomy for the correction of cleft lip and palate maxillary hypoplasia in non-syndromic cleft patients aged 15 years or older. DATA COLLECTION AND ANALYSIS Two review authors assessed studies for eligibility. Two review authors independently extracted data and assessed the risk of bias in the included studies. We contacted trial authors for clarification or missing information whenever possible. All standard methodological procedures expected by Cochrane were used. MAIN RESULTS We found six publications involving a total of 47 participants requiring maxillary advancement of 4 mm to 10 mm. All of them related to a single trial performed between 2002 and 2008 at the University of Hong Kong, but not all of the publications reported outcomes from all 47 participants. The study compared maxillary distraction osteogenesis with orthognathic surgery, and included participants from 13 to 45 years of age.Results and conclusions should be interpreted with caution given the fact that this was a single trial at high risk of bias, with a small sample size.The main outcomes assessed were hard and soft tissue changes, skeletal relapse, effects on speech and velopharyngeal function, psychological status, and clinical morbidities.Both interventions produced notable hard and soft tissue improvements. Nevertheless, the distraction group demonstrated a greater maxillary advancement, evaluated as the advancement of Subspinale A-point: a mean difference of 4.40 mm (95% CI 0.24 to 8.56) was recorded two years postoperatively.Horizontal relapse of the maxilla was significantly less in the distraction osteogenesis group five years after surgery. A total forward movement of A-point of 2.27 mm was noted for the distraction group, whereas a backward movement of 2.53 mm was recorded for the osteotomy group (mean difference 4.8 mm, 95% CI 0.41 to 9.19).No statistically significant differences could be detected between the groups in speech outcomes, when evaluated through resonance (hypernasality) at 17 months postoperatively (RR 0.11, 95% CI 0.01 to 1.85) and nasal emissions at 17 months postoperatively (RR 3.00, 95% CI 0.14 to 66.53), or in velopharyngeal function at the same time point (RR 1.28, 95% CI 0.65 to 2.52).Maxillary distraction initially lowered social self-esteem at least until the distractors were removed, at three months postoperatively, compared to the osteotomy group, but this improved over time and the distraction group had higher satisfaction with life in the long term (two years after surgery) (MD 2.95, 95% CI 014 to 5.76).Adverse effects, in terms of clinical morbidities, included mainly occlusal relapse and mucosal infection, with the frequency being similar between groups (3/15 participants in the distraction osteogenesis group and 3/14 participants in the osteotomy group). There was no severe harm to any participant. AUTHORS' CONCLUSIONS This review found only one small randomised controlled trial concerning the effectiveness of distraction osteogenesis compared to conventional orthognathic surgery. The available evidence is of very low quality, which indicates that further research is likely to change the estimate of the effect. Based on measured outcomes, distraction osteogenesis may produce more satisfactory results; however, further prospective research comprising assessment of a larger sample size with participants with different facial characteristics is required to confirm possible true differences between interventions.
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Affiliation(s)
- Dimitrios Kloukos
- University of BernDepartment of Orthodontics and Dentofacial Orthopedics, School of Dental MedicineFreiburgstrasse 7BernSwitzerland3010
| | | | - Patrick Sequeira‐Byron
- University of BernDepartment of Preventive, Restorative and Pediatric DentistryFreiburgstrasse 7BernSwitzerlandCH‐3010
| | - Christos Katsaros
- University of BernDepartment of Orthodontics and Dentofacial OrthopedicsFreiburgstr. 7BernSwitzerlandCH‐3010
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Biomechanical evaluation of different fixation systems after Le Fort I osteotomy in polyurethane models of unilateral clefts. Br J Oral Maxillofac Surg 2016; 54:757-61. [PMID: 27182011 DOI: 10.1016/j.bjoms.2016.04.019] [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] [Received: 09/08/2015] [Accepted: 04/19/2016] [Indexed: 11/21/2022]
Abstract
We compared the stability of three different titanium plate-and-screw fixation systems after Le Fort I osteotomy in polyurethane models of unilateral clefts. Thirty-six models were divided into 3 groups. In the first group, we adapted standard Plates 1mm thick with 2.0mm screws and placed them bilaterally on the zygomatic buttress and the piriform rim. In the second group, we did the same and added Plates 0.6mm thick with 1.6mm screws between the standard 2mm miniplates on both sides. In the last group, we placed Plates 1.4mm thick with 2.0mm screws bilaterally on the maxillary zygomatic buttress and piriform rim. Each group was tested in the inferosuperior (IS) and anteroposterior (AP) directions with a servo-hydraulic testing unit. In the IS direction, displacement values were not significantly different up to 80N, but between 80 and 210N, those in the 2×1.4mm group were better. In the AP direction, displacement values were not significantly different up to 40N, but between 40 and 180N, they were better in the standard with 1.6×0.6mm group and the 2×1.4mm group. When normal biting forces (90 - 260N) in the postoperative period are considered, the greatest resistance to occlusal loads was seen in the 2×1.4mm group. In the others, the biomechanical properties were better in the AP direction.
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McNulty RJ, Cook VA, Millar K, Devlin MF. The Glasgow splint: modification of occlusal splint for cleft osteotomies. Br J Oral Maxillofac Surg 2015; 54:e1-2. [PMID: 26614586 DOI: 10.1016/j.bjoms.2015.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 10/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Richard J McNulty
- Clinical Fellow Oral and Maxillofacial Surgery, West of Scotland Regional Oral and Maxillofacial Department, Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF
| | - Victoria A Cook
- Consultant Oral and Maxillofacial Surgeon, Whitefield Rd, Dunfermline, Fife, KY12 0SU
| | - Kirsty Millar
- Oral and Maxillofacial Laboratory technician, West of Scotland Regional Oral and Maxillofacial Department, Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF
| | - Mark F Devlin
- Consultant Cleft Lip and Palate/ Oral and Maxillofacial Surgeon, West of Scotland Regional Oral and Maxillofacial Department, Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF
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Abreu A, Levy-Bercowski D, Yu J, Salgueiro M, Kalathingal S, Ferreira Susin L, Baker P. Interdisciplinary treatment of an adult with bilateral cleft lip and palate with missing premaxilla: The prosthodontic perspective. J Prosthet Dent 2015; 114:609-13. [DOI: 10.1016/j.prosdent.2014.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 09/05/2014] [Accepted: 09/08/2014] [Indexed: 11/24/2022]
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50
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Midfacial Volumetric and Upper Lip Soft Tissue Changes After Le Fort I Advancement of the Cleft Maxilla. J Oral Maxillofac Surg 2015; 73:708-18. [DOI: 10.1016/j.joms.2014.10.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/28/2014] [Accepted: 10/28/2014] [Indexed: 11/18/2022]
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