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Huqh MZU, Abdullah JY, AL-Rawas M, Husein A, Ahmad WMAW, Jamayet NB, Genisa M, Yahya MRB. Development of Artificial Neural Network-Based Prediction Model for Evaluation of Maxillary Arch Growth in Children with Complete Unilateral Cleft Lip and Palate. Diagnostics (Basel) 2023; 13:3025. [PMID: 37835768 PMCID: PMC10572375 DOI: 10.3390/diagnostics13193025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Cleft lip and palate (CLP) are the most common congenital craniofacial deformities that can cause a variety of dental abnormalities in children. The purpose of this study was to predict the maxillary arch growth and to develop a neural network logistic regression model for both UCLP and non-UCLP individuals. METHODS This study utilizes a novel method incorporating many approaches, such as the bootstrap method, a multi-layer feed-forward neural network, and ordinal logistic regression. A dataset was created based on the following factors: socio-demographic characteristics such as age and gender, as well as cleft type and category of malocclusion associated with the cleft. Training data were used to create a model, whereas testing data were used to validate it. The study is separated into two phases: phase one involves the use of a multilayer neural network and phase two involves the use of an ordinal logistic regression model to analyze the underlying association between cleft and the factors chosen. RESULTS The findings of the hybrid technique using ordinal logistic regression are discussed, where category acts as both a dependent variable and as the study's output. The ordinal logistic regression was used to classify the dependent variables into three categories. The suggested technique performs exceptionally well, as evidenced by a Predicted Mean Square Error (PMSE) of 2.03%. CONCLUSION The outcome of the study suggests that there is a strong association between gender, age, and cleft. The difference in width and length of the maxillary arch in UCLP is mainly related to the severity of the cleft and facial growth pattern.
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Affiliation(s)
- Mohamed Zahoor Ul Huqh
- Orthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| | - Johari Yap Abdullah
- Craniofacial Imaging Lab, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia
| | - Matheel AL-Rawas
- Prosthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| | - Adam Husein
- Prosthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| | - Wan Muhamad Amir W Ahmad
- Department of Biostatistics, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| | - Nafij Bin Jamayet
- Division of Restorative Dentistry (Prosthodontics), School of Dentistry, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia;
| | - Maya Genisa
- Biomedical Programme, Faculty of Pascasarjana, YARSI University, Jakarta 10510, Indonesia;
| | - Mohd Rosli Bin Yahya
- Oral & Maxillofacial Department, Hospital Raja Perempuan Zainab II, Kota Bharu 15586, Malaysia;
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Wang YC, Lu TC, Chen YA, Chen PKT, Liao YF. Outcomes of alveolar cleft repair in complete cleft lip and palate after tertiary gingivoperiosteoplasty and segmental Le Fort I osteotomy. Clin Oral Investig 2023; 27:4643-4652. [PMID: 37273019 DOI: 10.1007/s00784-023-05090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Gingivoperiosteoplasty is often used for reconstruction of alveolar defects in infants with cleft lip and palate. This study aimed to examine outcomes of tertiary gingivoperiosteoplasty, which has not previously been investigated. MATERIALS AND METHODS This prospective study included 11 adults with complete cleft lip and palate (n = 12 sites) who consecutively underwent segmental Le Fort I osteotomy and concomitant gingivoperiosteoplasty for correction of skeletal class III deformity, nasoalveolar fistula and alveolar cleft. Outcomes included clinical and radiographic evaluations of gingivoperiosteoplasty at the time of osteotomy (presence of nasoalveolar fistula, residual cleft defect and unsupported root ratio of cleft-adjacent teeth), and determination of influencing factors for the clinical success of alveolar cleft repair. Study variables included age, gender, pre-surgical orthodontic treatment and alveolar cleft width of cleft-adjacent canine and angulation between cleft-adjacent teeth before surgery and 1-week postsurgery. RESULTS Posttreatment, no nasoalveolar fistula remained. The residual cleft defect decreased significantly (p < 0.01). The unsupported root ratio of cleft-adjacent teeth did not differ (p > 0.05); eight cleft sites reached Bergland I or II (67% success). One-week postsurgery, the minimal alveolar cleft width of cleft-adjacent canine was significantly less in the success group compared with the failed group (p = 0.01). CONCLUSIONS Tertiary gingivoperiosteoplasty and segmental Le Fort I osteotomy decreased nasoalveolar fistulas and induced alveolar bone formation. The minimal alveolar cleft width immediately after surgery was the major influencing factor of clinical success. CLINICAL RELEVANCE Segmental Le Fort I osteotomy with simultaneous gingivoperiosteoplasty efficaciously repairs adult alveolar clefts.
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Affiliation(s)
- Yi-Chin Wang
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Ting-Chen Lu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ying-An Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Yu-Fang Liao
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, No. 123, Dinghu Road, Guishan District, Taoyuan City, 333, Taiwan.
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Martires S, Kamat NV, Dhupar V. Orthosurgical Management of a Patient with Cleft Lip and Palate. Contemp Clin Dent 2020; 11:171-178. [PMID: 33110333 PMCID: PMC7583545 DOI: 10.4103/ccd.ccd_200_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/23/2018] [Accepted: 09/04/2018] [Indexed: 11/08/2022] Open
Abstract
A 31-year-old male patient reported with a chief complaint of a forwardly placed lower jaw. Oral examination revealed Angle's Class III relationship bilaterally and cephalometrically; the patient presented with a small-sized retrognathic maxilla and normal mandible. Orthosurgical treatment was carried out with 4 mm of maxillary advancement and 4 mm of mandibular setback to achieve ideal overjet, overbite, and intercuspation of teeth. The ANB angle showed a drastic change from −9.5° to 1° and a successful conversion of the skeletal profile from Class III to Class I. Orthosurgical treatment can thus be an effective means of treating a patient with cleft lip and palate but requires a detailed understanding of the case and a sound diagnosis to attain a successful outcome.
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Affiliation(s)
- Sergio Martires
- Department of Orthodontics and Dentofacial Orthopaedics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Nandini V Kamat
- Department of Orthodontics and Dentofacial Orthopaedics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Vikas Dhupar
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, Goa, India
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Challenges in the Successful Reconstruction of Cleft Lip and Palate: Managing the Nasomaxillary Deformity in Adolescence. Plast Reconstr Surg 2020; 145:591e-603e. [PMID: 32097323 DOI: 10.1097/prs.0000000000006614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The surgical techniques and execution of primary cleft lip and palate repair are no longer the greatest challenge to achieving successful rehabilitation for those born with facial clefting (i.e., bilateral and unilateral cleft lip and palate). Despite a surgeon's best efforts, when cleft palate repair is carried out during infancy, by the mixed dentition, a majority will demonstrate nasomaxillary deficiency. The cleft team's commitment to a family under their care is to ensure that the newborn reaches adulthood reconstructed without need for special regard to their original birth malformation. Guiding principles are provided for the accurate diagnosis and reliable reconstruction of the bilateral and unilateral cleft lip and palate adolescent/adult who presents with nasomaxillary deficiency and any residual oronasal fistula, bony defects, cleft dental gap(s), nasal obstructions, and associated facial dysmorphology. Successful orthognathic surgery provides a stable foundation on which any remaining soft-tissue cleft lip or cleft nasal deformities can be accurately assessed and then reconstructed.
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Zhang Y, Wang Y, Zhang Y, Li S, Wang L, Qian Y. Cone-Beam Computed Tomography Evaluation of Skeletal Deformities and Pharyngeal Airway in Chinese Han Individuals With Nonsyndromic Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2019; 57:65-72. [PMID: 31296040 DOI: 10.1177/1055665619860700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: This study examined the relationships between skeletal deformities and the pharyngeal airway of patients with nonsyndromic unilateral cleft lip and palate (UCLP). Design: Retrospective study. Setting: Orthodontics and Oral and Maxillofacial Surgery Departments in the Affiliated Hospital of Stomatology, Nanjing Medical University, China. Patients, Participants: The sample comprised 30 nonsyndromic UCLP patients and 30 healthy controls. Each group has 23 males and 7 females. Interventions: All cone-beam computed tomography images were obtained with the participant in the standard supine position and asked to bite with intercuspal position without swallowing or moving their heads and tongues during scanning. Main Outcome Measure(s): SNA, SNB, ANB, anterior cranial base, Wits appraisal, maxillary length (PTM-ANS || FH), maxillary position (S-PTM || FH), mandibular length (Go-Pog || MP), FMA, posterior face height, anterior face height, Posterior-Anterior face height, lower face height, pharyngeal airway volumes, and areas were evaluated by Dolphin imaging software. Results: The UCLP group showed significantly decreased SNA, SNB, ANB, PTM-ANS || FH, S-PTM || FH, P-A Face Height compared with the controls. However, the airway volumes and areas showed no significant difference between 2 groups. The total airway volume and minimum cross-sectional area in UCLP patients were related to the Go-Pog || MP and FMA. Conclusions: Patients with UCLP have both the maxillary and mandibular deficiencies in the sagittal dimension. Both the sagittal and vertical relationships of the jaw might affect the airway volume and area. However, no significant difference was detected in airway volume and area in UCLP patients when compared with the controls.
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Affiliation(s)
- Yuan Zhang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuhua Wang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yaoyuan Zhang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Sheng Li
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lin Wang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yajing Qian
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu, China
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Roy AA, Rtshiladze MA, Stevens K, Phillips J. Orthognathic Surgery for Patients with Cleft Lip and Palate. Clin Plast Surg 2019; 46:157-171. [DOI: 10.1016/j.cps.2018.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chang CS, Wallace CG, Hsiao YC, Hsieh YJ, Wang YC, Chen NH, Liao YF, Liou EJW, Chen PKT, Chen JP, Chen YR. Airway Changes after Cleft Orthognathic Surgery Evaluated by Three-Dimensional Computed Tomography and Overnight Polysomnographic Study. Sci Rep 2017; 7:12260. [PMID: 28947808 PMCID: PMC5612929 DOI: 10.1038/s41598-017-12251-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 09/04/2017] [Indexed: 11/12/2022] Open
Abstract
Cleft lip and palate is the most common congenital craniofacial anomaly. Up to 60% of these patients will benefit from cleft orthognathic surgery, which consists primarily of maxillary advancement and mandibular setback to address midface retrusion and relative mandibular protrusion, respectively. It is believed that maxillary advancement can enlarge the airway whilst mandibular setback can reduce the airway, but this has not previously been quantified for cleft patients undergoing orthognathic surgery. This unique longitudinal prospective study of 18 patients was conducted between April 2013 and July 2016. No significant changes occurred by six months postoperatively in body mass index, apnoea-hypopnoea index or lowest oxygen saturation (LSAT). There was a mean increase of 0.73 cm3 in velopharyngeal volume, a mean decrease of 0.79 cm3 in oropharyngeal volume, an improvement in snoring index, and no statistically significant change in hypopharyngeal volume. In conclusion, cleft orthognathic surgery that produced anterior advancement of the maxilla, setback of the mandible and clockwise rotation of the maxillo-mandibular complex resulted in increased velopharyngeal, decreased oropharyngeal and unchanged hypopharyngeal airways, and improved snoring, but did not significantly alter objective sleep-related breathing function.
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Affiliation(s)
- Chun-Shin Chang
- Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan (R.O.C.)
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Christopher Glenn Wallace
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Yen-Chang Hsiao
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Yuh-Jia Hsieh
- Craniofacial Research Center, Department of Medical Research, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Yi-Chin Wang
- Craniofacial Research Center, Department of Medical Research, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Ning-Hung Chen
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Yu-Fang Liao
- Craniofacial Research Center, Department of Medical Research, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Eric Jen-Wein Liou
- Craniofacial Research Center, Department of Medical Research, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Philip Kuo-Ting Chen
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.).
| | - Jyh-Ping Chen
- Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan (R.O.C.)
| | - Yu-Ray Chen
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
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Karia H, Shrivastav S, Karia AK. Three-dimensional evaluation of the airway spaces in patients with and without cleft lip and palate: A digital volume tomographic study. Am J Orthod Dentofacial Orthop 2017; 152:371-381. [DOI: 10.1016/j.ajodo.2016.12.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 12/01/2016] [Accepted: 12/01/2016] [Indexed: 10/19/2022]
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Susarla SM, MacIsaac ZM, Swanson E, Davidson E, Kumar A. Acellular Dermal Matrix as an Adjunct Material in Cleft Le Fort I Osteotomies. J Craniofac Surg 2017; 28:225-226. [PMID: 27997450 DOI: 10.1097/scs.0000000000003308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the use of acellular dermal matrix in the management of nasal lining deficiency at the time of Le Fort I osteotomy. METHODS This was a retrospective cohort study of patients with residual/recurrent oronasal fistulae who underwent Le Fort I osteotomy. In instances where there was an inadequate volume of nasal mucosa for tension-free closure or for defects >1 cm in width, the acellular dermal matrix was used for augmentation. Demographic and cleft-related factors were recorded. Complications (recurrent fistula, infection, seroma, and wound dehiscence) were recorded. RESULTS Over the 3-year period, the authors used acellular dermal matrix to augment nasal lining in 8 subjects. The sample's mean age was 18.7 ± 3.1 years; 5 subjects were male. Six patients had bilateral cleft defects. The mean follow-up time was 20.2 ± 3.2 years. There were no episodes of infection, seroma, wound dehiscence, or recurrent fistula. CONCLUSION Acellular dermal matrix is a useful adjunct for managing nasal liningdeficiency at the time of Le Fort I osteotomy. There were no episodes of bone graft extrusion, infection, tooth loss, or bone graft loss. The Enemark scores improved significantly across both subsets (P <0.001). There was 1 recurrent fistula in the allograft bone alone group.Residual alveolar clefts and oronasal fistulae can be successfully managed at the time of Le Fort I osteotomy using allograft bone and acellular dermal matrix.
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Affiliation(s)
- Srinivas M Susarla
- *Craniofacial Center, Seattle Children's Hospital, Seattle, WA †Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA ‡Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Le Fort III Distraction Using Rotation Advancement of the Midface in Patients with Cleft Lip and Palate. Plast Reconstr Surg 2013; 132:1532-1541. [DOI: 10.1097/prs.0b013e3182a97ebc] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Treatment algorithm for bilateral alveolar cleft based on the position of the premaxilla and the width of the alveolar gap. J Plast Reconstr Aesthet Surg 2013; 66:1212-8. [DOI: 10.1016/j.bjps.2013.04.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 04/16/2013] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
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de Ladeira PRS, Alonso N. Protocols in cleft lip and palate treatment: systematic review. PLASTIC SURGERY INTERNATIONAL 2012; 2012:562892. [PMID: 23213503 PMCID: PMC3503280 DOI: 10.1155/2012/562892] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/24/2012] [Indexed: 11/17/2022]
Abstract
Objectives. To find clinical decisions on cleft treatment based on randomized controlled trials (RCTs). Method. Searches were made in PubMed, Embase, and Cochrane Library on cleft lip and/or palate. From the 170 articles found in the searches, 28 were considered adequate to guide clinical practice. Results. A scarce number of RCTs were found approaching cleft treatment. The experimental clinical approaches analyzed in the 28 articles were infant orthopedics, rectal acetaminophen, palatal block with bupivacaine, infraorbital nerve block with bupivacaine, osteogenesis distraction, intravenous dexamethasone sodium phosphate, and alveoloplasty with bone morphogenetic protein-2 (BMP-2). Conclusions. Few randomized controlled trials were found approaching cleft treatment, and fewer related to surgical repair of this deformity. So there is a need for more multicenter collaborations, mainly on surgical area, to reduce the variety of treatment modalities and to ensure that the cleft patient receives an evidence-based clinical practice.
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Affiliation(s)
| | - Nivaldo Alonso
- Division of Burns and Plastic Surgery, Department of Surgery, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Rua Afonso Brás, 473 cj 65 Vila Nova Conceição, 04511-000 São Paulo, SP, Brazil
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Chigurupati R. Orthognathic surgery for secondary cleft and craniofacial deformities. Oral Maxillofac Surg Clin North Am 2012; 17:503-17. [PMID: 18088803 DOI: 10.1016/j.coms.2005.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Orthognathic surgery is a critical component of surgical management of craniofacial deformities such as cleft lip and palate, craniofacial dysostoses, and mandibulofacial dysostoses. These operations can correct discrepancy in jaw relationship and malocclusion, relieve airway obstruction, correct facial asymmetry, optimize facial aesthetics, improve speech articulation, improve ability to masticate, and enhance psychological development and social interaction. Oral and maxillofacial surgeons who treat these deformities should be part of a craniofacial team to provide interdisciplinary care for patients. Distraction osteogenesis is a useful technique in the management of severe craniofacial deformities but does not replace conventional orthognathic surgery, which is safe and predictable. Recent advances in three-dimensional imaging and planning tools have made it possible to plan surgery more accurately and predictably.
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Affiliation(s)
- Radhika Chigurupati
- Department of Oral and Maxillofacial Surgery, University of California-San Francisco, 521 Parnassus Avenue, C-522, San Francisco, CA 94143-0440, USA
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Fong JHJ, Wu HT, Chio YW, Gonzalez AM, Huang CK, Chen YW, Kao SY. Comprehensive rehabilitation after severe maxillofacial injury in a cleft patient. J Chin Med Assoc 2010; 73:543-8. [PMID: 21051033 DOI: 10.1016/s1726-4901(10)70118-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 07/01/2010] [Indexed: 10/18/2022] Open
Abstract
We present here a complex oral rehabilitation procedure for a 19-year-old male patient with an operated cleft lip and palate who suffered motorcycle accident injuries including facial lacerations, and a severe mandible fracture with loss of teeth, gingiva and alveolar bone. His initial skeletal and occlusal relationship made the emergent surgical management extremely difficult. Emergent soft tissue repair and open reduction surgery for the comminuted fracture at the mandible were performed during the intensive care period. A 2-year period of comprehensive procedures including surgical/orthodontic treatment, implant surgery and bone graft and prosthetic restoration for oral and maxillofacial rehabilitation to treat the severely compromised soft and hard tissue status, intermaxillary jaw discrepancy, and severe malocclusion, were sequentially performed. Satisfactory results were observed after a 5-year follow-up.
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Affiliation(s)
- Jenny Hwai-Jen Fong
- Department of Stomatology, Taipei Veterans General Hospital, 201 Section 2 Shih-Pai Road, Taipei, Taiwan, R.O.C
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Chong DK, Portnof JE, Xu H, Salyer KE. Reviewing the orthognathic surgical care of the patient with cleft lip and palate: the single surgeon experience. J Craniofac Surg 2010; 20 Suppl 2:1895-904. [PMID: 19816372 DOI: 10.1097/scs.0b013e3181b6c69f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients with cleft lip and palate are best treated in a multidisciplinary setting and benefit from being treated by experienced surgeons in high-volume centers. We present the evaluation of 103 consecutive patients with cleft lip and palate treated by a senior craniofacial surgeon. The results of orthognathic surgery in respect to function, stability, cosmesis, and complications are audited.
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Affiliation(s)
- David K Chong
- Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Melbourne, Australia
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Kumar A, Gabbay JS, Nikjoo R, Heller JB, O'Hara CM, Sisodia M, Garri JI, Wilson LS, Kawamoto HK, Bradley JP. Improved Outcomes in Cleft Patients with Severe Maxillary Deficiency after Le Fort I Internal Distraction. Plast Reconstr Surg 2006; 117:1499-509. [PMID: 16641719 DOI: 10.1097/01.prs.0000206308.86089.86] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Correction of severe maxillary deficiency in cleft lip-cleft palate patients often results in undercorrection, relapse, and need for secondary corrective procedures. Le Fort I internal distraction osteogenesis offers an alternative to one-step orthognathic advancement, with advantages of gradual lengthening through scar and earlier treatment in growing patients. METHODS Patients with cleft lip-cleft palate deformities and maxillary deficiency were divided into three groups treated by Le Fort I advancement: group 1, mild to moderate deficiency (< 10 mm) with conventional orthognathic procedure; group 2, severe deficiency (> or = 10 mm) with conventional orthognathic procedure; and group 3, distraction procedure for severe deficiency (> or = 10 mm) (n = 51). Preoperative, postoperative, and follow-up (> 1 year) lateral cephalogram measurements were compared including angular (SNA and SNB) and linear (Deltax = horizontal and Deltay = vertical) changes. The Pittsburgh Speech Score was used to assess for velopharyngeal insufficiency (score > 3). RESULTS Results demonstrated that group 1 patients had a mean SNA change from preoperatively (78.7) to postoperatively (83.8), and a horizontal change of 5.0 mm, with no relapse. Group 2 patients had a mean SNA change from preoperatively (76.3) to postoperatively (82.0) and a horizontal change of 7.2 mm, with 63 percent relapse. Group 3 patients had a mean SNA change from preoperatively (74.1) to postoperatively (84.9) and a horizontal change of 16.5 mm, with 15 percent relapse. Thus, for severe maxillary deficiency, the distraction group had 48 percent less relapse than the conventional Le Fort I group. Postoperative speech evaluation showed velopharyngeal insufficiency in the following: group 1, four of 20 patients (20 percent); group 2, nine of 11 patients (82 percent); and group 3, nine of 20 patients (45 percent). CONCLUSION These data suggest that Le Fort I internal distraction for severe cleft maxillary deficiency leads to better dental occlusion, less relapse, and better speech results.
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Affiliation(s)
- Anand Kumar
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California, USA
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