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van Roey VL, Ombashi S, Pleumeekers MM, Mathijssen IMJ, Mink van der Molen AB, Munill M, Versnel SL. Comparison of two surgical protocols for the treatment of unilateral cleft lip and palate: a multidisciplinary systematic review and meta-analysis. Int J Oral Maxillofac Surg 2024; 53:803-820. [PMID: 38664107 DOI: 10.1016/j.ijom.2024.04.003] [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: 08/15/2023] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 08/27/2024]
Abstract
There is still no unanimous agreement on the optimal surgical protocol(s) for the treatment of unilateral cleft lip and palate (UCLP), and a huge variety of protocols are employed by cleft centres across the world. The aim of this systematic review and meta-analysis was to compare reported patient outcomes of the Oslo protocol (and modifications) (OP) and delayed hard palate closure protocols (DHPCP) from a multidisciplinary perspective. A systematic search of multiple databases was conducted until September 2023. Studies reporting any patient outcomes of these protocols were included. Random-effects meta-analyses were performed for evidence synthesis, including comparisons of results between the types of protocol. The quality of evidence was evaluated using the ROBINS-I tool. In total, 62 articles (42 studies) reporting patients with UCLP were reviewed, involving 1281 patients following the OP and 655 following DHPCP. Equally poor long-term sagittal maxillofacial growth was found, and similar results for velopharyngeal insufficiency and nasolabial appearance. In contrast, OP was associated with a lower rate of oronasal fistulas. Disregarding the scarcity of comparable evidence for some domains, the results of this review, overall, favour OP over DHPCP. However, caution should be taken when interpreting the results on velopharyngeal insufficiency and oronasal fistulas, since the possibility of confounding and other biases remains.
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Affiliation(s)
- V L van Roey
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
| | - S Ombashi
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - M M Pleumeekers
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Dutch Craniofacial Centre, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - I M J Mathijssen
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Dutch Craniofacial Centre, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - A B Mink van der Molen
- Department of Plastic and Reconstructive Surgery, UMC Utrecht, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Munill
- Department of Maxillofacial Surgery, Hospital Vall d'Hebron, Barcelona, Spain
| | - S L Versnel
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Dutch Craniofacial Centre, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Sennimalai K, Selvaraj M, Sameemullah KH, Gothankar GS, Siddiqui HP, Arora G, Mohaideen K. Research Trends in Presurgical Infant Orthopaedic Treatment in Patients with Cleft Lip and Palate: A Bibliometric Analysis of 100 Most-Cited Articles. Cleft Palate Craniofac J 2024:10556656241285812. [PMID: 39314073 DOI: 10.1177/10556656241285812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
OBJECTIVE To assess research trends and publication patterns of literature related to presurgical infant orthopaedics (PSIO) through a bibliometric analysis of the top 100 most-cited articles. MATERIAL AND METHODS The top 100 most-cited articles were identified in the Web of Science (WoS) database using search terms related to PSIO on April 23, 2024, without any restrictions to study design, publication date and language. Standard information about each study was extracted. Citations from WoS, Scopus and PubMed databases were compared. The level of evidence for each article included was assessed. Association between different variables was calculated using Spearman's correlation coefficient with statistical significance set at p < 0.05. Visual analysis of the author's keyword co-occurrence, co-authorship analysis of authors, and citation analysis of journals and authors were performed using VOSviewer. RESULTS Top cited articles were published from 1994 to 2020, with total individual database citations being WoS (n = 5378), Scopus (n = 6184) and PubMed (n = 10 450). Eleven articles were considered classic articles. Cleft Palate and Craniofacial Journal (Impact Factor = 1.1) had a maximum number of articles and citations. Two hundred eighty-five individuals contributed to top-cited articles, with 62 corresponding authors from 19 countries. A maximum number of authors were affiliated with universities in the United States. The most common keyword used was "nasoalveolar molding (n = 24)", "cleft palate (n = 16)", and "infant orthopedics (n = 16)". The study design of the majority of articles was retrospective and follow-up studies (level 3; n = 53). A weak negative correlation was observed between citation metrics and both the publication year (P < 0.01) and the level of evidence (P < 0.01). CONCLUSION This analysis recognises the contributions of experts and offers valuable insights into trends that have shaped the development and evidence related to PSIO research. Future research should focus on integrating advanced technologies, conducting longitudinal studies, fostering collaboration, and emphasizing patient-centred outcomes.
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Affiliation(s)
- Karthik Sennimalai
- Department of Orthodontics, All India Institute of Medical Sciences, Jammu, Jammu and Kashmir, India
| | - Madhanraj Selvaraj
- Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Greeshma Shantharam Gothankar
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | | | - Garima Arora
- Department of Orthodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Kaja Mohaideen
- Department of Research Analytics, Saveetha Dental College and Hospital, Chennai, India
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Tabellion M, Lisson JA. Three-dimensional analysis of palatal morphology and PAS in patients with cleft lip and palate prior to orthodontic treatment. Head Face Med 2024; 20:40. [PMID: 39090693 PMCID: PMC11293093 DOI: 10.1186/s13005-024-00440-2] [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: 06/20/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Since many different conclusions of craniofacial anomalies and their relation to the posterior airway space coexist, this comparative clinical study investigated the palatal morphology concerning volumetric size, posterior airway space dimension and the adenoids of patients with and without a cleft before orthodontic treatment. METHODS Three-dimensional intraoral scans and cephalometric radiographs of n = 38 patients were used for data acquisition. The patients were divided into three groups: unilateral cleft lip and palate (n = 15, 4 female, 11 male; mean age 8.57 ± 1.79 years), bilateral cleft lip and palate (n = 8, 0 female, 8 male; mean age 8.46 ± 1.37 years) and non-cleft control (n = 15, 7 female, 8 male; mean age 9.03 ± 1.02 years). The evaluation included established procedures for measurements of the palatal morphology and posterior airway space. Statistics included Shapiro-Wilk-Test and simple ANOVA (Bonferroni) for the three-dimensional intraoral scans and cephalometric radiographs. The level of significance was set at p < 0.05. RESULTS The palatal volume and cephalometric analysis showed differences between the three groups. The palatal volume, the superior posterior face height and the depth of the bony nasopharynx of patients with cleft lip and palate were significantly smaller than for non-cleft control patients. The superior posterior face height of bilateral cleft lip and palate patients was significantly smaller than in unilateral cleft lip and palate patients (BCLP: 35.50 ± 2.08 mm; UCLP: 36.04 ± 2.95 mm; p < 0.001). The percentage of the adenoids in relation to the entire nasopharynx and the angle NL/SN were significantly bigger in patients with cleft lip and palate than in the non-cleft control. In particular, the palatal volume was 32.43% smaller in patients with unilateral cleft lip and palate and 48.69% smaller in patients with bilateral cleft lip and palate compared to the non-cleft control. CONCLUSIONS Skeletal anomalies relate to the dimension of the posterior airway space. There were differences among the subjects with cleft lip and palate and these without a cleft. This study showed that the morphology of the palate and especially transverse deficiency of the maxilla resulting in smaller palatal volume relates to the posterior airway space. Even the adenoids seem to be affected, especially for cleft lip and palate patients.
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Affiliation(s)
- Maike Tabellion
- Department of Orthodontics (G56), Saarland University, Kirrberger Strasse 100, 66424, Homburg/Saar, Germany.
| | - Jörg Alexander Lisson
- Department of Orthodontics (G56), Saarland University, Kirrberger Strasse 100, 66424, Homburg/Saar, Germany
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Peixoto AP, Miranda F, de Oliveira Pinto R, Ribeiro TTDC, Lara FSS, Machado FMDC, Garib D. Maxillary arch dimensions in bilateral cleft lip and palate in the age 0-5 months. Orthod Craniofac Res 2024. [PMID: 39003677 DOI: 10.1111/ocr.12836] [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: 11/06/2023] [Revised: 06/07/2024] [Accepted: 07/04/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION The complete bilateral cleft lip and palate (BCLP) divides the maxillary arch into three segments, separated from each other, resulting in abnormal growth of the alveolar arch. This study evaluated the maxillary arch dimensions in BCLP and compared them with neonates without craniofacial anomalies. METHODS This retrospective study was conducted in a tertiary cleft centre. Sixty-six neonates aged 0-5 months were divided into two groups: cleft group-children with BCLP (23 boys and 18 girls) and control group-children without craniofacial deformities (15 boys and 10 girls). The dental models were processed by a 3D scanner. Landmarks were marked to achieve inter-canine distance, inter-tuberosity distance and arch length measurements. t-Tests were used for intergroup comparisons (p < .05). RESULTS The maxillary cleft arch was demonstrated to be wider and longer in the posterior region compared to the control group. The inter-canine distance did not present differences between the cleft and controls. The inter-canine distance of the control group was the only measurement influenced by the variable sex. CONCLUSIONS The cleft significantly interfered with the arch posterior width and arch sagittal length, making them larger. There was no statistical difference in the measurements between sex in the cleft group.
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Affiliation(s)
- Adriano Porto Peixoto
- Department of Orthodontics, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | - Felicia Miranda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | | | - Tiago Turri de Castro Ribeiro
- Department of Orthodontics, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | | | | | - Daniela Garib
- Department of Orthodontics, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
- Department of Orthodontics, Bauru Dental School, University of São Paulo, São Paulo, Brazil
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Thiruvenkatachari B, Bonanthaya K, Kuijpers Jagtman AM, Sandler J, Powar RS, Hussain SA, Subramaniyan B, Bhola N, Bhat HK, Ramachandra V, Jayakumar S, Batra P, Chakkaravarthi S, Thailavathy V, Prathap M, Elumalai T, Nambiar K, Vijayakumar C, Mahajan RK, Sood SC, Kahlon SS, Bijapur S, Kamble RH, Keluskar KM, Nilgar A, Khan FA, Das D, Sridhar S, Buch A, Kumar S, Mohanraj R, Listl S, Chopra S, Jadhav V, Arora A, Valiya C, Pattamata M. A multi-centric, single-blinded, randomized, parallel-group study to evaluate the effectiveness of nasoalveolar moulding treatment in non-syndromic patients with complete unilateral cleft lip, alveolus and palate (NAMUC study): a study protocol for a randomized controlled trial. Trials 2024; 25:453. [PMID: 38965585 PMCID: PMC11223389 DOI: 10.1186/s13063-024-08229-z] [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: 05/25/2024] [Accepted: 06/04/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Cleft lip and palate (CLP) are among the most common congenital anomaly that affects up to 33,000 newborns in India every year. Nasoalveolar moulding (NAM) is a non-surgical treatment performed between 0 and 6 months of age to reduce the cleft and improve nasal aesthetics prior to lip surgery. The NAM treatment has been a controversial treatment option with 51% of the cleft teams in Europe, 37% of teams in the USA and 25 of cleft teams in India adopting this methodology. This treatment adds to the already existing high burden of care for these patients. Furthermore, the supporting evidence for this technique is limited with no high-quality long-term clinical trials available on the effectiveness of this treatment. METHOD The NAMUC study is an investigator-initiated, multi-centre, single-blinded randomized controlled trial with a parallel group design. The study will compare the effectiveness of NAM treatment provided prior to lip surgery against the no-treatment control group in 274 patients with non-syndromic unilateral complete cleft lip and palate. The primary endpoint of the trial is the nasolabial aesthetics measured using the Asher McDade index at 5 years of age. The secondary outcomes include dentofacial development, speech, hearing, cost-effectiveness, quality of life, patient perception, feeding and intangible benefits. Randomization will be carried out via central online system and stratified based on cleft width, birth weight and clinical trial site. DISCUSSION We expect the results from this study on the effectiveness of treatment with NAM appliance in the long term along with the cost-effectiveness evaluation can eliminate the dilemma and differences in clinical care across the globe. TRIAL REGISTRATION ClinicalTrials.gov CTRI/2022/11/047426 (Clinical Trials Registry India). Registered on 18 November 2022. The first patient was recruited on 11 December 2022. CTR India does not pick up on Google search with just the trial number. The following steps have to be carried out to pick up. How to search: ( https://ctri.nic.in/Clinicaltrials/advsearch.php -use the search boxes by entering the following details: Interventional trial > November 2022 > NAMUC).
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Affiliation(s)
- Badri Thiruvenkatachari
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India.
| | | | - Anne Marie Kuijpers Jagtman
- Department of Orthodontics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical Faculty, University of Bern, Bern, Switzerland
| | - Jonathan Sandler
- Chesterfield Royal Hospital, Chesterfield Royal Hospital NHS Foundation Trust, Calow, England
| | - Rajesh S Powar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Syed Altaf Hussain
- Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India
| | - B Subramaniyan
- Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India
| | - Nitin Bhola
- Shri Sharad Pawar Dental College and Hospital (SPDC), Wardha, Maharashtra, India
| | - Hari Kishore Bhat
- Yenepoya University: Yenepoya (Deemed to Be University), Mangaluru, Karnataka, India
| | | | | | - Puneet Batra
- Manav Rachna Dental College, Faridabad, Haryana, India
| | - Subhiksha Chakkaravarthi
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - V Thailavathy
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - Manoj Prathap
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - Thulasiram Elumalai
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - Karthika Nambiar
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - Charanya Vijayakumar
- Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India
| | | | | | | | | | | | - K M Keluskar
- Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education & Research, Belagavi, India
| | - Amit Nilgar
- Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education & Research, Belagavi, India
| | - Faizan Ahmed Khan
- Yenepoya University: Yenepoya (Deemed to Be University), Mangaluru, Karnataka, India
| | | | - Swetha Sridhar
- Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India
| | | | | | | | - Stefan Listl
- Heidelberg University BIOMS: Universitat Heidelberg Bioquant, Heidelberg, Germany
| | | | - Vikrant Jadhav
- Shri Sharad Pawar Dental College and Hospital (SPDC), Wardha, Maharashtra, India
| | - Anika Arora
- Manav Rachna Dental College, Faridabad, Haryana, India
| | | | - Madhuri Pattamata
- Radboud Universiteit Nijmegen: Radboud Universiteit, Nijmegen, The Netherlands
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R V, Singhal R, Namdev R, Kumar A, Dayma C, Rani A. Treatment Outcomes of Lip Taping in Patients with Non-syndromic Cleft Lip and/or Palate: A Systematic Review and Meta-analysis. Cleft Palate Craniofac J 2024:10556656241249822. [PMID: 38711400 DOI: 10.1177/10556656241249822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE To conduct a systematic review of the data in peer-reviewed medical literature and evaluate the effectiveness of lip taping as a pre-surgical naso-alveolar molding (NAM) technique in infants with cleft lip and/or palate. DESIGN An electronic search of various databases for relevant studies, regardless of date, from inception to June 2023 was carried out and evaluated. After completing the electronic search and applying our inclusion/exclusion criteria, 6 studies-2 randomized control trials, 2 non-randomized studies, and 2 case series-were included. Data extraction of relevant articles was done independently by 2 authors. Quality assessment was done using the JBI prevalence critical appraisal tool and certainty of evidence was carried out by GRADE approach. MAIN OUTCOME MEASURES Nasolabial Aesthetics, Dentoalveolar Relationship. RESULTS A total of six studies were included in the current review. Meta-analysis was carried out, and forest plots were obtained for a single mean from the lip-taping group. 3 studies had a low risk of bias, while 3 studies displayed a serious risk of bias. Significant improvement in various outcome measures was noted with lip taping when compared with the control group although the certainty of evidence was very low. CONCLUSION When compared to no therapy, lip taping appears to ameliorate dentoalveolar measurements and nasolabial aesthetics. To increase our knowledge of lip taping, more research will be needed in the future, as there are not many studies to prove lip taping is better than other treatment approaches.
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Affiliation(s)
- Vignesh R
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Ruchi Singhal
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Ritu Namdev
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Adarsh Kumar
- Department of Public Health Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Charu Dayma
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Asha Rani
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
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Cleft and Craniofacial Surgery. J Oral Maxillofac Surg 2023; 81:E120-E146. [PMID: 37833020 DOI: 10.1016/j.joms.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Parhofer R, Rau A, Strobel K, Gölz L, Stark R, Ritschl LM, Wolff KD, Kesting MR, Grill FD, Seidel CL. The impact of passive alveolar molding vs. nasoalveolar molding on cleft width and other parameters of maxillary growth in unilateral cleft lip palate. Clin Oral Investig 2023; 27:5001-5009. [PMID: 37353667 PMCID: PMC10492684 DOI: 10.1007/s00784-023-05119-7] [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: 01/18/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE Passive alveolar molding (PAM) and nasoalveolar molding (NAM) are established presurgical infant orthodontic (PSIO) therapies for cleft lip palate (CLP) patients. PAM guides maxillary growth with a modified Hotz appliance, while NAM also uses extraoral taping and includes nasal stents. The effects of these techniques on alveolar arch growth have rarely been compared. MATERIAL AND METHODS We retrospectively compared 3D-scanned maxillary models obtained before and after PSIO from infants with unilateral, non-syndromic CLP treated with PAM (n = 16) versus NAM (n = 13). Nine anatomical points were set digitally by four raters and transversal/sagittal distances and rotations of the maxilla were measured. RESULTS Both appliances reduced the anterior cleft, but NAM percentage wise more. NAM decreased the anterior and medial transversal width compared to PAM, which led to no change. With both appliances, the posterior width increased. The alveolar arch length of the great and small segments and the sagittal length of the maxilla increased with PAM but only partially with NAM. However, NAM induced a significant greater medial rotation of the larger and smaller segment compared to PAM with respect to the lateral angle. CONCLUSIONS NAM and PAM presented some significant differences regarding maxillary growth. While NAM reduced the anterior cleft and effectively rotated the segments medially, PAM allowed more transversal and sagittal growth. CLINICAL RELEVANCE The results of this study should be taken into consideration when to decide whether to use PAM or NAM, since they show a different outcome within the first few months. Further studies are necessary regarding long-term differences.
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Affiliation(s)
- Robert Parhofer
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Gückstr. 11, 91054 Erlangen, Germany
| | - Andrea Rau
- Department of Oral and Maxillofacial Surgery/Plastic Operations, Universität Greifswald, Fleischmannstr. 8, 17489 Greifswald, Germany
| | - Karin Strobel
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Gückstr. 11, 91054 Erlangen, Germany
| | - Lina Gölz
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Gückstr. 11, 91054 Erlangen, Germany
| | - Renée Stark
- Institute for Health Economics and Healthcare Management, Helmholtz Zentrum Munich, Neuherberg, Ingolstädter Landstr. 1, 85764 Oberschleißheim, Germany
| | - Lucas M. Ritschl
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Lagerstr. 3, 81675 Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Lagerstr. 3, 81675 Munich, Germany
| | - Marco R. Kesting
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Gückstr. 11, 91054 Erlangen, Germany
| | - Florian D. Grill
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Lagerstr. 3, 81675 Munich, Germany
| | - Corinna L. Seidel
- Department of Orthodontics and Orofacial Orthopedics, Ludwig-Maximilian-Universität (LMU) München, Goethestr. 70, 80336 Munich, Germany
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Artuza-Rosado G, Argueta-Figueroa L, Bautista-Hernández MA, Torres-Rosas R. Evidencia de la efectividad del uso de aparatología ortopédica prequirúrgica en pacientes con labio y paladar hendido: revisión sistemática. INVESTIGACIÓN CLÍNICA 2023. [DOI: 10.54817/ic.v64n1a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
This review article aimed to evaluate the evidence on the use of a presurgical orthopedic appliance (POP) in patients with cleft lip and palate. The search was conducted using Medline/PubMed, Scholar Google, Clinical Trails, ProQuest, Scopus, and Web of Science databases. During the search, 7,926 records were found, of which 105 full-text articles were analyzed, and 23 studies included analysis in patients with the use of POP, and their control groups without the use of POP prior to the same type of surgery. The devices most used for POP in the management of LPH were: the passive palate (Hotz palate), the nasolaveolar moulding (NAM), the McNeil device, and finally, the T-traction. The primary outcomes evaluated were: facial aesthetics and nasal appearance; the evaluation of cephalometric measurements, upper airways, nasal fissure width, as well as anatomical references such as inter-canine and inter-tuberosity distances. In addition, studies that evaluated occlusion and phonation were found. The evidence from this literature suggests that the use of active appliances had a better effect than passive appliances in terms of facial aesthetics and approximation of the maxillary seg-ments for the closure of the fissure. However, the heterogeneity, the risk of bias, and the low quality of the studies do not allow to state firm conclusions.
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Affiliation(s)
- Gonzalo Artuza-Rosado
- Especialidad en Ortodoncia, División de Posgrado, Facultad de Odontología, Universidad Autónoma Benito Juárez de Oaxaca (UABJO), Oaxaca, México
| | - Liliana Argueta-Figueroa
- CONACYT, Facultad de Odontología, Universidad Autónoma Benito Juárez de Oaxaca (UABJO). Oaxaca, México
| | - Mario A. Bautista-Hernández
- Clínica de ortodoncia asociada al Centro de Estudios en Ciencias de la Salud y la Enfermedad, División de posgrado, de Facultad de Odontología, Universidad Autónoma Benito Juárez de Oaxaca (UABJO). Oaxaca, México
| | - Rafael Torres-Rosas
- Centro de Estudios en Ciencias de la Salud y la Enfermedad, División de posgrado, de Facultad de Odontología, Universidad Autónoma Benito Juárez de Oaxaca (UABJO). Oaxaca, México
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Singh G, Vohra G. A novel modification of nasoalveolar molding procedure to enhance ease of use. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2023. [DOI: 10.4103/jclpca.jclpca_22_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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Dallaserra M, Pantoja T, Salazar J, Araya I, Yanine N, Villanueva J. Effectiveness of pre-surgical orthopedics on patients with cleft lip and palate: A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e506-e520. [PMID: 35151895 DOI: 10.1016/j.jormas.2022.02.004] [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: 06/13/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Evaluate the effectiveness of pre-surgical orthopedics (PSO) in patients with cleft lip palate (CLP) in maxillary morphology (MM), facial growth and development (FGD), occlusal alterations (OA), parental satisfaction (PS), and side effects. DESIGN Systematic review and meta-analysis of randomized and controlled clinical trials. Searches was performed in CENTRAL, MEDLINE, and EMBASE. RESULTS From the eight studies included, three are randomized clinical trials, and five clinical trials are controlled. MM was evaluated by the intercanine width (Mean difference (MD) =1.44; CI95%= -0.30, 3.19; very low certainty), anteroposterior length (MD=1.32; CI95%= -0.59, 3.24; very low certainty) and intertuberocity width (MD=0.09; CI95%= -0.68, 0.49; certainty: very low). FGD was evaluated by SNA angle (MD: 1.29; P = 0.306; moderate certainty), SNB angle (MD: -0.79; P = 0.550; moderate certainty) and ANB angle (MD: 1; P = 0.362; moderate certainty). OA was evaluated by 5-years-old-index (MD= -0.09; P = 0.49; moderate certainty) and by Huddart score (MD=0.51; P = 0.736; moderate certainty). A valid questionnaire assessed PS only in one study (MD= -0.1; P = 0.199; moderate certainty). No studies reported side effects. CONCLUSION Due to the uncertainty of the effect of PSO on MM and the lack of clinically relevant effect on FGD, OA, or PS, it is not reasonable to include this intervention as a treatment until future studies clarify its effect.
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Affiliation(s)
- Matías Dallaserra
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile
| | - Tomás Pantoja
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 (8330023), Santiago de Chile
| | - Josefina Salazar
- Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile
| | - Ignacio Araya
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile
| | - Nicolás Yanine
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile
| | - Julio Villanueva
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Service of Maxillofacial Surgery. Hospital Clínico San Borja-Arriarán, Santiago de Chile. Av. Santa Rosa 1234 (8360160), Santiago de Chile.
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12
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Albustani SH, Dziedzic A, Abid M. The Perception and Experience of Parents of Children with Cleft Lip and Palate Concerning the Use Pre-Surgical Infant Orthopedics: A Questionnaire-Based Cross-Sectional Survey. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1054. [PMID: 35884038 PMCID: PMC9318393 DOI: 10.3390/children9071054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 11/21/2022]
Abstract
Background: A transitory period prior to the surgical correction of cleft lip and palate (CLP) is associated with adverse impacts, which may require a medical intervention. Pre-surgical infant orthopedics (PSIO) is deemed to reduce the functional and psychological burden, offering a transition until the definite surgical intervention. Aim: To assess the attitude of Iraqi mothers concerning the application and management of pre-surgical orthopedic appliances in children with cleft lip and palate, taking consideration of the mothers’ occupational status. Methods: The cross-sectional study was conducted in the College of Dentistry at Baghdad University from 5 January 2020 to 4 December 2021. A questionnaire form was validated based on existing data related to the assessment of parents’ satisfaction concerning PSIO. Results: A concern related to the impression procedure was reported by a minority of the participants (6.8%) and it was associated mainly to the perceptions of housewives’ vs. working mothers (p < 0.05). The perceived infants’ discomfort during the impression procedure reported at 11.9% was significantly associated with housewives’ status (p < 0.05). In general, the vast majority of respondents considered the impression as being non-invasive (96.6%). Most mothers found no difficulties in following the instructions of the specialist regarding the insertion of the PSIO and/or taping the elastic bands (62.7%). Respondents believed that CLP infants routinely require PSIO treatment. Interestingly, only a minority of mothers performed an Internet search to look for information about PSIO (7%). The majority indicated the PSIO treatment as beneficial for their infant and a substantial proportion of respondents were satisfied with the outcomes of PSIO, encouraging other parents to consent the PSIO treatment. Conclusion: In general, mothers broadly acknowledged the primary concept of PSIO and accepted the proposed treatment, with a positive attitude towards pre-surgical CLP management, regardless their socio-economic status. They seemed to understand well the expected benefits of PSIO, including feeding improvement, normalization of speech, and optimization of future surgical outcomes.
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Affiliation(s)
- Shaymaa Hadi Albustani
- Department of Conservative Dentistry with Endodontics, University of Al-Qadisiyah, Al-Qadisiyah 13261, Iraq;
| | - Arkadiusz Dziedzic
- Department of Restorative Dentistry with Endodontics, Medical University of Silesia, 40-055 Katowice, Poland
| | - Mushriq Abid
- Orthodontic Department, College of Dentistry, University of Baghdad, Baghdad 10071, Iraq
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13
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Joos U. Cleft lip, alveolus and palate: Defect or dislocation malformation? Importance of adopting a physiological concept for surgical repair in achieving optimal outcomes in LMICs. Part 1: Physiological processes in facial development. J Oral Biol Craniofac Res 2021; 12:102-108. [PMID: 34820255 DOI: 10.1016/j.jobcr.2021.11.001] [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: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022] Open
Abstract
The conventional surgical procedures for the closure of cleft-lip and palate are based on proven plastic-surgical procedures from tumour surgery or traumatology. These flap surgeries take little account of the fact that the treatment of such malformations takes place during the time of a child's increased growth and is known to lead to pronounced scarring and skeletal growth disorders. It is therefore imperative to develop modified surgical procedures based on physiological growth processes. These physiological procedures must include the reconstruction of all facial structures such as orofacial, palatal and pharyngeal muscles, complete nose, upper jaw and palate. Transfer of this know how to low resource LMIC and training is essential if optimal outcomes are to be achieved.
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Affiliation(s)
- Ulrich Joos
- International Medical College, University of Duisburg-Essen, 48147, Muenster, Germany
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14
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Aihara Y, Yanagawa T, Sasaki M, Sasaki K, Shibuya Y, Adachi K, Togashi S, Takaoka S, Tabuchi K, Bukawa H, Sekido M. Nasal molding prevents relapse of nasal deformity after primary rhinoplasty in patients with unilateral complete cleft lip: An outcomes-based comparative study of palatal plate alone versus nasoalveolar molding. Clin Exp Dent Res 2021; 8:197-208. [PMID: 34689427 PMCID: PMC8874052 DOI: 10.1002/cre2.502] [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: 05/06/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives In recent years, many studies have reported that the presurgical nasoalveolar molding method improves the nose morphology; however, the reason for its effectiveness after surgery has never been understood. We evaluated the effect of nasoalveolar molding by comparing it with a passive orthopedic method without a nasal stent and focusing on the nostril morphology after primary cheiloplasty using various measurement methods. We then analyzed the essential factors. Materials and methods The patients involved were 31 infants with unilateral complete cleft lip and palate treated with primary cheiloplasty at the University of Tsukuba Hospital from 2004 to 2011. Of the 31 infants, 16 received nasoalveolar molding treatment and 15 received passive orthopedic treatment as controls. Photographic facial measurements were performed for all patients immediately and 7 months after primary cheiloplasty. The esthetics of the nostrils were assessed according to the left–right nostril symmetry, as measured by the Hausdorff distance, area ratio, perimeter ratio, and aspect a/u (the aspect ratio of the affected side)/(the aspect ratio of the unaffected side) ratio. In addition, the inclination of the nasal ridge was assessed using anthropometric measurements (Grc‐Grn∠midline and midline∠columellar axis). Results The area ratio, perimeter ratio, and Grc‐Grn∠midline were significantly greater in the nasoalveolar molding group immediately after surgery (p = 0.00062, 0.016, and 0.048, respectively) than in the control group. However, the Hausdorff distance and aspect a/u ratio were more favorable (p = 0.0018 and 0.0039, respectively) in the nasoalveolar molding group after 7 months. Conclusions The results of our study suggested that using nasoalveolar molding as a presurgical orthopedic treatment could improve the shape of the nasal cartilage with surgeon's corrections.
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Affiliation(s)
- Yukiko Aihara
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Toru Yanagawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masahiro Sasaki
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kaoru Sasaki
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoichiro Shibuya
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Koji Adachi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shinji Togashi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shohei Takaoka
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Katsuhiko Tabuchi
- Department of Molecular and Cellular Physiology, Institute of Medicine, Academic Assembly, Shinshu University, Nagano, Japan
| | - Hiroki Bukawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Mitsuru Sekido
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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15
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Kalaskar R, Bhaje P, Sharma P, Balasubramanian S, Ninawe N, Ijalkar R. Comparative evaluation of nasal and alveolar changes in complete unilateral cleft lip and palate patients using intraoral and extraoral nasoalveolar molding techniques: randomized controlled trial. J Korean Assoc Oral Maxillofac Surg 2021; 47:257-268. [PMID: 34462383 PMCID: PMC8408650 DOI: 10.5125/jkaoms.2021.47.4.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/04/2021] [Indexed: 11/07/2022] Open
Abstract
Objectives Cleft lip and palate is a common congenital anomaly that impairs the aesthetics, speech, hearing, and psychological and social life of an individual. To achieve good aesthetic outcomes, presurgical nasoalveolar molding (NAM) has become important. Currently, the intraoral NAM technique is widely practiced. Numerous modifications have been made to intraoral NAM techniques, but the original problem of compliance leading to discontinuation of treatment remains unsolved. Therefore, the present study compared an extraoral NAM technique with the intraoral NAM technique. Materials and Methods Twenty infants with complete unilateral cleft lip and palate were included and divided into two equal groups. Group A received the intraoral NAM technique, and Group B received the extraoral NAM technique. Pre- and postoperative extraoral and intraoral measurements were recorded. Results Groups A and B did not differ significantly in any extraoral or intraoral parameter. Conclusion The extraoral NAM technique is as effective as the intraoral NAM technique in achieving significant nasal and alveolar changes in com-plete unilateral cleft lip and palate patients. Additionally, it reduces the need for frequent hospital visits for activation and the stress associated with the insertion and removal of the intraoral NAM plate, thereby improving compliance.
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Affiliation(s)
- Ritesh Kalaskar
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Priyanka Bhaje
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Priyanka Sharma
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Shruti Balasubramanian
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Nupur Ninawe
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Rajesh Ijalkar
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
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16
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Continuous circular closure in unilateral cleft lip and plate repair in one surgery. J Craniomaxillofac Surg 2021; 50:76-85. [PMID: 34896005 DOI: 10.1016/j.jcms.2021.07.002] [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: 11/30/2020] [Revised: 06/05/2021] [Accepted: 07/31/2021] [Indexed: 12/17/2022] Open
Abstract
The study aims at assessing wound healing and safety of single-stage two-layers continuous closure in patients with unilateral cleft lip and palate (UCLP). In this retrospective, descriptive cohort study, we assessed wound healing without fistula formation at 1, 3, and 6 months after a single-stage two-layer UCLP repair, in which the midline suture is continuously circular all along the oral and nasal sides. We examined lengths of hospital stay and the incidence of intra- and postoperative adverse events. Furthermore, we compared the cleft width at birth and on the day of surgery, after presurgical orthopaedics. Eleven UCLP patients underwent one cleft surgery between July 2016 and June 2018 at the age of 8-9 months. Full primary healing occurred in all patients without fistulas. Median length of post-operative hospital stay was 5 days (range = 4-9 days). No intra- or postoperative adverse events above Grade I (according to ClassIntra and Clavien-Dindo, respectively) occurred. Median and interquartile range (IQR) of the palatal cleft width decreased significantly from birth to surgery, i.e., from 12.0 mm (10.8-13.6 mm) to 5.0 mm (4.0-7.5 mm) anteriorly and from 14.0 mm (11.5-15.0 mm) to 7.3 mm (6.0-8.5 mm) posteriorly (p = 0.0033 in both cases). Given these preliminary results, the concept of single-stage continuous circular closure in UCLP has potential for further investigation. However, it remains to be proven that there are no relevant adverse effects such as inhibition of maxillary growth. Registered in clinicaltrials.gov:NCT04108416.
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17
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Three-dimensional imaging technique to compare digital impression CEREC Omnicam intraoral camera (CAD) and tri-dimensional cone-beam computed tomography, to measure maxillary casts: Unilateral and bilateral cleft lip and palate up to 6 months of age, applied in nanotechnology. APPLIED NANOSCIENCE 2021. [DOI: 10.1007/s13204-021-01846-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Garland K, McNeely B, Dubois L, Matic D. Systematic Review of the Long-Term Effects of Presurgical Orthopedic Devices on Patient Outcomes. Cleft Palate Craniofac J 2021; 59:156-165. [PMID: 33678051 PMCID: PMC8750140 DOI: 10.1177/1055665621998176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To perform a systematic review of the literature to identify the long-term
effects of presurgical orthopedic (PSO) device use on patient outcomes. Design: A comprehensive literature review of Embase and Ovid databases was performed
to identify all English-language publications related to unilateral cleft
lip and palate, presurgical devices, and patient outcomes. Studies were
excluded if they did not report patient outcomes beyond 2 years of age, did
not describe the use of a PSO device, were case reports (n < 10), or were
purely descriptive studies. Main Outcome Measures: Reported patient outcomes following the use of PSO devices. Results: Following a review of all articles by 2 independent reviews, 30 articles were
selected for inclusion. Overall, there was no reported consensus as to the
long-term effects of PSO devices. Furthermore, this study identified that
only 10% of published research controlled for confounding factors that could
influence the reported results. Confounding factors that were identified
included different operating surgeon, different surgical protocols, and
different rates of revision surgeries. Conclusions: Overall, this systematic review identified 2 important conclusions. Firstly,
there is no consensus in the literature about the long-term effects of PSO
devices on long-term patient outcomes. Secondly, research in this domain is
limited by confounding factors that influence the applicability of the
reported results.
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Affiliation(s)
- Katie Garland
- Division of Plastic Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Brendan McNeely
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luc Dubois
- Division of Vascular Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Damir Matic
- Division of Plastic Surgery, Department of Surgery, Western University, London, Ontario, Canada
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19
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Batra P, Raghavan S, Gribel BF. Nasoalveolar molding appliances. Am J Orthod Dentofacial Orthop 2021; 159:e85. [PMID: 33546838 DOI: 10.1016/j.ajodo.2020.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Puneet Batra
- Uttar Pradesh India, and Belo Horizonte, Minas Gerais, Brazil
| | | | - Bruno F Gribel
- Uttar Pradesh India, and Belo Horizonte, Minas Gerais, Brazil
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20
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Galassi TV, Souza-Brosco TV, Lopes LD, de Almeida AM, da Silva Dalben G, de Paiva JB, Neto JR, Ozawa TO. Does Infant Orthopedics and Neonate Lip Surgery Influence the Occlusal Relationship in Patients With Unilateral Cleft Lip and Palate (UCLP)? Cleft Palate Craniofac J 2021; 58:1265-1273. [PMID: 33486979 DOI: 10.1177/1055665620984352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare occlusal relationship in patients undergoing neonate versus conventional lip surgery (LS) with and without infant orthopedics (IO) by assessment of dental arch relationship in individuals with complete unilateral cleft lip and palate. MATERIAL AND METHODS Three groups treated by different protocols; Group I: neonate LS (1-15 days) + IO and palatoplasty (13-31 months); Group II: LS (3-12 months) + IO and palatoplasty (15-35 months); and Group III: LS (3-6 months) without IO and palatoplasty (12-18 months). The 112 intraoral photographs of individuals of all groups, obtained between 6 and 12 years of age, were assessed by the occlusal index for intraoral photograph rating. The groups were compared by the χ2 test. The correlation between surgical timing and the scores was tested by the Spearman test (P < .05). RESULTS Group I presented the highest percentage of score 5, group II exhibited highest percentage of score 1, and group III presented the lowest percentage of score 5 according to the χ2 test (P = .029). The Spearman correlation test revealed statistically significant difference between timing of LS and the occlusal index. The earlier the surgical timing, the higher the occlusal index (P = .019). CONCLUSIONS Infant orthopedics has demonstrated the possibility of postponing primary plastic surgeries. Patients submitted to late lip and palate repair had the best prognosis, while patients undergoing lip repair from 1 to 15 days of life, even operating the palate later, had the worst prognosis. Neonate LS negatively influenced the occlusal relationships.
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Affiliation(s)
- Thalita V Galassi
- Department of Orthodontics and Pediatrics, Faculty of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Telma V Souza-Brosco
- Plastic Surgery Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
| | - Lucy D Lopes
- Department of Prosthodontics, Faculty of Dentistry, University of Sao Paulo, Brazil
| | - Araci Malagodi de Almeida
- Orthodontics Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
| | - Gisele da Silva Dalben
- Pediatric Dentistry Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
| | - Joao B de Paiva
- Department of Orthodontics and Pediatrics, Faculty of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - José Rino Neto
- Department of Orthodontics and Pediatrics, Faculty of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Terumi O Ozawa
- Orthodontics Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
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21
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A Three-Dimensional Study of the Nasolabial Soft Tissue Symmetry in Children With Unilateral Complete Cleft Lip and Palate Using Traditional and Split-Type Nasoalveolar Molding. J Craniofac Surg 2021; 31:1785-1789. [PMID: 32569046 DOI: 10.1097/scs.0000000000006593] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Presurgical nasoalveolar molding (NAM) is the most common preoperative treatment for cleft lip and palate. However, NAM may have some limitations such as requiring high technical sensitivity and frequent visits. To simplify the device, some scholars have changed the traditional NAM into a split-NAM consisting of a alveolar molding plate and a nasal hook. This study compared the shaping effect of split NAM and traditional NAM on nasolabial soft tissue using three-dimensional (3D) measurement. METHODS A total of 39 patients with unilateral cleft lip and palate (UCLP) were enrolled and divided into 2 groups. 13 patients were treated with split-NAM while the other 26 patients were treated with traditional NAM. 3D images of all patients' craniofacial soft tissue before and after NAM treatment were recorded and measured by three-dimensional software. Statistical analysis of measurements in both groups was performed using SPSS software. RESULTS After treatment, nasal soft tissue symmetry in the split-NAM group was better improved than that in the NAM group in vertical and anterior-posterior direction, but was worse improved in transverse direction. There was no significant difference in labial soft tissue symmetry between two groups. CONCLUSIONS The split NAM can better elevate the alar and nostrils of the cleft side, and have a better forward effect on alar outer edge, nasal base, and nostrils. However, the traditional NAM can better reduce the width of nasal base.
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22
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Rossell-Perry P. The Surgical Nasoalveolar Molding: A Rational Treatment for Unilateral Cleft Lip Nose Deformity and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3044. [PMID: 32983795 PMCID: PMC7489733 DOI: 10.1097/gox.0000000000003044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
The purposes of this study were to evaluate surgical outcomes after primary surgery to address unilateral cleft lip, nose, and palate deformities and to perform a review of the literature to evaluate the effects of nasoalveolar molding (NAM) plus primary surgical repair on nonsyndromic unilateral cleft lip and palate. METHODS A cohort study of 37 primary complete unilateral cleft lip nasal deformity repairs was performed by a single surgeon. The outcomes were anthropometric measurements of the repaired lip, nose, and alveolar cleft width at the age of 1 and 5 years. A review of the literature was performed for studies published until March 2020 to evaluate the effect of presurgical NAM on nasolabial aesthetics. RESULTS Statistically significant differences were observed between pre- and postoperative columellar angle and alveolar cleft width. A total of 308 studies were identified, and 8 were included in the final analysis of 684 patients. The overall study quality was low according to the Oxford Centre of Evidence-Based Medicine, and GRADE level of evidence was low. CONCLUSIONS Primary cheilorhinoplasty alone is a good approach to improve nose appearance and alveolar gap in patients with unilateral cleft lip nose and palate deformity. Definitive conclusions about the effectiveness of presurgical NAM cannot be drawn. Available scientific evidence is not sufficient to demonstrate that combined use of presurgical nasoalveolar molding and primary surgery provides better nasolabial aesthetic outcomes than does primary surgery alone.
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Affiliation(s)
- Percy Rossell-Perry
- From the Post Graduate Studies School of Medicine, San Martin de Porres University, Santa Anita, Peru; and Department of Plastic Surgery, Edgardo Rebagliati Hospital, Lima, Peru
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23
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Bruggink R, Baan F, Kramer G, Claessens C, Kuijpers-Jagtman AM, Bronkhorst EM, Maal TJJ, Ongkosuwito E. The effect of lip closure on palatal growth in patients with unilateral clefts. PeerJ 2020; 8:e9631. [PMID: 32821547 PMCID: PMC7396139 DOI: 10.7717/peerj.9631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022] Open
Abstract
Objectives The objective of this study was to compare maxillary dimensions and growth in newborns with Complete Unilateral Cleft Lip and Palate (UCLP) to healthy newborns before and after cheiloplasty. Additionally, a palatal growth curve is constructed to give more information about the natural growth before surgical intervention. Methods Twenty-eight newborns with complete UCLP were enrolled in this study. Multiple plaster-casts of each child during their first year were collected and grouped in before and after cheiloplasty. A previous developed semi-automatic segmentation tool was used to assess the maxillary dimensions and were compared to a healthy control group. Z-scores were calculated to indicate differences between the two populations and if cheiloplasty had influence on maxillary growth. Furthermore, the prediction model created in a previous study was used to indicate differences between predictions and the outcome in UCLP measurements. The analysis was tested for inter- and intra-observer variability. Results Results show differences in alveolar and palatal shape in UCLP patients in comparison with healthy controls. Prior to cheiloplasty an increased width and alveolar length was observed while the palatal depth was decreased. After cheiloplasty the widths moved towards normal but were still significantly larger. Conclusion Infants with unilateral cleft lip and palate show a wider maxillary arch in comparison with the control population. Initial treatment has most influence on the width of the arch, which decreased towards normal.
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Affiliation(s)
- Robin Bruggink
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboudumc 3DLab, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank Baan
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboudumc 3DLab, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gem Kramer
- "Alkmaarse Orthodontisten", Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Colet Claessens
- Radboudumc 3DLab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, Groningen, The Netherlands.,Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland.,Faculity of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Ewald M Bronkhorst
- Department of Dentistry - Preventive and Restorative Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas J J Maal
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edwin Ongkosuwito
- Radboudumc 3DLab, Radboud University Medical Center, Nijmegen, The Netherlands.,Amalia Cleft and Craniofacial centre, Radboud University Medical Center, Nijmegen, The Netherlands
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Nalabothu P, Benitez BK, Dalstra M, Verna C, Mueller AA. Three-Dimensional Morphological Changes of the True Cleft under Passive Presurgical Orthopaedics in Unilateral Cleft Lip and Palate: A Retrospective Cohort Study. J Clin Med 2020; 9:jcm9040962. [PMID: 32244361 PMCID: PMC7230798 DOI: 10.3390/jcm9040962] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 11/16/2022] Open
Abstract
The aim of this cohort study was to quantify the morphological changes in the palatal cleft and true cleft areas with passive plate therapy using a new analysis method based on three-dimensional standardized reproducible landmarks. Forty-five casts of 15 consecutive patients with complete unilateral cleft lip and palate were laser scanned and investigated retrospectively. The landmarks and the coordinate system were defined, and the interrater and intrarater measurement errors were within 1.0 mm. The morphological changes of the cleft palate area after a period of 8 months of passive plate therapy without prior lip surgery are presented graphically. The median decrease in cleft width was 38.0% for the palatal cleft, whereas it was 44.5% for the true cleft. The width of the true and palatal cleft decreased significantly over a period of 8 months. The true cleft area decreased by 34.7% from a median of 185.4 mm2 (interquartile range, IQR = 151.5-220.1) to 121.1 mm2 (IQR = 100.2-144.6). The palatal cleft area decreased by 31.5% from a median of 334 mm2 (IQR = 294.9-349.8) to 228.8 mm2. The most important clinical considerations are the reproducibility and reliability of the anatomical points, as well as the associated morphological changes. We propose using the vomer edge to establish a validated measuring method for the width, area, and height of the true cleft.
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Affiliation(s)
- Prasad Nalabothu
- Department of Orthodontics and Pediatric Dentistry, University Center for Dentistry, 4031 Basel, Switzerland; (P.N.); (M.D.); (C.V.)
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland;
| | - Benito K. Benitez
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland;
| | - Michel Dalstra
- Department of Orthodontics and Pediatric Dentistry, University Center for Dentistry, 4031 Basel, Switzerland; (P.N.); (M.D.); (C.V.)
| | - Carlalberta Verna
- Department of Orthodontics and Pediatric Dentistry, University Center for Dentistry, 4031 Basel, Switzerland; (P.N.); (M.D.); (C.V.)
| | - Andreas A. Mueller
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland;
- Correspondence: ; Tel.: +41-61-328-60-95
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25
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Allareddy V, Shusterman S, Ross E, Palermo V, Ricalde P. Dentofacial Orthopedics for the Cleft Patient: The Latham Approach. Oral Maxillofac Surg Clin North Am 2020; 32:187-196. [PMID: 32081579 DOI: 10.1016/j.coms.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Presurgical infant dentofacial orthopedic treatment (PSIOT) is a process by which cleft maxillary and soft tissue segments can be moved before surgical repair of lip. One of the PSIOT approaches used is the fixed PSIOT using Latham appliances. In this article, the authors provide an overview of this approach and the step-by-step process of placing these appliances intraorally. Prospective randomized clinical studies are necessary to definitively answer concerns surrounding the long-term effects of PSIOT.
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Affiliation(s)
- Veerasathpurush Allareddy
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, 138AD (MC841), Chicago, IL 60612-7211, USA.
| | - Stephen Shusterman
- HarvardSchool of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA; Emeritus, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Elizabeth Ross
- Department of Developmental Biology, Boston Children's Hospital, Harvard School of Dental Medicine, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Victoria Palermo
- Florida Craniofacial Institute, 4200 North Armenia Avenue, Tampa, FL 33607, USA
| | - Pat Ricalde
- Florida Craniofacial Institute, St. Joseph's Cleft and Craniofacial Center, 4200 North Armenia Avenue, Tampa, FL 33607, USA
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26
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Saad MS, Fata M, Farouk A, Habib AMA, Gad M, Tayel MB, Marei MK. Early Progressive Maxillary Changes with Nasoalveolar Molding: Randomized Controlled Clinical Trial. JDR Clin Trans Res 2019; 5:319-331. [PMID: 31860800 DOI: 10.1177/2380084419887336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Quantitative assessment of 3-dimensional progressive changes of the maxillary geometry in unilateral cleft lip palate (UCLP) with and without nasoalveolar molding (NAM). METHODS The study was designed as a prospective 2-arm randomized controlled clinical trial conducted in parallel. Forty infants with nonsyndromic UCLP were randomly assigned into a NAM-treated group (n = 20) and non-NAM treated group (n = 20). A total of 120 laser-scanned maxillary casts were collected and blindly analyzed via a modified algorithm at T0 (initial visit; baseline), T1 (after 3 wk; first interval), and T2 (after 6 wk; second interval). The main outcome measures were the amount and rate of cleft gap changes, the midline position, and the transverse, sagittal, and vertical growth through intervals. RESULTS More than 50% of the cleft gap (56.42%; P < 0.001) was reduced in the first 3 wk of alveolar molding (AM). The end point of the AM was obtained in 6 wk (86.25%; P < 0.001); then, the kinks of the greater segment were noticed. The AM effect decreased as far as posterior; the anterior arch width reduced slightly (1.23%; P < 0.001), while the middle and posterior arches increased slightly (P > 0.999 and P = 0.288, respectively). The posterior arch width was the least changing and was considered a baseline, while the anterior was the pivot of the segment rotation. Both groups showed different patterns of segment rotation and sagittal growth. The non-NAM treated group showed a slight increase in cleft gap length, arch width, and midline position. CONCLUSION Based on this study, it was concluded that the NAM treatment is effective in minimizing cleft severity and realigning maxillary segments without the deterioration of the transverse and vertical arch growth. Near follow-up visits are recommended to monitor the rapid gap reduction within the first 3 wk. Further trials are recommended to compare the outcomes regarding the sagittal growth to reference values (ClinicalTrials.gov NCT03029195). KNOWLEDGE TRANSFER STATEMENT The results of this study will help clinicians understand nasoalveolar molding biomechanics that may improve the treatment outcomes for patients with unilateral cleft lip and palate. The trial data can be a valuable guide to the qualitative and quantitative predictive virtual molding in computer aided design-simulated nasoalveolar molding therapy. The modified algorithm can be used by researchers to quantify the rate, the sequence, and the direction of the maxillary segments movement in unilateral cleft lip and palate.
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Affiliation(s)
- M S Saad
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - M Fata
- Department of Oral Medicine, Periodontology, Oral Diagnosis, and Radiology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - A Farouk
- Department of Plastic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - A M A Habib
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - M Gad
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - M B Tayel
- Department of Electrical Engineering, Faculty of Engineering, Alexandria University, Alexandria, Egypt
| | - M K Marei
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Multivariate analysis of factors affecting dental arch relationships in Japanese unilateral cleft lip and palate patients at Hokkaido University Hospital. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.odw.2007.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Midface Growth in Patients With Unilateral Cleft Lip and Palate Treated With a Nasoalveolar Molding Protocol. J Craniofac Surg 2019; 30:1640-1643. [DOI: 10.1097/scs.0000000000005356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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29
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Steinberg B, Caccamese J, Costello BJ, Woerner J. Cleft and Craniofacial Surgery. J Oral Maxillofac Surg 2019; 75:e126-e150. [PMID: 28728728 DOI: 10.1016/j.joms.2017.04.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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30
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Evaluation of Airway Volume in Cleft Lip and Palate Following Nasoalveolar Molding. J Craniofac Surg 2018; 29:2143-2147. [DOI: 10.1097/scs.0000000000004681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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31
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Peterson P, Mars M, Gowans A, Larson O, Neovius E, Henningsson G, Andlin-Sobocki A, Pegelow M, Lemberger M, Raud-Westberg LM, Karsten ALA. Mean GOSLON Yardstick Scores After 3 Different Treatment Protocols—A Long-term Study of Patients With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2018; 56:236-247. [DOI: 10.1177/1055665618774010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: (1) To evaluate dental arch relationships, with the Great Ormond Street, London and Oslo (GOSLON) Yardstick, of participants with Unilateral cleft lip and palate (UCLP) and treated with 1-stage palatal closure with 3 different surgical protocols (2) to compare the mean GOSLON ratings with other CLP centers. Design: Retrospective study of medical charts and dental models. Setting: Karolinska University Hospital, Stockholm, Sweden. Participants: Eighty-seven patients with UCLP operated with 1-stage palatal repair. Thirty-five were operated with Veau-Wardill-Kilner (VWK) technique 1975 to 1986, 31 with minimal incision technique (MIT) from 1987 to 1997, and 21 according to MIT with muscle reconstruction (MITmr) 1998 to 2004. Interventions: Dental casts at ages 5 (n = 87), 7 to 8 (n = 27), 10 (n = 81), 16 (n = 61), and 19 (n = 35) years were rated by 10 assessors with the GOSLON Yardstick. Information of other interventions was retrieved from patients’ charts. Main outcome measures: Mean GOSLON ratings. Results: A total of 82% of the participants were rated as having excellent to satisfactory outcome. Weighted κ statistics for the 10 assessors was good for inter-rater agreement and good/very good for intra-rater agreement. Conclusions: The mean GOSLON score in the Stockholm overall material at age 10 was 2.67. The VWK technique resulted in a greater need of orthognathic surgery than the MIT ( P < .01). The MITmr did not produce better dental arch relationships than MIT at age 5 ( P < .05). The best dental arch relationships were found in the MIT group at 10 years, mean 2.58, which is not significantly different from other centers with excellent outcome except Gothenburg and Vienna.
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Affiliation(s)
- Petra Peterson
- Department of Reconstructive Plastic Surgery, Stockholm Cranofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Mars
- Department of Orthodontics, Great Ormond Street Hospital, London, United Kingdom
| | - Alan Gowans
- Department of Orthodontics, Leeds Dental Institute and Royal, College of Surgeons of Edinburgh, United Kingdom
| | - Ola Larson
- Department of Reconstructive Plastic Surgery, Stockholm Cranofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Neovius
- Department of Reconstructive Plastic Surgery, Stockholm Cranofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - Gunilla Henningsson
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karoliniska Insitutet, Stockholm, Sweden
| | | | - Marie Pegelow
- Division of Orthodontics and Jaw Orthopedics, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mathias Lemberger
- Division of Orthodontics and Jaw Orthopedics, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Liisi M. Raud-Westberg
- Department of Reconstructive Plastic Surgery, Stockholm Cranofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta L-A Karsten
- Department of Reconstructive Plastic Surgery, Stockholm Cranofacial Team, Karolinska University Hospital, Stockholm, Sweden
- Division of Orthodontics, Department of Dental Medicine, Karolinska University Hospital, Stockholm, Sweden
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32
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Hay N, Patel B, Haria P, Sommerlad B. Maxillary Growth in Cleft Lip and Palate Patients, With and Without Vomerine Flap Closure of the Hard Palate at the Time of Lip Repair: A Retrospective Analysis of Prospectively Collected Nonrandomized Data, With 10-Year Cephalometric Outcomes. Cleft Palate Craniofac J 2018; 55:1205-1210. [PMID: 29652539 DOI: 10.1177/1055665618764960] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the midterm effect on maxillary growth of vomerine flap (VF) closure of the hard palate, at the time of lip repair. DESIGN A retrospective analysis of prospectively collected nonrandomized data. INTERVENTIONS Consecutive participants with a unilateral cleft lip and palate (UCLP) were operated on, at 3 months of age, by the same surgeon. They were divided into 2 groups, those who had a VF and those who did not (non-VF). SETTING Participants were treated at 2 hospitals in the United Kingdom. PARTICIPANTS Twenty-eight participants in the VF group and 24 participants in the non-VF group attended follow-up at 10 years of age. MAIN OUTCOME MEASURES Standardized lateral cephalometric radiographs were taken at 10 years. Following tracing and digitization, parameters to assess the maxillary growth were analyzed. RESULTS No statistically significant differences were found in the anterior-posterior or vertical skeletal cephalometric parameters. CONCLUSIONS The results of this study support the statement that VF repair does not significantly affect maxillary growth in patients with a UCLP, when assessed cephalometrically at 10 years of age. It should be noted that at this age, growth is not yet complete.
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Affiliation(s)
- Norman Hay
- 1 Great Ormond Street Hospital, London, United Kingdom
| | - Brijesh Patel
- 1 Great Ormond Street Hospital, London, United Kingdom
| | - Priya Haria
- 1 Great Ormond Street Hospital, London, United Kingdom
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Akarsu-Guven B, Arisan A, Ozgur F, Aksu M. Influence of nasoalveolar molding on skeletal development in patients with unilateral cleft lip and palate at 5 years of age. Am J Orthod Dentofacial Orthop 2018; 153:489-495. [PMID: 29602340 DOI: 10.1016/j.ajodo.2017.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The aim of this retrospective study was to assess the influence of presurgical nasoalveolar molding (NAM) on skeletal development in patients with operated unilateral cleft lip and palate at 5 years of age. MATERIALS Lateral cephalometric radiographs of 26 unilateral cleft lip and palate patients who had undergone presurgical NAM (NAM group) and 20 unilateral cleft lip and palate patients who did not have any presurgical NAM (non-NAM group) were analyzed. The radiographs were digitally traced using Quick Ceph Studio software (version 3.5.1.r (1151); Quick Ceph Systems, San Diego, Calif). Independent samples t tests were performed for statistical analysis. RESULTS No significant differences were observed in sagittal and vertical skeletal measurements between the NAM and non-NAM groups. CONCLUSIONS NAM resulted in no significant difference in skeletal development in unilateral cleft lip and palate patients compared with those without NAM in early childhood.
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Affiliation(s)
- Bengisu Akarsu-Guven
- Department of Orthodontics, Faculty of Dentistry, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey
| | - Arda Arisan
- Department of Orthodontics, Faculty of Dentistry, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey
| | - Figen Ozgur
- Department of Plastic, Reconstructive and Esthetic Surgery, Faculty of Medicine, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey
| | - Muge Aksu
- Department of Orthodontics, Faculty of Dentistry, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey.
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Abstract
OBJECTIVE The specific aim of this retrospective cross-sectional study was to assess the efficacy of DynaCleft® as a method of presurgical orthopedics with infants with a unilateral cleft lip and cleft palate who used an oral obturator. STUDY DESIGN Data was collected from 25 infants all of comparable age diagnosed with a unilateral complete cleft lip and palate. Eight patients used DynaCleft ® and an obturator (Group Alpha) and seventeen patients only had an obturator (Group Beta). Maxillary impression casts were obtained from each patient at the initial clinic visit and at the time of cleft lip repair. Differences in alveolar cleft width were compared between the two groups. Casts were measured twice by one observer using a digital caliper. RESULTS Group Alpha began treatment on an average age of 24.25 days and Group Beta an average of 15.35 days of age. The average cleft width of Group Alpha was 8.13 mm and after treatment it was 4.59 mm. The average cleft width of Group Beta was 8.09 mm and 6.92 mm after treatment. Results of paired t-tests and two-sample t-test showed that cleft width changes between the two groups were significant (P = .03). CONCLUSIONS DynaCleft ® significantly decreased the size of the alveolar cleft width compared to infants who did not use it. Providers should consider using DynaCleft® for patients who may not have access to infant maxillary orthopedics.
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Konst EM, Prahl C, Weersink-Braks H, De Boo T, Prahl-Andersen B, Kuijpers-Jagtman AM, Severens JL. Cost-Effectiveness of Infant Orthopedic Treatment regarding Speech in Patients with Complete Unilateral Cleft Lip and Palate: A Randomized Three-Center Trial in the Netherlands (Dutchcleft). Cleft Palate Craniofac J 2017; 41:71-7. [PMID: 14697066 DOI: 10.1597/02-069] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the cost-effectiveness of infant orthopedic treatment (IO), compared with no such treatment in children with complete unilateral cleft lip and palate (UCLP) focusing on the effects on speech development at age 2.5 years. Design In a three-center prospective, randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed longitudinally: one group was treated with IO based on a modified Zurich approach in the first year of life (IO group) and the other group did not receive this treatment (non-IO group). Patients The participants had complete UCLP without soft tissue bands or other malformations. They were born at term and their parents were native Dutch speakers. Outcome Measures The effect of IO on speech development at age 2.5 years was measured blindly by five expert listeners judging the “total impression of speech quality” on a 10-point equal-appearing interval scale. Costs were measured from a societal viewpoint in Euro. Results and Conclusion The IO group (n = 10) obtained a statistically significant higher rating, compared with the non-IO group (n = 10). The effect size was large, indicating that the improvement may be considered a clinically important change. The cost for treatment by the orthodontist was higher in the IO group. For both groups, the mean cost was related to the mean rating for “total impression of speech quality.” The resulting cost-effectiveness for IO, compared to non-IO was €1041 for 1.34 point speech quality improvement. The financial investment that is necessary to obtain this improvement seems limited. Thus, from the perspective of speech development, the cost-effectiveness of IO over non-IO seems acceptable at this point in time.
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Affiliation(s)
- Emmy M Konst
- Department of Orthodontics and Oral Biology, University Medical Centre St. Radboud, University of Nijmegen, The Netherlands.
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Prahl C, Kuijpers-Jagtman AM, Van 't Hof MA, Prahl-Andersen B. Infant Orthopedics in UCLP: Effect on Feeding, Weight, and Length: A Randomized Clinical Trial (Dutchcleft). Cleft Palate Craniofac J 2017; 42:171-7. [PMID: 15748108 DOI: 10.1597/03-111.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To study the effects of infant orthopedics (IO) on feeding, weight, and length. Design Prospective two-arm randomized controlled trial in three academic Cleft Palate Centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation method. Setting Cleft Palate Centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. Patients Infants with complete unilateral cleft lip and palate (UCLP), no other malformations. Interventions One group (IO+) wore passive maxillary plates during the first year of life, but the other group (IO−) did not. All other interventions were the same for both groups. Main Outcome Measures Bottle feeding velocity (mL/min) at intake, 3, 6, 15, and 24 weeks (T0 to T24); weight-for-age, length-for-age, and weight-for-length using z scores; reference values from the Netherlands’ third nationwide survey on growth. Results Feeding velocity increased with time from 2.9 to 13.2 mL/min in the IO− group and from 2.6 to 13.8 mL/min in the IO+ group; no significant differences were found between groups. Weight-for-age, length-for-age, and weight-for-length (z scores) did not differ significantly between groups, but overall the infants with unilateral cleft lip and palate in both groups had significantly lower mean z scores for weight-for-age and height-for-age than the reference during the first 14 months, and had lower mean values for weight-for-length after soft palate closure. Conclusion Infant orthopedics with the aim of improving feeding and consequent nutritional status in infants with unilateral cleft lip and palate can be abandoned.
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Affiliation(s)
- Charlotte Prahl
- Department of Orthodontics and Oral Biology, University Medical Center Nijmegen, Nijmegen, Netherlands
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37
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Bongaarts CAM, Kuijpers-Jagtman AM, van 't Hof MA, Prahl-Andersen B. The Effect of Infant Orthopedics on the Occlusion of the Deciduous Dentition in Children with Complete Unilateral Cleft Lip and Palate (Dutchcleft). Cleft Palate Craniofac J 2017; 41:633-41. [PMID: 15516167 DOI: 10.1597/03-051.1] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Evaluation of the effect of infant orthopedics (IO) on the occlusion of the deciduous dentition in patients with unilateral cleft lip and palate (UCLP). Design Prospective, two-arm, randomized, controlled clinical trial with three participating cleft palate centers (Dutchcleft). Setting Cleft Palate Centers of the University Medical Center Nijmegen, Academic Center of Dentistry Amsterdam, and Dijkzigt University Hospital Rotterdam, The Netherlands. Patients Children with complete UCLP (n = 54) were included. Interventions In a concealed allocation procedure, half of the patients was randomized to wear a plate till surgical closure of the soft palate (IO+), and the other half (IO−) did not have a plate. Mean Outcome Measures Dental arch relationships were assessed at 4 and 6 years of age with the 5-year-old index; the Huddart-score; and measurements of overjet, overbite, and sagittal occlusion. Results There were no significant differences found between the IO+ and IO− groups for the 5-year-old index; the Huddart-score; and overjet, overbite, and sagittal occlusion. Conclusions IO had no observable effect on the occlusion in the deciduous dentition at 4 and 6 years of age. Considering the occlusion only, there is no need to perform IO in children with UCLP.
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Affiliation(s)
- Catharina A M Bongaarts
- Department of Orthodontics and Oral Biology, University Medical Center, Nijmegen, the Netherlands
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Bongaarts CAM, van 't Hof MA, Prahl-Andersen B, Dirks IV, Kuijpers-Jagtman AM. Infant Orthopedics Has No Effect on Maxillary Arch Dimensions in the Deciduous Dentition of Children with Complete Unilateral Cleft Lip and Palate (Dutchcleft). Cleft Palate Craniofac J 2017; 43:665-72. [PMID: 17105327 DOI: 10.1597/05-129] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: Evaluation of the effect of infant orthopedics on maxillary arch dimensions in the deciduous dentition in patients with unilateral cleft lip and palate. Design: Prospective two-arm randomized controlled clinical trial with three participating cleft palate centers. Setting: Cleft palate centers of the Radboud University Nijmegen Medical Center, Academic Center of Dentistry Amsterdam, and University Medical Center Rotterdam, the Netherlands. Patients: Children with complete unilateral cleft lip and palate (n = 54) were included. Interventions: Patients were randomly divided into two groups. Half of the patients (IO+) had a presurgical orthopedic plate until surgical closure of the soft palate at the age of 52 weeks; the other half (IO−) did not undergo presurgical orthopedics. Mean outcome measures: Maxillary arch dimensions were assessed on dental casts at 4 and 6 years of age with measurements for arch width, arch depth, arch length, arch form, and the vertical position of the lesser segment. Contact and collapse were assessed also. Results: There were no clinically significant differences found between IO+ and IO− for any of the variables. Conclusions: Infant orthopedics had no observable effect on the maxillary arch dimensions or on the contact and collapse scores in the deciduous dentition at the ages of 4 and 6 years. Considering the Dutchcleft results to date, there is no need to perform infant orthopedics for unilateral cleft lip and palate patients.
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Affiliation(s)
- Catharina A M Bongaarts
- Department of Orthodontics and Oral Biology, Radboud University Nijmegen Medical Center, 309 Tandheelkunde, 6500 HB Nijmegen, the Netherlands
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39
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Prahl C, Prahl-Andersen B, van 't Hof MA, Kuijpers-Jagtman AM. Infant Orthopedics and Facial Appearance: A Randomized Clinical Trial (Dutchcleft). Cleft Palate Craniofac J 2017; 43:659-64. [PMID: 17105328 DOI: 10.1597/05-139] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To study the effect of infant orthopedics on facial appearance. Design: Prospective two-arm randomized controlled trial in parallel with three participating academic cleft palate centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation method. Setting: Cleft Palate Centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. Patients: Infants with complete unilateral cleft lip and palate, no other malformations. Interventions: One group (IO+) wore passive maxillary plates during the first year, the other group (IO−) did not. Main Outcome Measure(s): Two metrical response modalities were used (i.e., visual analog scales and reference scores) to score facial appearance. Full face and cropped photographs were compared with reference photographs and were judged. The photographs were judged by 45 judges, 24 laypeople, and 21 professionals. Transformation of the scores into z scores was applied to compare and to pool both response modalities. The validity of each individual judge was evaluated, as was the reliability of the scales. Differences between the treatment groups were evaluated by means of t tests. Results: Photographs were available of 41 subjects, 21 with and 20 without infant orthopedics. No significant differences were found between groups. Mean z-score values for the full-face photographs were: group IO+ = 0.10 (SD = 0.73) and group IO− = −0.03 (SD = 0.48); for the cropped photographs were: group IO+ = 0.12 (SD = 0.71) and group IO− = −0.06 (SD = 0.55). Conclusions: Infant orthopedics have no effect on facial appearance.
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Affiliation(s)
- Charlotte Prahl
- Department of Orthodontics, Academic Center for Dentistry, Louwesweg 1, 1066 EA Amsterdam, the Netherlands.
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Konst EM, Rietveld T, Peters HFM, Weersink-Braks H. Use of a Perceptual Evaluation Instrument to Assess the Effects of Infant Orthopedics on the Speech of Toddlers with Cleft Lip and Palate. Cleft Palate Craniofac J 2017; 40:597-605. [PMID: 14577817 DOI: 10.1597/1545-1569_2003_040_0597_uoapei_2.0.co_2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the effects of infant orthopedics (IO) administered in the first year of life on the speech characteristics of 2.5-year-old children with complete unilateral cleft lip and palate (UCLP) using a perceptual evaluation instrument with equal-appearing interval (EAI) scales. Design In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed longitudinally. One group received IO based on a modified Zurich approach (IO group), and the other group did not (non-IO group). The appliance was used until soft palate closure at age 12 months. Hard palate closure is delayed until 9 years of age. Participants Three groups of 2.5-year-old toddlers participated in this investigation: 10 IO, 10 non-IO, and 8 noncleft controls matched for age and socioeconomic status. Method Five trained listeners assessed the children's speech in a blinded perceptual rating procedure. They judged 13 specific speech characteristics and indicated their total impression of speech on EAI scales. Results The reliability and consistency of 11 of the rating scales was good. The intelligibility rating scale was the single speech characteristic that distinguished the IO group from the non-IO group; the IO group was judged to be superior. The cleft groups differed from the noncleft group on 9 of the 11 scales. Conclusions Evaluation of speech by means of the present newly developed perceptual rating instrument showed that the IO group obtained significantly higher ratings for intelligibility than the non-IO group. The groups did not differ regarding any of the other speech aspects.
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Affiliation(s)
- Emmy M Konst
- Department of Orthodontics and Oral Biology, University Medical Centre St. Radboud, University of Nijmegen, the Netherlands.
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Hosseini HR, Kaklamanos EG, Athanasiou AE. Treatment outcomes of pre-surgical infant orthopedics in patients with non-syndromic cleft lip and/or palate: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2017; 12:e0181768. [PMID: 28742129 PMCID: PMC5524403 DOI: 10.1371/journal.pone.0181768] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/05/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-syndromic clefts lip and/or palate (CL/P) defects may have manifold significant and detrimental consequences for the affected individuals and their family environment. Although the use of pre-surgical infant orthopedics (PSIO) was introduced as a means to improve management and treatment outcomes, there still remains a controversy. OBJECTIVE To investigate the effectiveness of PSIO in patients with non-syndromic CL/P and evaluate the quality of the available evidence. SEARCH METHODS Search without restrictions, together with hand searching, until May 2016. SELECTION CRITERIA Randomized clinical trials investigating the effects of pre-surgical infant orthopedic appliances. DATA COLLECTION AND ANALYSIS Following study retrieval and selection, data extraction and individual study risk of bias assessment using the Cochrane Risk of Bias Tool took place. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach. RESULTS Finally 20 papers (3 unique trials) were identified, involving a total of 118 patients with unilateral complete CL/P and 16 with cleft of the soft and at least two thirds of the hard palate. Eight publications were considered as being of low, four of unclear and eight of high risk of bias. In general, the investigated appliances did not present significant effects when compared to each other or to no treatment in terms of feeding and general body growth, facial esthetics, cephalometric variables, maxillary dentoalveolar variables and dental arch relationships, speech and language evaluation, caregiver-reported outcomes, economic evaluation, as well as, adverse effects and problems. Overall, the quality of the available evidence was considered low. CONCLUSIONS The aforementioned findings could provide initial guidance in the clinical setting. However, given the multitude of parameters, which may have affected the results, good practice would suggest further research, in order to reach more robust relevant recommendations for management decisions in individual cases.
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Affiliation(s)
- Hamid Reza Hosseini
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Eleftherios G. Kaklamanos
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Athanasios E. Athanasiou
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Alzain I, Batwa W, Cash A, Murshid ZA. Presurgical cleft lip and palate orthopedics: an overview. Clin Cosmet Investig Dent 2017; 9:53-59. [PMID: 28615974 PMCID: PMC5459959 DOI: 10.2147/ccide.s129598] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with cleft lip and/or palate go through a lifelong journey of multidisciplinary care, starting from before birth and extending until adulthood. Presurgical orthopedic (PSO) treatment is one of the earliest stages of this care plan. In this paper we provide a review of the PSO treatment. This review should help general and specialist dentists to better understand the cleft patient care path and to be able to answer patient queries more efficiently. The objectives of this paper were to review the basic principles of PSO treatment, the various types of techniques used in this therapy, and the protocol followed, and to critically evaluate the advantages and disadvantages of some of these techniques. In conclusion, we believe that PSO treatment, specifically nasoalveolar molding, does help to approximate the segments of the cleft maxilla and does reduce the intersegment space in readiness for the surgical closure of cleft sites. However, what we remain unable to prove equivocally at this point is whether the reduction in the dimensions of the cleft presurgically and the manipulation of the nasal complex benefit our patients in the long term.
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Affiliation(s)
| | - Waeil Batwa
- Orthodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alex Cash
- Cleft Lip and Palate Orthodontics, Queen Victoria NHS Foundation Trust, South Thames Cleft Service, London, UK
| | - Zuhair A Murshid
- Orthodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Fernandes VM, Jorge PK, Carrara CFC, Gomide MR, Machado MAAM, Oliveira TM. Three-dimensional digital evaluation of dental arches in infants with cleft lip and/or palate. Braz Dent J 2017. [PMID: 26200157 DOI: 10.1590/0103-6440201300161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to measure and compare the dimensions of the dental arches on three-dimensional digital study models in children with and without cleft lip and palate before the primary surgery. The sample consisted of 223 digital models of children aged 3-9 months, divided into 5 groups: without craniofacial deformities, unilateral and bilateral incomplete cleft lip and alveolus, unilateral and bilateral complete cleft lip and alveolus, unilateral cleft lip and palate, and bilateral cleft lip and palate. Dental casts of the maxillary dental arches of the children were used. The dental casts underwent a process of scanning through 3D scanner and the measurements used for the correlation among groups were made on the scanned images. Statistical analysis was performed by t test and ANOVA followed by Tukey test. The results showed that the intercanine distance and anterior cleft width was wider in children with unilateral cleft lip and palate. The intertuberosity distances and posterior cleft width was wider in children with bilateral cleft lip and palate among the groups. Children with cleft lip and palate before the primary surgery had wider maxillary arch dimensions than the children without cleft lip and palate.
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Affiliation(s)
- Viviane Mendes Fernandes
- Department of Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo, Bauru, SP, Brasil
| | - Paula Karine Jorge
- Department of Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo, Bauru, SP, Brasil
| | - Cleide Felício Carvalho Carrara
- Department of Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo, Bauru, SP, Brasil
| | - Márcia Ribeiro Gomide
- Department of Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo, Bauru, SP, Brasil
| | | | - Thais Marchini Oliveira
- Department of Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo, Bauru, SP, Brasil
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SAKODA KL, JORGE PK, CARRARA CFC, MACHADO MADAM, VALARELLI FP, PINZAN A, OLIVEIRA TM. 3D analysis of effects of primary surgeries in cleft lip/palate children during the first two years of life. Braz Oral Res 2017; 31:e46. [DOI: 10.1590/1807-3107bor-2017.vol31.0046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/27/2017] [Indexed: 11/22/2022] Open
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Jorge PK, Gnoinski W, Vaz Laskos K, Felício Carvalho Carrara C, Gamba Garib D, Okada Ozawa T, Andrade Moreira Machado MA, Pinelli Valarelli F, Oliveira TM. Comparison of two treatment protocols in children with unilateral complete cleft lip and palate: Tridimensional evaluation of the maxillary dental arch. J Craniomaxillofac Surg 2016; 44:1117-22. [DOI: 10.1016/j.jcms.2016.06.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/31/2016] [Accepted: 06/30/2016] [Indexed: 11/28/2022] Open
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Berkowitz S. Letter to the Editor. Cleft Palate Craniofac J 2016; 53:377-9. [DOI: 10.1597/15-240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Samuel Berkowitz
- Department of Orthodontics University of Illinois College of Dentistry 11035 Paradela Street Coral Gables, FL 33156
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Kaye A, Thaete K, Snell A, Chesser C, Goldak C, Huff H. Initial Nutritional Assessment of Infants With Cleft Lip and/or Palate: Interventions and Return to Birth Weight. Cleft Palate Craniofac J 2016; 54:127-136. [PMID: 26882024 DOI: 10.1597/15-163] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess and quantify cleft team practices with regard to nutritional support in the neonatal period Design : Retrospective review. SETTING Tertiary pediatric hospital. PATIENTS One hundred consecutive newborn patients with a diagnosis of cleft lip and/or cleft palate between 2009 and 2012. MAIN OUTCOME MEASURES Birth weight, cleft type, initial cleft team weight measurements, initial feeding practices, recommended nutritional interventions, and follow-up nutritional assessments. RESULTS All patients in the study were evaluated by a registered dietitian and an occupational feeding therapist. Average birth weight and average age at the first cleft team visit were similar for each cleft type: cleft lip (CL), cleft lip and palate (CLP), and cleft palate (CP). The calculated age (in days) for return to birth weight was significantly different between cleft types: CL = 13.58 days, CLP = 15.88 days, and CP = 21.93 days. Exclusive use of breast milk was 50% for patients with CL, 30.3% for patients with CLP, and 21.4% for patients with CP. Detailed nutritional interventions were made for 31 patients at the first visit: two with CL, 14 with CLP, and 15 with CP. CONCLUSIONS Distinct differences were seen in neonatal weight gain between cleft types. There was significantly greater total weight gain for patients with CL at their first visit and significantly slower return to birth weight for patients with isolated CP. Patients with CL required far fewer interventions at the initial assessment and were more likely to be provided breast milk exclusively or in combination with formula. Infants with CP were far less likely to receive any breast milk. Patients with CLP and CP required frequent nutritional interventions.
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Overview of orthodontic care for children with cleft lip and palate, 1915-2015. Am J Orthod Dentofacial Orthop 2015; 148:543-56. [DOI: 10.1016/j.ajodo.2015.07.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 11/19/2022]
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Gandedkar NH, Kiat CC, Kanesan P, Lee WC, Chen PY, Leng Yeow VK. Presurgical nasoalveolar molding therapy in cleft lip and palate individuals: Case series and review. APOS TRENDS IN ORTHODONTICS 2015. [DOI: 10.4103/2321-1407.163424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The nasoalveolar molding (NAM) therapy is advocated to reduce the severity of alveolar cleft and nasal deformity. NAM therapy has demonstrated to be an effective method for reducing cleft and improve nose anatomy. This paper presents a case report of three cleft lip and palate individuals treated with NAM therapy. Furthermore, the paper highlights the advantages of NAM therapy along with an enumeration of literature suggesting in favor of NAM therapy and otherwise. Regardless of controversies and divergent views involved with NAM therapy, the immediate success of NAM therapy facilitating primary lip repair surgery cannot be under-emphasized.
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Affiliation(s)
- Narayan H. Gandedkar
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Chng Chai Kiat
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Palaniselvam Kanesan
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Wen Cong Lee
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Por Yong Chen
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Vincent Kok Leng Yeow
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
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Borgnat F, Martin P, Paulus C. [Implant-borne prosthetic rehabilitation in patients with cleft lip and palate: A retrospective study on 43 patients]. ACTA ACUST UNITED AC 2015; 116:229-34. [PMID: 26141597 DOI: 10.1016/j.revsto.2015.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 03/27/2015] [Accepted: 04/20/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Implant-borne rehabilitation in cleft lip and palate patient are aimed to allow for good orofacial functions, stable occlusion, and adequate support for the naso-labial region. The goal of our study was to evaluate the functional and esthetic results of the implant-born dental rehabilitation of the cleft lip and palate patients in our department. MATERIAL AND METHODS Our retrospective study concerned patients operated between 1995 and 2010 in our department. All included patients suffered from a cleft alveolus and lip, with or without cleft palate. Dental implants were placed in the bone-grafted alveolus and the end of growth and at distance from the bone graft procedure. Criteria of implant survival and implant-borne rehabilitation success were defined. RESULTS A total of 78 implants were placed in 43 patients between 1995 and 2010. Two implants were lost (implant survival rate: 97.4%). Despite this loss, all the patients could be rehabilitated with good functional and esthetic results. DISCUSSION Implant-borne rehabilitation is a reliable solution for prosthetic rehabilitation in patients with cleft lip and palate. This solution allows for avoiding removable prosthesis and dental mutilation.
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Affiliation(s)
- F Borgnat
- Service de chirurgie maxillo-faciale, hôpital Femme-Mère-Enfant, CHU de Lyon, boulevard Pinel, 69500 Bron, France.
| | - P Martin
- Service de chirurgie maxillo-faciale, hôpital Femme-Mère-Enfant, CHU de Lyon, boulevard Pinel, 69500 Bron, France
| | - C Paulus
- Service de chirurgie maxillo-faciale, hôpital Femme-Mère-Enfant, CHU de Lyon, boulevard Pinel, 69500 Bron, France
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