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Poulet V, Cavallier Z, Vaysse F, Lauwers F, Prevost A. Use of nasal retainers in the primary management of cleft lip: Current practices in France. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101812. [PMID: 38460822 DOI: 10.1016/j.jormas.2024.101812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND The primary surgical management of cleft lip (CL) or cleft lip and palate (CLP) aims to achieve harmonious lip and nasal symmetry while ensuring satisfactory ventilation. Postoperative nasal retainers are commonly used, though both duration of use and conformer type used vary widely. This study aimed to establish an inventory of current practices for primary cheilorhinoplasty and nasal retainer use in France. METHODS A survey was sent to surgeons within and outside the French National Clefts and Facial Malformations (MAFACE) network. Questions focused on age when primary cleft closure is performed, retainer types used, conformation duration, and estimated patient compliance. Responses were collected March-July 2023. RESULTS Thirty-two surgeons responded with substantial variations in practices. For isolated CL, the age for primary cleft closure was 1-6 months, with 28 % performing surgery at 3 months, 12.5 % between 3 and 6 months, 44 % at 6 months. In cases with CLP, 63 % performed simultaneous surgery at 6 months. Two surgeons (6 %) reported preoperative nasoalveolar molding and 30 surgeons (94 %) reported postoperative nasal retainer use. Retainer type used immediately after surgery varied, with equal use of commercial retainers (31 %), silicone sheets (31 %), and in-house retainers (31 %). Duration of retainer prescription was in majority 3-4 months. Notably, 44 % of surgeons reported <70 % adherence rates for the recommended conformation duration, while 25 % reported very good compliance. CONCLUSION Primary cheilorhinoplasty and nasal conformation practices are highly diverse in France. Suboptimal patient compliance demonstrates the need for improved retainer design and strategies to enhance compliance.
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Affiliation(s)
- Vinciane Poulet
- Maxillo-Facial Surgery Department, Toulouse Purpan University Hospital, Place Baylac, 31059, Toulouse, France.
| | - Zoé Cavallier
- Maxillo-Facial Surgery Department, Toulouse Purpan University Hospital, Place Baylac, 31059, Toulouse, France
| | - Frédéric Vaysse
- Odontology Department, Toulouse Purpan University Hospital, 3 chemin des Maraîchers, 31400 Toulouse, France
| | - Frédéric Lauwers
- Maxillo-Facial Surgery Department, Toulouse Purpan University Hospital, Place Baylac, 31059, Toulouse, France
| | - Alice Prevost
- Maxillo-Facial Surgery Department, Toulouse Purpan University Hospital, Place Baylac, 31059, Toulouse, France
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Onah II, Okwesili OR. Proposed grading system of unilateral cleft lip to predict surgical challenges. Niger J Clin Pract 2023; 26:1192-1196. [PMID: 37635616 DOI: 10.4103/njcp.njcp_34_23] [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] [Indexed: 08/29/2023]
Abstract
Background It is a common practice to subjectively categorize cleft lip deformities into narrow and wide cleft. The proposed grading of unilateral cleft lip can serve as a predictive factor of the difficulties to be encountered during repair and the expected outcome of surgery. Materials and Methods This was a 5-years retrospective study of the records of 32 patients with unilateral cleft lip that presented to a single surgical unit. We grouped the patients based on the age at surgery. We calculated the alar base width ratios of the cleft to non-cleft sides, and this was used for grading. We graded the clefts using ratio of 1.00-1.50 for mild cleft, 1.51 to 2.00 for moderate cleft, 2.01-3.00 for severe cleft, and >3.00 for extensive cleft lip. Results The youngest child was 1 month old, while the oldest was 50 years. Majority of the patients (17) were older than 2 years at the time of surgery. Only nine babies (28.1% of the patients) were able to have their surgery done within the age of 6 months. Those that had extensive unilateral cleft lip were 10 (31.3%). However, a total of 18 (56.3% of the patients) had cleft lips that were either mild or moderate grade. Conclusion This grading of unilateral cleft lip helps in objective preoperative assessment of the severity and in predicting the difficulty expected during lip repair. It is also helpful in assigning clefts to trainees and in determining which patients should be referred to an experienced surgeon.
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Affiliation(s)
- I I Onah
- Department of Plastic Surgery, National Orthopaedic Hospital, Enugu; Institute of Orthopedics and Plastic Surgery, Abia State University, Uturu, Abia State, Nigeria
| | - O R Okwesili
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu State, Nigeria
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Alkebsi K, Sakran KA, Abdo Y, Shi B, Li C. Stability of nasal symmetry following primary cleft lip and nasal repair: five years of follow-up. Int J Oral Maxillofac Surg 2023; 52:451-459. [PMID: 35973881 DOI: 10.1016/j.ijom.2022.07.011] [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: 09/14/2021] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
Despite advances in cleft lip treatment, various levels of residual deformity remain after primary repair of cleft lip and palate. The aim of the current study was to compare the stability of short- and long-term postoperative nasal symmetry. This retrospective study included 100 consecutive non-syndromic patients with unilateral complete cleft lip who underwent primary cleft lip repair with follow-up of 5 years. Measurements taken from basal and frontal standard photograph views, obtained preoperatively (T1) and immediately (T2), 1 year (T3), and 5 years postoperative (T4), were analysed. Paired and independent t-tests were applied to assess the significance of differences and relationships, while the inter-class correlation coefficient was used to assess reliability; P < 0.05 was considered significant. The male to female ratio was 1:1; mean age at the time of surgery was 0.43 ± 0.25 years. All patients showed significant improvements following unilateral complete cleft lip repair. All variables measured at T3 revealed a significant relapse when compared to T2, except alar base position, which showed a constant mean across all postoperative follow-ups. Late relapse (T3-T4) was not significant for alar collapse, alar base position, or columellar angle (all P > 0.05). On the other hand, columellar height (P = 0.003), and nostril height (P = 0.038) and width (P = 0.007) showed significant improvements during the late relapse period. In conclusion, the majority of the relapse and changes following the nasal cleft repair occurred within the first postoperative year. However, nasal asymmetries tended to remain stable or reduced during the first 5 postoperative years.
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Affiliation(s)
- K Alkebsi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - K A Sakran
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Y Abdo
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen; School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - B Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
| | - C Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Postoperative Nasal Conformers in Cleft Rhinoplasty: Are They Efficacious? J Craniofac Surg 2023:00001665-990000000-00565. [PMID: 36850032 DOI: 10.1097/scs.0000000000009213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/12/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Lip and nose symmetry the goal of repair of unilateral cleft lip and different preoperative and postoperative treatments have been developed with this purpose. The objective of this study was to compare 2 techniques used for primary cleft lip nose repair. MATERIALS AND METHODS This is an retrospective study between 2 groups of patients with unilateral cleft lip and palate who underwent primary nasolabial repair either with or without postoperative nasal conformers. Data collection was accomplished by evaluation of nasal symmetry through anthropometric measurements under general anesthesia during primary cleft palate repair. RESULTS Our comparative study did not find a statistically significant difference regarding percentile indexes of nasal asymmetry between the 2 groups. Major revision requirement (>3 mm of asymmetry in any of the nose measurements) was observed in 3.84% of nasal conformer group and 4.65% of the group without nasal conformers. CONCLUSIONS The results obtained from this study provides showed that placement of postoperative nasal conformers did not improve nasal symmetry in patients with unilateral cleft lip and palate. Based on these findings and available scientific evidence, definitive conclusions about the effectiveness of these devices on nasal symmetry after unilateral cleft lip nose repair cannot be drawn.
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Wei H, Xu X, Wan T, Yang Y, Zhang Y, Wu Y, Liang Y. Correction of narrow nostril deformity secondary to cleft lip: indications for different surgical methods and a retrospective study. Front Pediatr 2023; 11:1156275. [PMID: 37206975 PMCID: PMC10188927 DOI: 10.3389/fped.2023.1156275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Background Cleft lip and/or palate (CLP) can lead to severe nasolabial deformities that significantly affect the appearance of the patient. Among all types of nasolabial deformities, narrow nostril deformities are the most troublesome, causing poor and unstable surgical outcomes. The purpose of this study was to develop an algorithm for surgical method selection for revision of narrow nostril deformities secondary to CLP based on retrospective clinical data. Materials and methods Patients with narrow nostril deformities secondary to CLP were enrolled in the study. Before surgery, patients' clinical data were collected and the width of the nasal floor and the length of the alar rim were measured. Surgical methods were determined according to the measurements. After surgery, a nostril retainer was applied for 6 months to consolidate and maintain the nostril shape. The surgical method and postsurgical changes were recorded for the final summary of the algorithm to select surgical methods for narrow nostril deformities. Results The data from 9 patients were analyzed. According to the width of the nasal floor and the length of the alar rim, correct surgical methods were determined. Four patients received nasolabial skin flaps to widen the soft tissue of the nasal floor. Three patients received upper lip scar tissue flaps to treat the narrow nasal floor. For the short alar rim, free alar composite tissue flap or narrowing of the nostril of the noncleft side was recommended. Conclusion The width of the nasal floor and the length of the alar rim are critical elements to consider when selecting the correct surgical method for revising narrow nostril deformities secondary to CLP. The proposed algorithm provides a reference for selecting surgical methods in future clinical practice.
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Affiliation(s)
- Hongpu Wei
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xiaofeng Xu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Teng Wan
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yusheng Yang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yong Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Correspondence: Yong Zhang Yilai Wu Yun Liang
| | - Yilai Wu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Correspondence: Yong Zhang Yilai Wu Yun Liang
| | - Yun Liang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Correspondence: Yong Zhang Yilai Wu Yun Liang
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Xu Y, Zeng N, Li J, Zheng Q, Shi B. Growth patterns of the nasolabial region following unilateral cleft lip primary repair. Front Pediatr 2023; 11:1136467. [PMID: 36994436 PMCID: PMC10040551 DOI: 10.3389/fped.2023.1136467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/16/2023] [Indexed: 03/31/2023] Open
Abstract
Surgical correction is the optimal way of repairing a congenital cleft lip. Patients with this condition often undergo initial surgical treatment at an early age and achieve an acceptable outcome. However, their levels of satisfaction will decrease in later stages of life as facial growth and development will inevitably cause changes in long-term outcomes, especially in the nasolabial region. Therefore, it is important for surgeons to understand nasolabial development after primary treatment and tailor their surgical techniques appropriately. This review focuses on the growth patterns of the nasolabial region after primary repair, so as to provide references for operative strategy.
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Evaluation of Divine Proportions in Face and Smile of Patients With Unilateral Cleft Lip and Palate. J Craniofac Surg 2020; 31:1717-1720. [PMID: 32310886 DOI: 10.1097/scs.0000000000006466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION AND AIM The facial view of patients with cleft lip and palate greatly affects their psychological well-being and usually leads to introspection. The aim of this study was to compare the face and smile of cleft lip and palate patients and normal population with divine proportion. METHOD In this retrospective study, 20 female patients (14-25 years) with unilateral cleft lip and palate, who referred to Orthodontic Department of Mashhad School of Dentistry, were selected. The control group consisted of 10 normal female persons with ideal face and normal occlusion. After scanning photographs of full face, profile, and smile views of them, the divine proportions were measured by Photoshop software. Then the data were entered into SPSS software version 22 and analyzed using 2 sample independent t test. P value less than 0.05 were considered as significant. RESULTS In the study group all proportions were significantly less than the golden proportion. Ls-Rcus/Rch-Rcus and Ls-Lcus/Lch-Lcus had the least difference and Sn-Sm/N-Sn and Sn-Sm/Sm-Me had the most. In the control group, all proportions except Ls-Lcus/Lch-Lcus and Ls-Rcus/Rch-Rcus, were less than the golden proportion. Sn-Sm/N-Sn had the most difference and N-Sn/Sm-Me had the least.Approximately all proportions in cleft patients were significantly different from normal population. Ls-Lcus/Lch-Lcus had the highest difference between study and control group; however, Tr-Sn/Tr-Me in both groups were equal. CONCLUSIONS The differences between facial indices in cleft lip and palate patients, normal people and golden proportion were significant. As facial proportions of normal people in the authors' study were also different from divine proportions, the authors can conclude that to reach acceptable esthetic results, the authors can approximate patients to normal populations. Unfortunately, the patients with large bone defects, cannot reach to the "esthetic" divine proportion even after reconstructive surgery.
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Facial Anthropometric Evaluation of Unilateral Cleft Lip and Palate Patients: Infancy Through Adolescence. J Craniofac Surg 2017; 29:353-357. [PMID: 29194260 DOI: 10.1097/scs.0000000000004199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Craniofacial anthropometric studies measure the differences in humans' craniofacial dimensions. The aim of this study was to determine facial anthropometric dimensions of newborn to 12-year-old girls with nonsyndromic unilateral cleft lip and palate (UCLP). METHODS In this cross-sectional analytical study, data was collected from 65 infant to 12-year old girls with UCLP. Digital frontal and profile facial photographs were transferred to a computer and desired anthropometric landmarks were traced on each image. Fifteen anthropometric parameters were measured which were the angles of facial, nasofacial, nasomental, Z, nasolabial, inclination of nasal base and labial fissure, nasal deviation, mentocervical, facial convexity and also ratios of nasal prominence relative to nasal height, middle to lower facial third, upper lip to lower lip height, columellar length relative to upper lip, and incisal show relative to incisal width. Pearson coefficient and linear regression were used for statistical analysis. RESULTS Upper lip to lower lip height ratio and angles of nasofacial, nasolabial, and facial convexity decreased with the age of the patients. In contrast, nasomental angle and the ratios of columellar length to upper lip length, middle facial height to lower facial height, and incisal show relative to incisal width increased. Other parameters studied did not appear to have any significant correlation with age. CONCLUSION In the girls with UCLP, various craniofacial dimensions have different growth rates with some parts growing slower than others. Some of the parameters studied were significantly correlated with age, thus growth-related curves and equations were obtained and presented.
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