Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: dental anomalies in 8-year olds

Dose Reduction by Field of View Optimisation in Cone-Beam Computed Tomography of Unilateral Alveolar Clefts

OBJECTIVE

This study aimed to investigate how much the field of view (FOV) can be decreased while still depicting the necessary anatomical structures. A secondary aim was to assess how many incidental findings were missed with a reduced FOV.

MATERIAL AND METHODS

In this retrospective study, 170 CBCT volumes from children with a mean age of 9.4 years were collected. All CBCT had a FOV of 80 × 50 mm covering the maxilla. The present study analysed whether a smaller FOV can be used while still including necessary anatomical structures. Measurements of the minimal height and width that include vital anatomical structures were performed with two FOV reduction protocols: one smaller (includes the cleft, adjacent central incisor and adjacent canine) and one larger (includes both canines, nasal floor and the cleft).

RESULTS

The use of the larger protocol resulted in a FOV of 44.3 × 36.5 mm (95th percentile); for the smaller protocol, the FOV was 28.1 × 34.9 mm (95th percentile). In the larger protocol, incidental findings were missed in 22%. In the smaller protocol, 35% of the incidental findings were missed. However, most of these findings were irrelevant to the planning of the bone graft.

CONCLUSION

A FOV of 50 × 40 mm (41% dose reduction compared with the original FOV) is suggested to fully depict the cleft area, central incisors, nasal floor and both canines. A FOV of 35 × 40 mm (56% dose reduction compared with the original FOV) is suggested to depict the cleft and the ipsilateral canine and central incisor adjacent to the cleft.

Facial growth in patients with unilateral cleft lip and palate at 19 years of age after three different one-stage palatal repairs: a longitudinal study with prediction from cephalograms at 5 years of age

OBJECTIVES

To compare cephalometric long-term outcomes in patients with unilateral cleft lip and palate (UCLP) and treated with three different surgical protocols for palatal repair. Furthermore, to investigate growth longitudinally and evaluate the possibility to predict the outcome at age 19 from cephalometric values at 5 years.

MATERIALS/METHODS

Lateral cephalograms of 68 patients, operated according to the Veau-Wardill-Kilner technique (n = 13), the minimal incision technique (n = 39), or MIT with muscle reconstruction (MITmr) (n = 16) were assessed. At a mean age of 19.0 (SD 0.7) years, 17 skeletal and 6 soft tissue variables were analysed using analysis of variance (ANOVA) with pairwise comparison. Lateral cephalograms at a mean age of 5.1 (SD 0.4) years, from 32 of the 68 patients were used to predict values at 19 years, using a multiple linear regression.

RESULTS

There were statistically significant differences between the three surgical techniques for eight of the skeletal variables and for two of the soft-tissue variables at 19 years. The angle between the sella/nasion plane and the nasion/A plane (SNA) was 74.5 (SD 3.8) after Veau-Wardill-Kilner (VWK), 77.6 (SD 5.3) after minimal incision technique (MIT), and 76.7 (SD 2.6) after MITmr. Adjusted for baseline values, at 5 years, only face height had a significant effect dependent on surgical technique.

LIMITATIONS

Due to the exclusion criteria or missing medical records, only 43% of 157 consecutive patients could be included in the study.

CONCLUSION

MIT and MITmr resulted in better cephalometric results regarding facial growth sagittally and vertically compared to VWK. Most of the cephalometric variables measured showed a strong positive relation between the value at 5 and the value at 19 years of age.

Volumetric Assessment of Resorption Patterns of Bilateral Alveolar Clefts in Cone-Beam Computed Tomography in Two- Stage Bone Graft

OBJECTIVE

Few studies have analysed the outcome of bone grafts in bilateral alveolar clefts and the bone fill with a two-step surgery method. The currently applied three-dimensional method used in this study enables a comprehensive description of the bone fill of bilateral clefts after bone grafting. The study aimed to describe alveolar cleft volume and bone fill after alveolar bone grafting of bilateral alveolar clefts treated with two-step bone grafting, with a comparison between the first and the second bone graft site. A secondary aim was to investigate whether the cleft volume on the non-surgical side changed after contralateral surgery.

MATERIALS AND METHODS

In this retrospective study, 60 CBCT scans from 20 patients were included (8 girls and 12 boys) with an age range of 6.5-11.5 years (mean age 8.7). The cleft volume was measured in pre- and post-operative CBCT scans and assessed in ITK-SNAP to calculate the bone fill of the cleft.

RESULTS

After bone grafting, 47% of the first bone-grafted cleft was filled with bone, and 33% of the second bone-grafted cleft, without significant difference between them (p = 0.03). The mean preoperative cleft volume was 0.42cm3 and the mean residual cleft volume after bone graft was 0.23cm3. There was however a significant difference when comparing the bone fill between the nasal and the dental part (p < 0.001).

CONCLUSION

Almost half of the cleft volume was filled with bone after bone grafting. The order of the bone graft side did not influence the bone fill of the cleft.

Impact of Cleft Palate Anastomosis in Cleft Lip and Palate Patients with Coexisting Cleft Lip Anastomosis Scar Based on Cephalometric Measurements

(1) Background: This article focuses on examining components affecting the overbite, overjet, and the effect of palate surgery on craniofacial morphology with a concomitant cleft lip fusion scar, and a comparison of patients who had only a cleft lip fusion scar. Patients with unilateral cleft lip (UCL) and patients with unilateral cleft lip and palate (UCLP) were included in the study. We aimed to find if cephalometric parameters were significantly different in these groups. (2) Material and methods: The study group consisted of a lateral cranial radiograph of patients with UCLP (n = 30) and UCL (n = 30). Cephalometric radiographs were saved electronically, and cephalometric analysis was performed using a computer program. (3) Results: We observed that a statistically significant higher degree of maxillary prognathism occurred in the UCL than in the UCLP. We observed the anterior position of the upper lip in relation to E-line in patients with cleft lip. (4) Conclusions: The results present the effect of cleft palate surgery on further forward growth of the maxilla. There was a decreased ANB angle present in the skeletal class II in patients with UCL and UCLP. The SNB angle was not increased, and the reverse overjet was due to the rectroclination of the upper incisors and protruded lower incisors.

Deep orofacial phenotyping of population-based infants with isolated cleft lip and isolated cleft palate

Isolated orofacial clefts (OFC) are common with poorly understood aetiology. Heterogeneous phenotypes and subphenotypes confound aetiological variant findings. To improve OFC phenome understanding, population-based, consecutive, pre-treatment infants with isolated unilateral cleft lip (UCL, n = 183) and isolated cleft palate (CP, n = 83) of similar ancestry were grouped for deep phenotyping. Subphenotypes stratified by gender and cleft severity were evaluated for primary dental malformations and maturation using radiographs. We found that cleft severity and tooth agenesis were inadequate to distinguish heterogeneity in infants with UCL and CP. Both groups featured slow dental maturity, significantly slower in males and the UCL phenotype. In 32.8% of infants with UCL, supernumerary maxillary lateral incisors were present on the cleft lip side, but not in infants with CP, suggesting a cleft dental epithelium and forme fruste cleft dentoalveolus of the UCL subphenotype. The findings underscored the importance of deep phenotyping to disclose occult OFC subphenotypes.