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Yamanishi T, Arimura Y, Kirikoshi S, Hara T, Nishio T, Seikai T, Uematsu S, Nishio J. Clinical outcomes of gingivoperiosteoplasty for unilateral cleft lip and palate performed in early childhood. J Plast Reconstr Aesthet Surg 2024; 97:268-274. [PMID: 39173578 DOI: 10.1016/j.bjps.2024.07.067] [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: 05/18/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/24/2024]
Abstract
Conventional gingivoperiosteoplasty (GPP) performed during infancy adversely affects maxillary development. However, the outcomes of this procedure in early childhood have rarely been reported. Therefore, we examined the postoperative outcomes of GPP conducted in patients aged 1.5 years with unilateral cleft lip and palate (UCLP). This study included 87 non-syndromic patients with complete UCLP who had undergone early two-stage palatoplasty during the 1999-2004 period. The protocol comprised soft palate plasty at 1 year of age and hard palate closure at 1.5 years of age. In the GPP group (n = 34), we introduced the GPP procedure during hard palate closure; in the non-GPP group (n = 53), the labial side of the alveolar cleft remained intact. We examined computed tomography images taken at 8 years of age to observe bone formation at the alveolar cleft site. We also conducted cephalometric analysis to examine maxillary development at 12 years of age. Bone bridges at the alveolar cleft site were observed in 92% and 5.6% of the GPP and non-GPP groups, respectively. Moreover, 56% of the GPP group did not require secondary alveolar bone grafting (sABG), whereas all the patients in the non-GPP group underwent sABG. No statistically significant differences were noted in the maxillary anteroposterior length (GPP: 45.5 ± 3.7 mm, non-GPP: 45.9 ± 3.5 mm, p = 0.67) and sella-nasion-point A angle (GPP: 75.6 ± 4.5°, non-GPP: 73.8 ± 12.6°, p = 0.49). This study's findings suggest that GPP performed at 1.5 years of age minimises the necessity of sABG and does not exert a negative influence on maxillofacial development.
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Affiliation(s)
- Tadashi Yamanishi
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka 594-1101, Japan.
| | - Yuki Arimura
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka 594-1101, Japan; Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Kita-ku, Okayama 700-8558, Japan
| | - Shoko Kirikoshi
- Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Graduate School of Dental Medicine, Faculty of Dental Medicine, Hokkaido University, Kita 13 Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8586, Japan
| | - Takayuki Hara
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka 594-1101, Japan
| | - Takahiro Nishio
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka 594-1101, Japan
| | - Tetsuya Seikai
- Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Graduate School of Dental Medicine, Faculty of Dental Medicine, Hokkaido University, Kita 13 Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8586, Japan
| | - Setsuko Uematsu
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka 594-1101, Japan
| | - Juntaro Nishio
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka 594-1101, Japan
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Craniofacial Growth at Age 6–11 Years after One-Stage Cleft Lip and Palate Repair: A Retrospective Comparative Study with Historical Controls. CHILDREN 2022; 9:children9081228. [PMID: 36010118 PMCID: PMC9406322 DOI: 10.3390/children9081228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
Background: Primary alveolar bone grafting inhibits craniofacial growth. However, its effect on craniofacial growth in one-stage cleft lip and palate protocols is unknown. This study investigated whether primary alveolar bone grafting performed during one-stage unilateral cleft lip and palate repair negatively affects growth up to 6–11 years old. Methods: The craniofacial growth, dental arch relationship and palatal morphology at 6–11 years old in children with unilateral cleft lip and palate were compared retrospectively. Two cohorts after a one-stage protocol without (Group A) and with (Group B) primary bone grafting at the same center were compared. Further, cephalometric measurements for growth were compared with an external cohort of a one-stage protocol and a heathy control. Results: Group A comprised 16 patients assessed at 6.8 years (SD 0.83), and Group B comprised 15 patients assessed at 9 years (SD 2.0). Cephalometric measurements indicated similar sagittal maxillary growth deficits and a significant deviation in maxillary inclination in both groups compared to the healthy group. Moderate to severe changes in palatal morphology were observed in 70% of the members in both groups. Conclusion: Omitting primary alveolar bone grafting under the one-stage protocol with two-flap palatoplasty studied did not improve growth at 6–11 years. The results implicate two-flap palatoplasty with secondary healing as having greater adverse effects on growth than primary alveolar bone grafting. Dental and palatal morphology was considerably compromised regardless of primary alveolar bone grafting.
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Kim J, Jeong W. Secondary bone grafting for alveolar clefts: surgical timing, graft materials, and evaluation methods. Arch Craniofac Surg 2022; 23:53-58. [PMID: 35526839 PMCID: PMC9081425 DOI: 10.7181/acfs.2022.00115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/19/2022] [Indexed: 11/11/2022] Open
Abstract
Alveolar cleft belongs to the spectrum of cleft lip and/or palate, affecting 75% of cleft lip/palate patients. The goals of alveolar cleft treatment are stabilizing the maxillary arch, separating the nasal and oral cavities, and providing bony support for both erupting teeth and the nasal base via the piriform aperture. Secondary alveolar bone grafting is a well-established treatment option for alveolar cleft. Secondary alveolar bone grafting is performed during the period of mixed dentition using autologous bone from various donor sites. There are several issues relevant to maximizing the success of secondary alveolar bone grafting, including the surgical timing, graft material, and surgical technique. In this study, we reviewed issues related to surgical timing, graft materials, and evaluation methods in secondary alveolar bone grafting.Abbreviations: ABG, alveolar bone grafting; CBCT, cone-beam computed tomography; DBM, demineralized bone matrix; GPP, gingivoperiosteoplasty; rhBMP, recombinant human bone morphogenetic protein; 2D, two dimensional; 3D, three dimensional
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Affiliation(s)
- Junhyung Kim
- Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Woonhyeok Jeong
- Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
- Correspondence: Woonhyeok Jeong Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea E-mail:
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de Castro Ribeiro TT, Castillo RAD, Ozawa TO, Ramalho-Ferreira G, Castillo AAD, Janson G. Late alveolar bone grafting in complete unilateral cleft lip and palate (UCLP): Biomechanical considerations for the success of orthodontic finishing. J Orthod 2022; 49:457-462. [PMID: 35323076 DOI: 10.1177/14653125221087289] [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: 11/16/2022]
Abstract
Orthodontic treatment in patients with cleft lip and palate (CLP) is challenging. Alignment of the maxillary segments and orthodontic levelling of the teeth adjacent to the cleft area are important before alveolar bone grafting (ABG), in the permanent dentition. In this clinical report, orthodontic procedures, before and after late ABG, are described as an alternative that can optimise the orthodontic and periodontal results. The gingival margins of the teeth adjacent to the cleft area were levelled. Root divergence was corrected. Interdental papilla and improvement of the periodontal condition were obtained.
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Affiliation(s)
- Tiago Turri de Castro Ribeiro
- Department of Orthodontics, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | - Rosalinda Aliaga-Del Castillo
- Department of Orthodontics, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | - Terumi Okada Ozawa
- Department of Orthodontics, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | - Gabriel Ramalho-Ferreira
- Department of Oral and Maxillofacial Surgery, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | | | - Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
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Chhajlani R, Chhajlani P, Bonanthaya K, Mahajan RK. Alveolar bone grafting and gingivoperiosteoplasty in bilateral cleft lip and palate. Curr Opin Otolaryngol Head Neck Surg 2021; 29:327-332. [PMID: 34091502 DOI: 10.1097/moo.0000000000000737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Gingivoperiosteoplasty (GPP) and alveolar bone grafting (ABG) procedures have a vast history. There have been many publications regarding ABG and secondary ABG, with and without presurgical infant orthopedics (PSIO), in bilateral cleft lip and palate patients. There is little long-term data available describing results of both techniques. RECENT FINDINGS The interdisciplinary approach to primary and secondary surgical procedures has proven to be beneficial for patients with bilateral cleft lip and palate. In the neonates, naso-alveolar molding (NAM) has been found to optimize the aesthetic outcome as well as re-approximating the arches to facilitate GPP. During the mixed dentition stage, arch preparation/expansion before the secondary ABG procedure improves arch morphology, restores the functional interarch relationship, and facilitates surgery. SUMMARY This review aims to highlight the key points of both the procedures and why combining both procedures along with PSIO procedures such as NAM might be helpful for the patients in the long term.
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Affiliation(s)
- Rahul Chhajlani
- Dr. Chhajlani's Maxillofacial, Cleft and Facial Plastic Surgery Centre
- Department of Oral and Maxillofacial Surgery, Index Institute of Dental Sciences, Malwanchal University, Indore
- Department of Maxillofacial and Cleft Surgery, Smile Train Centre, CHL Medical Centre, Ujjain
- Department of Maxillofacial Surgery, Varma Union Hospital, CHL Group of Hospitals
| | - Prakash Chhajlani
- Dr Chhajlani's Cosmetic and Plastic Surgery Centre
- Department of Plastic and Reconstructive Surgery, Index Medical College Hospital and Research Centre, Indore
| | - Krishnamurthy Bonanthaya
- Department of Maxillofacial and Cleft Surgery, Smile Train Centre, Bhagwan Mahaveer Jain Hospital, Bangalore
| | - Ravi Kumar Mahajan
- Department of Plastic, Cosmetic, Reconstructive and Microvascular Surgery, Amandeep Hospital, Amritsar, India
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Dr Ian Jackson and the Influence of a Global Traveling Plastic Surgery Fellowship on His Career. J Craniofac Surg 2021; 32:1197-1198. [PMID: 33674502 DOI: 10.1097/scs.0000000000007587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Carbullido MK, Dean RA, Kamel GN, Davis GL, Hornacek M, Segal RM, Ewing E, Lance SH, Gosman AA. Long-Term Treatment Outcomes of Primary Alveolar Bone Grafts for Alveolar Clefts: A Qualitative Systematic Review. Cleft Palate Craniofac J 2021; 59:86-97. [PMID: 33631994 DOI: 10.1177/1055665621995047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Alveolar bone grafting is utilized to manage alveolar clefts in patients with cleft lip and palate. However, the timing of bone grafting is variable with conflicting evidence supporting the use of primary alveolar bone grafting (PABG) in clinical practice. PRIMARY AIM To provide a qualitative systematic review analysis of long-term outcomes after PABG. MATERIALS AND METHODS A qualitative systematic review was performed following the Cochrane Handbook and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Summative findings were evaluated using Confidence in the Evidence from Reviews of Qualitative research to assess the quality of evidence supporting the findings. RESULTS After removing duplication, 2182 publications were identified, and 2131 were excluded after screening through titles and abstracts. Inclusion criteria for this study included patients who underwent PABG at 24 months of age or younger and a minimum of 5 year follow-up. Thirty-two publications met the inclusion criteria and were included for qualitative analysis. Primary outcome measures included cephalometric analysis, bone graft survival, occlusal analysis, hypomineralization, tooth eruption, radiograph analysis, and arch relationships. Four assessment themes were characterized from the systematic review: (1) bone graft survival, (2) craniofacial skeletal relationships, (3) occlusion and arch forms, and (4) recommendations for utilizing PABG in practice. CONCLUSION The reported systematic review provides evidence that performing PABG leads to poor long-term outcomes related to bone graft survival and maxillary growth restriction despite some reported positive outcomes.
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Affiliation(s)
- M Kristine Carbullido
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Riley A Dean
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, USA
| | - George N Kamel
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, USA.,Fresh Start Center for Craniofacial Anomalies, 14444Rady Children's Hospital, San Diego, CA, USA
| | - Greta L Davis
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Michael Hornacek
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Rachel M Segal
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Emily Ewing
- Fresh Start Center for Craniofacial Anomalies, 14444Rady Children's Hospital, San Diego, CA, USA
| | - Samuel H Lance
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, USA.,Fresh Start Center for Craniofacial Anomalies, 14444Rady Children's Hospital, San Diego, CA, USA
| | - Amanda A Gosman
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, USA.,Fresh Start Center for Craniofacial Anomalies, 14444Rady Children's Hospital, San Diego, CA, USA
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Spolyar JL. Nasoalveolar Molding (NAM), Latham Treatment, or Other: Controlling the Narrative. Cleft Palate Craniofac J 2019; 57:661-663. [PMID: 31690098 DOI: 10.1177/1055665619884458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- John L Spolyar
- UDM School of Dentistry, Department of Orthodontics, Detroit, MI, USA.,Ian Jackson Craniofacial & Cleft Palate Clinic, Wm Beaumont Hospital, Royal Oak, MI, USA.,Wm Beaumont Hospital, Royal Oak, MI, USA
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Segna E, Khonsari RH, Meazzini MC, Battista VMA, Picard A, Autelitano L. Maxillary shape at the end of puberty in operated unilateral cleft lip and palate: A geometric morphometric assessment using computer tomography. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:9-13. [PMID: 31255828 DOI: 10.1016/j.jormas.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Cleft lip and palate (CLP) surgery interferes with maxillary growth and contributes to transversal and sagittal growth impairment. Our retrospective descriptive study aimed to evaluate maxillary bone shape in a homogenous unilateral CLP patient group using geometric morphometrics based on CT-scan data. MATERIAL AND METHODS We included all patients with available CT-scans at the end of pubertal growth and operated on at Smile House of Milan, according to the standard protocol, involving two surgical steps: (1) primary closure of the lip and soft palate at 6 months of age and (2) early secondary gingivoalveoloplasty (GAP) associated with hard palate repair at 18-36 months. Shape differences between CLP and an age-matched control group were characterized using geometric morphometrics based on 15 3D landmarks. RESULTS We included 16 unilateral CLP patients and 20 age-matched controls. Principal component and canonical variate analyses showed that the maxillary shape in CLP was significantly different from controls but that this difference was limited. Linear and angular measurements confirmed these differences. CONCLUSION Early secondary GAP results in satisfactory maxillary shape, with significant but limited differences relative to controls.
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Affiliation(s)
- E Segna
- Service de Chirurgie Maxillofaciale et Chirurgie Plastique, filière maladies rares TeteCou, centre de référence maladies rares MAFACE, Hôpital Universitaire Necker-Enfants Malades, Université Sorbonne Paris-Cité, Université Paris-Descartes, AP-HP, 75015 Paris, France.
| | - R H Khonsari
- Service de Chirurgie Maxillofaciale et Chirurgie Plastique, filière maladies rares TeteCou, centre de référence maladies rares MAFACE, Hôpital Universitaire Necker-Enfants Malades, Université Sorbonne Paris-Cité, Université Paris-Descartes, AP-HP, 75015 Paris, France
| | - M C Meazzini
- Smile House Department of Craniofacial Surgery, San-Paolo Hospital, Milan, Italy
| | - V M A Battista
- Smile House Department of Craniofacial Surgery, San-Paolo Hospital, Milan, Italy
| | - A Picard
- Service de Chirurgie Maxillofaciale et Chirurgie Plastique, filière maladies rares TeteCou, centre de référence maladies rares MAFACE, Hôpital Universitaire Necker-Enfants Malades, Université Sorbonne Paris-Cité, Université Paris-Descartes, AP-HP, 75015 Paris, France
| | - L Autelitano
- Smile House Department of Craniofacial Surgery, San-Paolo Hospital, Milan, Italy
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Siegenthaler M, Bettelini L, Brudnicki A, Rachwalski M, Fudalej PS. Early versus late alveolar bone grafting in unilateral cleft lip and palate: Dental arch relationships in pre-adolescent patients. J Craniomaxillofac Surg 2018; 46:2052-2057. [PMID: 30416034 DOI: 10.1016/j.jcms.2018.09.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/30/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To evaluate the dental arch relationship in preadolescent children with complete unilateral cleft lip and palate after early secondary alveolar bone grafting (E-ABG) by comparing to late bone grafting (L-ABG). MATERIAL AND METHODS Two raters blindly assessed the dental arch relationship with the modified Huddart-Bodenham (HB) Index for 2 groups: E-ABG group (36 children, mean age 9.6 years) and L-ABG group (56 children, mean age 11.1 years). The groups differed with respect to age at which alveolar bone grafting was performed: between 1.4 and 4.1 years (mean 2.2 years, E-ABG group) and after 8 years (L-ABG group). T-test was run to compare scores between 2 groups. Regression analysis was carried out to evaluate gender, age at cleft repair, age at ABG, and age at assessment with the HB index. RESULTS The overall HB scores were -6.77 and -4.25 in the E-ABG and L-ABG groups, respectively (p = 0.025). Regression analysis showed that only the age at cleft repair influenced the HB scores. CONCLUSION ABG carried out between 2 and 4 years of age does not seem to negatively affect the dental arch relationship at the age of 10 years in comparison to L-ABG.
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Affiliation(s)
| | - Lisa Bettelini
- Private Practice, Winkelstrasse 22, 1716 Plaffeien, Switzerland
| | - Andrzej Brudnicki
- Department of Paediatric Surgery (Head of the Department: Prof. Ewa Sawicka), Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Martin Rachwalski
- Department of Maxillofacial and Plastic Surgery (Head of the Department: Prof. Arnaud Picard), National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015 Paris, France
| | - Piotr S Fudalej
- Department of Orthodontics (Head of the Department: Doc. Milos Spidlen), Institute of Dentistry and Oral Sciences, Palacky University Olomouc, Palackeho 12, 771 00 Olomouc, Czech Republic; Department of Orthodontics and Dentofacial Orthopaedics (Head of the Department: Prof. Christos Katsaros), University of Bern, Freiburgstrasse 9, 3010 Bern, Switzerland.
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El-Ashmawi NA, ElKordy SA, Salah Fayed MM, El-Beialy A, Attia KH. Effectiveness of Gingivoperiosteoplasty on Alveolar Bone Reconstruction and Facial Growth in Patients With Cleft Lip and Palate: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2018; 56:438-453. [DOI: 10.1177/1055665618788421] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Noha A. El-Ashmawi
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | - Sherif A. ElKordy
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | - Mona M. Salah Fayed
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, Malaysia
| | - Amr El-Beialy
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | - Khaled H. Attia
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
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Preoperative Alveolar Segment Position as a Predictor of Successful Gingivoperiosteoplasty in Patients with Unilateral Cleft Lip and Palate. Plast Reconstr Surg 2018; 141:971-982. [DOI: 10.1097/prs.0000000000004231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Altuğ AT. Presurgical Nasoalveolar Molding of Bilateral Cleft Lip and Palate Infants: An Orthodontist's Point of View. Turk J Orthod 2017; 30:118-125. [PMID: 30112503 DOI: 10.5152/turkjorthod.2017.17045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/13/2017] [Indexed: 11/22/2022]
Abstract
Nonsyndromic complete cleft lip and palate deformity is primarily functional, then esthetic, and finally but not least importantly, a dental challenge. Feeding and facial appearance are important during the first years of a newborn. Nutrition is universally provided by passive feeding plates. If the Cleft Team prefers to use active plates, alveolar molding combined with nasal approaches in infants is the best method to improve esthetics to date. Orthodontists are predominantly responsible for achieving both the goals. After those difficulties have been met in early days of the life, dentists are mainly responsible for the treatment thereafter. If the infants have a dentoalveolar unity without any fistulas and correctly aligned maxillary deciduous teeth, this is a real success. Therefore, this article is an overview of presurgical infant orthopedics and its contribution to subsequent dental practice.
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Affiliation(s)
- Ayşe Tuba Altuğ
- Department of Orthodontics, Ankara University School of Dentistry, Ankara, Turkey
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Chang DK, Kanack M, Pretorius D, Calvert S, Patino-Ochoa C, Gosman A. Ultrasound Evaluation of Primary Alveolar Grafting in Cleft Lip/Palate Treatment: Development of a Novel Sonographic Grading System. Cleft Palate Craniofac J 2016; 53:614-21. [DOI: 10.1597/14-253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To explore ultrasonographic evaluation of primary alveolar repair in cleft lip/palate patients and develop a grading system to assess outcomes of graft success. Design Sixteen patients with an average age of 2 years 1 month had sonograms performed at various points in their treatment to determine the feasibility of ultrasound in visualizing alveolar bone defects and changes over time postgrafting. A total of 23 sonograms were performed: 21 at an average of 12 months postoperatively and 2 at an average of 1 month preoperatively. Main Outcome Measures A 10-point grading system was developed assessing three categories: locations of lateral bone bridging across the cleft, quantification of residual defects with air or fluid channels, and locations of calcification. Three operators graded 10 sonograms to assess interobserver reliability, and the scores were also validated against dental radiographs in patients old enough for radiographic imaging. Results Linear weighted kappa statistics revealed substantial interobserver agreement for total scores, with an average kappa value of .708. In limited patients with radiographs, a total score of 9/10 correlated with a Chelsea score of 6.5/8 and category A. Conclusions Sonographic evaluation, coupled with this novel grading system, shows potential for early assessment of outcomes of graft success when evaluating new techniques of primary alveolar grafting.
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Affiliation(s)
- Daniel K. Chang
- Plastic and Reconstructive Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Melissa Kanack
- Department of Plastic Surgery, University of California, Irvine
| | - Dolores Pretorius
- School of Medicine, Department of Radiology, University of California, San Diego
| | - Stephanie Calvert
- School of Medicine, Department of Radiology, University of California, San Diego
| | - Cesar Patino-Ochoa
- School of Medicine, Department of Radiology, University of California, San Diego
| | - Amanda Gosman
- Director of Pediatric Plastic Surgery, School of Medicine, Department of Surgery, University of California, San Diego
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Tovo AHS, Prietsch JR, Collares MVM. Tomographic Assessment of Bone Formation After the Collares Technique of Gingivoperiosteoplasty in Patients With Cleft Lip and Palate. Cleft Palate Craniofac J 2015; 53:47-56. [PMID: 25950239 DOI: 10.1597/14-089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This cross-sectional study sought to assess bone formation and spontaneous tooth eruption in a cohort of 25 consecutive patients aged 6 to 11 years who underwent primary gingivoperiosteoplasty by the Collares technique. DESIGN Cross-sectional study assessing bone formation in the cleft area using a within-group time series design. SETTING Hospital de Clínicas de Porto Alegre (HCPA), a tertiary hospital in Brazil. PATIENTS Twenty-five patients with nonsyndromic, complete unilateral cleft lip and palate, no comorbidities, and unerupted permanent canines. INTERVENTION Cheiloplasty was performed by means of the Millard II technique, with the addition of a triangle at the mucocutaneous junction, vomer flap nasal floor closure, and wide subperiosteal elevation, followed by gingivoperiosteoplasty by the Collares technique. MAIN OUTCOME MEASURES Cone-beam computed tomography was used to assess treatment effect. In a novel method, software was used to obtain two three-dimensional reconstructions, one each of the cleft and noncleft sides, enabling quantitative comparison of bone presence in the alveolar defect area. RESULTS Of the 25 patients, 24 achieved bone bridge formation. The cleft side had 75.1% (67.9%-82.3%) of the bone volume, 70.5% (53.1%-87.9%) of the height, and 63.3% (44.1%-82.5%) of the width of the noncleft side. Bone formation was 17.28% lower in patients with lateral incisor agenesis. CONCLUSION Collares gingivoperiosteoplasty performed well as a technique for alveolar repair in patients with cleft lip and palate, allowing spontaneous eruption of deciduous and permanent lateral incisors through the bone bridge created.
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Effect of maxillary alveolar reconstruction on nasal symmetry of cleft lip and palate patients: a study comparing iliac crest bone graft and recombinant human bone morphogenetic protein-2. J Plast Reconstr Aesthet Surg 2014; 67:1201-8. [PMID: 24909628 DOI: 10.1016/j.bjps.2014.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 04/18/2014] [Accepted: 05/10/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recombinant human bone morphogenetic protein (rhBMP)-2 has been used in some craniofacial centers worldwide. However, its influence on nasal morphology is unknown. Thus, the objective of this investigation was to assess the effect of maxillary alveolar reconstruction on nasal position and symmetry in unilateral complete cleft lip patients who underwent traditional iliac crest bone grafting transferring versus reconstruction using rhBMP-2. METHODS Nineteen unilateral complete cleft lip patients were randomly divided into two groups. In group 1, patients underwent traditional iliac crest bone grafting transferring (n = 11) and in group 2, patients underwent alveolar reconstruction using collagen matrix with lyophilized rhBMP-2 (n = 8). Computerized tomography (CT) imaging was performed preoperatively and at 6 months postoperatively using a previously standardized protocol. Linear distances using anatomic landmarks were performed using tridimensional CT data reformatted by the OsiriX(®) software. Quantitative and qualitative measurements to assess intra- and inter-group nasal position modifications were performed. RESULTS Intra-group pre- and postoperative comparisons showed significant differences (p < 0.05) in two linear measurements of group 1, while group 2 did not present a difference (p > 0.05). Group 2 presented significant postoperative enhancement (p < 0.05) in the quantitative nasal symmetry in one measurement. Qualitative analysis showed postoperative nasal symmetry enhancement in 75% of the measurements of group 2 and 36% of group 1. There was no statistically significant difference in the inter-group comparisons. CONCLUSIONS Our study demonstrated that both groups showed similar effect on nasal symmetry.
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Hsieh CHY, Ko EWC, Chen PKT, Huang CS. The effect of gingivoperiosteoplasty on facial growth in patients with complete unilateral cleft lip and palate. Cleft Palate Craniofac J 2014; 47:439-46. [PMID: 20180706 DOI: 10.1597/08-207] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Gingivoperiosteoplasty performed at the time of lip repair of cleft patients is one kind of alveolar repair. The purpose of this retrospective study was to evaluate the effect of gingivoperiosteoplasty on facial growth of patients with complete unilateral cleft lip and palate (UCLP). DESIGN Retrospective study. PATIENTS Sixty-two consecutive patients with nonsyndromic complete unilateral cleft lip/palate with 5-year-olds' record were included in this retrospective study. INTERVENTIONS All the patients had received nasoalveolar molding treatment before cheiloplasty at the age of 3 to 6 months. Twenty-six patients had gingivoperiosteoplasty performed at the time of cheiloplasty and function as the GPP group. Thirty-six patients did not have gingivoperiosteoplasty at the time of cheiloplasty and function as the non-GPP group. MAIN OUTCOME MEASURES Cephalometry was used to evaluate the facial growth at 5 years of age in the two groups of patients. RESULTS Gingivoperiosteoplasty had significant effects on the maxillary position (SNA), intermaxillary position (ANB), maxillary length (PMP-ANS), and maxillary alveolar length (PMP-A) at the age of 5 years. The SNA and ANB angles were larger in non-GPP group than in the GPP group by 3.0 degrees and 2.6 degrees , respectively. The maxillary length (PMP-ANS) and maxillary alveolar length (PMP-A) were larger in the non-GPP group than in the GPP group by 2.1 and 2.9 mm, respectively. CONCLUSIONS In patients with UCLP, the sagittal growth of the maxilla would be affected more adversely in the GPP group than in the non-GPP group at the age of 5 years.
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A novel pre-surgical maxillary orthodontic device using β-titanium wire for wide unilateral cleft lip and palate patients: Preliminary study of its efficacy and impact for the maxillary formation. J Plast Reconstr Aesthet Surg 2014; 67:167-72. [DOI: 10.1016/j.bjps.2013.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/08/2013] [Accepted: 10/08/2013] [Indexed: 11/17/2022]
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Mao LX, Shen GF, Fang B, Xia YH, Ma XH, Wang B. Bone Grafting, Corticotomy, and Orthodontics: Treatment of Cleft Alveolus in a Chinese Cohort. Cleft Palate Craniofac J 2013; 50:662-70. [DOI: 10.1597/12-034r] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective A multimodal therapy was applied to solve a set of related problems including collapse of the posterior segment, high level gingival margin of canine, and resorption of grafted bone in a cohort of Chinese youngsters with cleft lip and palate. This study aimed to evaluate the benefits of this treatment procedure. Methods Thirty patients with unilateral cleft lip and palate were included in this prospective study. All patients had previously undergone only cleft lip and palate repair and presented with alveolar cleft and an obvious step in the gingival margin between the canine tooth and the teeth beside it. A multimodal therapy that included bone grafting, corticotomy, and orthodontics was applied to solve these problems. Grafted bone volume, parallelism of the roots, root resorption, gingival margin, and mobility of the canine on the cleft side were established before surgery, 1 week after surgery, and after straightening of the canine. Results Less than 25% of the grafted bone was reabsorbed in 25 of the 30 patients, while less than 50% was resorbed in the remaining five. The roots of the canines on the cleft side were mostly parallel to the adjacent teeth. Root resorption and mobility of the canines were slight. The difference in the gingival margin between the canines on the cleft side and the other side was small. Conclusions Canines moved into the grafted bone safely and effectively, thus achieving a normal gingival margin and retaining grafted bone volume in one operation.
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Affiliation(s)
- Li-Xia Mao
- Center of Cranio-facial Orthodontics, Shanghai Jiao Tong University
| | - Guo-Fang Shen
- Department of Oral and Maxillofacial Surgery, Shanghai Jiao Tong University
| | - Bing Fang
- Center of Cranio-facial Orthodontics, College of Stomatology Affiliated 9th People's Hospital, Shanghai Jiao Tong University
| | - Yun-Hui Xia
- Center of Cranio-facial Orthodontics, College of Stomatology Affiliated 9th People's Hospital, Shanghai Jiao Tong University
| | - Xu-Hui Ma
- Center of Cranio-facial Orthodontics, College of Stomatology Affiliated 9th People's Hospital, Shanghai Jiao Tong University
| | - Bo Wang
- Center of Cranio-facial Orthodontics, College of Stomatology Affiliated 9th People's Hospital, Shanghai Jiao Tong University
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Uzel A, Alparslan ZN. Long-Term Effects of Presurgical Infant Orthopedics in Patients with Cleft Lip and Palate: A Systematic Review. Cleft Palate Craniofac J 2011; 48:587-95. [DOI: 10.1597/10-008] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to assess the scientific evidence on the efficiency of presurgical infant orthopedic appliances in patients with cleft lip and palate to shed light on a specific, contemporary discussion of whether the appliances have long-term advantages with respect to treatment outcomes. Design A systematic review. Method Two literature surveys from the five electronic databases were performed with a 1-month interval. Randomized controlled trials and controlled clinical trials (controls had no presurgical infant orthopedics) that had follow-up periods of a minimum of 6 years were included in the study. The exceptions to the follow-up limit were studies related to feeding and parent satisfaction. Results Of the 319 articles retrieved in the literature surveys, 12 were qualified for the final analysis. The level of evidence of these articles ranged from 1b to 4. Eight randomized controlled trials and four controlled clinical trials were available on eight treatment outcomes. The longest follow-up period of the randomized controlled trials was 6 years. No randomized controlled trials were found on active presurgical infant orthopedic appliances and on nasoalveolar molding appliances. Conclusions Based on the results, presurgical infant orthopedic appliances have no long-term positive effects on seven of the eight studied treatment outcomes in patients with cleft lip and palate. More randomized controlled trials need to be done to have evidence regarding the effects of presurgical infant orthopedics in different surgical protocols. Also, the encouraging results about the effect of nasolaveolar molding appliances on nasal symmetry have to be supported by future randomized controlled trials.
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Affiliation(s)
- Aslihan Uzel
- Department of Orthodontics, Faculty of Dentistry
| | - Z. Nazan Alparslan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Çukurova University, Adana, Turkey
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Fudalej P, Janiszewska-Olszowska J, Wedrychowska-Szulc B, Katsaros C. Early alveolar bone grafting has a negative effect on maxillary dental arch dimensions of pre-school children with complete unilateral cleft lip and palate. Orthod Craniofac Res 2011; 14:51-7. [DOI: 10.1111/j.1601-6343.2011.01507.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nagasao T, Ogata H, Miyamoto J, Jiang H, Kaneko T, Isshiki Y, Nakajima T. Alveolar bone grafting for patients with unilateral complete alveolar and palatal clefts improves the bony structure of the nose. Cleft Palate Craniofac J 2008; 46:9-18. [PMID: 19115796 DOI: 10.1597/07-169.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This is a retrospective study regarding the effect of alveolar bone grafting (ABG) on morphological changes in the bony structure of the nose in alveolar and palatal cleft patients. METHODS Sixty-five randomly selected adults were included in the present study. Of the 65 subjects, 21 had no congenital anomaly and were designated as the control group (n = 21; mean age 22.4 +/- 4.3 years). Forty-four had unilateral complete clefts of the alveolus and palate on the left side. The patients with clefts were further divided into two subgroups based on presence or absence of ABG in their histories. These groups were termed the ABG(+) group (n = 24; mean age 20.3 +/- 2.5 years) and the ABG(-) group (n = 20; mean age 32 +/- 4.5 years), respectively. An anatomical structure that constitutes the bony component of the nose was defined. This structure, composed of the nasal bones and part of the frontal process of the maxilla, was termed the BSEN (bony structure of the external nose). The symmetry of the BSEN was assessed quantitatively by performing morphological measurements on computerized tomographic images of each patient's skull, and these measurements were compared among the control, ABG(+), and ABG(-) groups. RESULTS The BSEN presented more symmetric features in the ABG(+) group patients than in the ABG(-) group patients. CONCLUSION ABG improves symmetry of the BSEN. This finding justifies ABG in terms of cosmetic improvement of the external nose in patients with unilateral complete alveolar and palatal clefts.
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Affiliation(s)
- Tomohisa Nagasao
- Department of Plastic and Reconstructive Surgery, Keio University Hospital, Shinjuku-Ward Shinanomachi 35 Tokyo, Japan.
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