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Fujiki RB, Zhao F, Niedenthal PM, Thibeault SL. Facial Expressions of Emotion in Children with Cleft Lip and Palate. Cleft Palate Craniofac J 2024:10556656241271650. [PMID: 39193752 DOI: 10.1177/10556656241271650] [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: 08/29/2024] Open
Abstract
OBJECTIVE To examine the facial movements children with cleft lip and palate (CLP) employ to express basic emotions. Ability of observers to interpret facial expressions of children with CLP was also considered. DESIGN Prospective case-control design. SETTING Outpatient craniofacial anomalies clinic. PATIENTS Twenty-five children with CLP (age 8 to 12) and 25 age/sex-matched controls. OUTCOME MEASURES Children were video recorded making facial expressions representing anger, disgust, fear, happiness, sadness, and surprise. Magnitude of children's facial movements was quantified and compared using OpenFace. Subsequently, emotion videos were presented to 19 adults who were asked to identify the emotion conveyed in each facial expression. Accuracy of emotion recognition was compared across groups. RESULTS Compared with controls, children with CLP employed significantly (P < .05) smaller magnitude superior and lateral perioral movements to express disgust (Cohen's d = .50), happiness (Cohen's d = 1.1), and fear (Cohen's d = .93). For disgust and sadness, children with CLP employed significantly greater magnitude movements of the nose and chin, presumably to compensate for reduced perioral range of motion. For anger, happiness, and sadness, children with CLP employed smaller magnitude movements of the upper face when compared with controls. Observers identified disgust (OR = 1.26), and fear (OR = 2.44) significantly less accurately in children with CLP when compared with controls. CONCLUSIONS Children with CLP employed different facial movements to express certain emotions. Observers less accurately identified some emotions conveyed by facial expressions in children with CLP when compared with controls, likely due in part to differences in facial movements. Future research should explore the implications of these differences for social communication.
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Affiliation(s)
| | - Fangyun Zhao
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Paula M Niedenthal
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Susan L Thibeault
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
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Merkl M, Starke V, Ivanic-Sefcikova M, Brommer M, Zemann W, Schwaiger M. Cleft lip re-repair: How does it affect the nasolabial appearance? J Craniomaxillofac Surg 2024:S1010-5182(24)00241-5. [PMID: 39198130 DOI: 10.1016/j.jcms.2024.08.013] [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: 04/04/2024] [Revised: 05/24/2024] [Accepted: 08/19/2024] [Indexed: 09/01/2024] Open
Abstract
Cleft lip re-repair is a procedure frequently endorsed to enhance a compromised nasolabial appearance. However, the actual effect of such revision surgery on the nasolabial appearance has scarcely been studied. Therefore, the aim of this study was to critically review surgical outcomes of patients that underwent surgical re-do of their cleft lip, using well-validated objective and subjective methods and standardised outcome measures. 20 patients with at least 6 months follow-up after cleft lip re-repair were assessed. Standardised pre- and postoperative photographs were analysed. The objective assessment was carried out using the SymNose-software. Furthermore, a subjective evaluation of the nasolabial area was conducted by ten examiners who rated seven parameters using a Likert-scale ranging from 1to5. The objective evaluation showed substantial improvement regarding symmetry values. Significant postoperative decrease in labial asymmetry from 26.42% (±8.13) to 18.77% (±6.28) (p < 0.001) and upper lip asymmetry in relation to the facial midline (26.91% (±8.03) vs. 18.27% (±5.17) (p < 0.001)) was observed. Similar results were corroborated in the subjective analysis. Differences regarding the ratings were detected considering the examiners' professional background and level of expertise. Cleft re-repair was found to significantly improve upper lip symmetry and lead to a more harmonious nasolabial appearance.
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Affiliation(s)
- Markus Merkl
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Vasco Starke
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Michala Ivanic-Sefcikova
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Marc Brommer
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Wolfgang Zemann
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Michael Schwaiger
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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Trotman CA, Faraway J, Bennett ME, Garson GD, Phillips C, Bruun R, Daniel R, David LR, Ganske I, Leeper LK, Rogers-Vizena CR, Runyan C, Scott AR, Wood J. Decision Considerations and Strategies for Lip Surgery in Patients with Cleft lip/Palate: A Qualitative Study. JOURNAL OF DERMATOLOGY AND DERMATITIS 2023; 8:115. [PMID: 38919736 PMCID: PMC11197461 DOI: 10.31579/2578-8949/115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Objective To qualitatively assess surgeons' decision making for lip surgery in patients with cleft lip/palate (CL/P). Design Prospective, non-randomized, clinical trial. Setting Clinical data institutional laboratory setting. Patients Participants The study included both patient and surgeon participants recruited from four craniofacial centers. The patient participants were babies with a CL/P requiring primary lip repair surgery (n=16) and adolescents with repaired CL/P who may require secondary lip revision surgery (n=32). The surgeon participants (n=8) were experienced in cleft care. Facial imaging data that included 2D images, 3D images, videos, and objective 3D visual modelling of facial movements were collected from each patient, and compiled as a collage termed the 'Standardized Assessment for Facial Surgery (SAFS)' for systematic viewing by the surgeons. Interventions The SAFS served as the intervention. Each surgeon viewed the SAFS for six distinct patients (two babies and four adolescents) and provided a list of surgical problems and goals. Then an in-depth-interview (IDI) was conducted with each surgeon to explore their decision-making processes. IDIs were conducted either 'in person' or virtually, recorded, and then transcribed for qualitative statistical analyses using the Grounded Theory Method. Results Rich narratives/themes emerged that included timing of the surgery; risks/limitations and benefits of surgery; patient/family goals; planning for muscle repair and scarring; multiplicity of surgeries and their impact; and availability of resources. In general, there was surgeon agreement for the diagnoses/treatments. Conclusions The themes provided important information to populate a checklist of considerations to serve as a guide for clinicians.
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Affiliation(s)
- Carroll Ann Trotman
- College of Dentistry, The Ohio State University, Ohio, United States of America
| | - Julian Faraway
- Department of Mathematical Sciences, University of Bath, Bath, United Kingdom
| | - M Elizabeth Bennett
- Department of Orthodontics, UNC Adams School of Dentistry, Chapel Hill, North Carolina
| | - G David Garson
- Department of Public Administration, School of Public and International Affairs, North Carolina State University, Raleigh, North Carolina
| | - Ceib Phillips
- Department of Orthodontics, UNC Adams School of Dentistry, Chapel Hill, North Carolina
| | - Richard Bruun
- Department of Developmental Biology, Harvard School of Dental Medicine
| | - Renie Daniel
- Department of Oral and Maxillofacial Surgery, UNC Adams School of Dentistry, Chapel Hill, North Carolina
| | - Lisa Renee David
- Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Health, Wake Forest, North Carolina
| | - Ingrid Ganske
- Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Lauren K Leeper
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina Health, Chapel Hill, North Carolina
| | | | - Christopher Runyan
- Department of Plastic Surgery, Wake Forest Baptist Health, Wake Forest, North Carolina
| | - Andrew R Scott
- Department of Otolaryngology, Tufts University School of Medicine, Boston, Massachusetts
| | - Jeyhan Wood
- Department of Plastic Surgery, University of North Carolina Health, Chapel Hill, North Carolina
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Trotman CA, Faraway J, Bennett ME, Garson GD, Phillips C, Bruun R, Daniel R, David LR, Ganske I, Leeper LK, Rogers-Vizena CR, Runyan C, Scott AR, Wood J. Decision Considerations and Strategies for Lip Surgery in Patients with Cleft lip/Palate: A Qualitative Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.20.23287416. [PMID: 37131720 PMCID: PMC10153332 DOI: 10.1101/2023.04.20.23287416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Objective To qualitatively assess surgeons decision making for lip surgery in patients with cleft lip/palate (CL/P). Design Prospective, non-randomized, clinical trial. Setting Clinical data institutional laboratory setting. Patients Participants The study included both patient and surgeon participants recruited from four craniofacial centers. The patient participants were babies with a CL/P requiring primary lip repair surgery (n=16) and adolescents with repaired CL/P who may require secondary lip revision surgery (n=32). The surgeon participants (n=8) were experienced in cleft care. Facial imaging data that included 2D images, 3D images, videos, and objective 3D visual modelling of facial movements were collected from each patient, and compiled as a collage termed the Standardized Assessment for Facial Surgery (SAFS) for systematic viewing by the surgeons. Interventions The SAFS served as the intervention. Each surgeon viewed the SAFS for six distinct patients (two babies and four adolescents) and provided a list of surgical problems and goals. Then an in-depth-interview (IDI) was conducted with each surgeon to explore their decision-making processes. IDIs were conducted either in person or virtually, recorded, and then transcribed for qualitative statistical analyses using the Grounded Theory Method. Results Rich narratives/themes emerged that included timing of the surgery; risks/limitations and benefits of surgery; patient/family goals; planning for muscle repair and scarring; multiplicity of surgeries and their impact; and availability of resources. For diagnoses/treatments, surgeons agreed, and level of surgical experience was not a factor. Conclusions The themes provided important information to populate a checklist of considerations to serve as a guide for clinicians.
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Papathanasiou E, Scott AR, Trotman CA, Beale C, Price LL, Huggins GS, Zhang Y, Georgakoudi I, Van Dyke TE. Specialized Pro-Resolving Mediators Reduce Scarring After Cleft Lip Repair. Front Immunol 2022; 13:871200. [PMID: 35572588 PMCID: PMC9094441 DOI: 10.3389/fimmu.2022.871200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Residual scarring after cleft lip repair surgery remains a challenge for both surgeons and patients and novel therapeutics are critically needed. The objective of this preclinical experimental study was to evaluate the impact of the methyl-ester of pro-resolving lipid mediator lipoxin A4 (LXA4-ME) on scarring in a novel rabbit model of cleft lip repair. Methods A defect of the lip was surgically created and repaired in eight six-week old New Zealand white rabbits to simulate human cleft lip scars. Rabbits were randomly assigned to topical application of PBS (control) or 1 ug of LXA4-ME (treatment). 42 days post surgery all animals were euthanized. Photographs of the cleft lip area defect and histologic specimens were evaluated. Multiple scar assessment scales were used to compare scarring. Results Animals treated with LXA4-ME exhibited lower Visual Scar Assessment scores compared to animals treated with PBS. Treatment with LXA4-ME resulted in a significant reduction of inflammatory cell infiltrate and density of collagen fibers. Control animals showed reduced 2D directional variance (orientation) of collagen fibers compared to animals treated with LXA4-ME demonstrating thicker and more parallel collagen fibers, consistent with scar tissue. Conclusions These data suggest that LXA4-ME limits scarring after cleft lip repair and improves wound healing outcomes in rabbits favoring the resolution of inflammation. Further studies are needed to explore the mechanisms that underlie the positive therapeutic impact of LXA4-ME on scarring to set the stage for future human clinical trials of LXA4-ME for scar prevention or treatment after cleft lip repair.
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Affiliation(s)
- Evangelos Papathanasiou
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA, United States
- Center for Clinical and Translational Research, Forsyth Institute, Cambridge, MA, United States
| | - Andrew R. Scott
- Department of Otolaryngology – Head & Neck Surgery, Tufts University School of Medicine, Boston, MA, United States
| | - Carroll Ann Trotman
- College of Dentistry, The Ohio State University, Columbus, OH, United States
| | - Corinna Beale
- Tufts Comparative Medicine Services, Tufts University, Boston, MA, United States
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, United States
- Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States
| | - Gordon S. Huggins
- Molecular Cardiology Research Institute and Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, United States
| | - Yang Zhang
- Department of Biomedical Engineering, Tufts University School of Engineering, Medford, MA, United States
| | - Irene Georgakoudi
- Department of Biomedical Engineering, Tufts University School of Engineering, Medford, MA, United States
| | - Thomas E. Van Dyke
- Center for Clinical and Translational Research, Forsyth Institute, Cambridge, MA, United States
- Department of Oral Medicine, Infection and Immunity, Faculty of Medicine, Harvard University, Boston, MA, United States
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Sitzman TJ, Carle AC, Lundberg JN, Heaton PC, Helmrath MA, Trotman CA, Britto MT. Marked Variation Exists Among Surgeons and Hospitals in the Use of Secondary Cleft Lip Surgery. Cleft Palate Craniofac J 2020; 57:198-207. [PMID: 31597471 PMCID: PMC6957675 DOI: 10.1177/1055665619880056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify child-, surgeon-, and hospital-specific factors at the time of primary cleft lip repair that are associated with the use of secondary cleft lip surgery. DESIGN Retrospective cohort study. SETTING Forty-nine pediatric hospitals. PARTICIPANTS Children who underwent cleft lip repair between 1999 and 2015. MAIN OUTCOME MEASURE Time from primary cleft lip repair to secondary lip surgery. RESULTS By 5 years after primary lip repair, 24.0% of children had undergone a secondary lip surgery. In multivariable analysis, primary lip repair before 3 months had a 1.22-fold increased hazard of secondary surgery (95% confidence interval [CI]: 1.02-1.46) compared to repair at 7 to 12 months of age, and children with multiple congenital anomalies had a 0.77-fold decreased hazard of secondary surgery (95% CI: 0.68-0.87). After adjusting for cleft type, age at repair, presence of multiple congenital anomalies, and procedure volume, there remained substantial variation in secondary surgery use among surgeons and hospitals (P < .01). For children with unilateral cleft lip repaired at 3 to 6 months of age, the predicted proportion of children undergoing secondary surgery within 5 years of primary repair ranged from 4.9% to 21.8% across surgeons and from 4.5% to 24.7% across hospitals. CONCLUSIONS There are substantial differences among surgeons and hospitals in the rates of secondary lip surgery. Further work is needed to identify causes for this variation among providers.
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Affiliation(s)
- Thomas J. Sitzman
- Division of Plastic Surgery, Phoenix Children’s Hospital, Phoenix, AZ, USA
- Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
| | - Adam C. Carle
- Department of Pediatrics, College of Medicine, University of Cincinnati, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, USA
| | | | - Pamela C. Heaton
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Michael A. Helmrath
- Division of Pediatric and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Carroll-Ann Trotman
- Department of Orthodontics, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Maria T. Britto
- Department of Pediatrics, College of Medicine, University of Cincinnati, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Trotman CA, Faraway J, Hadlock TA. Facial mobility and recovery in patients with unilateral facial paralysis. Orthod Craniofac Res 2020; 23:82-91. [PMID: 31529611 PMCID: PMC11218815 DOI: 10.1111/ocr.12346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/02/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE (a) To quantify longitudinal 3D changes in facial soft tissue movements in adults with unilateral facial paralysis, and (b) to compare the patients' movements with an age- and sex-frequency matched control group. SETTINGS AND SAMPLE POPULATION Prospective 3D facial movement data of 36 patients and 68 control participants. Patients' data were collected within 6 weeks of onset of symptoms (baseline) and then at 3 and 12 weeks after baseline. MATERIALS AND METHODS The 3D facial movement data were collected during different facial animations. Mean group measurements of displacement, velocity and asymmetry were computed. Two sample t tests were used to test for significant group differences, and linear mixed models were fit to test for significant changes over time in the patient group. Also, 3D dynamic modelling and vector plots were computed to isolate the patients' abnormal movements and/or paralysis. RESULTS The patients' mean baseline movements were significantly less for both the paralysed and contralateral sides of the face with much greater movement asymmetry than the controls. Patients' mean measures improved significantly from baseline to 12 weeks. The measures were closer to, but fell short of, the control values. CONCLUSION In unilateral facial paralysis, the contralateral facial side was affected by the paralysis and may be tethered or limited in its movement by the paralysed side. The comprehensive measurement set and 3D facial mapping effectively tracked patient recovery and isolated paralysed facial regions. The 3D measures can be used for diagnosis and outcome assessment of different treatments.
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Affiliation(s)
- Carroll Ann Trotman
- Department of Orthodontics, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Julian Faraway
- Department of Mathematical Sciences, University of Bath, Bath, UK
| | - Tessa A. Hadlock
- Department of Otolaryngology, Facial Nerve Center, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Abstract
Burden of care has become a commonly used terminology in healthcare in the recent years. Burden of care is the balance how much patients and families commit to their time, compromise quality of life, undergo multiple interventions, and take risks weighing against the benefits the patients and families receive. Cleft lip and palate, congenital anomaly, demands a long-term and interdisciplinary care. These children are at high risk of various treatment/intervention episodes increasing the burden of care. This subject has been widely discussed with many other diseases and health conditions at national, international meetings, and World Health Organization as well. We bring out some facts and practices affecting the burden of care in cleft lip and palate.
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Cleft and Craniofacial Center, Sri Ramachandra University, Chennai, India
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Difference in Degrees of Satisfaction with Orthognathic Surgery and Orthodontic Treatment between Skeletal Class III and Cleft Patients. J Craniofac Surg 2019; 30:985-991. [PMID: 30817507 DOI: 10.1097/scs.0000000000005425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the degrees of satisfaction with orthognathic surgery and orthodontic treatment between skeletal Class III and cleft patients. MATERIALS AND METHODS The samples consisted of Class III group (N = 25) and Cleft group (N = 16). The Modified Orthognathic Quality of Life Questionnaires, which had 5 domains (oral function [OF], awareness of dentofacial deformity [ADD], social relationship [SR], facial esthetics [FE], and nose/lip esthetics [NLE]), were evaluated with 5 rates (0 [very satisfactory] to 4 [very unsatisfactory]) at initial visit (T1), just before surgery (T2), 3 to 6 months after surgery (T3), and at debonding or 1 year after surgery (T4). The scores at each stage, amount of change between stages, and effect size (ES) in the 5 domains were investigated. RESULTS Compared to Class III group, Cleft group exhibited lower satisfaction scores of NLE domain during all stages (all P < 0.001) and of SR domain and total domains at T4 stage (P < 0.05, P < 0.01). Cleft group showed significant improvement of satisfaction scores in FE domain during T1-T2 (P < 0.01), in SR, FE, NLE, and total domains during T2-T3 (all P < 0.01), in OF, SR, and total domains during T3-T4 (P < 0.05, P < 0.01, P < 0.01), and in all domains during T1-T4 (ADD, P < 0.05; OF, SR, and NLE, P < 0.01; FE and total, P < 0.001). Cleft group exhibited large improvement of ES only at SR and FE domains during T2-T3 (-0.81 and -1.09, respectively). CONCLUSIONS Owing to lower satisfaction of NLE domain at all stages in cleft patients, clinicians should recommend adjunctive cosmetic surgery for nose and lip after completion of treatment.
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Bennett KG, Patterson AK, Schafer K, Haase M, Ranganathan K, Carlozzi N, Vercler CJ, Kasten SJ, Buchman SR, Waljee JF. Decision-Making in Cleft-Related Surgery: A Qualitative Analysis of Patients and Caregivers. Cleft Palate Craniofac J 2019; 57:161-168. [PMID: 31382774 DOI: 10.1177/1055665619866552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Preference-sensitive surgical decisions merit shared decision-making, as decision engagement can reduce decisional conflict and regret. Elective cleft-related procedures are often preference sensitive, and therefore, we sought to better understand decision-making in this population. DESIGN Semistructured interviews were conducted to elicit qualitative data. A hierarchical codebook was developed through an iterative process in preparation for thematic analysis. Thematic analysis was performed to examine differences between patients and caregivers. SETTING Multidisciplinary cleft clinic at a tertiary care center. PARTICIPANTS Patients with cleft lip aged 8 and older (n = 31) and their caregivers (n = 31) were purposively sampled. Inability to converse in English, intellectual disability, or syndromic diagnoses resulted in exclusion. MAIN OUTCOME MEASURES Preferences surrounding surgical decision-making identified during thematic analysis. RESULTS Mean patient age was 12.7 (standard deviation: 3.1). Most had unilateral cleft lip and palate (43.8%). Three themes emerged: Insufficient Understanding of Facial Difference and Treatment, Diversity of Surgical Indications, and Barriers to Patient Autonomy. Almost half of caregivers believed their children understood their clefts, but most of these children failed to provide information about their cleft. Although many patients and caregivers acknowledged that surgery addressed function and/or appearance, patients and caregivers exhibited differences regarding the necessity of surgery. Furthermore, a large proportion of patients believed their opinions mattered in decisions, but less than half of caregivers agreed. CONCLUSIONS Patients with clefts desire to participate in surgical decisions but have limited understanding of their facial difference and surgical indications. Cleft surgeons must educate patients and facilitate shared decision-making.
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Affiliation(s)
- Katelyn G Bennett
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Annie K Patterson
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kylie Schafer
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Madeleine Haase
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Noelle Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | | | - Steven J Kasten
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven R Buchman
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer F Waljee
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
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Quantifying Soft Tissue Shape and Symmetry: Patients with Cleft Lip/Palate and Facial Paralysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1715. [PMID: 29707466 PMCID: PMC5908516 DOI: 10.1097/gox.0000000000001715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/22/2018] [Indexed: 12/03/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The objective of this study was to demonstrate simple three-dimensional analyses of facial soft tissue shape and asymmetry. Methods: There were 2 study samples: one retrospective comprised patients with repaired cleft lip and palate (CL/P) and control subjects; and the other prospective comprised patients with unilateral facial paralysis (FP) and control subjects. The data collected were digitized three-dimensional facial landmarks. Scores for shape and asymmetry of subjects’ faces and for different facial regions were generated using Procrustes methods. Pivotal bootstrap methods and analysis of variance were used to test for significant differences in the scores between the patients and controls, and plots of the scores were generated to compare differences among the subjects. Results: (1) Shape scores: The CL/P patients demonstrated significant overall and regional facial differences (P ≤ 0.01). The patients were further from the control mean, especially those with unilateral CL/P. Patients with FP demonstrated significant differences (P ≤ 0.05) for the lower face only. (2) Asymmetry scores: CL/P and FP patients demonstrated significant overall and regional facial differences (CL/P, P ≤ 0.0001; FP, P ≤ 0.01). CL/P and FP patients were more asymmetric and were further from the control mean, and patients with unilateral CL/P were more asymmetric than the bilateral CL/P patients. Conclusion: Clinicians can use the analyses to isolate differences and/or changes in the face due to shape or asymmetry, or a combination of both; based on the score plots, the extent of the shape and asymmetry differences can be compared among subjects and the extent of changes due to surgery measured.
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12
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Papathanasiou E, Trotman CA, Scott AR, Van Dyke TE. Current and Emerging Treatments for Postsurgical Cleft Lip Scarring: Effectiveness and Mechanisms. J Dent Res 2017. [PMID: 28650705 DOI: 10.1177/0022034517717261] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Cleft lip with or without cleft palate is the most common congenital malformation of the head and the third-most common birth defect. Surgical repair of the lip is the only treatment and is usually performed during the first year of life. Hypertrophic scar (HTS) formation is a frequent postoperative complication that impairs soft tissue form, function, or movement. Multiple lip revision operations are often required throughout childhood, attempting to optimize aesthetics and function. The mechanisms guiding HTS formation are multifactorial and complex. HTS is the result of dysregulated wound healing, where excessive collagen and extracellular matrix proteins are deposited within the wound area, resulting in persistent inflammation and resultant fibrosis. Many studies support the contribution of dysregulated, exaggerated inflammation in scar formation. Fibrosis and scarring result from chronic inflammation that interrupts tissue remodeling in normal wound healing. Failure of active resolution of inflammation pathways has been implicated. The management of HTS has been challenging for clinicians, since current therapies are minimally effective. Emerging evidence that specialized proresolving mediators of inflammation accelerate wound healing by preventing chronic inflammation and allowing natural uninterrupted tissue remodeling suggests new therapeutic opportunities in the prevention and management of HTS.
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Affiliation(s)
- E Papathanasiou
- 1 Center for Clinical and Translational Research, Forsyth Institute, Cambridge, MA, USA.,2 Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA, USA
| | - C A Trotman
- 3 Department of Orthodontics, Tufts University School of Dental Medicine, Boston, MA, USA
| | - A R Scott
- 4 Department of Otolaryngology and Pediatrics, Tufts University School of Medicine, Boston, MA, USA
| | - T E Van Dyke
- 1 Center for Clinical and Translational Research, Forsyth Institute, Cambridge, MA, USA
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13
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Sitzman TJ, Coyne SM, Britto MT. The Burden of Care for Children with Unilateral Cleft Lip: A Systematic Review of Revision Surgery. Cleft Palate Craniofac J 2016; 53:84-94. [DOI: 10.1597/14-202] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To identify the average rate of revision surgery following cleft lip repair. Design PubMed, CINAHL, and SCOPUS were searched from database inception through March 2013 using the search terms cleft lip and surgery. Two investigators independently screened all abstracts and determined eligibility from review of full manuscripts using prespecified inclusion and exclusion criteria. Strengths and limitation of the studies were assessed, followed by qualitative synthesis. The I2 test of homogeneity was performed to determine if meta-analysis was appropriate. Results The search identified 3034 articles. Of those, 45 met the inclusion criteria. Studies were primarily case series and retrospective cohort studies, with only one randomized controlled trial. One-third of studies (n = 15) did not describe how the study sample was selected. Follow-up duration was not reported in one-fourth of studies (n = 11). Nasolabial aesthetics were reported in 44% of studies (n = 20). The incidence of revision surgery ranged from 0% to 100%. Meta-analysis was precluded because of study heterogeneity (I2 = 97%). Conclusions The average incidence of cleft lip revision surgery cannot be estimated from the published literature, due to significant heterogeneity among existing reports and limited study quality. To provide valid information about the burden of care for unilateral cleft lip, a population-based or multicenter longitudinal cohort study is necessary; this study should measure the number of surgical procedures and the patient's aesthetic outcomes.
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Affiliation(s)
| | | | - Maria T. Britto
- Pediatrics, Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Matsumoto K, Nozoe E, Okawachi T, Ishihata K, Nishinara K, Nakamura N. Preliminary Analysis of the 3-Dimensional Morphology of the Upper Lip Configuration at the Completion of Facial Expressions in Healthy Japanese Young Adults and Patients With Cleft Lip. J Oral Maxillofac Surg 2016; 74:1834-46. [PMID: 27129635 DOI: 10.1016/j.joms.2016.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop criteria for the analysis of upper lip configuration of patients with cleft lip while they produce various facial expressions by comparing the 3-dimensional (3D) facial morphology of healthy Japanese adults and patients with cleft lip. PATIENTS AND METHODS Twenty healthy adult Japanese volunteers (10 men, 10 women, controls) without any observed facial abnormalities and 8 patients (4 men, 4 women) with unilateral cleft lip and palate who had undergone secondary lip and nose repair were recruited for this study. Facial expressions (resting, smiling, and blowing out a candle) were recorded with 2 Artec MHT 3D scanners, and images were superimposed by aligning the T-zone of the faces. The positions of 14 specific points were set on each face, and the positional changes of specific points and symmetry of the upper lip cross-section were analyzed. Furthermore, the configuration observed in healthy controls was compared with that in patients with cleft lip before and after surgery. RESULTS The mean absolute values for T-zone overlap ranged from 0.04 to 0.15 mm. Positional changes of specific points in the controls showed that the nose and lip moved backward and laterally upward when smiling and the lips moved forward and downward medially when blowing out a candle; these movements were bilaterally symmetrical in men and women. In patients with cleft lip, the positional changes of the specific points were minor compared with those of the controls while smiling and blowing out a candle. The left-versus-right symmetry of the upper lip cross-section exceeded 1.0 mm in patients with cleft lip, which was markedly higher than that in the controls (0.17 to 0.91 mm). These left-versus-right differences during facial expressions were decreased after surgery. CONCLUSION By comparing healthy individuals with patients with cleft lip, this study has laid the basis for determining control values for facial expressions.
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Affiliation(s)
- Kouzou Matsumoto
- Attending Staff and Postgraduate Student, Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Etsuro Nozoe
- Associate Professor, Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
| | - Takako Okawachi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kiyohide Ishihata
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kazuhide Nishinara
- Associate Professor, Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Norifumi Nakamura
- Professor, Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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The Americleft Project: Burden of Care from Secondary Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e442. [PMID: 26301131 PMCID: PMC4527616 DOI: 10.1097/gox.0000000000000415] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/08/2015] [Indexed: 11/25/2022]
Abstract
Background: The burden of care for children with cleft lip and palate extends beyond primary repair. Children may undergo multiple secondary surgeries to improve appearance or speech. The purpose of this study was to compare the use of secondary surgery between cleft centers. Methods: This retrospective cohort study included 130 children with complete unilateral cleft lip and palate treated consecutively at 4 cleft centers in North America. Data were collected on all lip, palate, and nasal surgeries. Nasolabial appearance was rated by a panel of judges using the Asher-McDade scale. Risk of secondary surgery was compared between centers using the log-rank test, and hazard ratios estimated with a Cox proportional hazards model. Results: Median follow-up was 18 years (interquartile range, 15–19). There were significant differences among centers in the risks of secondary lip surgery (P < 0.001) and secondary rhinoplasty (P < 0.001). The cumulative risk of secondary lip surgery by 10 years of age ranged from 5% to 60% among centers. The cumulative risk of secondary rhinoplasty by 20 years of age ranged from 47% to 79% among centers. No significant differences in nasolabial appearance were found between children who underwent secondary lip or nasal surgery and children who underwent only primary surgery (P > 0.10). Conclusions: Although some cleft centers were significantly more likely to perform secondary surgery, the use of secondary surgery did not achieve significantly better nasolabial appearance than what was achieved by children who underwent only primary surgery.
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Frequency and socio-psychological impact of taunting in school-age patients with cleft lip-palate surgical repair. Int J Pediatr Otorhinolaryngol 2015; 79:1041-8. [PMID: 25943954 DOI: 10.1016/j.ijporl.2015.04.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/12/2015] [Accepted: 04/13/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Cleft lip-palate (CLP) is a "social" pathology because of its impact on the child's facial appearance and speech. School is the first place where children are confronted to others and when they start socializing. Taunting and bullying are common and their psychological impact remains hard to assess. The aim of this study was to evaluate the importance of taunting in school and its impact in CLP patients who had surgical repair. METHODS We conducted a multicenter prospective study where we consecutively included patients ≥ 12 years who had CLP repair. During a multidisciplinary consultation they were asked to complete a questionnaire (3 parts: surgical outcomes, taunting and its impact, socio-economic status) previously approved by our psychologists. RESULTS 55 patients were included (37 B, 18 G) (mean age 15.5 years): 11 CL, 13 CP and 31 CLP. 69% of patients reported having suffered from taunting and peer victimization in school. In 84% of the cases, taunting was linked to the CLP defect itself. The teasing started in primary school to reach a peak of aggressiveness in middle school. 42% of patients reported that bullying occurred at least once a day (16/38). Regarding the psychological impact of taunting, 50% of patients reported sadness, 31% depression and 26.3% were marked for life. At one time or another 29% of patients did not want to attend school because of the teasing. The grade retention rate amounted to 37.7% (20/53), and 2 patients were in special education classes. As a matter of fact, 50% of these children repeated their 1st or 2nd year of primary school. Furthermore, 47% of patients wanted to change something to their face, but 63% of them never spoke to their surgeon about additional surgeries even though they were teased in school. CONCLUSIONS Taunting is common in children with CLP. This study highlights the high frequency and impact of taunting on the daily lives and self-perception of patients with CLP or CLP repair. It is important for healthcare professionals to be aware of this issue in the context of a multidisciplinary approach.
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Iliopoulos C, Mitsimponas K, Lazaridou D, Neukam FW, Stelzle F. A retrospective evaluation of the aesthetics of the nasolabial complex after unilateral cleft lip repair using the Tennison-Randall technique: a study of 44 cases treated in a single cleft center. J Craniomaxillofac Surg 2014; 42:1679-83. [PMID: 24962045 DOI: 10.1016/j.jcms.2014.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/14/2014] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Among numerous techniques that have been described for lip repair, the Tennison-Randall method has gained popularity over time and is preferred by many surgeons due to the predictability of the outcome. This study aims to evaluate the esthetic outcome reached in the nasolabial region following primary lip repair with the use of this method. MATERIALS AND METHODS Forty-four patients with unilateral cleft lip (with or without alveolar cleft) were assessed retrospectively through a photographic evaluation by two clinicians with regard to the aesthetics of the lip and nose separately as anatomical subunits as well as of the nasolabial region as an anatomical complex. The collected data were statistically analyzed with regard to the cleft subtype and the performance of corrective surgeries for the lip and/or the nose. RESULTS The method was associated with good results, especially when it comes to the appearance of the nose as an anatomical subunit, as well as of the nasolabial region as a complex, regarding cleft lip patients without an alveolar cleft. CONCLUSION The Tennison-Randall technique proved to be a very satisfying method in terms of the esthetic long-term outcome in our patient collective.
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Affiliation(s)
- Christos Iliopoulos
- Department of Oral and Maxillofacial Surgery (Director: Prof. Dr. Dr. Dr. h.c. Friedrich Wilhelm Neukam), University Hospital of Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Oestliche Stadtmauerstrasse 27, 91054, Erlangen, Germany.
| | - Konstantinos Mitsimponas
- Department of Oral and Maxillofacial Surgery (Director: Prof. Dr. Dr. Dr. h.c. Friedrich Wilhelm Neukam), University Hospital of Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Oestliche Stadtmauerstrasse 27, 91054, Erlangen, Germany
| | - Dimitra Lazaridou
- Department of Oral and Maxillofacial Surgery (Director: Prof. Dr. Dr. Dr. h.c. Friedrich Wilhelm Neukam), University Hospital of Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Oestliche Stadtmauerstrasse 27, 91054, Erlangen, Germany
| | - Friedrich Wilhelm Neukam
- Department of Oral and Maxillofacial Surgery (Director: Prof. Dr. Dr. Dr. h.c. Friedrich Wilhelm Neukam), University Hospital of Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Oestliche Stadtmauerstrasse 27, 91054, Erlangen, Germany
| | - Florian Stelzle
- Department of Oral and Maxillofacial Surgery (Director: Prof. Dr. Dr. Dr. h.c. Friedrich Wilhelm Neukam), University Hospital of Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Oestliche Stadtmauerstrasse 27, 91054, Erlangen, Germany
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Mercado AM, Phillips C, Vig KWL, Trotman CA. The effects of lip revision surgery on nasolabial esthetics in patients with cleft lip. Orthod Craniofac Res 2014; 17:216-25. [PMID: 24846148 DOI: 10.1111/ocr.12046] [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] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES 1) To determine the concordance among surgeons on subjective assessments of nasolabial esthetics in children with repaired cleft lip; and 2) to evaluate longitudinal changes in nasolabial esthetics in relation to cleft lip revision surgery. SETTING AND SAMPLE POPULATION School of Dentistry at University of North Carolina, Chapel Hill. Children with repaired unilateral cleft lip: 32 had lip revision surgery and 27 did not have surgery. MATERIALS AND METHODS Retrospective observational study from a non-randomized clinical trial. Ratings of nasolabial esthetics performed by six surgeons using the Asher-McDade scale at baseline and 12-month follow-up. RESULTS Concordance among surgeons ranged from poor to acceptable. Nasolabial ratings at follow-up were better in the Revision group than in the Non-Revision group, although differences were small. The most prevalent change in the Revision Group was improvement in one or more units on the scale, while 'no change' was most prevalent in the Non-Revision group. Participants in the Revision group were more likely to receive a 'no' in relation to the need for lip or nose revision at the follow-up visit. CONCLUSION There were mild esthetic improvements observed in relation to lip revision surgery, which should be interpreted with caution given the subjectivity of the rating method used.
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Affiliation(s)
- A M Mercado
- College of Dentistry, The Ohio State University, Columbus, OH, USA
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Kuijpers MAR, Chiu YT, Nada RM, Carels CEL, Fudalej PS. Three-dimensional imaging methods for quantitative analysis of facial soft tissues and skeletal morphology in patients with orofacial clefts: a systematic review. PLoS One 2014; 9:e93442. [PMID: 24710215 PMCID: PMC3977868 DOI: 10.1371/journal.pone.0093442] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/04/2014] [Indexed: 01/11/2023] Open
Abstract
Background Current guidelines for evaluating cleft palate treatments are mostly based on two-dimensional (2D) evaluation, but three-dimensional (3D) imaging methods to assess treatment outcome are steadily rising. Objective To identify 3D imaging methods for quantitative assessment of soft tissue and skeletal morphology in patients with cleft lip and palate. Data sources Literature was searched using PubMed (1948–2012), EMBASE (1980–2012), Scopus (2004–2012), Web of Science (1945–2012), and the Cochrane Library. The last search was performed September 30, 2012. Reference lists were hand searched for potentially eligible studies. There was no language restriction. Study selection We included publications using 3D imaging techniques to assess facial soft tissue or skeletal morphology in patients older than 5 years with a cleft lip with/or without cleft palate. We reviewed studies involving the facial region when at least 10 subjects in the sample size had at least one cleft type. Only primary publications were included. Data extraction Independent extraction of data and quality assessments were performed by two observers. Results Five hundred full text publications were retrieved, 144 met the inclusion criteria, with 63 high quality studies. There were differences in study designs, topics studied, patient characteristics, and success measurements; therefore, only a systematic review could be conducted. Main 3D-techniques that are used in cleft lip and palate patients are CT, CBCT, MRI, stereophotogrammetry, and laser surface scanning. These techniques are mainly used for soft tissue analysis, evaluation of bone grafting, and changes in the craniofacial skeleton. Digital dental casts are used to evaluate treatment and changes over time. Conclusion Available evidence implies that 3D imaging methods can be used for documentation of CLP patients. No data are available yet showing that 3D methods are more informative than conventional 2D methods. Further research is warranted to elucidate it. Systematic review registration International Prospective Register of Systematic Reviews, PROSPERO CRD42012002041
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Affiliation(s)
- Mette A. R. Kuijpers
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Cleft Palate Craniofacial Unit, Radboud University Medical Centre, Nijmegen, The Netherlands
- * E-mail:
| | - Yu-Ting Chiu
- Department of Dentistry and Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Rania M. Nada
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carine E. L. Carels
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Cleft Palate Craniofacial Unit, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Piotr S. Fudalej
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern Switzerland
- Department of Orthodontics, Palacky University Olomouc, Olomouc, Czech Republic
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Brudnicki A, Bronkhorst EM, Nada R, Dudkiewicz Z, Kaminek M, Katsaros C, Fudalej PS. Nasolabial appearance after two palatoplasty types in cleft lip and palate. Orthod Craniofac Res 2014; 17:124-31. [PMID: 24417872 DOI: 10.1111/ocr.12039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Facial appearance is important for normal psychosocial development in children with cleft lip and palate (CLP). There is conflicting evidence on how deficient maxillary growth may affect nasolabial esthetics. METHODS We retrospectively investigated nasolabial appearance in two groups, the Langenback (35 children; mean age 11.1 years; range: 7.9-13.6) and Vomerplasty (58 children; mean age 10.8 years; range: 7.8-14), who received unilateral CLP surgery by the same surgeon. The hard palate repair technique differed between the two groups. In the Langenback group, palatal bone on the non-cleft side only was left denuded, inducing scar formation and inhibiting maxillary growth. In the Vomerplasty group, a vomerplasty with tight closure of the soft tissues on the palate was applied. Thirteen lay judges rated nasolabial esthetics on photographs using a modified Asher-McDade's index. RESULTS Nasolabial esthetics in both groups was comparable (p > 0.1 for each nasolabial component). Inferior view was judged as the least esthetic component and demonstrated mean scores 3.18 (SD = 0.63) and 3.13 (SD = 0.47) in the Langenback and Vomerplasty groups, respectively. Mean scores for other components were from 2.52 (SD = 0.63) to 2.81 (SD = 0.62). Regression analysis showed that vomerplasty is related with slight improvement in the nasal profile only (coefficient B = -0.287; p = 0.043; R(2 ) = 0.096). CONCLUSIONS This study demonstrates that the use of vomerplasty instead of the Langenbeck technique is weakly associated with the nasolabial appearance among pre-adolescent patients with UCLP.
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Affiliation(s)
- A Brudnicki
- Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland
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Chung EH, Borzabad-Farahani A, Yen SLK. Clinicians and laypeople assessment of facial attractiveness in patients with cleft lip and palate treated with LeFort I surgery or late maxillary protraction. Int J Pediatr Otorhinolaryngol 2013; 77:1446-50. [PMID: 23871270 PMCID: PMC3943337 DOI: 10.1016/j.ijporl.2013.05.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 05/28/2013] [Accepted: 05/31/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the changes in the facial attractiveness (FA) in two groups of cleft lip and palate patients with Class III malocclusions treated using LeFort I surgery or late maxillary protraction. MATERIALS AND METHODS Standardized pre- and post-treatment photographs were taken of 32 patients (17 corrected by orthognathic surgery and 17 by late maxillary protraction). The photographs were randomized and 42 clinicians and 121 laypeople rated them on a 10-point FA scale via a web-based survey. RESULTS Clinicians' mean FA values increased from 4.45 to 5.16 [95% CI of mean difference (MD), 0.59-0.82, p<0.001] in surgical cases and 4.84 to 5.30 (95% CI of MD, 0.35-0.56, p<0.001) in protraction cases. The laypeople mean FA values increased from 5.07 to 5.54 (95% CI of MD, 0.40-0.53, p<0.001) in surgical cases and 5.51 to 5.68 (95% CI of MD, 0.11-0.23, p<0.001) in protraction cases. When patients combined, laypeople rated FA 0.64 points higher (95% CI, 0.54-0.74, p<0.001) in pre-treatment and 0.38 points higher (95% CI, 0.27-0.48, p<0.05) in post-treatment relative to clinicians. CONCLUSION Both clinicians and laypeople perceived an improvement of FA after both treatments. Laypeople rated FA higher compared to clinicians.
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Affiliation(s)
- Eun Hee Chung
- Formerly, Pediatric Dentistry, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Ali Borzabad-Farahani
- Orthodontics, Warwick Dentistry, Warwick Medical School, University of Warwick, Coventry, UK; Formerly, Craniofacial Orthodontics, Children’s Hospital of Los Angeles; Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
| | - Stephen L-K Yen
- Craniofacial Orthodontics, Children’s Hospital of Los Angeles; Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
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Trotman CA, Phillips C, Faraway JJ, Hartman T, van Aalst JA. Influence of objective three-dimensional measures and movement images on surgeon treatment planning for lip revision surgery. Cleft Palate Craniofac J 2013; 50:684-95. [PMID: 23855676 DOI: 10.1597/12-191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : To determine whether a systematic evaluation of facial soft tissues of patients with cleft lip and palate, using facial video images and objective three-dimensional measurements of movement, change surgeons' treatment plans for lip revision surgery. Design : Prospective longitudinal study. Setting : The University of North Carolina School of Dentistry. Patients, Participants : A group of patients with repaired cleft lip and palate (n = 21), a noncleft control group (n = 37), and surgeons experienced in cleft care. Interventions : Lip revision. Main Outcome Measures : (1) facial photographic images; (2) facial video images during animations; (3) objective three-dimensional measurements of upper lip movement based on z scores; and (4) objective dynamic and visual three-dimensional measurement of facial soft tissue movement. Results : With the use of the video images plus objective three-dimensional measures, the operating surgeon changed the problem list of the surgical treatment plan for 86% of the patients (95% confidence interval, 0.64 to 0.97) and the surgical goals for 71% of the patients (95% confidence interval, 0.48 to 0.89). The surgeon group varied in the percentage of patients for whom the problem list was modified, ranging from 24% (95% confidence interval, 8% to 47%) to 48% (95% confidence interval, 26% to 70%) of patients, and the percentage for whom the surgical goals were modified, ranging from 14% (94% confidence interval, 3% to 36%) to 48% (95% confidence interval, 26% to 70%) of patients. Conclusions : For all surgeons, the additional assessment components of the systematic valuation resulted in a change in clinical decision making for some patients.
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Popat H, Zhurov AI, Richmond S, Marshall D, Rosin PL. Determining normal and abnormal lip shapes at border positions for use as a longitudinal surgical outcome measure. J Oral Rehabil 2013; 40:348-57. [PMID: 23397893 DOI: 10.1111/joor.12037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2013] [Indexed: 11/28/2022]
Abstract
Objective measures of facial movement are important for interventions where surgical repositioning of facial structures can influence soft tissue mobility and include the management of patients with cleft lip, facial nerve palsy and orthognathic surgery. As such, the aim of this study is to present a method for determining the outcome of surgical procedures on lip shape during speech. A control group (CG) of 115 average subjects and 30 patients with a Class 3 malocclusion requiring bimaxillary surgery performed four reproducible verbal utterances during image capture using a non-invasive, three-dimensional (3D) motion scanner (3dMDFace™ Dynamic System). Landmark coordinates around the lips of the 3D facial shells were extracted and subjected to discriminant analysis and principal component analysis to statistically differentiate lip shapes between the CG and the patient group (PG) pre- and post-surgery. Pre-surgically, the PG showed statistically significant differences in lip shape during speech in the lateral and vertical dimensions, preferring a wider, shorter lip shape when compared with the CG for all the utterances. The shape differences normalised towards the CG post-surgery. The method presented utilises pre-existing statistical shape analyses and can be reproduced in the clinical setting to provide a diagnostic and functional outcome tool. In this example, correction of the Class 3 skeletal disproportions appeared to normalise lip shape during speech.
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Affiliation(s)
- H Popat
- Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, UK.
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Trotman CAE, Faraway J, Soltmann R, Hartman T, van Aalst J. Facial soft tissue dynamics before and after primary lip repair. Cleft Palate Craniofac J 2012; 50:315-22. [PMID: 23050657 DOI: 10.1597/12-080] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives : (1) To collect three-dimensional, dynamic facial images from two groups of infants: one group born with cleft lip and palate slated to have a primary lip repair and a second, age-matched, noncleft control group. (2) To develop analyses to determine differences in facial movement between infants with cleft lip with or without palate (CL±P) and noncleft control infants and to determine changes in facial movement before and after primary lip repair. Design : Longitudinal, prospective case-control study. Setting : Facial Animation Laboratory at the University of North Carolina School of Dentistry. Participants : Two groups of infants: one group with unrepaired CL±P slated to have primary lip repair (n = 15) and a second group of age-matched, noncleft controls (n = 15). Interventions : Movement testing before and 4 months after primary lip repair in infants with CL±P and at similar time points in noncleft infants. Main Outcome Measures : Seven measures of facial movement. Results : The range of facial movements increased by 17% for all infants during the 4-month period. Compared with the noncleft group (1) infants with unilateral CL±P had 50% less nasolabial movement, and this difference did not change due to the lip repair; and (2) infants with unilateral or bilateral CL±P had 58% and 118% greater lateral upper lip movement, respectively, and 3.67 and 3.56 times greater asymmetry of movement, respectively, before lip repair. The procedure almost entirely removed the hypermobility and decreased the asymmetry. Conclusions : Primary surgical lip repair decreased hypermobility and improved asymmetry of upper lip movement.
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Liu J, Zhou H, Weir MD, Xu HHK, Chen Q, Trotman CA. Fast-degradable microbeads encapsulating human umbilical cord stem cells in alginate for muscle tissue engineering. Tissue Eng Part A 2012; 18:2303-14. [PMID: 22697426 DOI: 10.1089/ten.tea.2011.0658] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Human umbilical cord mesenchymal stem cells (hUCMSCs) are inexhaustible and can be obtained without an invasive surgery. To date, there has been no report on seeding hUCMSCs in three-dimensional scaffolds for muscle tissue engineering. The objectives of this study were to (1) investigate hUCMSC seeding in a scaffold for muscle engineering and (2) develop a novel construct consisting of hUCMSC-encapsulating and fast-degradable microbeads inside a hydrogel matrix. The rationale was that the hydrogel matrix would maintain the defect volume, while the microbeads would degrade to release the cells and concomitantly create macropores in the matrix. hUCMSCs were encapsulated in alginate-fibrin microbeads, which were packed in an Arg-Gly-Asp (RGD)-modified alginate matrix (AM). This construct is referred to as hUCMSC-microbead-AM. The control consisted of the usual cell encapsulation in AM without microbeads (referred to as hUCMSC-AM). In the hUCMSC-AM construct, the hUCMSCs showed as round dots with no spreading at 1-14 days. In contrast, cells in the hUCMSC-microbead-AM construct had a healthy spreading and elongated morphology. The microbeads successfully degraded and released the cells at 8 days. Myogenic expressions for hUCMSC-microbead-AM were more than threefold those of hUCMSC-AM (p<0.05). Immunofluorescence for myogenic markers was much stronger for hUCMSC-microbead-AM than hUCMSC-AM. Muscle creatine kinase of hUCMSC-microbead-AM at 14 days was twofold that of hUCMSC-AM (p<0.05). In conclusion, hUCMSC encapsulation in novel fast-degradable microbeads inside a hydrogel matrix was investigated for muscle engineering. Compared to the usual method of seeding cells in a hydrogel matrix, hUCMSC-microbead-AM construct had greatly improved cell viability and myogenic differentiation, and hence, is promising to enhance muscle regeneration.
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Affiliation(s)
- Jun Liu
- Biomaterials and Tissue Engineering Division, Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland Dental School, Baltimore, Maryland 21201, USA
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Faces in 4 dimensions: Why do we care, and why the fourth dimension? Am J Orthod Dentofacial Orthop 2012; 140:895-9. [PMID: 22133956 DOI: 10.1016/j.ajodo.2011.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 07/01/2011] [Accepted: 07/01/2011] [Indexed: 11/21/2022]
Abstract
The purpose of this article is to describe a dynamic approach for 3-dimensional analyses of facial soft-tissue movements. The method and analysis have numerous applications but, most specifically, are used to assess diagnostic and treatment outcomes of soft-tissue surgery in patients with repaired cleft lip and palate.
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Faraway JJ, Trotman CA. Shape change along geodesics with application to cleft lip surgery. J R Stat Soc Ser C Appl Stat 2011; 60:743-755. [PMID: 22639469 DOI: 10.1111/j.1467-9876.2011.01017.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Continuous shape change is represented as curves in the shape space. A method for checking the closeness of these curves to a geodesic is presented. Three large databases of short human motions are considered and shown to be well approximated by geodesics. The motions are thus approximated by two shapes on the geodesic and the rate of progress along the path. An analysis of facial motion data taken from a study of subjects with cleft lip or cleft palate is presented that allows the motion to be considered independently from the static shape. Inferential methods for assessing the change in motion are presented. The construction of predicted animated motions is discussed.
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Popat H, Richmond S, Marshall D, Rosin PL. Facial Movement in 3 Dimensions. Otolaryngol Head Neck Surg 2011; 145:24-9. [DOI: 10.1177/0194599811401701] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. To construct 3-dimensional (3D) templates of average lip movement based on a group of normal healthy subjects. Study Design. Cross-sectional study. Setting. School of Dentistry, Cardiff University, United Kingdom. Subjects and Methods. One hundred fifteen white subjects were asked to perform 2 reproducible verbal gestures (/puppy/ and /rope/) in a normal relaxed manner. The sequences were captured using a noninvasive, 3D motion scanner (3dMDFace Dynamic System). Mesh-registration software was used to align sequential facial shells to a standardized reference plane. Lip movement during the verbal facial gestures was quantified using the displacement vectors ( x, y, z coordinates) of 6 lip landmarks of sequential 3D facial shells subtracted from the reference or rest shell. Descriptive statistics were used to build references for average lip movement, and independent t tests were used to compare lip movement between men and women. Results. Mean reference movements were created for lip opening, lip stretch, and lip purse that corresponded to the visemes /pu/ /ppy/ and /rope/, respectively. There were statistically significant differences in the lip movement between genders for the visemes /pu/ and /ppy/, although when quantified these were found not to be of clinical significance. Men favored left-sided movement and women right-sided movement, although only slightly—again, when quantified, this was considered to be within symmetrical limits. Conclusion. It was possible to quantify and create normal templates of lip movement for the words /puppy/ and /rope/. Men and women show similar standardized lip movements for these 2 words.
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Affiliation(s)
- Hashmat Popat
- Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - Stephen Richmond
- Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - David Marshall
- Cardiff School of Computer Science, Cardiff University, Cardiff, UK
| | - Paul L. Rosin
- Cardiff School of Computer Science, Cardiff University, Cardiff, UK
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