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Meazzini MC, Demonte LP, Parravicini F, Biglioli F, Autelitano L, Balbo N. Prospective study of nasal growth in bilateral cleft lip and palate patients after naso-alveolar moulding and primary columella lengthening compared to controls at 5, 10 and 20 years. Orthod Craniofac Res 2024; 27 Suppl 1:70-79. [PMID: 38284309 DOI: 10.1111/ocr.12761] [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: 04/27/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION A short columella, wide nostrils and a flat nasal tip are common features in patients with bilateral complete cleft lip and palate (BCLP). The objective of this study was to evaluate nasal morphology during growth in patients treated with naso-alveolar moulding (NAM) and primary surgical columella lengthening (PCL) compared with matched non-cleft individuals. STUDY DESIGN Prospective longitudinal case-control study. PARTICIPANTS AND METHODS Thirty-four consecutively treated BCLP patients at 5 and 10 years and at the end of growth (19.7 ± 2.0 years) were compared through normalized photogrammetry to a control of 34 age and sex-matched non-cleft individuals. Regression Models for Panel Data assessed how nasal measurements were influenced by surgery, age and gender. RESULTS Nasal protrusion was equal to non-cleft controls at all ages. Length of the columella was also comparable to controls at 5 and 10 years, but significantly shorter at the end of growth. Inter-alar and nasal tip width and nasolabial angle were significantly wider than controls at all ages: More than 60% of the patients have asked for correction of the nasal width, but no early surgery for columella lengthening was needed. CONCLUSIONS NAM and PCL have provided a nasal projection close to that of non-cleft individuals until adulthood, while length of the columella was physiological at 5 and 10, but shorter than controls at age 20. Width of the nasal tip and width of the alar bases were significantly wider than the controls and eventually required secondary nasal width correction in over two thirds of the sample.
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Affiliation(s)
- Maria Costanza Meazzini
- Department of Maxillo-Facial Surgery, Regional Center for CLP, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
- Department of Maxillo-Facial Surgery, San Gerardo Hospital, Monza, Italy
| | - Leonardo Paolo Demonte
- Department of Orthodontics, San Raffaele Hospital, University Vita-Salute, Milano, Italy
| | - Francesca Parravicini
- Department of Orthodontics, Policlinico Hospital, University of Milano, Milano, Italy
| | - Federico Biglioli
- Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
| | - Luca Autelitano
- Department of Maxillo-Facial Surgery, Regional Center for CLP, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
| | - Nicoletta Balbo
- Department of Social and Political Sciences, Dondena Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milano, Italy
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Al-Lami HA, Al-Rudainy D, Mohammed-Salih HS, Salman SM. Presurgical management trends and nasoalveolar molding usage for infants with cleft lip and palate in the capital of a developing country. J Orthod Sci 2024; 13:4. [PMID: 38516115 PMCID: PMC10953715 DOI: 10.4103/jos.jos_165_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/13/2023] [Accepted: 01/05/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUNDS Nasoalveolar molding (NAM) application is among presurgical management (PSM) techniques used for infants with cleft lip and palate (CLP). It helps to approximate the palatal cleft and to reshape the nasoalveolar complex prior to primary lip repair. This study aimed to explore types of PSM and the dental speciality provision for infants with CLP in Baghdad. The status of NAM usage and surgeons' perceptions toward NAM usage were assessed. MATERIALS AND METHODS This is a cross-sectional paper-based questionnaire study that collected responses of surgeons perform primary lip and nose repair regarding PSM. The questionnaire was distributed amongst public and private hospitals in Baghdad. Twenty surgeons were enrolled (only those surgeons who perform primary repair for infants with CLP); two females and eighteen males. RESULTS The majority of participants' responses suggested that the majority of infants with CLP were provided with baby feeding plates and lip straps. Six surgeons reported that a percentage of their patients who have been provided with NAM. PSM in Baghdad was mostly supplied by orthodontists and plastic surgeons, and the next most likely providers were prosthodontists. 82.35% of the surgeons found that primary surgical repair procedures were easier with NAM than for the other infants. The rest have not perceived any differences. CONCLUSIONS Orthodontists, surgeons and prosthodontists were involved in providing PSM. Baby feeding plates and lip straps were the most common PSM in Baghdad, although NAM is not uncommon. Most surgeons believe that using NAM made surgical procedures easier and permitted the prediction of surgical outcomes.
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Affiliation(s)
- Hadeel Adel Al-Lami
- Orthodontics Department, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Dhelal Al-Rudainy
- Orthodontics Department, College of Dentistry, University of Baghdad, Baghdad, Iraq
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Hattori Y, Pai BCJ, Saito T, Chou PY, Lu TC, Chang CS, Chen YR, Lo LJ. Long-term treatment outcome of patients with complete bilateral cleft lip and palate: a retrospective cohort study. Int J Surg 2023; 109:1656-1667. [PMID: 37073546 PMCID: PMC10389451 DOI: 10.1097/js9.0000000000000406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/06/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Patients with cleft lip and palate have functional and esthetic impairment and typically require multiple interventions in their life. Long-term evaluation following a treatment protocol, especially for patients with complete bilateral cleft lip and palate (BCLP), is important but was rarely reported in the literature. PATIENTS AND METHODS A retrospective review was conducted on all patients with complete BCLP born between 1995 and 2002 and treated at our center. Inclusion criteria were having adequate medical records and receiving continuous multidisciplinary team care at least until 20 years of age. Exclusion criteria were lack of regular follow-up and congenital syndromic abnormalities. The medical records and photos were reviewed, and facial bone development was evaluated using cephalometric analysis. RESULTS A total of 122 patients were included, with a mean age of 22.1 years at the final evaluation in this study. Primary one-stage cheiloplasty was performed in 91.0% of the patients, and 9.0% underwent two-stage repair with an initial adhesion cheiloplasty. All patients underwent two-flap palatoplasty at an average of 12.3 months. Surgical intervention for velopharyngeal insufficiency was required in 59.0% of patients. Revisional lip/nose surgery was performed in 31.1% during growing age and in 64.8% after skeletal maturity. Orthognathic surgery was applied in 60.7% of patients with retruded midface, of which 97.3% underwent two-jaw surgery. The average number of operations to complete the treatment was 5.9 per patient. CONCLUSION Patients with complete BCLP remain the most challenging group to treat among the cleft. This review revealed certain suboptimal results, and modifications have been made to the treatment protocol. Longitudinal follow-up and periodic assessment help to establish an ideal therapeutic strategy and improve overall cleft care.
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Affiliation(s)
- Yoshitsugu Hattori
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Betty C.-J. Pai
- Department of Craniofacial Orthodontics and Craniofacial Research Center, Chang Gung Memorial Hospital, Kwei Shan, Taoyuan, Taiwan
| | - Takafumi Saito
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Ting-Chen Lu
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Chun-Shin Chang
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Yu-Ray Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
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Meazzini MC, Parravicini F, Donati V, Brusati R, Biglioli F, Autelitano L. Photometric Evaluation of Adult Patients With Bilateral Cleft Lip and Palate Treated With Nasoalveolar Molding and Primary Columella Lengthening. Cleft Palate Craniofac J 2021; 59:852-858. [PMID: 34132105 DOI: 10.1177/10556656211024069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the nasal shape of young adults with BCLP treated with primary surgical columella lengthening and nasoalveolar molding (NAM). SETTING AND PATIENTS A group of 28 young adult patients with BCLP (mean age: 19.1±1.4 years) was compared through normalized photogrammetry to a control of 28 age- and sex-matched noncleft young adults. RESULTS Nasal protrusion and length of the columella were not different from noncleft young adults. On the other hand, nasolabial angle, columellar width, interalar, and nasal tip width were significantly wider than the noncleft controls. Thus, 27% of the patients have requested at this time secondary correction of the excessive nasal width. CONCLUSIONS Both NAM and primary rhinoplasty in patients with BCLP resulted in a near normal length of the columella and nasal projection until young adulthood. Nevertheless, width of all nasal features was significantly wider than the noncleft population and required secondary nasal correction in one-third of the sample.
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Affiliation(s)
- Maria Costanza Meazzini
- Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital (Milano), University of Milan, Italy.,Department of Maxillo-Facial Surgery and Craniofacial anomalies, San Gerardo Hospital University of Milan-Bicocca, Monza, Italy
| | - Francesca Parravicini
- Department of Maxillo-Facial Surgery and Craniofacial anomalies, San Gerardo Hospital University of Milan-Bicocca, Monza, Italy
| | - Vera Donati
- Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital (Milano), University of Milan, Italy
| | - Roberto Brusati
- Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital (Milano), University of Milan, Italy
| | - Federico Biglioli
- Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital (Milano), University of Milan, Italy
| | - Luca Autelitano
- Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital (Milano), University of Milan, Italy
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Esenlik E, Gibson T, Kassam S, Sato Y, Garfinkle J, Figueroa AA, AlQatami F, Runyan C, Alperovich M, Golinko MS, Lee C, Chatzigianni A, Zafeiriadis AA, Santiago P, Hosseinian B, Kaygısız EU, Üçüncü N, Aslan BI, Uzuner FD, Gülşen A, Akkurt A, Arslan SG, Sabás M, Muñoz-Mendoza MA, Masis D, Holguin L, Granados A, Rojas NE, Campo B, Keskin K, Akçam MO, Lowe KM, Morselli PG, Pannuto L, Yarza IN, Martinez AT, Coşkun EY, Nissan S. NAM Therapy-Evidence-Based Results. Cleft Palate Craniofac J 2020; 57:529-531. [PMID: 31960709 DOI: 10.1177/1055665619899752] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.
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Affiliation(s)
- Elçin Esenlik
- Department of Orthodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Travis Gibson
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Serena Kassam
- Department of Pediatric Dentistry, Faculty of Dentistry, New York University, NY, USA.,Division of Pediatric Dentistry, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pediatric Dentistry, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yuki Sato
- Japan Orthodontic Centre, Tokyo, Japan
| | | | | | | | - Christopher Runyan
- Department of Plastic Surgery, Wake Forest Baptist Health Hospital, Winston-Salem, NC, USA
| | - Michael Alperovich
- Department of Plastic Surgery, Yale University Faculty of Medicine, New Haven, CT, USA
| | - Michael S Golinko
- Department of Plastic Surgery, University of Vanderbilt, Nashville, TN, USA
| | - Catherine Lee
- Plastic Surgery Department (Cleft-Craniofacial), Singapore General Hospital, Singapore.,Department of Surgery, National University Hospital of Singapore, Singapore
| | - Athina Chatzigianni
- Department of Orthodontics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios A Zafeiriadis
- Department of Orthodontics, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Private Practice, Thessaloniki, Greece
| | - Pedro Santiago
- Duke University, Durham, NC, USA.,Department of Orthodontics, University of North Carolina, Chapel Hill, USA
| | | | - Emine Uluğ Kaygısız
- Department of Orthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Neslihan Üçüncü
- Department of Orthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Belma Işık Aslan
- Department of Orthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Fatma Deniz Uzuner
- Department of Orthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Ayşe Gülşen
- Department of Plastic and Reconstructive Surgery, Medical Faculty, Gazi University, Ankara, Turkey
| | - Atılım Akkurt
- Department of Orthodontics, Faculty of Dentistry, Dicle University, Diyarbakır, Turkey
| | - Seher Gündüz Arslan
- Department of Orthodontics, Faculty of Dentistry, Dicle University, Diyarbakır, Turkey
| | - Mariana Sabás
- Hospital of Pediatrics S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | | | | | - Lizbeth Holguin
- Craniofacial Department, El Paso Children's Hospital, TX, USA
| | | | - Nancy Edith Rojas
- Odontology Research Center of Columbia College-CICO, Heroes, Bogotá, Colombia
| | - Beatrice Campo
- IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Kamile Keskin
- Department of Orthodontics, Faculty of Dentistry, Dicle University, Diyarbakır, Turkey
| | - M Okan Akçam
- Department of Orthodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Kristen M Lowe
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado, CO, USA.,Craniofacial Orthodontics Program, Children's Hospital Colorado, CO, USA
| | - Paolo G Morselli
- Plastic Surgery Department, Alma Mater University of Bologna, Bologna, Italy
| | - Lucia Pannuto
- Plastic Surgery Department, Alma Mater University of Bologna, Bologna, Italy
| | - Ignacio Nacho Yarza
- Oral Surgery, Clinica Yarza, Carrer de Joaquim Botia, Palma De Mallorca, Spain
| | | | | | - Sagit Nissan
- Maxillofacial and Dental Health-Center, Tel-Aviv, Israel
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