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Carvalho LIDM, Araújo EGOD, de Souza BES, Martins HDD, Tanikawa DYS, Valença AMG, Mélo CB, de Lucena EHG, Lacerda RHW, Bonan PRF. TeleCleft: Development and Evaluation of a Mobile Application for Monitoring Cleft Patients. Cleft Palate Craniofac J 2024:10556656241271721. [PMID: 39105434 DOI: 10.1177/10556656241271721] [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: 08/07/2024] Open
Abstract
OBJECTIVE Development and evaluation of a mobile application for remote monitoring and guidance of pediatric patients diagnosed with cleft lip and/or palate (CL ± P) and their caregivers. DESIGN This is a pilot cross-sectional, applied, and quantitative study. SETTING The study was conducted in two tertiary care treatment centers in Brazil. PARTICIPANTS The participants included 20 caregivers and infants undergoing treatment with nasoalveolar molding (NAM) for CL ± P. INTERVENTIONS The intervention involved using the TeleCleft mobile application for remote monitoring and guidance of caregivers and infants during NAM treatment. MAIN OUTCOME MEASURE(S) The main outcome measures included usability and satisfaction of users with the TeleCleft application. RESULTS The results showed high usability and satisfaction ratings among users of the TeleCleft application. Most participants found remote monitoring to be effective and expressed positive opinions about its convenience and usefulness. CONCLUSION TeleCleft could be a viable tool for remote monitoring and guidance, reducing the need for patients and caregivers to travel to treatment centers, which could potentially alleviate the burden of care faced by families during the journey of CL ± P treatment.
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Affiliation(s)
| | | | | | | | | | - Ana Maria Gondim Valença
- Postgraduate Program in Health Family - Federal University of Paraíba, João Pessoa - Paraíba, Brazil
| | - Cláudia Batista Mélo
- Professional Masters Program in Gerontology - Federal University of Paraíba, João Pessoa - Paraíba, Brazil
| | | | - Rosa Helena Wanderley Lacerda
- Postgraduate Program in Dentistry - Federal University of Paraíba, João Pessoa - Paraíba, Brazil
- Cleft Lip and Palate Center - Hospital Universitário Lauro Wanderley, Federal University of Paraíba, João Pessoa - Paraíba, Brazil
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Dunworth K, Porras Fimbres D, Trotta R, Hollins A, Shammas R, Allori AC, Santiago PE. Systematic Review and Critical Appraisal of the Evidence Base for Nasoalveolar Molding (NAM). Cleft Palate Craniofac J 2024; 61:654-677. [PMID: 36330703 DOI: 10.1177/10556656221136325] [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] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To critically appraise the body of scientific literature supporting the risks and efficacy of nasoalveolar molding (NAM), specifically in contrast to alternative methods of presurgical infant orthopedics (PSIO) or to treatment without PSIO. MAIN OUTCOME MEASURES Five outcome domains were considered: nasolabial aesthetics; dentoalveolar relationship; midfacial growth; cost and burden of care; and number of anesthetic events. DESIGN MEDLINE, Embase, and Scopus were queried for articles from the first description of the Grayson-Santiago NAM technique (1993) through December 13, 2021. After the application of inclusionary and exclusionary criteria, selected articles were critically appraised using a systematic framework that included risk of bias assessment using the Cochrane RoB 2.0 and ROBINS-I tools. RESULTS A total of 88 studies were included. Level-I and -II evidence showed on par or better approximation and alveolar alignment achieved by NAM compared to other PSIO. Level-II and -III evidence showed improved nasolabial aesthetics compared to other PSIOs. Level-II and -III evidence supported no harm to maxillofacial skeletal growth through age 12. Sparse level-III evidence supported a reduced number of labial or nasal revisions following NAM. Level-II and -III evidence showed NAM requiring upfront cost and frequent appointments but reducing caregiver psychosocial burden and reducing long-term costs compared to select alternatives. Many studies carried a high risk of bias. CONCLUSIONS Current evidence supports the overall efficacy of NAM regarding short/mid-term outcomes, with a low risk of negative effects on midfacial growth or dental development. The high risk of bias discovered in many papers underscores the need for robust study design in future research.
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Affiliation(s)
| | | | - Rose Trotta
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Andrew Hollins
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Ronnie Shammas
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Alexander C Allori
- Duke University School of Medicine, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
| | - Pedro E Santiago
- Duke University School of Medicine, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
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Ocak I, Akarsu-Guven B, Karakaya J, Ozgur F, Aksu M. Effects of nasoalveolar molding on maxillary arch dimensions and malocclusion characteristics in primary dentition patients with cleft lip and palate. Int J Paediatr Dent 2024; 34:94-101. [PMID: 37351851 DOI: 10.1111/ipd.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Nasoalveolar molding (NAM) is a presurgical orthopedic technique used in the management of cleft lip and palate deformities. Despite the widespread use of NAM therapy, there is a need for further investigation to assess its specific effects on arch dimensions and malocclusion characteristics. AIM To evaluate the effects of NAM therapy on maxillary arch dimensions and malocclusion characteristics in patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). DESIGN Patients in primary dentition were referred to the Institutional Department of Orthodontics. The NAM group consisted of 21 patients with UCLP (mean age 4.7 ± 0.7 years) and 12 patients with BCLP (mean age 4.8 ± 0.7 years). Sixteen patients with UCLP (mean age 4.9 ± 0.9 years) and five patients with BCLP (mean age 5.4 ± 1.1 years) were included in the non-NAM group. The plaster models of all patients were digitized. Dental arch dimensions and malocclusion characteristics were analyzed via digital software. One-way ANOVA with Bonferroni correction was used for statistical analysis. RESULTS Intercanine and intermolar widths showed statistically significant differences according to the cleft type (p < .01). There was no statistically significant effect of NAM therapy on maxillary arch parameters and malocclusion characteristics (p > .05). The prevalence of anterior crossbite was 12.1% in the NAM group and 23.8% in the non-NAM group. CONCLUSION NAM therapy did not affect the maxillary arch dimensions and malocclusion characteristics in patients with UCLP and BCLP. The cleft type was the main factor, leading to a significant difference in maxillary widths.
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Affiliation(s)
- Irmak Ocak
- Department of Orthodontics, Faculty of Dentistry, Ankara Medipol University, Ankara, Turkey
| | - Bengisu Akarsu-Guven
- Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Figen Ozgur
- Department of Plastic Reconstructive and Aesthetic Surgery, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Siriwiroj S, Pisek P, Punyavong P, Jenwitheesuk K, Surakunprapha P, Winaikosol K. The Effect of Presurgical Nasoalveolar Molding on Oronasal Fistula Following Primary Palatoplasty. J Craniofac Surg 2023:00001665-990000000-01227. [PMID: 37983067 DOI: 10.1097/scs.0000000000009872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/09/2023] [Indexed: 11/21/2023] Open
Abstract
OBJECTIVE Presurgical nasoalveolar molding (PNAM) is widely used in cleft care protocol. This study investigated the correlation between PNAM and oronasal fistula after primary palatoplasty. METHODS A case-controlled study of 80 unilateral and bilateral complete cleft palate patients who underwent cleft palate repair were enrolled. Patients were divided into 2 groups: (1) no PNAM use and (2) PNAM use. The incidence of oronasal fistula and postoperative complications were compared between groups. RESULTS Forty patients in each group demonstrated the same baseline characteristics. The PNAM group showed a significantly lower postoperative oronasal fistula rate (15% versus 50%, P=0.003). Palatal cleft width wider than 12.5 mm increases the odds ratio of fistula formation by 1.19-fold (P=0.037), and the PNAM protected against postoperative palatal fistula formation (odds ratio 0.20, P=0.003). CONCLUSION Presurgical nasoalveolar molding can reduce postoperative oronasal fistula in wide-gap Veau type III and IV cleft palate.
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Affiliation(s)
- Singto Siriwiroj
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University
| | - Poonsak Pisek
- Department of Orthodontics, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Pattama Punyavong
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University
| | - Kamonwan Jenwitheesuk
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University
| | - Palakorn Surakunprapha
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University
| | - Kengkart Winaikosol
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University
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Defabianis P, Guagnano R, Romano F. A Cross-Sectional Study of the Dental Arch Relationship and Palatal Morphology after Cleft Surgery in Italian Children with Unilateral Cleft and Lip Palate. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1559. [PMID: 37761520 PMCID: PMC10528838 DOI: 10.3390/children10091559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Dental arch relationships (DARs) and palatal morphology (PM) were evaluated in in non-syndromic complete unilateral cleft lip and palate (UCLP) Italian patients after surgery. Pre- and postnatal factors affecting the results were investigated. Sixty-six children with UCLP (40 boys and 26 girls, with a mean age of 10.1 ± 2.9 years), predominantly Caucasian (77%), were consecutively enrolled in this cross-sectional study. Twenty children had received a one-stage protocol consisting of an early periosteal palate surgical repair and lip closure and forty-six were submitted to a staged surgical protocol with delayed palate repair (DPR). A single clinician collected data on their medical history and carried out a dental examination. The DAR and PM were graded on dental casts according to the Eurocran index and dichotomised as favourable and unfavourable based on the treatment outcome. Multiple logistic regression analyses demonstrated that female sex (OR = 6.08, 95% CI: 1.47-25.23, p = 0.013), DPR (OR = 4.77, 95% CI: 1.14-19.93, p = 0.032) and the use of a neonatal plate (OR = 4.68, 95% CI: 1.27-17.16, p = 0.020) increased the odds of having favourable DAR, while only DPR (OR = 9.76, 95% CI: 2.40-39.71, p = 0.001) was significantly associated with a favourable PM. Based on these findings, only DPR had a significantly favourable effect on both DAR and DM in Italian children with complete UCLP.
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Affiliation(s)
- Patrizia Defabianis
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, 10126 Turin, Italy;
| | | | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, 10126 Turin, Italy;
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Current Concepts and Challenges in the Treatment of Cleft Lip and Palate Patients-A Comprehensive Review. J Pers Med 2022; 12:jpm12122089. [PMID: 36556309 PMCID: PMC9783897 DOI: 10.3390/jpm12122089] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Cleft lip and cleft palate has one of the highest incidences in the malformations of the oral cavity, that varies between populations. The background underlying the issue of cleft lip and palate is multifactorial and greatly depends on the genetic factors and environmental factors. The aim of this nonsystematic narrative review is to present the cleft palate and or lip pediatric population as target for interdisciplinary treatment. The purpose of this narrative review is to sum up the modern knowledge on the treatment of patients with clefts, as well as to highlight the importance of the great need for cooperation between different dental specialists along with medical professionals such as oral surgeons, prosthodontists, orthodontists along with medical professions such as pediatricians, speech therapists and phoniatrics, and laryngologist.
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Yin J, Zhang S, Huang N, Shi B, Zheng Q, Yang C. Short-term surgical outcomes in patients with unilateral complete cleft lip and palate after presurgical nasoalveolar molding therapy: A three-dimensional anthropometric study. Front Pediatr 2022; 10:1101184. [PMID: 36644403 PMCID: PMC9837100 DOI: 10.3389/fped.2022.1101184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This brief research report aimed to evaluate the short-term efficacy of presurgical nasoalveolar molding (PNAM) therapy on the nasolabial morphology three dimensionally in patients with non-syndromic complete unilateral cleft lip and palate (UCLP). METHODS Thirty-six patients with non-syndromic complete unilateral complete cleft lip and palate were enrolled retrospectively and categorized into 2 groups: 18 patients who had received PNAM treatment (PNAM group) and 18 age-matched patients who have not receive PNAM treatment (no PNAM group) from 2017 to 2021. The average starting age for PNAM therapy was 18.33 days, and the average PNAM treatment duration was 99.08 days. Twelve nasolabial parameters were measured to compare the postsurgical outcomes of two groups. RESULTS In PNAM groups, cleft width, vertical distance between double Crista philtri and columellar deviation were reduced compared to that in no PNAM group. And nostril height was larger than that in no PNAM group. The differences between two groups were statistically significant (p < .05). There were no statistical differences in columellar length, nostril width and bi-alar width between two groups. However, the nostril width on cleft side in PNAM group was decreased by an average of 1.1 mm. CONCLUSION Our result indicated that PNAM therapy decreased cleft width and vertical distance between Crista philtri. It also increased nasal symmetry by decreasing columellar deviation, increasing nostril height.
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Affiliation(s)
- Jiayi Yin
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Shiming Zhang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ning Huang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qian Zheng
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chao Yang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Ferreira A, Da Costa G. Primary care in early cleft lip and palate rehabilitation: A dental perspective. J Family Med Prim Care 2022; 11:1212-1215. [PMID: 35495811 PMCID: PMC9051670 DOI: 10.4103/jfmpc.jfmpc_990_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/22/2021] [Accepted: 12/07/2021] [Indexed: 12/04/2022] Open
Abstract
Oro-facial clefts are among the most commonly occurring congenital defects. Surgical interventions are commonly carried out to treat these deformities. Some inadequacies however, like scarring of the nasolabial complex and multiple interventions to achieve desired results still persist. Presurgical Nasoalveolar molding (PNAM) technique can be carried out before surgical repair, to facilitate a reduction in the severity of the cleft by actively molding and repositioning the clefted alveolar segments and the associated soft tissues. This case series describes the successful rehabilitation of two unilateral mid-facial cleft babies using the PNAM technique in a step wise manner with a two year follow up.
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Hinostroza-Flores M, Perona-Miguel de Priego GA, Loo-Valle J. [Pre-surgical orthopedic treatment with Hinostroza nasal retractor modification in complete unilateral palate fissure. Case report]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e065. [PMID: 38465277 PMCID: PMC10919824 DOI: 10.21142/2523-2754-0902-2021-065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/02/2021] [Indexed: 03/12/2024] Open
Abstract
Complete unilateral palatine fissure affects the region of the middle facial third and individuals born with this condition have altered structures on the side where the malformation developed. The objective of the present case report was to describe a pre-surgical orthopedics alternative in a female infant of 1 month 5 days of age with complete unilateral palatine fissure diagnosed with complete unilateral left palatine fissure. The Hinostroza nasal retractor modification was placed, allowing symmetry to the affected nasal structure with respect to the unaffected side. This procedure provides good results, low cost and easy handling and should be considered as an alternative treatment in neonates born with complete unilateral palatine fissure.
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Affiliation(s)
- Manuel Hinostroza-Flores
- Maestría de Odontopediatría, Universidad Científica del Sur. Lima, Perú. , Universidad Científica del Sur Maestría de Odontopediatría Universidad Científica del Sur Lima Peru
| | - Guido Alberto Perona-Miguel de Priego
- Maestría de Odontopediatría, Universidad Científica del Sur. Lima, Perú. , Universidad Científica del Sur Maestría de Odontopediatría Universidad Científica del Sur Lima Peru
| | - Jennifer Loo-Valle
- Especialidad de Odontopediatría, Universidad Científica del Sur. Lima, Perú. Universidad Científica del Sur Especialidad de Odontopediatría Universidad Científica del Sur Lima Peru
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