Facial profile esthetics in operated children with bilateral cleft lip and palate

Identification of Causative Variants Contributing to Nonsyndromic Orofacial Clefts Using Whole-Exome Sequencing in a Saudi Family

Objectives: Nonsyndromic orofacial clefts (NSOFCs) are the most common craniofacial malformations observed across the globe. They are classified into three types: (a) cleft palate, (b) cleft lip, and (c) cleft lip and palate. To identify the potential candidate genes contributing to polygenic diseases such as NSOFC, linkage analyses, genome-wide association studies, and genomic rearrangements can be used. Genomic analyses, based on massively parallel next-generation sequencing technologies, play a vital role in deciphering the genetic bases of NSOFCs. Materials and Methods: In this study, whole exome sequencing was employed to detect genes that likely contributed to the NSOFC phenotype in a consanguineous Saudi family. Results: The exome analysis revealed NRP1 (rs35320960) as one potential candidate gene that is involved in bone differentiation. The RPL27A gene (rs199996172), which plays a crucial role in ribosome biogenesis, also passed all filters to serve as a candidate gene for NSOFC in this family. Rare variants are situated within the 5' UTR of these two genes. Conclusion: The study suggests that rare variants in NRP1 and RPL27A may be associated with NSOFC disease etiology.

Orthodontic treatment of unilateral cleft lip and palate associated with maxillary canine/premolar transposition: case report

Introduction:

The cleft lip and palate is the most frequent craniofacial anomaly and as a consequence of this malformation some inadequate occlusal relationship between the arches are observed. Furthermore, dental absences, individual positioning changes of teeth as rotations, and in more rare situations the transpositions may be found as well.

Description:

In this context, in this article is reported a case of a 9-year-old patient with unilateral cleft lip and palate, with anterior and posterior crossbite on the left side, absence of the maxillary left lateral incisor, and transposition of the maxillary left canine and first premolar. The patient was treated with slow maxillary expansion, secondary graft and fixed orthodontic appliance, transposition maintenance and closing of the lateral incisor space with the first premolar, by means of mesialization of the posterior teeth.

Results:

At the end of the treatment, good intercuspation and an important aesthetic gain for the patient were achieved. The analysis three years after treatment revealed a good stability of the results obtained.

Photogrammetric Evaluation of Soft Tissue Profile and Frontal Photographs in Repaired Bilateral Cleft Lip and Palate

OBJECTIVE

To evaluate the soft tissue profile and frontal photographs of 8- to 12-year-old patients with repaired complete bilateral cleft lip and palate (BCLP).

METHODS

The profile and frontal photographs obtained from 31 nonsyndromic BCLP children (aged 8-12 years: 14 boys and 17 girls) were analyzed and compared with an age- and sex-matched normal population (18 boys and 32 girls). In each patient, 12 soft tissue angular and proportional parameters on the frontal photograph and 12 angular parameters for the profile photographs were developed and measured. Student t test was used to compare the mean value of the parameters between both sexes.

RESULTS

In the frontal view, there was a significant difference between the 2 study groups in the facial symmetry angle (P < .001), lower facial height proportion (P < .001), upper lip proportion (P < .001), and interalar width/distance between the inner canthus of the eyes (P < .001). In the profile view, there was a significant difference between the control group and the patients with cleft lip and palate in terms of nasofrontal angle (P < .001), nasal angle (P < .001), angle of the inferior facial third (P = .032), head position angle (P < .001), facial convexity angle (P < .001), total facial convexity angle (P < .001), and vertical nasal angle (P < .001).

CONCLUSION

In comparison with the normal population, the face of patients with repaired BCLP showed several soft tissue deformities, especially in the nasofrontal region, even after a surgical repair.

Breaking Symmetry: A Quantitative Analysis of Facial Skeleton Disharmony in Children Born with Bilateral Cleft Lip and Palate

Bilateral cleft lip and palate (BCLP) occurs when craniofacial precursors fail to form or fuse properly during development. The aim of this retrospective, cross-sectional investigation was to quantify directional asymmetry (DA) of the facial skeleton of children born with Veau Class IV nonsyndromic BCLP. To accomplish this goal, coordinate values of anatomical landmarks were acquired from three-dimensional cone beam computed tomographic images of the craniofacial skeleton of middle- to late-aged children born with BCLP and age- and sex-matched controls and used to compare patterns of asymmetry variation. Multivariate analyses revealed different patterns of DA variation across samples and identified approximately 30% of DA measures as significantly different. Magnitudes of statistically significant linear distances differ in the craniofacial region, with most smaller DA differences located near the orbits and frontal bone, while larger differences were localized mostly to the midface, alveolar ridge, and nasal borders. Generally, areas of the craniofacial skeleton derived from the maxillary and nasal prominences demonstrated the highest magnitudes of DA. The methods and results presented will be useful to biomedical researchers when identifying the extent to which patients with BCLP diverge from typical developmental expectations. Quantifying DA and assessing local differences across the craniofacial complex can aid medical practitioners when developing treatments to improve BCLP surgical algorithms and outcomes. Anat Rec, 302:1726-1732, 2019. © 2019 American Association for Anatomy.

Anatomical Reconstruction in Bilateral Cleft Lip With Mendoza Technique

: The bilateral cleft lip (BCL) is the most severe manifestation of orofacial clefts. Multiple techniques have been described to reconstruct BCL to obtain good aesthetic and functional results with minimal complications.

OBJECTIVE

Description of surgical technique for BCL reconstruction and present the postoperative results obtained.

METHODS

Patients with BCL of the cleft lip and palate at ABC Medical Center from June 2013 to June 2017 operated with Mendoza bilateral cheiloplasty were included. The procedure includes an anatomical reconstruction of the lip with minimal resection of tissue, alignment of the orbicularis muscle, vestibule creation, and complete use of the prolabium. The evaluation was carried out by photographs analyzing parameters of quality, symmetry, and alignment of lip and nose structures.

RESULTS

The authors included 36 patients, 15 women and 16 men. The average procedure time was 57 minutes. Photographs were evaluated 1 year postoperatively, symmetry in lip was observed in 91.6% of the patients, muscle continuity in 100%, deep gingivolabial sulcus in 94.5% of cases, closed nasal floor in 100% with no presence of nasovestibular fistulas.

CONCLUSIONS

This technique allows an anatomical BCL reconstruction with good aesthetic and functional results.