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Roth DM, Piña JO, Raju R, Iben J, Faucz FR, Makareeva E, Leikin S, Graf D, D'Souza RN. Tendon-associated gene expression precedes osteogenesis in mid-palatal suture establishment. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.11.590129. [PMID: 38798531 PMCID: PMC11118303 DOI: 10.1101/2024.05.11.590129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Orthodontic maxillary expansion relies on intrinsic mid-palatal suture mechanobiology to induce guided osteogenesis, yet establishment of the mid-palatal suture within the continuous secondary palate and causes of maxillary insufficiency remain poorly understood. In contrast, advances in cranial suture research hold promise to improve surgical repair of prematurely fused cranial sutures in craniosynostosis to potentially restore the obliterated signaling environment and ensure continual success of the intervention. We hypothesized that mid-palatal suture establishment is governed by shared principles with calvarial sutures and involves functional linkage between expanding primary ossification centres with the midline mesenchyme. We characterized establishment of the mid-palatal suture from late embryonic to early postnatal timepoints. Suture establishment was visualized using histological techniques and multimodal transcriptomics. We identified that mid-palatal suture formation depends on a spatiotemporally controlled signalling milieu in which tendon-associated genes play a significant role. We mapped relationships between extracellular matrix-encoding gene expression, tenocyte markers, and novel suture patency candidate genes. We identified similar expression patterns in FaceBase-deposited scRNA-seq datasets from cranial sutures. These findings demonstrate shared biological principles for suture establishment, providing further avenues for future development and understanding of maxillofacial interventions.
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Affiliation(s)
- Daniela M Roth
- Section on Craniofacial Genetic Disorders, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jeremie Oliver Piña
- Section on Craniofacial Genetic Disorders, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Resmi Raju
- Section on Craniofacial Genetic Disorders, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - James Iben
- Molecular Genomics Core, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Fabio R Faucz
- Molecular Genomics Core, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Elena Makareeva
- Section on Physical Biochemistry, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Sergey Leikin
- Section on Physical Biochemistry, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Daniel Graf
- Department of Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Canada
| | - Rena N D'Souza
- Section on Craniofacial Genetic Disorders, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
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Shabbir S, Sattar A, Sami QUA, Zia B, Pervez H. Bite Force Changes in Bilateral Cleft Lip and Palate Patients Before and After ALT-RAMEC Protocol. Cleft Palate Craniofac J 2022; 60:586-590. [PMID: 35130093 DOI: 10.1177/10556656211072730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To evaluate the bite force (BF) changes in bilateral cleft lip and palate (BCLP) in contrast to the non BCLP children after ALT-RAMEC Facemask therapy. The prospective study was carried out on a total of 60 subjects of age 6 to 13 years in a tertiary care hospital; treatment group, 30 children with BCLP and control group, 30 children without cleft lip and palate. Each cleft patient was received ALT-RAMEC Facemask treatment and their BF assessed at 4 different stages. Bite force taken before treatment, immediately, 3 months and 6 months after treatment. Bite force of the control group was taken at baseline to compare with the treatment group to demonstrate the difference in BF values. Independent t test and analysis of variance were used to perform statistical analysis. There was a significant difference in BF between the treatment group (BCLP) 122.53 ± 8.64 N and the control group (non BCLP) 181.38 ± 18.84 N at baseline. After the Alt RAMEC protocol, changes in BF recorded over 3 and 6 months of therapy showed significant improvement. The mean values of BF at 3months and 6 months were 106.7 ± 9.3 N and 137.4 ± 9.5 N, respectively. Bite force was significantly improved after ALT-RAMEC protocol followed by facemask therapy in BCLP patients.
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Affiliation(s)
- Sadia Shabbir
- 66812Jinnah Medical and Dental College, Karachi, Pakistan
| | - Anam Sattar
- 66818Dow International Dental College/Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Qurat Ul Ain Sami
- 66818Dow International Dental College/Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Babar Zia
- 66812Jinnah Medical and Dental College, Karachi, Pakistan
| | - Hana Pervez
- 66812Jinnah Medical and Dental College, Karachi, Pakistan
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Single Stage Cleft Lip and Palate Repair In Toddlers: Retrospective Review of Feasibility and Operative Experience. J Craniofac Surg 2021; 33:413-417. [PMID: 34519704 PMCID: PMC8865211 DOI: 10.1097/scs.0000000000008108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In children with cleft lip and palate (CLP), we aimed to compare a single-stage surgery group or all in one (AIO) approach with a 2-stage surgery group (2-SSG) of 18 and 12 toddlers, respectively. A retrospective review of 30 patients with CLP was conducted between 2007 and 2019. All in one procedure was performed at 12 to 24 months and 2-SSG patients had lip and primary nasal correction at 3 to 9 months, followed by palatoplasty and myringotomies at 12 to 16 months. In the AIO group, 13 (72.2%) patients had unilateral CLP, while 5 (27.8%) had bilateral CLP, which is comparable to the 2-SSG who had 8 (66.7%) unilateral CLP, 3 (25%) bilateral CLP, and 1 (8.3%) incomplete CL with submucous CP. The 2-SSG had a 30 minutes longer cumulative operative time and increased blood loss that was not statistically significant (P = 0.149 and 0.219, respectively). The AIO group had a slightly longer intubation (0.67 versus 0.33 day) and pediatric intensive care unit admission duration of 1.72 versus 1.67 days, (P = 0.427, 0.927), respectively. Total hospitalization time was significantly shorter with the AIO (8 versus 10.67 days, P = 0.016). The duration of postoperative pediatric intensive care unit and need for supplemental oxygen were higher in the AIO (38.9% versus 8.3%, P = 0.064). The “AIO” approach of lip, nasal, and palate surgery from 12 to 24 months completes early surgical care in a single operation. However, based on our review, this protocol must be selective; children with comorbidities or syndromes are advised to be exempted and operated in stages.
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Zhang Y, Wang Y, Zhang Y, Li S, Wang L, Qian Y. Cone-Beam Computed Tomography Evaluation of Skeletal Deformities and Pharyngeal Airway in Chinese Han Individuals With Nonsyndromic Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2019; 57:65-72. [PMID: 31296040 DOI: 10.1177/1055665619860700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: This study examined the relationships between skeletal deformities and the pharyngeal airway of patients with nonsyndromic unilateral cleft lip and palate (UCLP). Design: Retrospective study. Setting: Orthodontics and Oral and Maxillofacial Surgery Departments in the Affiliated Hospital of Stomatology, Nanjing Medical University, China. Patients, Participants: The sample comprised 30 nonsyndromic UCLP patients and 30 healthy controls. Each group has 23 males and 7 females. Interventions: All cone-beam computed tomography images were obtained with the participant in the standard supine position and asked to bite with intercuspal position without swallowing or moving their heads and tongues during scanning. Main Outcome Measure(s): SNA, SNB, ANB, anterior cranial base, Wits appraisal, maxillary length (PTM-ANS || FH), maxillary position (S-PTM || FH), mandibular length (Go-Pog || MP), FMA, posterior face height, anterior face height, Posterior-Anterior face height, lower face height, pharyngeal airway volumes, and areas were evaluated by Dolphin imaging software. Results: The UCLP group showed significantly decreased SNA, SNB, ANB, PTM-ANS || FH, S-PTM || FH, P-A Face Height compared with the controls. However, the airway volumes and areas showed no significant difference between 2 groups. The total airway volume and minimum cross-sectional area in UCLP patients were related to the Go-Pog || MP and FMA. Conclusions: Patients with UCLP have both the maxillary and mandibular deficiencies in the sagittal dimension. Both the sagittal and vertical relationships of the jaw might affect the airway volume and area. However, no significant difference was detected in airway volume and area in UCLP patients when compared with the controls.
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Affiliation(s)
- Yuan Zhang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuhua Wang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yaoyuan Zhang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Sheng Li
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lin Wang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yajing Qian
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu, China
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Cephalometric evaluation after two-stage palatoplasty combined with a Hotz plate: a comparative study between the modified Furlow and Widmaier-Perko methods. Int J Oral Maxillofac Surg 2017; 46:539-547. [PMID: 28174062 DOI: 10.1016/j.ijom.2017.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/07/2016] [Accepted: 01/10/2017] [Indexed: 11/21/2022]
Abstract
The effects on craniofacial growth of two different soft palate repair techniques in two-stage palatoplasty were investigated. This was a retrospective, cross-sectional cohort study of 68 children with non-syndromic, complete unilateral cleft lip and palate. Thirty-four patients were treated with the modified Furlow method (F-group) and the remaining 34 with the Widmaier-Perko method (P-group). Craniofacial growth was assessed by analyzing 12 angular and 12 linear measurements on lateral cephalograms. Composite facial diagrams from the two groups were compared with those of a control non-cleft group. Angular and linear measurements did not differ significantly between the two groups, implying that the craniofacial morphology was not affected by the difference in soft palate repair technique. However, small differences in anterior nasal spine and posterior nasal spine were found in cleft patients compared with controls. These findings suggest that the modified Furlow and Widmaier-Perko methods have a similar impact on craniofacial growth. Considering speech function, the modified Furlow method provides better craniofacial growth and speech function. However, the long-term effects of both methods on craniofacial growth after growth cessation remain to be determined.
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Brusati R. Evolution of my philosophy in the treatment of unilateral cleft lip and palate. J Craniomaxillofac Surg 2016; 44:901-11. [PMID: 27318751 DOI: 10.1016/j.jcms.2016.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/05/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022] Open
Abstract
At the end of 50-year-long clinical activity, the evolution of my approach to the treatment of unilateral cleft of the lip and palate is discussed. I had several teachers in this field (Rusconi, Reherman, Perko, Delaire, Talmant, Sommerlad and others) and I introduced in my approach what I considered to be improvements from all of them. My current protocol is related to the anatomy of the cleft: for wide clefts a two-stage protocol is applied (1° step: soft palate and lip and nose repair; 2° step: hard palate repair with gingivoalveoloplasty); for narrow cleft (less than 1 cm at the posterior border of hard palate) an "all in one" protocol is performed with or without gingivoalveoloplasty (in accordance to the presence or absence of contact between the stumps at alveolar level). The most important details regarding surgery of the lip and palate are discussed. Robust data collection on speech and skeletal growth is still needed to determine whether the "all in one" approach can be validated as the treatment of choice for unilateral complete lip and palate cleft in selected cases.
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Affiliation(s)
- Roberto Brusati
- Smile House-CLP Center, San Paolo University Hospital, via di Rudinì 8, Milan, Italy.
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Li J, Johnson CA, Smith AA, Salmon B, Shi B, Brunski J, Helms JA. Disrupting the intrinsic growth potential of a suture contributes to midfacial hypoplasia. Bone 2015; 81:186-195. [PMID: 24780877 DOI: 10.1016/j.bone.2014.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 04/16/2014] [Accepted: 04/18/2014] [Indexed: 11/19/2022]
Abstract
Children with unoperated cleft palates have nearly normal growth of their faces whereas patients who have had early surgical repair often exhibit midfacial hypoplasia. Surgical repair is responsible for the underlying bone growth arrest but the mechanisms responsible for these surgical sequelae are poorly understood. We simulated the effect of cleft palate repair by raising a mucoperiosteal flap in the murine palate. Three-dimensional micro-CT reconstructions of the palate along with histomorphometric measurements, finite element (FE) modeling, immunohistochemical analyses, and quantitative RT-PCR were employed to follow the skeletal healing process. Inflammatory bone resorption was observed during the first few days after denudation, which destroyed the midpalatal suture complex. FE modeling was used to predict and map the distribution of strains and their associated stresses in the area of denudation and the magnitude and location of hydrostatic and distortional strains corresponded to sites of skeletal tissue destruction. Once re-epithelialization was complete and wound contracture subsided, the midpalatal suture complex reformed. Despite this, growth at the midpalatal suture was reduced, which led to palatal constriction and a narrowing of the dental arch. Thus the simple act of raising a flap, here mimicked by denuding the mucoperiosteum, was sufficient to cause significant destruction to the midpalatal suture complex. Although the bone and cartilage growth plates were re-established, mediolateral skeletal growth was nonetheless compromised and the injured palate never reached its full growth potential. These data strongly suggest that disruption of suture complexes, which have intrinsic growth potential, should be avoided during surgical correction of congenital anomalies.
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Affiliation(s)
- Jingtao Li
- Department of Oral and Maxillofacial Surgery, West China Stomatology Hospital, Chengdu, China 610041; Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Chelsey A Johnson
- College of Medicine, University of Arizona, Tucson, AZ 85721, USA; Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Andrew A Smith
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Benjamin Salmon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA; Dental School, University Paris Descartes PRES Sorbonne Paris Cité, EA 2496, Montrouge, France; AP-HP Odontology Department Bretonneau, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Bing Shi
- Department of Oral and Maxillofacial Surgery, West China Stomatology Hospital, Chengdu, China 610041
| | - John Brunski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Jill A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA.
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Bichara L, Araújo R, Flores-Mir C, Normando D. Impact of primary palatoplasty on the maxillomandibular sagittal relationship in patients with unilateral cleft lip and palate: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2015; 44:50-6. [DOI: 10.1016/j.ijom.2014.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/29/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
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Gundlach KK, Bardach J, Filippow D, Stahl-de Castrillon F, Lenz JH. Two-stage palatoplasty, is it still a valuable treatment protocol for patients with a cleft of lip, alveolus, and palate? J Craniomaxillofac Surg 2013; 41:62-70. [DOI: 10.1016/j.jcms.2012.05.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 05/28/2012] [Accepted: 05/29/2012] [Indexed: 10/28/2022] Open
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Janiszewska-Olszowska J, Gawrych E, Wędrychowska-Szulc B, Stepien P, Konury J, Wilk G. Effect of primary correction of nasal septal deformity in complete unilateral cleft lip and palate on the craniofacial morphology. J Craniomaxillofac Surg 2012; 41:468-72. [PMID: 23273648 DOI: 10.1016/j.jcms.2012.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess the long-term effect of primary correction of the nasal septum during lip repair in unilateral complete cleft lip and palate on the craniofacial morphology. MATERIAL, SUBJECTS, METHODS The study material consisted of 54 lateral cephalograms made at the ages 7-22, including 28 cephalograms of patients from a study group (aged 7-14 years) after a primary correction of the nasal septum during lip closure and 26 cephalograms of patients from a control group (aged 12-22 years) operated on without septal correction. All cephalograms have been analysed with regard to skeletal, dental and soft-tissue relationships. Data distribution has been checked using Shapiro-Wilk test (α = 0.05). Student t-test was used to compare values of normal distribution and for the latter - Mann-Whitney test. RESULTS The comparison of all cephalometric values between the study and control groups revealed a statistically significant (α = 0.05) difference only for H (p = 0.0267), 1+: NB angle (p = 0.0175) and 1+: NA (mm) (p = 0.0249). Each of the three cephalometric measurements mentioned were greater in the study than in the control group. CONCLUSION No negative effect from the primary nasal septum correction on maxillary development could be found in the study group.
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Zemann W, Kärcher H, Drevenšek M, Koželj V. Sagittal maxillary growth in children with unilateral cleft of the lip, alveolus and palate at the age of 10 years: an intercentre comparison. J Craniomaxillofac Surg 2010; 39:469-74. [PMID: 21112793 DOI: 10.1016/j.jcms.2010.10.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 09/01/2010] [Accepted: 10/25/2010] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Aim of this intercentre study was to compare sagittal facial growth in children with unilateral cleft lip and palate treated with different surgical protocols. A first evaluation had been carried out at the age of 6 years, now the patients have been re-evaluated at the age of 10 years. MATERIAL AND METHOD 22 patients had been analyzed in centre 1, 32 patients in centre 2. All patients had presurgical orthopaedics. Centre 1 had lip repair at the age of 3 months and one-stage palatal closure with 1 year. Centre 2 had lip repair with 6 months, soft palate repair at 12 and hard palate repair at the age of 30 months. Sagittal growth was evaluated on lateral cephalograms. As control, data of 35 non-cleft children were used. Statistical analysis was carried out with student's t-test, multiple comparisons with Bonferroni. RESULTS There was considerably normal sagittal facial growth in centre 1, with tendency of forward growth of the mandible. In centre 2 there was a slight decrease in sagittal maxillary and mandibular growth with unchanged intergnathic relation. There was no statistically significant difference in sagittal growth between the centres. A re-evaluation has to be carried out after the final growth spurt.
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Affiliation(s)
- Wolfgang Zemann
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. H. Kärcher), Medical University Graz, Auenbruggerplatz 7, Graz, Austria.
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Campbell A, Costello BJ, Ruiz RL. Cleft lip and palate surgery: an update of clinical outcomes for primary repair. Oral Maxillofac Surg Clin North Am 2010; 22:43-58. [PMID: 20159477 DOI: 10.1016/j.coms.2009.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The comprehensive management of cleft lip and palate has received significant attention in the surgical literature over the last half century. It is the most common congenital facial malformation and has a significant developmental, physical, and psychological impact on those with the deformity and their families. In the United States, current estimates place the prevalence of cleft lip and palate or isolated cleft lip at approximately 1 in 600. There is significant phenotypic variation in the specific presentation of facial clefts. Understanding outcome data is important when making clinical decisions for patients with clefts. This article provides an update on current primary cleft lip and palate outcome data.
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Affiliation(s)
- Andrew Campbell
- Division of Craniofacial and Cleft Surgery, Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, 3471 Fifth Avenue, Suite 1112, Pittsburgh, PA 15213, USA
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Abstract
BACKGROUND The purpose of this prospective study was to evaluate craniofacial morphology in children with complete unilateral cleft lip and palate treated at the Brussels cleft center after a 1-stage complete closure at 3 months and compare the results with a series of children operated on at 3 and 6 months of age according to the Malek surgical protocol. METHODS A series of 72 consecutive patients who were operated on for nonsyndromic complete unilateral cleft lip and palate were included in this study at approximately the age of 10 years. Thirty-four were treated according to the Malek surgical treatment protocol: the soft palate was closed at a mean (SD) age of 3.04 (0.20) months, followed by simultaneous repair of the lip and hard palate at 6.15 (0.67) months. Thirty-eight underwent 1-stage all-in-one (AIO) closure of the lip and hard and soft palates at 2.98 (0.16) months. Craniofacial morphology was evaluated by means of a digital cephalometric analysis. Cephalometric data were compared with a noncleft control group (n = 40) matched according to age. The same 2 series of children were followed up until 15 years of age, and the results were again compared. RESULTS Statistical analysis (analysis of variance with post hoc Tukey test) showed in both groups who were operated on a decreased anteroposterior growth compared with the children without cleft at 10 years but the AIO group only was not different from the group without cleft. The maxillary (MxPI/SN) plane was significantly (P = 0.002) increased in the Malek cleft group compared with the AIO group with cleft. At 15 years of age, a difference was not observed anymore between the 2 groups for the anteroposterior growth or for the maxillary plane inclination. CONCLUSIONS One-stage AIO closure based on the Malek surgical principles provided good anteroposterior midfacial morphology and resulted in less opening of the maxillary plane to the anterior cranial base.
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Fudalej P, Katsaros C, Bongaarts C, Dudkiewicz Z, Kuijpers-Jagtman AM. Nasolabial esthetics in children with complete unilateral cleft lip and palate after 1- versus 3-stage treatment protocols. J Oral Maxillofac Surg 2009; 67:1661-6. [PMID: 19615579 DOI: 10.1016/j.joms.2009.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 04/04/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE Facial esthetics play an important role in social interactions. However, children with a repaired complete unilateral cleft lip and palate usually show some disfigurement of the nasolabial area. To date, few studies have assessed the nasolabial appearance after different treatment protocols. The aim of the present study was to compare the nasolabial esthetics after 1- and 3-stage treatment protocols. MATERIALS AND METHODS Four components of the nasolabial appearance (nasal form, nasal deviation, mucocutaneous junction, and profile view) were assessed by 4 raters in 108 consecutively treated children who had undergone either 1-stage closure (Warsaw group, 41 boys and 19 girls, mean age 10.8 years, SD 2.0) or 3-stage (Nijmegen group, 30 boys and 18 girls, mean age 8.9 years, SD 0.7). A 5-grade esthetic index of Asher-McDade was used, in which grade 1 indicates the most esthetic and grade 5 the least esthetic outcome. RESULTS The nasal form was judged the least esthetic in both groups and graded 3.1 (SD 1.1) and 3.2 (SD 1.1). The nasal deviation, mucocutaneous junction, and profile view were scored from 2.1 (SD 0.8) to 2.3 (SD 1.0) in both groups. The treatment outcome after the Warsaw and Nijmegen protocols was comparable. Neither overall nor any of the 4 components of the nasolabial appearance showed intercenter differences (P > .1). CONCLUSIONS The nasolabial appearance after the Warsaw (1-stage) and Nijmegen (3-stage) protocols was comparable. The technique of lip repair (triangular flap in Warsaw and Millard rotation advancement in Nijmegen) gave comparable results for the esthetics of the nasolabial area.
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Affiliation(s)
- Piotr Fudalej
- Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland.
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