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Zheng J, Sun Y, Yang Z, Guo D, Ren M, Jiang Y, Yuan W. Comparison of craniomaxillofacial morphology in children with unilateral cleft lip and palate treated with/without presurgical nasoalveolar molding - a retrospective study with a mean age of 5 years. Clin Oral Investig 2024; 28:326. [PMID: 38763957 DOI: 10.1007/s00784-024-05725-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES To three-dimensionally assess differences in craniomaxillofacial skeletal development in patients with operated unilateral cleft lip and palate (UCLP) treated with/without presurgical nasoalveolar molding (PNAM) with a mean age of 5 years. MATERIALS AND METHODS Cone-beam CT radiographs of 30 patients with UCLP who had undergone PNAM and 34 patients with UCLP who did not receive PNAM were analyzed. The data were stored in DICOM file format and were imported into the Dolphin Imaging program for 3D image reconstruction and landmark identification. 33 landmarks, 17 linear and three angular variables representing craniofacial morphology were analyzed and compared by using the Mann-Whitney U tests. RESULTS The vast majority of linear variables and 3D coordinates of landmark points reflecting craniofacial skeletal symmetry were not significantly different between the two groups. In terms of craniofacial skeletal development, the PNAM group had a significantly smaller anterior nasal spine offset in the midsagittal plane and a greater maxillary length compared to the non-PNAM group. CONCLUSIONS Evaluations performed in early childhood showed that treatment with/without PNAM in the neonatal period was not a major factor influencing craniomaxillofacial hard tissue development in patients with UCLP; moreover, PNAM treatment showed significant correction of skeletal deviation at the base of the nose. CLINICAL RELEVANCE Follow-up in early childhood has shown that PNAM treatment administered during the neonatal stage does not impede maxillary development and has benefits in correcting nasal floor deviation. It is a viable option for improving nasal deformity in children with unilateral cleft lip and palate.
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Affiliation(s)
- Jie Zheng
- Department of Orthodontics, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Hongshan District, Wuhan, Hubei, 430079, People's Republic of China
| | - Yangqi Sun
- Department of Orthodontics, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Hongshan District, Wuhan, Hubei, 430079, People's Republic of China
| | - Zhengkun Yang
- Department of Orthodontics, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Hongshan District, Wuhan, Hubei, 430079, People's Republic of China
| | - Di Guo
- Department of Orthodontics, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Hongshan District, Wuhan, Hubei, 430079, People's Republic of China
| | - Meiqing Ren
- Department of Orthodontics, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Hongshan District, Wuhan, Hubei, 430079, People's Republic of China
| | - Yanping Jiang
- Department of Gynaecology, Renmin Hospital of Wuhan University, #99 Zhangzhidong Road, Wuchang District, Wuhan, Hubei, 430060, People's Republic of China.
| | - Wenjun Yuan
- Department of Orthodontics, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Hongshan District, Wuhan, Hubei, 430079, People's Republic of China.
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2
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Garland K, Coyle M, Foley T, Matic D. Ten-Year Cephalometric Comparison of Patients With Cleft Palate who Received Treatment With Active or Passive Pre-surgical Orthopedic Devices. Cleft Palate Craniofac J 2023; 60:1359-1365. [PMID: 35698743 DOI: 10.1177/10556656221106891] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Pre-surgical orthopedic (PSO) devices can be used in the management of patient with cleft lip/palate (CL/P) to narrow the alveolar gap (AG) prior to lip surgery. There are few studies comparing these 2 devices. The objective of this work was to compare the effects of active and passive PSO devices on facial growth in a single surgeon's cohort of patients with CL/P over a 10-year period. METHODS A retrospective review of all patients with CL/P in a single surgeon's practice from 2002 to 2018 was performed. Preoperative measurements of AG size were done using electronic calipers on patient molds. Patient radiographs were taken at 5 and 10 years of age and cephalometric landmarks were plotted using specialized software. Independent sample t-tests were used to compare means for maxillary, mandibular, vertical, and dento-alveolar growth parameters. RESULTS Twenty patients with an active device and 23 patients with a passive device were included. No differences were observed in the basic demographic information between the two groups. At the time of lip repair, patients with a passive device had significantly larger horizontal AGs (P < .01), but by the time of palate repair, there was no difference between the two groups (P = .94). There was no significant difference in any growth measurements between the active and passive device groups at 5 and 10 years. CONCLUSIONS Despite closing the AG more quickly, patients treated with an active device have no significant difference in facial growth at 10 years compared to patients treated with a passive device.
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Affiliation(s)
- Katie Garland
- Division of Plastic Surgery, Western University, London, ON, Canada
| | - Michelle Coyle
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Tim Foley
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Damir Matic
- Division of Plastic Surgery, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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3
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Cleft and Craniofacial Surgery. J Oral Maxillofac Surg 2023; 81:E120-E146. [PMID: 37833020 DOI: 10.1016/j.joms.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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4
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Gillgrass T. The orthodontic management of patients with cleft lip and palate: from birth to the late mixed dentition. Br Dent J 2023; 234:873-880. [PMID: 37349434 DOI: 10.1038/s41415-023-5955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 06/24/2023]
Abstract
This is the first of two papers outlining the orthodontic management of patients with cleft lip and palate. This paper will review orthodontic input into children with cleft lip and palate from birth to the late mixed dentition before definitive orthodontics. It will emphasise the importance of timing in alveolar bone grafting, the role of the general dental practitioner and the impact of timing on definitive orthodontic outcome.
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Affiliation(s)
- Toby Gillgrass
- Cleft Surgical Service for Scotland & Glasgow Dental Hospital and School, Glasgow, United Kingdom.
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5
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A Preliminary Study of Interdisciplinary Approach with a Single-Stage Surgery in Children with Cleft Lip and Palate. J Pers Med 2022; 12:jpm12101741. [PMID: 36294880 PMCID: PMC9604880 DOI: 10.3390/jpm12101741] [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: 08/31/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
A two-stage surgical procedure involving labioplasty and palatoplasty is a common surgical modality performed in children with cleft lip and palate. Additionally, an alveolar cleft bone graft is performed prior to the eruption of the canine teeth. These three surgeries impose the burden of general anesthesia separately for each procedure, and the formation of scar tissue from the procedure inhibits maxillary growth. We adopted a single-stage surgical procedure to overcome these drawbacks. To date, there have been no reports comparing the treatment outcomes of alveolar morphology and maxillary growth and development in children who underwent single-stage surgery with those who underwent two-stage surgery using plaster casts and cephalograms. Twenty children aged 5–7 years were equally divided into two groups based on whether they had undergone a two- or single-stage procedure. Cephalometric analysis and analysis of dentition models were conducted. The results showed that the single-stage surgery exhibited significant differences in the sella-nasion angle, point A to McNamara line, maxillary length, mandibular body length, and posterior arch width and length compared with the two-stage surgery. Therefore, it was suggested that the single-stage surgery had a favorable effect on maxillary growth compared with the two-stage surgery.
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6
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Dallaserra M, Pantoja T, Salazar J, Araya I, Yanine N, Villanueva J. Effectiveness of pre-surgical orthopedics on patients with cleft lip and palate: A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e506-e520. [PMID: 35151895 DOI: 10.1016/j.jormas.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Evaluate the effectiveness of pre-surgical orthopedics (PSO) in patients with cleft lip palate (CLP) in maxillary morphology (MM), facial growth and development (FGD), occlusal alterations (OA), parental satisfaction (PS), and side effects. DESIGN Systematic review and meta-analysis of randomized and controlled clinical trials. Searches was performed in CENTRAL, MEDLINE, and EMBASE. RESULTS From the eight studies included, three are randomized clinical trials, and five clinical trials are controlled. MM was evaluated by the intercanine width (Mean difference (MD) =1.44; CI95%= -0.30, 3.19; very low certainty), anteroposterior length (MD=1.32; CI95%= -0.59, 3.24; very low certainty) and intertuberocity width (MD=0.09; CI95%= -0.68, 0.49; certainty: very low). FGD was evaluated by SNA angle (MD: 1.29; P = 0.306; moderate certainty), SNB angle (MD: -0.79; P = 0.550; moderate certainty) and ANB angle (MD: 1; P = 0.362; moderate certainty). OA was evaluated by 5-years-old-index (MD= -0.09; P = 0.49; moderate certainty) and by Huddart score (MD=0.51; P = 0.736; moderate certainty). A valid questionnaire assessed PS only in one study (MD= -0.1; P = 0.199; moderate certainty). No studies reported side effects. CONCLUSION Due to the uncertainty of the effect of PSO on MM and the lack of clinically relevant effect on FGD, OA, or PS, it is not reasonable to include this intervention as a treatment until future studies clarify its effect.
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Affiliation(s)
- Matías Dallaserra
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile
| | - Tomás Pantoja
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 (8330023), Santiago de Chile
| | - Josefina Salazar
- Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile
| | - Ignacio Araya
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile
| | - Nicolás Yanine
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile
| | - Julio Villanueva
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Cochrane Associated Center at Faculty of Dentistry. Universidad de Chile, Olivos 943 (8380492), Independencia, Santiago de Chile; Service of Maxillofacial Surgery. Hospital Clínico San Borja-Arriarán, Santiago de Chile. Av. Santa Rosa 1234 (8360160), Santiago de Chile.
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7
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Fujimoto M, Mano M, Sasaki A, Hasegawa H, Suzuki M, Nojiri N, Minami Y, Tokioka K, Suda N. Three-dimensional Analysis of Factors Related to the Effective Alveolar Molding in Presurgical Infant Orthopedics: Findings From a Pilot Study. Cleft Palate Craniofac J 2022:10556656221083804. [PMID: 35234083 DOI: 10.1177/10556656221083804] [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: 11/15/2022] Open
Abstract
OBJECTIVE Presurgical infant orthopedics (PIO) reduces the severity of the original cleft and burden on patients and their parents, provides better esthetics and function, and enables surgeons to achieve better surgical repair. To reduce the alveolar cleft width and to predict treatment difficulty using PIO, various measures were examined in pretreatment cast models. DESIGN Retrospective case-control pilot study. PATIENTS The patients were 22 infants with non-syndromic unilateral cleft lip and palate (UCLP), and cast models of these infants were used. METHODS After PIO using passive plates, infants with UCLP were divided into two groups: contact group (12 cases with close proximity of the greater and lesser segments) and non-contact group (10 cases without proximity of segments). The two groups were compared, and variables related to the proximity between alveolar clefts were examined. RESULTS There was no significant difference in age at PIO initiation between the two groups. However, the treatment duration was significantly longer in the non-contact group than in the contact group. Among the 13 variables, the initial lateral deviation of the nasal septum was significantly larger in the contact group than in the non-contact group. A significant positive correlation was observed between the initial lateral deviation of the nasal septum and reduction of the alveolar cleft width by PIO. CONCLUSION Initial lateral deviation of the nasal septum is a predictive factor for the proximity between alveolar segments in infants with UCLP at the PIO.
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Affiliation(s)
- Mai Fujimoto
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Mikiko Mano
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Au Sasaki
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Hiroya Hasegawa
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Masaharu Suzuki
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Naoko Nojiri
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Yuri Minami
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Kazuyuki Tokioka
- Department of Plastic and Reconstructive Surgery, Saitama Medical University, Japan
| | - Naoto Suda
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
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8
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Meazzini M, Parravicini F, Cohen N, Rossetti G, Autelitano L. Nasoalveolar molding and skeletal development in patients with bilateral cleft lip and palate: A retrospective cephalometric study at the completion of growth. J Craniomaxillofac Surg 2022; 50:400-405. [DOI: 10.1016/j.jcms.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/07/2021] [Accepted: 02/20/2022] [Indexed: 11/24/2022] Open
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9
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Rizell S, Küseler A, Heliövaara A, Skaare P, Brinck E, Bellardie H, Mooney J, Mølsted K, Karsten A, Sæle P, Chalien MN, Marcusson A, Eyres P, Shaw W, Semb G. Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: impact of maxillary dental agenesis on craniofacial growth and dental arch relationship in 8 year olds. Eur J Orthod 2021; 43:381-386. [PMID: 33693582 DOI: 10.1093/ejo/cjab007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND It is suggested that dental agenesis affects maxillary protrusion and dental arch relationship in children with unilateral cleft lip and palate (UCLP). In addition, an association between the need for orthognathic surgery and dental agenesis is reported. AIM The aim was to study the impact of maxillary dental agenesis on craniofacial growth and dental arch relationship in 8-year-old children with UCLP. SUBJECTS AND METHODS The sample consisted of individuals with UCLP from Scandcleft randomized trials. The participants had available data from diagnosis of maxillary dental agenesis as well as cephalometric measurements (n = 399) and GOSLON assessment (n = 408) at 8 years of age. RESULTS A statistically significant difference was found for ANB between individuals with agenesis of two or more maxillary teeth (mean 1.52°) in comparison with those with no or only one missing maxillary tooth (mean 3.30° and 2.70°, respectively). Mean NSL/NL was lower among individuals with agenesis of two or more maxillary teeth (mean 9.90°), in comparison with individuals with no or one missing maxillary tooth (mean 11.46° and 11.45°, respectively). The number of individuals with GOSLON score 4-5 was 47.2% in the group with two or more missing maxillary teeth and 26.1% respectively 26.3% in the groups with no or one missing maxillary tooth. No statistically significant difference was found in the comparison between individuals with no agenesis or with agenesis solely of the cleft-side lateral. CONCLUSION Maxillary dental agenesis impacts on craniofacial growth as well as dental arch relationship and should be considered in orthodontic treatment planning.
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Affiliation(s)
- Sara Rizell
- Clinic of Orthodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Sweden
| | - Annelise Küseler
- Cleft Palate Centre and University Hospital Aarhus and University of Aarhus, Denmark
| | - Arja Heliövaara
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital, Finland
| | - Pål Skaare
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Norway
| | - Eli Brinck
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Norway
| | - Haydn Bellardie
- University of the Western Cape, South Africa.,Greater Manchester Cleft Lip and Palate Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Jeanette Mooney
- Greater Manchester Cleft Lip and Palate Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Kirsten Mølsted
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Denmark
| | - Agneta Karsten
- Section of Orthodontics, Division of Orthodontics and Pedodontics, Department of Dental Medicine, Karolinska Institutet, Stockholm Craniofacial Team, Stockholm, Sweden
| | - Paul Sæle
- Oral Health Centre of Expertise, Western Norway, Bergen, Norway
| | - Midia Najar Chalien
- Clinic of Orthodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Sweden
| | - Agneta Marcusson
- Maxillofacial Unit, and Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Philip Eyres
- Greater Manchester Cleft Lip and Palate Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - William Shaw
- Greater Manchester Cleft Lip and Palate Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Gunvor Semb
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Norway.,Greater Manchester Cleft Lip and Palate Unit, Royal Manchester Children's Hospital, Manchester, UK
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10
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Garland K, McNeely B, Dubois L, Matic D. Systematic Review of the Long-Term Effects of Presurgical Orthopedic Devices on Patient Outcomes. Cleft Palate Craniofac J 2021; 59:156-165. [PMID: 33678051 PMCID: PMC8750140 DOI: 10.1177/1055665621998176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To perform a systematic review of the literature to identify the long-term
effects of presurgical orthopedic (PSO) device use on patient outcomes. Design: A comprehensive literature review of Embase and Ovid databases was performed
to identify all English-language publications related to unilateral cleft
lip and palate, presurgical devices, and patient outcomes. Studies were
excluded if they did not report patient outcomes beyond 2 years of age, did
not describe the use of a PSO device, were case reports (n < 10), or were
purely descriptive studies. Main Outcome Measures: Reported patient outcomes following the use of PSO devices. Results: Following a review of all articles by 2 independent reviews, 30 articles were
selected for inclusion. Overall, there was no reported consensus as to the
long-term effects of PSO devices. Furthermore, this study identified that
only 10% of published research controlled for confounding factors that could
influence the reported results. Confounding factors that were identified
included different operating surgeon, different surgical protocols, and
different rates of revision surgeries. Conclusions: Overall, this systematic review identified 2 important conclusions. Firstly,
there is no consensus in the literature about the long-term effects of PSO
devices on long-term patient outcomes. Secondly, research in this domain is
limited by confounding factors that influence the applicability of the
reported results.
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Affiliation(s)
- Katie Garland
- Division of Plastic Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Brendan McNeely
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luc Dubois
- Division of Vascular Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Damir Matic
- Division of Plastic Surgery, Department of Surgery, Western University, London, Ontario, Canada
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11
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Midface Growth in Patients With Unilateral Cleft Lip and Palate Treated With a Nasoalveolar Molding Protocol. J Craniofac Surg 2019; 30:1640-1643. [DOI: 10.1097/scs.0000000000005356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Steinberg B, Caccamese J, Costello BJ, Woerner J. Cleft and Craniofacial Surgery. J Oral Maxillofac Surg 2019; 75:e126-e150. [PMID: 28728728 DOI: 10.1016/j.joms.2017.04.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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13
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Murthy J. Commentary on: Management of cleft lip and palate in Egypt - A national survey. Indian J Plast Surg 2019; 51:296-297. [PMID: 30983729 PMCID: PMC6440353 DOI: 10.4103/ijps.ijps_246_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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14
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Fowler PV, Wholley C, Perry JG, Thompson JMD. Craniofacial morphology and soft tissue profile outcomes for complete unilateral and complete bilateral cleft lip and palate in New Zealand. Orthod Craniofac Res 2019; 22:139-146. [PMID: 30735011 DOI: 10.1111/ocr.12294] [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] [Received: 11/22/2018] [Revised: 01/09/2019] [Accepted: 01/28/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE (a) To establish baseline lateral craniofacial morphology and soft tissue profile outcomes for New Zealand children with complete unilateral and complete bilateral cleft lip and palate (CUCLP/CBCLP) and determine differences in relation to demographic characteristics including cleft type, sex and ethnicity and (b) To compare these outcomes to similar international studies. SETTINGS AND SAMPLE POPULATION Nation-wide prospective and retrospective cephalometric analysis of 76 patients with CUCLP and 23 patients with CBCLP pre-secondary alveolar bone graft. MATERIALS AND METHODS Assessment was undertaken by three experienced orthodontists blinded to patient identity. A total of 13 hard tissue and 8 soft tissue landmarks were identified allowing for an assessment of 16 angular, three linear and one ratio variables. Inter-assessor reliability was determined by pre-defined measurement error thresholds. RESULTS Inter-assessor reliability of cephalometric landmarks restricted reporting to 10 hard tissue, four soft tissue and one ratio variables. CUCLP had greater midface and mandibular retrusion than CBCLP. Females had greater midface and mandibular prominence and smaller nasal projections. The Pacific and Māori groups had more retrusive midfacial profiles, and the Pacific group had more prominent mandibles. A sub-analysis of New Zealand European CUCLP results found they were closely aligned to Eurocleft and Americleft study centres with less favourable outcomes. CONCLUSIONS The reliability of a number of cephalometric measurements was poor. Lateral craniofacial morphology and soft tissue profile outcomes varied between CUCLP/CBCLP, sex and ethnicity. The New Zealand European outcomes are similar to or less favourable to other studies.
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Affiliation(s)
- Peter V Fowler
- Hospital Dental Department, Christchurch Hospital, Christchurch, New Zealand.,Faculty of Health Science and Medicine, Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Chris Wholley
- Cleft Lip and Palate Unit, Perth Children's Hospital, Perth, Western Australia, Australia
| | | | - John M D Thompson
- Faculty of Health Science and Medicine, Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.,Faculty of Health Science and Medicine, Department of Obstetrics & Gynaecology, University of Auckland, Auckland, New Zealand
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15
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Stress Distribution Patterns within Viscero- and Neurocranium during Nasoalveolar Molding: a Finite Element Analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1832. [PMID: 30175012 PMCID: PMC6110680 DOI: 10.1097/gox.0000000000001832] [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: 03/29/2018] [Accepted: 04/18/2018] [Indexed: 11/26/2022]
Abstract
Background The purpose of this study was to evaluate the stress distribution patterns within the viscero- and neurocranium of neonates during nasoalveolar molding. Methods Finite element models of 3 different healthy neonates at different times of life (date of birth, 4 weeks, and 3.5 months) were generated on the basis of computed tomography scans. A validated workflow, including segmentation, meshing, setting of boundary conditions, and implementation of a bone density-dependent material model, was carried out for each model. A small and a large unilateral alveolar and hard palatal cleft were virtually cut in each model. The stress distribution pattern in each model was then analyzed by using Ansys APDL. Results Convergence analysis validated the results. The virtual experiments at the date of birth showed a stress pattern above a previously defined threshold value of 30,000 Pa in the ipsilateral naso-orbital-complex, frontal sinus, and the anterior fossa of the base of the skull, with von Mises values > 35,000 Pa. Stress patterns at the age of 4 weeks and 3.5 months showed reduced von Mises values at < 15,000 Pa. Conclusions Nasoalveolar molding therapy is a safe presurgical treatment modality without significant influence on the viscero- and neurocranium of neonates. Treatment, considering the stress distribution at the naso-orbital-complex and anterior fossa of the base of the skull, should begin in the second week of life, and treatment initiation of preterm infants should be adapted respectively.
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Assessment modalities of non-ionizing three-dimensional images for the quantification of facial morphology, symmetry, and appearance in cleft lip and palate: a systematic review. Int J Oral Maxillofac Surg 2018; 47:1095-1105. [DOI: 10.1016/j.ijom.2018.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/08/2018] [Accepted: 05/17/2018] [Indexed: 11/20/2022]
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Abstract
Wide bilateral cleft lip deformity reconstruction represents a special difficulty as it affects the lip, nose, and maxillary segments making single-stage reconstruction sometimes unobtainable. Many surgical and nonsurgical techniques have been prescribed to facilitate the definitive repair. Although some of these techniques proved to be useful, they have their inherent limitations and add another treatment step with all its possible complications and costs. The authors present a new method to address muscle layer repair in 1-stage procedure. It entails using fascial graft obtained from the temporalis muscle fascia or fascia lata, to reconstruct orbicularis oris lip muscle. Seven patients of wide bilateral cleft lip deformity (mean 17 mm) with a mean age of 4.4 months were subjected to single-stage lip reconstruction. After measuring the defect between both lateral muscle segments in front of the premaxilla intraoperatively ensuring that direct muscle repair could not be obtained, a fascial graft was harvested and sutured to both muscle edges. The authors found that, regardless the defect size or premaxilla protrusion, all wide clefts could be reconstructed satisfactorily in 1 stage procedure. No serious postoperative complications have been encountered in the lip or donor areas. Early follow-up reporting of the patients revealed stable repair. However more follow-up is still needed to assess late sequelae. In conclusion, fascial graft muscle repair of wide bilateral cleft lip deformity enables early 1-stage lip reconstruction without tension. The added donor morbidity is minimal and well tolerated.
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Akarsu-Guven B, Arisan A, Ozgur F, Aksu M. Influence of nasoalveolar molding on skeletal development in patients with unilateral cleft lip and palate at 5 years of age. Am J Orthod Dentofacial Orthop 2018; 153:489-495. [PMID: 29602340 DOI: 10.1016/j.ajodo.2017.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The aim of this retrospective study was to assess the influence of presurgical nasoalveolar molding (NAM) on skeletal development in patients with operated unilateral cleft lip and palate at 5 years of age. MATERIALS Lateral cephalometric radiographs of 26 unilateral cleft lip and palate patients who had undergone presurgical NAM (NAM group) and 20 unilateral cleft lip and palate patients who did not have any presurgical NAM (non-NAM group) were analyzed. The radiographs were digitally traced using Quick Ceph Studio software (version 3.5.1.r (1151); Quick Ceph Systems, San Diego, Calif). Independent samples t tests were performed for statistical analysis. RESULTS No significant differences were observed in sagittal and vertical skeletal measurements between the NAM and non-NAM groups. CONCLUSIONS NAM resulted in no significant difference in skeletal development in unilateral cleft lip and palate patients compared with those without NAM in early childhood.
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Affiliation(s)
- Bengisu Akarsu-Guven
- Department of Orthodontics, Faculty of Dentistry, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey
| | - Arda Arisan
- Department of Orthodontics, Faculty of Dentistry, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey
| | - Figen Ozgur
- Department of Plastic, Reconstructive and Esthetic Surgery, Faculty of Medicine, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey
| | - Muge Aksu
- Department of Orthodontics, Faculty of Dentistry, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey.
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Peanchitlertkajorn S, Mercado A, Daskalogiannakis J, Hathaway R, Russell K, Semb G, Shaw W, Lamichane M, Fessler J, Long RE. An Intercenter Comparison of Dental Arch Relationships and Craniofacial Form Including a Center Using Nasoalveolar Molding. Cleft Palate Craniofac J 2018; 55:821-829. [DOI: 10.1597/16-018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To compare dental arch relationship and craniofacial morphology of patients with CUCLP in pre-adolescence from five cleft centers including a center using NAM. Design: Retrospective cohort study. Setting: Five cleft centers in North America. Patients: One hundred eighty-two subjects with repaired CUCLP from the five cleft centers participated in the craniofacial form study. One hundred forty-eight subjects from four of the five centers participated in the dental arch relationship study. Methods: Digital dental models were assessed using the GOSLON Yardstick. Eighteen cephalometric measurements were performed. Measurement means, by center, were compared. Analysis of variance and Tukey-Kramer analysis were used to compare GOSLON scores and cephalometric measurements. Results: The center that performed neither PSOT (including NAM) nor primary bone grafting exhibited the most favorable mean GOSLON score. The same center also showed the highest mean SNA, ANB, and ANS-N-Pg angles. However, the mean ANB and ANS-N-Pg angles were not significantly different from those of the center using NAM. No statistically significant differences were seen for mandibular prominence, vertical dimensions, or dental inclinations. The center with NAM also showed a significantly smaller nasoform angle than two of the four other centers. Conclusion: The centers that used NAM and other forms of PSOT did not have better dental arch relationships or craniofacial morphology compared with the centers that performed only primary lip repair. However, this study was not designed to investigate the cause-and-effect relationship between specific outcomes and particular features of those protocols.
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Hosseini HR, Kaklamanos EG, Athanasiou AE. Treatment outcomes of pre-surgical infant orthopedics in patients with non-syndromic cleft lip and/or palate: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2017; 12:e0181768. [PMID: 28742129 PMCID: PMC5524403 DOI: 10.1371/journal.pone.0181768] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/05/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-syndromic clefts lip and/or palate (CL/P) defects may have manifold significant and detrimental consequences for the affected individuals and their family environment. Although the use of pre-surgical infant orthopedics (PSIO) was introduced as a means to improve management and treatment outcomes, there still remains a controversy. OBJECTIVE To investigate the effectiveness of PSIO in patients with non-syndromic CL/P and evaluate the quality of the available evidence. SEARCH METHODS Search without restrictions, together with hand searching, until May 2016. SELECTION CRITERIA Randomized clinical trials investigating the effects of pre-surgical infant orthopedic appliances. DATA COLLECTION AND ANALYSIS Following study retrieval and selection, data extraction and individual study risk of bias assessment using the Cochrane Risk of Bias Tool took place. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach. RESULTS Finally 20 papers (3 unique trials) were identified, involving a total of 118 patients with unilateral complete CL/P and 16 with cleft of the soft and at least two thirds of the hard palate. Eight publications were considered as being of low, four of unclear and eight of high risk of bias. In general, the investigated appliances did not present significant effects when compared to each other or to no treatment in terms of feeding and general body growth, facial esthetics, cephalometric variables, maxillary dentoalveolar variables and dental arch relationships, speech and language evaluation, caregiver-reported outcomes, economic evaluation, as well as, adverse effects and problems. Overall, the quality of the available evidence was considered low. CONCLUSIONS The aforementioned findings could provide initial guidance in the clinical setting. However, given the multitude of parameters, which may have affected the results, good practice would suggest further research, in order to reach more robust relevant recommendations for management decisions in individual cases.
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Affiliation(s)
- Hamid Reza Hosseini
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Eleftherios G. Kaklamanos
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Athanasios E. Athanasiou
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Maillard S, Retrouvey JM, Ahmed MK, Taub PJ. Correlation between Nasoalveolar Molding and Surgical, Aesthetic, Functional and Socioeconomic Outcomes Following Primary Repair Surgery: a Systematic Review. J Oral Maxillofac Res 2017; 8:e2. [PMID: 29142654 PMCID: PMC5676312 DOI: 10.5037/jomr.2017.8302] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 05/29/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The authors performed a systematic review to evaluate the potential beneficial effects of the nasoalveolar molding appliance on nonsyndromic unilateral clefts of the lip and/or palate prior to primary lip repair. MATERIAL AND METHODS A literature search was performed using three electronic databases (PubMed, Embase, Web of Science) and three journals ("Cleft Palate-Craniofacial Journal", "Plastic and Reconstructive Surgery Journal" and "American Journal of Orthodontics and Dentofacial Orthopaedic") from January 1980 to April 2017. Data extraction was performed with tables treating different subjects: surgical, aesthetical, functional, socio-economical effects of nasoalveolar molding (NAM) appliances and the evolution of NAM appliances, especially three-dimensional technology. RESULTS Of the 145 articles retrieved in the literature surveys, 28 were qualified for the final analysis and 20 studies were excluded because of their small sample size (less than 10 patients) and/or too long follow-up (exceeded 18 months). Four randomized controlled trials were available. Although literature allowed discussing the short-term benefits of NAM appliance and the three-dimensional technology, scientific evidence is lacking. CONCLUSIONS Based on the results, nasoalveolar molding appliances have positive surgical, aesthetical, functional and socio-economical effects on unilateral clefts of the lip and/or palate treatment before the primary repair surgeries. Three-dimensional technology results in a more efficient and predictable nasoalveolar molding appliance treatment. However, nasoalveolar molding appliance effect in a short term remains unclear with the available literature. Further studies that integrate three-dimensional technology in a large scale are still needed.
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Affiliation(s)
- Sophie Maillard
- Division of Orthodontics, Faculty of Dentistry, McGill University, Montreal, QuebecCanada.
| | - Jean-Marc Retrouvey
- Division of Orthodontics, Faculty of Dentistry, McGill University, Montreal, QuebecCanada.
| | - Mairaj K. Ahmed
- Departments of Dentistry/Oral/Maxillofacial Surgery, Otolaryngology, and Surgery. Mount Sinai Cleft and Craniofacial Center, Icahn School of Medicine at Mount Sinai, New YorkUSA.
| | - Peter J. Taub
- Departments of Dentistry, Pediatrics, Surgery and Medical Education, Mount Sinai Cleft and Craniofacial Center, Icahn School of Medicine at Mount Sinai, New YorkUSA.
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Hardwicke J, Nassimizadeh M, Richard B. Reporting of Randomized Controlled Trials in Cleft Lip and Palate: A 10-Year Review. Cleft Palate Craniofac J 2017; 54:142-152. [PMID: 26101810 DOI: 10.1597/14-267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives Reviews of the quality of reporting of randomized controlled trials (RCTs) have recently been conducted in different surgical specialties. In this review of RCTs relating to cleft lip, cleft palate, and cleft lip and palate (CL/P), we investigate the quality of reporting against the Consolidated Standards of Reporting Trials (CONSORT) checklist. Design A systematic review of CL/P RCTs published from 2004 to 2013, with the included articles scored against the CONSORT checklist. Patients, Participants The literature search identified 174 articles. Studies were selected for participants with CL/P who were involved in an RCT with prospective data collection and reported in a full journal article. A total of 6352 participants were included from 65 CUP RCTs during the study period. Main Outcome Measures The methodological quality of RCTs was assessed using the CONSORT checklist and Jadad scale. Results The mean CONSORT score was 15.8, and the mean Jadad score was 3.3. There was a significant positive correlation between the CONSORT and Jadad score ( P < .0001, ρ = .47). The only significant correlation showed that with an increasing number of authors, both the CONSORT and the Jadad score increased. Conclusion This analysis has shown that that there are deficiencies in the transparent reporting of factors such as randomization implementation, blinding, and participant flow. Interventions, outcomes, and the interpretation of results are well presented. We would recommend that RCTs are conceived and undertaken using the CONSORT checklist and reported in a clear and reproducible manner.
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Affiliation(s)
- Joseph Hardwicke
- West Midlands Cleft Lip and Palate Service, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom, and School of Dentistry, University of Birmingham, Birmingham, United Kingdom
| | - Mohammad Nassimizadeh
- West Midlands Cleft Lip and Palate Service, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Bruce Richard
- West Midlands Cleft Lip and Palate Service, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
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Rodman RE, Tatum S. Controversies in the Management of Patients with Cleft Lip and Palate. Facial Plast Surg Clin North Am 2016; 24:255-64. [DOI: 10.1016/j.fsc.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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: 10] [Impact Index Per Article: 1.3] [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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25
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Gandedkar NH, Kiat CC, Kanesan P, Lee WC, Chen PY, Leng Yeow VK. Presurgical nasoalveolar molding therapy in cleft lip and palate individuals: Case series and review. APOS TRENDS IN ORTHODONTICS 2015. [DOI: 10.4103/2321-1407.163424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The nasoalveolar molding (NAM) therapy is advocated to reduce the severity of alveolar cleft and nasal deformity. NAM therapy has demonstrated to be an effective method for reducing cleft and improve nose anatomy. This paper presents a case report of three cleft lip and palate individuals treated with NAM therapy. Furthermore, the paper highlights the advantages of NAM therapy along with an enumeration of literature suggesting in favor of NAM therapy and otherwise. Regardless of controversies and divergent views involved with NAM therapy, the immediate success of NAM therapy facilitating primary lip repair surgery cannot be under-emphasized.
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Affiliation(s)
- Narayan H. Gandedkar
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Chng Chai Kiat
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Palaniselvam Kanesan
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Wen Cong Lee
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Por Yong Chen
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Vincent Kok Leng Yeow
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
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Noverraz RLM, Disse MA, Ongkosuwito EM, Kuijpers-Jagtman AM, Prahl C. Transverse dental arch relationship at 9 and 12 years in children with unilateral cleft lip and palate treated with infant orthopedics: a randomized clinical trial (DUTCHCLEFT). Clin Oral Investig 2015; 19:2255-65. [PMID: 25855466 PMCID: PMC4656704 DOI: 10.1007/s00784-015-1451-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 03/11/2015] [Indexed: 11/30/2022]
Abstract
Objective A long-term evaluation to assess the transverse dental arch relationships at 9 and 12 years of age in unilateral cleft lip and palate treated with or without infant orthopedics (IO). The hypothesis is that IO has no effect on the transverse dental arch relationship. Material and methods A prospective two-arm randomized controlled trial (DUTCHCLEFT) in three academic cleft palate centers (Amsterdam, Nijmegen and Rotterdam, the Netherlands). Fifty-four children with complete unilateral cleft lip and palate and no other malformations were enrolled in this evaluation. One group wore passive maxillary plates (IO+) during the first year of life, and the other group did not (IO−). Until the age of 1.5, all other interventions were the same. Hard palate was closed simultaneously with bone grafting according to protocol of all teams. Orthodontic treatment was performed when indicated. The transverse dental arch relationship was assessed on dental casts using the modified Huddart/Bodenham score to measure the maxillary arch constriction at 9 and 12 years of age. Results No significant differences were found between the IO+ and IO− groups. Differences between the centers increased from 9 to 12 years of age. Conclusions Transverse dental arch relationships at 9 and 12 years of age do not differ between children with UCLP treated with or without IO. Clinical relevance There is no orthodontic need to perform IO as applied in this study in children with UCLP.
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Affiliation(s)
- R L M Noverraz
- Department of Orthodontics, Academic Centre for Dentistry Amsterdam (ACTA), Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - M A Disse
- Department of Orthodontics, Academic Centre for Dentistry Amsterdam (ACTA), Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - E M Ongkosuwito
- Department of Orthodontics and Craniofacal Biology and Cleft Palate Craniofacial Centre, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A M Kuijpers-Jagtman
- Department of Orthodontics and Craniofacal Biology and Cleft Palate Craniofacial Centre, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C Prahl
- Department of Orthodontics, Academic Centre for Dentistry Amsterdam (ACTA), Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.
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Niranjane PP, Kamble RH, Diagavane SP, Shrivastav SS, Batra P, Vasudevan SD, Patil P. Current status of presurgical infant orthopaedic treatment for cleft lip and palate patients: A critical review. Indian J Plast Surg 2015; 47:293-302. [PMID: 25593413 PMCID: PMC4292105 DOI: 10.4103/0970-0358.146573] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Rehabilitation of cleft lip and palate (CLP) patients is a challenge for all the concerned members of the cleft team, and various treatment modalities have been attempted to obtain aesthetic results. Presurgical infant orthopaedics (PSIO) was introduced to reshape alveolar and nasal segments prior to surgical repair of cleft lip. However, literature reports lot of controversy regarding the use of PSIO in patients with CLP. Evaluation of long-term results of PSIO can provide scientific evidence on the efficacy and usefulness of PSIO in CLP patients. The aim was to assess the scientific evidence on the efficiency of PSIO appliances in patients with CLP and to critically analyse the current status of PSIO. A PubMed search was performed using the terms PSIO, presurgical nasoalveolar moulding and its long-term results and related articles were selected for the review. The documented studies report no beneficial effect of PSIO on maxillary arch dimensions, facial aesthetics and in the subsequent development of dentition and occlusion in CLP patients. Nasal moulding seems to be more beneficial and effective in unilateral cleft lip and palate patients with better long-term results.
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Affiliation(s)
- P Priyanka Niranjane
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
| | - R H Kamble
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
| | - S Pallavi Diagavane
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
| | - S Sunita Shrivastav
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
| | - Puneet Batra
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Modinagar, Kadrabad, Meerut, Uttar Pradesh, India
| | - S D Vasudevan
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
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Grayson BH, Garfinkle JS. Early cleft management: the case for nasoalveolar molding. Am J Orthod Dentofacial Orthop 2014; 145:134-42. [PMID: 24485726 DOI: 10.1016/j.ajodo.2013.11.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Barry H Grayson
- Associate professor of surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - Judah S Garfinkle
- Assistant professor of plastic surgery and orthodontics, and director of Craniofacial Orthodontics, Oregon Health and Science University, Portland; private practice, Portland, Ore.
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Hathaway RR, Long RE. Early cleft management: in search of evidence. Am J Orthod Dentofacial Orthop 2014; 145:135-41. [PMID: 24485727 DOI: 10.1016/j.ajodo.2013.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ron R Hathaway
- Former director, Craniofacial Center, Peyton Manning's Children's Hospital at St Vincent, Indianapolis, Ind.
| | - Ross E Long
- Director, Lancaster Cleft Palate Clinic, Lancaster, Pa
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30
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Measuring Value at the Provider Level in the Management of Cleft Lip and Palate Patients. Ann Plast Surg 2014; 72:312-7. [DOI: 10.1097/sap.0b013e318268a960] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maxillary reaction patterns identified by three-dimensional analysis of casts from infants with unilateral cleft lip and palate. J Orofac Orthop 2013; 74:275-86. [DOI: 10.1007/s00056-013-0153-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 12/07/2012] [Indexed: 11/26/2022]
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de Ladeira PRS, Alonso N. Protocols in cleft lip and palate treatment: systematic review. PLASTIC SURGERY INTERNATIONAL 2012; 2012:562892. [PMID: 23213503 PMCID: PMC3503280 DOI: 10.1155/2012/562892] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/24/2012] [Indexed: 11/17/2022]
Abstract
Objectives. To find clinical decisions on cleft treatment based on randomized controlled trials (RCTs). Method. Searches were made in PubMed, Embase, and Cochrane Library on cleft lip and/or palate. From the 170 articles found in the searches, 28 were considered adequate to guide clinical practice. Results. A scarce number of RCTs were found approaching cleft treatment. The experimental clinical approaches analyzed in the 28 articles were infant orthopedics, rectal acetaminophen, palatal block with bupivacaine, infraorbital nerve block with bupivacaine, osteogenesis distraction, intravenous dexamethasone sodium phosphate, and alveoloplasty with bone morphogenetic protein-2 (BMP-2). Conclusions. Few randomized controlled trials were found approaching cleft treatment, and fewer related to surgical repair of this deformity. So there is a need for more multicenter collaborations, mainly on surgical area, to reduce the variety of treatment modalities and to ensure that the cleft patient receives an evidence-based clinical practice.
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Affiliation(s)
| | - Nivaldo Alonso
- Division of Burns and Plastic Surgery, Department of Surgery, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Rua Afonso Brás, 473 cj 65 Vila Nova Conceição, 04511-000 São Paulo, SP, Brazil
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de Menezes LM, Rizzatto SMD, Allgayer S, Heitz C, Burnett LH. The importance of interdisciplinary approach for managing cleft lip and palate: a case report. J World Fed Orthod 2012. [DOI: 10.1016/j.ejwf.2012.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Papadopoulos MA, Koumpridou EN, Vakalis ML, Papageorgiou SN. Effectiveness of pre-surgical infant orthopedic treatment for cleft lip and palate patients: a systematic review and meta-analysis. Orthod Craniofac Res 2012; 15:207-36. [DOI: 10.1111/j.1601-6343.2012.01552.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Brons S, van Beusichem ME, Bronkhorst EM, Draaisma J, Bergé SJ, Maal TJ, Kuijpers-Jagtman AM. Methods to quantify soft-tissue based facial growth and treatment outcomes in children: a systematic review. PLoS One 2012; 7:e41898. [PMID: 22879898 PMCID: PMC3412871 DOI: 10.1371/journal.pone.0041898] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/28/2012] [Indexed: 01/03/2023] Open
Abstract
Context Technological advancements have led craniofacial researchers and clinicians into the era of three-dimensional digital imaging for quantitative evaluation of craniofacial growth and treatment outcomes. Objective To give an overview of soft-tissue based methods for quantitative longitudinal assessment of facial dimensions in children until six years of age and to assess the reliability of these methods in studies with good methodological quality. Data Source PubMed, EMBASE, Cochrane Library, Web of Science, Scopus and CINAHL were searched. A hand search was performed to check for additional relevant studies. Study Selection Primary publications on facial growth and treatment outcomes in children younger than six years of age were included. Data Extraction Independent data extraction by two observers. A quality assessment instrument was used to determine the methodological quality. Methods, used in studies with good methodological quality, were assessed for reliability expressed as the magnitude of the measurement error and the correlation coefficient between repeated measurements. Results In total, 47 studies were included describing 4 methods: 2D x-ray cephalometry; 2D photography; anthropometry; 3D imaging techniques (surface laser scanning, stereophotogrammetry and cone beam computed tomography). In general the measurement error was below 1 mm and 1° and correlation coefficients range from 0.65 to 1.0. Conclusion Various methods have shown to be reliable. However, at present stereophotogrammetry seems to be the best 3D method for quantitative longitudinal assessment of facial dimensions in children until six years of age due to its millisecond fast image capture, archival capabilities, high resolution and no exposure to ionizing radiation.
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Affiliation(s)
- Sander Brons
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Peterson-Falzone SJ. Adali N, Mars M, Petrie A, Noar J, Somerlad B. Presurgical orthopedics has no effect on archform in unilateral cleft lip and palate. Cleft Palate Craniofac J. 2012;49(1):5-13. Cleft Palate Craniofac J 2012; 49:764-5. [PMID: 22591140 DOI: 10.1597/12-037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Fudalej P, Katsaros C, Dudkiewicz Z, Offert B, Piwowar W, Kuijpers M, Kuijpers-Jagtman AM. Dental arch relationships following palatoplasty for cleft lip and palate repair. J Dent Res 2011; 91:47-51. [PMID: 21984705 DOI: 10.1177/0022034511425674] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Palatal scarring is assumed to be a primary cause of facial growth derangement in cleft lip and palate. Evidence supporting this hypothesis is confounded by the clinical involvement of various surgeons, and therefore definitive conclusions are not possible. In this study, we investigated the dental arch relationship in two groups, Exposed (47 children; 11.2 yrs) and Unexposed (61 children; 11.2 yrs), with a unilateral cleft lip and palate operated on by the same surgeon. The technique of hard palate repair differed between the two groups. In the Exposed group, palatal bone of the non-cleft side only was left denuded, inducing scar formation. In the Unexposed group, a vomerplasty with tight closure of the soft tissues was applied. Three raters graded the dental arch relationship and palatal morphology using the EUROCRAN Index. The dental arch relationship in the Exposed group was less favorable than in the Unexposed group (p = 0.009). Palatal morphology in both groups was comparable (p = 0.323). This study demonstrates that reduction of denuded bony areas on the palate after palatal repair with a vomer flap had a favorable effect on the dental arch relationship. For palatal morphology, no effect of the type of palatal repair was found.
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Affiliation(s)
- P Fudalej
- Department of Orthodontics and Craniofacial Biology, Kasprzaka Str. 17a, Warsaw, Poland.
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Uzel A, Alparslan ZN. Long-Term Effects of Presurgical Infant Orthopedics in Patients with Cleft Lip and Palate: A Systematic Review. Cleft Palate Craniofac J 2011; 48:587-95. [DOI: 10.1597/10-008] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to assess the scientific evidence on the efficiency of presurgical infant orthopedic appliances in patients with cleft lip and palate to shed light on a specific, contemporary discussion of whether the appliances have long-term advantages with respect to treatment outcomes. Design A systematic review. Method Two literature surveys from the five electronic databases were performed with a 1-month interval. Randomized controlled trials and controlled clinical trials (controls had no presurgical infant orthopedics) that had follow-up periods of a minimum of 6 years were included in the study. The exceptions to the follow-up limit were studies related to feeding and parent satisfaction. Results Of the 319 articles retrieved in the literature surveys, 12 were qualified for the final analysis. The level of evidence of these articles ranged from 1b to 4. Eight randomized controlled trials and four controlled clinical trials were available on eight treatment outcomes. The longest follow-up period of the randomized controlled trials was 6 years. No randomized controlled trials were found on active presurgical infant orthopedic appliances and on nasoalveolar molding appliances. Conclusions Based on the results, presurgical infant orthopedic appliances have no long-term positive effects on seven of the eight studied treatment outcomes in patients with cleft lip and palate. More randomized controlled trials need to be done to have evidence regarding the effects of presurgical infant orthopedics in different surgical protocols. Also, the encouraging results about the effect of nasolaveolar molding appliances on nasal symmetry have to be supported by future randomized controlled trials.
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Affiliation(s)
- Aslihan Uzel
- Department of Orthodontics, Faculty of Dentistry
| | - Z. Nazan Alparslan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Çukurova University, Adana, Turkey
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Infant Orthopedics in Cleft Lip and Palate have No Effect on Maxillary Arch Dimensions in Children Younger than Age 6. J Evid Based Dent Pract 2011; 11:38-40. [DOI: 10.1016/j.jebdp.2010.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bessell A, Hooper L, Shaw WC, Reilly S, Reid J, Glenny A. Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate. Cochrane Database Syst Rev 2011; 2011:CD003315. [PMID: 21328261 PMCID: PMC7144736 DOI: 10.1002/14651858.cd003315.pub3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cleft lip and cleft palate are common birth defects, affecting about one baby of every 700 born. Feeding these babies is an immediate concern and there is evidence of delay in growth of children with a cleft as compared to those without clefting. In an effort to combat reduced weight for height, a variety of advice and devices are recommended to aid feeding of babies with clefts. OBJECTIVES This review aims to assess the effects of these feeding interventions in babies with cleft lip and/or palate on growth, development and parental satisfaction. SEARCH STRATEGY The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 27 October 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE via OVID (1950 to 27 October 2010), EMBASE via OVID (1980 to 27 October 2010), PsycINFO via OVID (1950 to 27 October 2010) and CINAHL via EBSCO (1980 to 27 October 2010). Attempts were made to identify both unpublished and ongoing studies. There was no restriction with regard to language of publication. SELECTION CRITERIA Studies were included if they were randomised controlled trials (RCTs) of feeding interventions for babies born with cleft lip, cleft palate or cleft lip and palate up to the age of 6 months (from term). DATA COLLECTION AND ANALYSIS Studies were assessed for relevance independently and in duplicate. All studies meeting the inclusion criteria were data extracted and assessed for validity independently by each member of the review team. Authors were contacted for clarification or missing information whenever possible. MAIN RESULTS Five RCTs with a total of 292 babies, were included in the review. Comparisons made within the RCTs were squeezable versus rigid feeding bottles (two studies), breastfeeding versus spoon-feeding (one study) and maxillary plate versus no plate (two studies). No statistically significant differences were shown for any of the primary outcomes when comparing bottle types, although squeezable bottles were less likely to require modification. No difference was shown for infants fitted with a maxillary plate compared to no plate. However, there was some evidence of an effect on weight at 6 weeks post-surgery in favour of breastfeeding when compared to spoon-feeding (mean difference 0.47; 95% confidence interval 0.20 to 0.74). AUTHORS' CONCLUSIONS Squeezable bottles appear easier to use than rigid feeding bottles for babies born with clefts of the lip and/or palate, however, there is no evidence of a difference in growth outcomes between the bottle types. There is weak evidence that breastfeeding is better than spoon-feeding following surgery for cleft. There was no evidence to suggest that maxillary plates assist growth in babies with clefts of the palate. No evidence was found to assess the use of any types of maternal advice and/or support for these babies.
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Affiliation(s)
- Alyson Bessell
- University of BristolDepartment of Oral and Dental SciencesLower Maudlin StreetBristolUKBS1 2LY
| | - Lee Hooper
- University of East AngliaSchool of Medicine, Health Policy & PracticeNorwichUKNR4 7TJ
| | - William C Shaw
- School of Dentistry, The University of ManchesterDepartment of OrthodonticsCoupland 3 Building, Oxford RoadManchesterUKM13 9PL
| | - Sheena Reilly
- University of MelbourneDepartment of PediatricsMelbourneVictoriaAustralia
| | - Julie Reid
- Royal Children's HospitalSpeech Pathology DepartmentMelbourneAustralia
| | - Anne‐Marie Glenny
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
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