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Haque S, Khamis MF, Alam MK, Wan Ahmad AWM. The Assessment of 3D Digital Models Using GOSLON Yardstick Index: Exploring Confounding Factors Responsible for Unfavourable Treatment Outcome in Multi-Population Children With UCLP. Front Pediatr 2021; 9:646830. [PMID: 34262887 PMCID: PMC8273310 DOI: 10.3389/fped.2021.646830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
To evaluate dental arch relationship (DAR) using GOSLON Yardstick and also to explore the association between multiple factors (age, gender, UCLP types, UCLP side, Family history of cleft, family history of Class III malocclusion, techniques of cheiloplasty, techniques of palatoplasty) and DAR in children unilateral cleft lip and palate (UCLP) in different populations. Two hundred fifty-five laser scanned 3D digital models (LS3DM) of UCLP children (5-12 years) from Malaysia, Bangladesh, and Pakistan were included. The intra- and inter-examiner agreements were evaluated by kappa statistics, to compare the GOSLON mean score between the populations and to explore the responsible factors that affect DAR, one way ANOVA, and crude logistic regression analysis was used, respectively. The mean GOSLON score was 2.97; 3.40 and 3.09 in Malaysia, Bangladesh, and Pakistan, respectively. Twenty seven, 40, and 30 subjects were in unfavourable (category rating 4 and 5) groups in Malaysia, Bangladesh, and Pakistan, respectively. A significant association was found between techniques of palatoplasty (p = 0.03; p = 0.04 and p = 0.04 in Malaysia, Bangladesh, and Pakistan, respectively) and unfavourable DAR. Different cheiloplasty techniques (p = 0.04) and gender (p = 0.03) also exhibited noteworthy associations with unfavourable DAR in the Bangladeshi population. Bardach techniques of palatoplasty were significantly associated with unfavourable DAR in all three populations. Moreover, male UCLP and modified Millard techniques of cheiloplasty were also associated with unfavourable DAR in the Bangladeshi population.
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Affiliation(s)
- Sanjida Haque
- Orthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Mohd Fadhli Khamis
- Oral Biology and Forensic Odontology Unit, School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.,Forensic Odontology Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
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Pegelow M, Rizell S, Karsten A, Mark H, Lilja J, Chalien MN, Lemberger M, Peterson P, Fitzsimons K, Deacon S, Medina J, Calvert M, Mars M. Reliability and Predictive Validity of Dental Arch Relationships Using the 5-Year-Olds’ Index and the GOSLON Yardstick to Determine Facial Growth. Cleft Palate Craniofac J 2020; 58:619-627. [DOI: 10.1177/1055665620960971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims: To determine reliability and predictive validity of the 5-year-olds’(5YO) Index and GOSLON Yardstick in 119 patients born with unilateral cleft lip and palate at 5, 7/8, 10, 15/16, and 19 years. Methods: Five hundred thirty-four dental study models were appraised by 2 teams in 2 centers, twice in each center. Intrateam and interteam reliability in scoring the models was calculated using κ. Dental arch prediction rates were calculated as the proportion of models remaining in the same category (good–scores 1 and 2; fair–score 3; poor–scores 4 and 5) over time. Results: Intrateam and interteam κ statistics ranged from 0.74 to 0.89 and from 0.74 to 0.81, respectively. The 5YO Index and GOSLON Yardstick at 5 years produced almost identical results. The prediction rate of 19-year-old (n = 106) outcome was >80% for those in groups 1 and 2 at 5 years, while for those in groups 4 and 5 prediction was poor (<40%). Prediction of groups 4 and 5 remained poor until 10 years when it increased to 77%. At 15/16 years prediction rate was 93% for those in groups 4 and 5. Prediction of cases in group 3 was very poor at all ages. Conclusions: These results question the predictive value of “poor” dental arch relationships before 10 years of age. However, the predictive value of “good” dental arch relationship scores over time is good in all age groups. This has implications for audit policies to predict facial growth outcomes.
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Affiliation(s)
- Marie Pegelow
- Unit of Orthodontics, Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm Craniofacial Team, Stockholm, Sweden
| | - Sara Rizell
- Clinic of Orthodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Sweden
| | - Agneta Karsten
- Unit of Orthodontics, Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm Craniofacial Team, Stockholm, Sweden
| | - Hans Mark
- Institute of Clinical Sciences, Department of Plastic Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Lilja
- Institute of Clinical Sciences, Department of Plastic Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Midia Najar Chalien
- Clinic of Orthodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Sweden
| | - Mathias Lemberger
- Unit of Orthodontics, Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm Craniofacial Team, Stockholm, Sweden
| | - Petra Peterson
- Department of Plastic and Craniofacial Surgery, Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - Kate Fitzsimons
- Clinical Effectiveness Unit, Royal College of Surgeons, London, United Kingdom
| | - Scott Deacon
- University Hospitals Bristol NHS Foundation Trust, United Kingdom
| | - Jibby Medina
- Clinical Effectiveness Unit, Royal College of Surgeons, London, United Kingdom
| | - Mary Calvert
- Formerly, Maxillofacial and Dental Department, Hospital for Children, Great Ormond Street, London, United Kingdom
| | - Michael Mars
- Formerly, Cleft lip and Palate Team, Hospital for Children, Great Ormond Street, London, United Kingdom
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Unilateral Cleft Lip and Palate Surgical Protocols and Facial Growth Outcomes. J Craniofac Surg 2018; 29:1562-1568. [DOI: 10.1097/scs.0000000000004810] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Peterson P, Mars M, Gowans A, Larson O, Neovius E, Henningsson G, Andlin-Sobocki A, Pegelow M, Lemberger M, Raud-Westberg LM, Karsten ALA. Mean GOSLON Yardstick Scores After 3 Different Treatment Protocols—A Long-term Study of Patients With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2018; 56:236-247. [DOI: 10.1177/1055665618774010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: (1) To evaluate dental arch relationships, with the Great Ormond Street, London and Oslo (GOSLON) Yardstick, of participants with Unilateral cleft lip and palate (UCLP) and treated with 1-stage palatal closure with 3 different surgical protocols (2) to compare the mean GOSLON ratings with other CLP centers. Design: Retrospective study of medical charts and dental models. Setting: Karolinska University Hospital, Stockholm, Sweden. Participants: Eighty-seven patients with UCLP operated with 1-stage palatal repair. Thirty-five were operated with Veau-Wardill-Kilner (VWK) technique 1975 to 1986, 31 with minimal incision technique (MIT) from 1987 to 1997, and 21 according to MIT with muscle reconstruction (MITmr) 1998 to 2004. Interventions: Dental casts at ages 5 (n = 87), 7 to 8 (n = 27), 10 (n = 81), 16 (n = 61), and 19 (n = 35) years were rated by 10 assessors with the GOSLON Yardstick. Information of other interventions was retrieved from patients’ charts. Main outcome measures: Mean GOSLON ratings. Results: A total of 82% of the participants were rated as having excellent to satisfactory outcome. Weighted κ statistics for the 10 assessors was good for inter-rater agreement and good/very good for intra-rater agreement. Conclusions: The mean GOSLON score in the Stockholm overall material at age 10 was 2.67. The VWK technique resulted in a greater need of orthognathic surgery than the MIT ( P < .01). The MITmr did not produce better dental arch relationships than MIT at age 5 ( P < .05). The best dental arch relationships were found in the MIT group at 10 years, mean 2.58, which is not significantly different from other centers with excellent outcome except Gothenburg and Vienna.
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Affiliation(s)
- Petra Peterson
- Department of Reconstructive Plastic Surgery, Stockholm Cranofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Mars
- Department of Orthodontics, Great Ormond Street Hospital, London, United Kingdom
| | - Alan Gowans
- Department of Orthodontics, Leeds Dental Institute and Royal, College of Surgeons of Edinburgh, United Kingdom
| | - Ola Larson
- Department of Reconstructive Plastic Surgery, Stockholm Cranofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Neovius
- Department of Reconstructive Plastic Surgery, Stockholm Cranofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - Gunilla Henningsson
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karoliniska Insitutet, Stockholm, Sweden
| | | | - Marie Pegelow
- Division of Orthodontics and Jaw Orthopedics, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mathias Lemberger
- Division of Orthodontics and Jaw Orthopedics, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Liisi M. Raud-Westberg
- Department of Reconstructive Plastic Surgery, Stockholm Cranofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta L-A Karsten
- Department of Reconstructive Plastic Surgery, Stockholm Cranofacial Team, Karolinska University Hospital, Stockholm, Sweden
- Division of Orthodontics, Department of Dental Medicine, Karolinska University Hospital, Stockholm, Sweden
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Buj-Acosta C, Paredes-Gallardo V, Montiel-Company JM, Albaladejo A, Bellot-Arcís C. Predictive validity of the GOSLON Yardstick index in patients with unilateral cleft lip and palate: A systematic review. PLoS One 2017; 12:e0178497. [PMID: 28570588 PMCID: PMC5453533 DOI: 10.1371/journal.pone.0178497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 05/14/2017] [Indexed: 12/02/2022] Open
Abstract
Among the various indices developed for measuring the results of treatment in patients born with unilateral cleft lip and palate (UCLP), the GOSLON Yardstick index is the most widely used to assess the efficacy of treatment and treatment outcomes, which in UCLP cases are closely linked to jaw growth. The aim of this study was to conduct a systematic review to validate the predictability of growth using the GOSLON Yardstick in patients born with UCLP. A systematic literature review was conducted in four Internet databases: Medline, Cochrane Library, Scopus and Embase, complemented by a manual search and a further search in the databases of the leading journals that focus on this topic. An electronic search was also conducted among grey literature. The search identified a total of 131 articles. Duplicated articles were excluded and after reading titles and abstracts, any articles not related to the research objective were excluded, leaving a total of 21 texts. After reading the complete text, only three articles fulfilled the inclusion criteria. The results showed a predictive validity of between 42.2% and 64.7%, which points to a lack of evidence in the literature for the predictive validity of the GOSLON Yardstick index used in children born with UCLP.
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Affiliation(s)
- Cindy Buj-Acosta
- Orthodontics Teaching Unit, Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Vanessa Paredes-Gallardo
- Orthodontics Teaching Unit, Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
- * E-mail:
| | - José María Montiel-Company
- Preventive Teaching Unit, Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Alberto Albaladejo
- Orthodontics Department, Faculty of Dentistry, University of Salamanca, Salamanca, Spain
| | - Carlos Bellot-Arcís
- Orthodontics Teaching Unit, Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Arshad AI, Alam MK, Khamis MF. Assessment of complete unilateral cleft lip and palate patients: Determination of factors effecting dental arch relationships. Int J Pediatr Otorhinolaryngol 2017; 92:70-74. [PMID: 28012538 DOI: 10.1016/j.ijporl.2016.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of the current study was to assess the treatment outcome of non-syndromic patients having complete unilateral cleft lip and palate (CUCLP) by using GOSLON index and to determine any association of pre and/or postnatal factors with the treatment outcome. MATERIALS AND METHODS One hundred and one sets of dental models of patients having CUCLP were assessed in this retrospective study. Five examiners that were blinded to case-specific information scored the dental models at two instances with an interval of two weeks to ensure memory bias elimination (5 × 101 × 2 = 1010 observations). Calibration courses were conducted prior to scoring and each examiner was provided with scoring sheets, pictures of GOSLON reference models and flowcharts explaining the scoring method. RESULTS According to GOSLON index, a mean (SD) GOSLON score of 3.04 (1.25) was determined. Based on treatment outcome groups, 62 patients had favorable (grade 1, 2, and 3) and 39 cases had unfavorable (grade 4 and 5) treatment outcome. Chi-square tests revealed a significant association of gender (P = 0.002), cheiloplasty (P = 0.001) and palatoplasty (P < 0.001) with the treatment outcome. These associations were further explored by entering five independent variables in the logistic regression models. CONCLUSIONS The current study found an intermediate treatment outcome of CUCLP cases using GOSLON index. Final logistic model showed that gender, cheiloplasty, and palatoplasty had significantly higher odds of influencing outcomes. Identification of these factors provides us an evidence of traditional and outdated surgical methods and encourages clinicians to adopt current techniques to improve treatment outcomes. This implementation will facilitate comparison between the traditional and current techniques of primary surgical repair.
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Affiliation(s)
- Anas Imran Arshad
- School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
| | | | - Mohd Fadhli Khamis
- Forensic Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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Urbanova W, Klimova I, Brudnicki A, Polackova P, Kroupova D, Dubovska I, Rachwalski M, Fudalej PS. The Slav-cleft: A three-center study of the outcome of treatment of cleft lip and palate. Part 1: Craniofacial morphology. J Craniomaxillofac Surg 2016; 44:1767-1776. [PMID: 27663676 DOI: 10.1016/j.jcms.2016.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/25/2016] [Accepted: 06/10/2016] [Indexed: 11/26/2022] Open
Abstract
Results of a comparison of the outcomes of treatment of cleft lip and palate can be affected by growth characteristics of populations from which subjects with the clefts are derived. Moreover, conventional cephalometric techniques used in cleft studies for analysis of facial morphology provide only a partial description of shape and are confounded by biases regarding the reference structures. In this retrospective comparison, craniofacial morphology of preadolescent patients with unilateral cleft lip and palate treated in Warsaw (n = 35, age = 10.6 years, SD = 1.2), Prague (n = 38, age = 11.6 years, SD = 1.4), and Bratislava (n = 26, age = 10.5 years, SD = 1.6) were evaluated on cephalograms with the cephalometric method used in the Eurocleft study and geometric morphometrics. We found that patients treated in Warsaw showed slightly more favorable outcomes than in Prague and Bratislava. The differences were related primarily to the position of maxillary alveolar process, cranial base, mandibular angle, and soft tissues. Although no association between a component of treatment protocol and the outcome was found, it is possible that organizational factors such as participation of high-volume, experienced surgeons contributed to these results.
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Affiliation(s)
- Wanda Urbanova
- Department of Orthodontics and Cleft Anomalies, Dental Clinic, 3rd Medical Faculty, Charles University, Faculty Hospital Royal Vineard, Šrobárova 50, 100 34 Prague 10, Czech Republic
| | - Irena Klimova
- Cleft Center, Clinic of Plastic and Reconstructive Surgery, Comenius University, Pažítková ul. č. 4, 821 01 Bratislava, Slovakia
| | - Andrzej Brudnicki
- Department of Pediatric Surgery, Institute of Mother and Child, Kasprzaka Str. 17a, 01-211 Warsaw, Poland
| | - Petra Polackova
- Department of Orthodontics and Cleft Anomalies, Dental Clinic, 3rd Medical Faculty, Charles University, Faculty Hospital Royal Vineard, Šrobárova 50, 100 34 Prague 10, Czech Republic
| | - Daniela Kroupova
- Cleft Center, Clinic of Plastic and Reconstructive Surgery, Comenius University, Pažítková ul. č. 4, 821 01 Bratislava, Slovakia
| | - Ivana Dubovska
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacky University Olomouc, Palackého 12, 779 00 Olomouc, Czech Republic
| | - Martin Rachwalski
- Department of Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Straße 62, 50937 Köln, Germany
| | - Piotr Stanislaw Fudalej
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacky University Olomouc, Palackého 12, 779 00 Olomouc, Czech Republic; Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland.
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Gurlen SO, Aras I, Dogan S. Nasopharyngeal Airway Volume for Different GOSLON Scores in Patients with Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2015; 52:e176-9. [DOI: 10.1597/14-119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study is to evaluate the nasopharyngeal airway volumes of patients with unilateral cleft lip and palate (UCLP) with different GOSLON scores. Methods The study sample consisted of 34 patients with UCLP and 20 controls with no cleft history. In the UCLP group, three experienced examiners used the GOSLON Yardstick to rate dental arch relationships, and the sample was divided into three groups as GOSLON 2 (G2) (n = 13), GOSLON 3 (G3) (n = 10), and GOSLON 4 (G4) (n = 11). Airway volumes were constructed using three-dimensional computed tomography data and divided into four compartments named the nasal airway, and superior, middle, and inferior pharyngeal airways. Results No statistically significant difference was detected among G2, G3, and G4 between the constitutive airway departments of the nasopharyngeal region. However, nasal airway volumes were significantly higher in the control group when compared with the UCLP group. Discussion Although there was no correlation among the investigated parameters, it is also a fact that airway capacities display a great variability among patients when investigated three dimensionally. Conclusion Although the severity of GOSLON scores might predetermine the extent of which the airways are affected from the cleft, a larger sample size is needed in future studies.
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Affiliation(s)
| | - I. Aras
- Ege University, School of Dentistry, Department of Orthodontics, Izmir, Turkey
| | - S. Dogan
- Ege University, School of Dentistry, Department of Orthodontics, Izmir, Turkey
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