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Effect of Bone-Borne Trans -Sutural Distraction Osteogenesis Therapy on the Cranial Base of Children With Midfacial Hypoplasia Due to Cleft Lip and Palate. J Craniofac Surg 2023; 34:551-555. [PMID: 36310153 DOI: 10.1097/scs.0000000000009101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/05/2022] [Indexed: 11/07/2022] Open
Abstract
Bone-borne trans -sutural distraction osteogenesis (TSDO) is widely used to treat midfacial hypoplasia in children with cleft lip and palate; however, its effects on the cranial base are still poorly understood. The authors aimed to study morphological changes in the cranial base after TSDO. Pre and postoperative computed tomography (CT) images of cleft lip and palate children with midfacial skeleton dysplasia who underwent TSDO were collected retrospectively, and their corresponding 3-dimensional models were measured. Results showed no significant change in the length of the anterior or posterior cranial fossa, but the length of the middle cranial fossa increased significantly. The anterior cranial base rotated upward with the sella turcica at the center, whereas the cranial base angle increased. The sphenoid bone exhibited morphological changes. Post-TSDO, the lateral plate of the pterygoid process increased in length. The angle of the 2 lateral plates of the pterygoid process, the greater wings of the sphenoid bone, and the smaller wings of the sphenoid bone decreased. Posterior inclination of the pterygoid process increased. Mean volume of the sphenoidal sinus increased postoperatively compared with the preoperative volume. Apparent changes in the cranial base after TSDO are primarily in the middle cranial fossa, manifesting as an increase in the sphenoid bone body length, expansion of the sphenoidal sinus volume, growth of the pterygoid process forward and downward, a decrease in the angle of both the greater and smaller wings of the sphenoid bone, and an increase in the posterior inclination of the pterygoid process.
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The Relationship Between Dental Agenesis and Maxillary Hypoplasia in Patients With Cleft Lip and Palate. J Craniofac Surg 2021; 32:2012-2015. [PMID: 33840758 DOI: 10.1097/scs.0000000000007555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Both dental agenesis and maxillary growth restriction are well-recognized sequelae in patients with unilateral cleft lip and palate, but their etiology remains controversial. The aim of this study was to evaluate the relationship between hypodontia and maxillary volume. A retrospective review of patients age 6 to 9 with Veau III (unilateral) cleft palate who underwent Cone Beam Computer Tomography in preparation for alveolar bone grafting at 2 major Children's Hospitals between 2010 and 2016 was conducted and serial panoramic radiographs were reviewed. Thirty-eight patients were identified that met inclusion criteria and had adequate imaging. Group 1 ("poor growers") consisted of the bottom 50% of Sella-Nasion-A point minus Sella-Nasion-B point (ANB) angles and Group 2 ("good growers") consisted of the top 50% of ANB angles. Group 1 had a significantly higher mean number of missing teeth (1.58 ± 0.28 missing teeth) compared to Group 2 (0.74 ± 0.23 missing teeth), and significantly lower maxillary volume (12.88 ± 0.61 cm3 versus 15.24 ± 0.88 cm3, respectively). The severity of maxillary hypoplasia in cleft patients increases with increased dental agenesis. These data indicate that intrinsic factors play a significant role in maxillary growth restriction in cleft patients, independent of the sequelae of surgical intervention.
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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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Batwa W, Almarhoon HA, Almoammar KA, Alqahtani N, Albarakati SF, Al-Jewair T. Dento-skeletal characteristics of cleft patients with missing teeth. Clin Cosmet Investig Dent 2018; 10:237-244. [PMID: 30519115 PMCID: PMC6233474 DOI: 10.2147/ccide.s170717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this study was to compare the cephalometric skeletal and dental characteristics of unilateral complete cleft lip and palate (UCCLP) subjects with and without missing teeth. Design A retrospective records review was conducted for patients who are being treated at the cleft lip and palate (CLP) clinics in the College of Dentistry. Methods Ninety-six consecutive records of non-syndromic UCCLP subjects were recruited (33 subjects without missing teeth, 50 subjects with only one missing tooth, and 13 subjects with two or more missing teeth). Skeletal and dental characteristics were assessed using lateral cephalometric radiographs in UCCLP subjects with missing teeth and compared to the group with no missing teeth. A total of 25 linear and angular measurements were analyzed and compared between the sample groups. Results Of the dental variables tested, overjet was significantly different between the three groups. The UCCLP subjects with multiple missing teeth had the smallest overjet (–3.89±2.75 mm; P=0.015) among the three groups. None of the skeletal characteristics reached statistical significance. Conclusion Missing teeth influence the dental but not skeletal characteristics of UCCLP. Overjet is significantly reduced in UCCLP subjects with multiple missing teeth. Future studies with larger sample sizes are warranted.
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Affiliation(s)
- Waeil Batwa
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Hala A Almarhoon
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Khalid A Almoammar
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Nasser Alqahtani
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Sahar F Albarakati
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Thikriat Al-Jewair
- Advanced Education Program in Orthodontics and Dentofacial Orthopedics, UMKC School of Dentistry, Kansas City, MO, USA
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Antonarakis GS, Tompson BD, Fisher DM. Preoperative Cleft Lip Measurements and Maxillary Growth in Patients with Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2016; 53:e198-e207. [DOI: 10.1597/14-274] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Maxillary growth in patients with cleft lip and palate is highly variable. The authors' aim was to investigate associations between preoperative cleft lip measurements and maxillary growth determined cephalometrically in patients with complete unilateral cleft lip and palate (cUCLP). Design Retrospective cross-sectional study. Patients Children with cUCLP. Methods Preoperative cleft lip measurements were made at the time of primary cheiloplasty and available for each patient. Maxillary growth was evaluated on lateral cephalometric radiographs taken prior to any orthodontic treatment and alveolar bone grafting (8.5 ± 0.7 years). The presence of associations between preoperative cleft lip measurements and cephalometric measures of maxillary growth was determined using regression analyses. Results In the 58 patients included in the study, the cleft lateral lip element was deficient in height in 90% and in transverse width in 81% of patients. There was an inverse correlation between cleft lateral lip height and transverse width with a β coefficient of −0.382 ( P = .003). Patients with a more deficient cleft lateral lip height displayed a shorter maxillary length (β coefficient = 0.336; P = .010), a less protruded maxilla (β coefficient = .334; P =.008), and a shorter anterior maxillary height (β coefficient = 0.306; P = .020) than those with a less deficient cleft lateral lip height. Conclusions Patients with cUCLP present with varying degrees of lateral lip hypoplasia. Preoperative measures of lateral lip deficiency are related to later observed deficiencies of maxillary length, protrusion, and height.
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Affiliation(s)
| | - Bryan D. Tompson
- Division of Orthodontics, The Hospital for Sick Children, Department of Orthodontics, Faculty of Dentistry, University of Toronto, Toronto Ontario, Canada
| | - David M. Fisher
- Cleft Lip and Palate Program, Division of Plastic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Three-dimensional quantitative evaluation of midfacial skeletal changes after trans-sutural distraction osteogenesis for midfacial hypoplasia in growing patients with cleft lip and palate. J Craniomaxillofac Surg 2015; 43:1749-57. [DOI: 10.1016/j.jcms.2015.08.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/03/2015] [Accepted: 08/27/2015] [Indexed: 11/24/2022] Open
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Antonarakis GS, Fisher DM. Permanent Tooth Agenesis and Maxillary Hypoplasia in Patients with Unilateral Cleft Lip and Palate. Plast Reconstr Surg 2015; 136:648e-656e. [DOI: 10.1097/prs.0000000000001694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hardwicke J, Chhabra P, Richard B. Absent maxillary lateral incisor as evidence of poor midfacial growth in unilateral cleft lip and palate. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:392-5. [DOI: 10.1016/j.oooo.2014.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/03/2014] [Accepted: 12/12/2014] [Indexed: 11/28/2022]
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Lateral Incisor Agenesis Predicts Maxillary Hypoplasia and Le Fort I Advancement Surgery in Cleft Patients. Plast Reconstr Surg 2015; 135:142e-148e. [DOI: 10.1097/prs.0000000000000779] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Watkins SE, Meyer RE, Strauss RP, Aylsworth AS. Classification, epidemiology, and genetics of orofacial clefts. Clin Plast Surg 2014; 41:149-63. [PMID: 24607185 DOI: 10.1016/j.cps.2013.12.003] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Orofacial clefts (OFCs) include a broad range of facial conditions that differ in cause and disease burden. In the published literature, there is substantial ambiguity in both terminology and classification of OFCs. This article discusses the terminology and classification of OFCs and the epidemiology of OFCs. Demographic, environmental, and genetic risk factors for OFCs are described, including suggestions for family counseling. This article enables clinicians to counsel families regarding the occurrence and recurrence of OFCs. Although much of the information is detailed, it is intended to be accessible to all health professionals for use in their clinical practices.
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Affiliation(s)
- Stephanie E Watkins
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr Boulevard, Chapel Hill, NC, USA.
| | - Robert E Meyer
- Birth Defects Monitoring Program, Division of Public Health, North Carolina Department of Health and Human Services, State Center for Health Statistics, 222 North Dawson Street, Cotton Building, Raleigh, NC 27603, USA
| | - Ronald P Strauss
- UNC Center for AIDS Research, UNC School of Dentistry, UNC School of Medicine, University of North Carolina at Chapel Hill, 104 South Building, CB# 3000, Chapel Hill, NC 27599-3000, USA
| | - Arthur S Aylsworth
- Departments of Pediatrics and Genetics, University of North Carolina at Chapel Hill, CB# 7487, UNC Campus, Chapel Hill, NC 27599-7487, USA
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Antonarakis GS, Adibfar A, Tompson BD, Daskalogiannakis J, Fisher DM. Presurgical cleft lip anthropometrics and dental arch relationships in patients with complete unilateral cleft lip and palate. Cleft Palate Craniofac J 2014; 52:269-76. [PMID: 24805871 DOI: 10.1597/13-272] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate associations between anthropometric lip measurements and dental arch relationships in patients with complete unilateral cleft lip and palate (CUCLP). DESIGN Retrospective cross-sectional study. PATIENTS Children with CUCLP. METHODS Anthropometric lip measurements, made immediately prior to lip repair, were available for each patient. The dental arch relationships were evaluated on dental study casts (8.6 ± 0.9 years) taken prior to any orthodontic treatment and prior to alveolar bone graft, using the modified Huddart and Bodenham (MHB) scoring system. The presence of associations between anthropometric lip measurements and dental arch relationships was determined using linear regression analysis. RESULTS In the 63 patients included in the study, the cleft lateral lip element was deficient in height in 87% and in transverse width in 86% of patients. Patients with more deficient cleft-side lateral lip height were more likely to present with more negative MHB scores (r = .443; P < .001). Conversely, patients with more deficient cleft-side lateral lip transverse width more often presented with more positive MHB scores (r = .281; P = .025). CONCLUSIONS In patients with CUCLP, there is a wide variability in the degree of deficiency of the cleft-side lateral lip element, both in the vertical and in the transverse dimension. The extent of this deficiency may, in part, predict the resulting dental arch relationships.
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