1
|
Beaumont C, Bellerive A, Julien AS, Leclerc JE. Occlusal Outcomes in Non-Robin Sequence Patients with Isolated Cleft Palate. Cleft Palate Craniofac J 2024:10556656241236078. [PMID: 38389267 DOI: 10.1177/10556656241236078] [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: 02/24/2024] Open
Abstract
OBJECTIVES 1. To assess the skeletal class occlusion and lateral cephalometry in children with isolated cleft palates (non-Robin sequence) and 2. to identify associations between these findings and pre-palatoplasty cleft palate measurements. STUDY DESIGN Retrospective cohort study. SETTING North American Institutional Tertiary Paediatric Center. PATIENTS Our cleft database was reviewed, and patients were included if they had an isolated cleft palate without a Robin Sequence diagnosis, had a Furlow palatoplasty and had available per operative cleft palate measurements and available lateral cephalogram between 6 and 8 years old. Thirty-two patients matched to inclusion criteria. INTERVENTION Furlow's Palatoplasty. MAIN OUTCOME AND MEASURES Cleft size at palatoplasty, cephalometric measurements and skeletal occlusal classes were analysed. ANOVA was used to test the association between cephalometric measurements and occlusal classes. Results are presented as means with a 95% confidence interval. The association between cleft measurements and cephalometric parameters was tested with Spearman Correlation (rs). RESULTS The skeletal occlusal outcome at 7 years old for this series of patients was: Class I: 19%; Class II: 59% and Class III: 22%. No single cleft measurement at palatoplasty was predictive of the skeletal occlusal outcome. A larger hard palate cleft was associated with a shorter antero-posterior maxilla. CONCLUSIONS The skeletal occlusal class outcomes were similar to those found in a previous study in the literature. The occlusal prognosis appears to be better than in patients with Robin Sequence or with an associated cleft lip. No preoperative measurement was found to be associated with the occlusal outcome.
Collapse
Affiliation(s)
- Catherine Beaumont
- Department of Otolaryngology - Head and Neck Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | | | - Anne-Sophie Julien
- Department of Mathematics and Statistic, Pavillon Alexandre-Vachon, Université Laval, Quebec City, QC, Canada
| | - Jacques E Leclerc
- Department of Otolaryngology-Head and Neck Surgery, Centre hospitalier universitaire de Québec - Université Laval, Quebec City, QC, Canada
| |
Collapse
|
2
|
Antonarakis GS, Huanca Ghislanzoni L, Fisher DM. Sella turcica dimensions and maxillary growth in patients with unilateral cleft lip and palate. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e916-e921. [PMID: 35697253 DOI: 10.1016/j.jormas.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to investigate associations between sella turcica dimensions and maxillary growth in children with unilateral cleft lip and palate (UCLP). METHODS Forty-nine patients with non-syndromic UCLP, prior to secondary alveolar bone-grafting, were included. The outcomes measured were sella turcica and maxillary cephalometric measurements, and scores representing dental arch relationships derived from dental casts. On lateral cephalograms, sella width, height, and area were measured, as well as maxillary length, height, protrusion, and inclination. Dental arch relationships were measured using the modified Huddart/Bodenham (MHB) scoring system, and translated GOSLON yardstick score. Multiple linear regression was used to assess associations between sella turcica measurements and either cephalometric parameters or MHB/GOSLON scores, including age and sex as covariables. RESULTS No significant associations were found between sella turcica dimensions and dental arch relationships. For cephalometric measurements, sella height and area were associated with basal maxillary length, alveolar maxillary length, and anterior maxillary height. CONCLUSIONS Sella height and area seem to be predictors for both maxillary length and height as assessed cephalometrically, in a sample of patients with non-syndromic UCLP.
Collapse
Affiliation(s)
- Gregory S Antonarakis
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Switzerland.
| | - Luis Huanca Ghislanzoni
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Switzerland
| | - David M Fisher
- Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
3
|
|
4
|
Comparison of Presurgical Anthropometric Measures of Right and Left Complete Unilateral Cleft Lip and/or Palate. Plast Reconstr Surg 2022; 149:248e-253e. [PMID: 35077422 DOI: 10.1097/prs.0000000000008769] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Left clefts occur twice as frequently as right ones. The sidedness has been suggested to influence certain outcomes. Some surgeons consider a right cleft more challenging to repair. This is often attributed to their reduced prevalence. The authors question whether this may be caused by morphologic differences. The authors' hypothesis is that there are anthropometric differences between left and right complete cleft lips. METHODS Patients with complete unilateral cleft lip, with or without cleft palate, operated on at the age of 3 to 6 months, between 2000 and 2018, by a single surgeon, were included. Eight standardized anthropometric measurements of the cleft lip, collected just before cleft lip repair, compare lip and vermillion dimensions and ratios between left and right clefts. RESULTS One hundred thirty-nine left and 80 right unilateral cleft lips were compared. A significant difference was found between left and right clefts for cleft-side to non-cleft-side ratios comparing the lateral lip element vertical heights and vermillion heights. CONCLUSIONS Patients with right cleft lips have a greater degree of lateral lip element hypoplasia, demonstrating greater deficiencies of lateral lip element vertical height and vermillion height when compared to patients with left clefts. This has clinical implications for preoperative assessment, choice of surgical technique, and postoperative and long-term outcomes.
Collapse
|
5
|
Botticelli S, Küseler A, Marcusson A, Mølsted K, Nørholt SE, Cattaneo PM, Pedersen TK. Do Infant Cleft Dimensions Have an Influence on Occlusal Relations? A Subgroup Analysis Within an RCT of Primary Surgery in Patients With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2019; 57:378-388. [DOI: 10.1177/1055665619875320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: To investigate whether infant cleft dimensions, in a surgical protocol with early or delayed hard palate closure, influence occlusion before orthodontics. Design: Subgroup analysis within a randomized trial of primary surgery (Scandcleft). Setting: Tertiary health care. One surgical centre. Patients and Methods: A total of 122 unilateral cleft lip and palate infants received primary cheilo-rhinoplasty and soft palate closure at age 4 months and were randomized for hard palate closure at age 12 versus 36 months. A novel 3D analysis of cleft size and morphology was performed on digitized presurgical models. Occlusion was scored on 8-year models using the modified Huddarth–Bodenham (MHB) Index and the Goslon Yardstick. Main Outcome Measurements: Differences in MHB and Goslon scores among the 2 surgical groups adjusted for cleft size. Results: The crude analysis showed no difference between the 2 surgical groups in Goslon scores but a better MHB ( P = .006) for the group who received delayed hard palate closure. When adjusting for the ratio between cleft surface and palatal surface (3D Infant Cleft Severity Ratio) and for posterior cleft dimensions at tuberosity level, the delayed hard palate closure group received 3.65 points better for MHB (confidence interval: 1.81; 5.48; P < .001) and showed a trend for reduced risk of receiving a Goslon of 4 or 5 ( P = .052). For posterior clefts larger than 9 mm, the Goslon score was better in the delayed hard palate closure group ( P = .033). Conclusions: Seen from an orthodontic perspective, when the soft palate is closed first, and the cleft is large, the timing of hard palate closure should be planned in relation to posterior cleft size.
Collapse
Affiliation(s)
- Susanna Botticelli
- Section of Orthodontics, Aarhus University, Aarhus, Denmark
- Cleft Lip and Palate Center, IKH, Region Midt-Denmark
| | - Annelise Küseler
- Section of Orthodontics, Aarhus University, Aarhus, Denmark
- Cleft Lip and Palate Center, IKH, Region Midt-Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital-Denmark
| | - Agneta Marcusson
- Maxillofacial Unit, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Kirsten Mølsted
- Copenhagen Cleft Palate Center-University Hospital of Copenhagen-Denmark
| | - Sven E. Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital-Denmark
- Section of Oral Surgery and Oral Pathology, Aarhus University-Denmark
| | | | - Thomas K. Pedersen
- Section of Orthodontics, Aarhus University, Aarhus, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital-Denmark
| |
Collapse
|
6
|
Siegenthaler M, Bettelini L, Brudnicki A, Rachwalski M, Fudalej PS. Early versus late alveolar bone grafting in unilateral cleft lip and palate: Dental arch relationships in pre-adolescent patients. J Craniomaxillofac Surg 2018; 46:2052-2057. [PMID: 30416034 DOI: 10.1016/j.jcms.2018.09.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/30/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To evaluate the dental arch relationship in preadolescent children with complete unilateral cleft lip and palate after early secondary alveolar bone grafting (E-ABG) by comparing to late bone grafting (L-ABG). MATERIAL AND METHODS Two raters blindly assessed the dental arch relationship with the modified Huddart-Bodenham (HB) Index for 2 groups: E-ABG group (36 children, mean age 9.6 years) and L-ABG group (56 children, mean age 11.1 years). The groups differed with respect to age at which alveolar bone grafting was performed: between 1.4 and 4.1 years (mean 2.2 years, E-ABG group) and after 8 years (L-ABG group). T-test was run to compare scores between 2 groups. Regression analysis was carried out to evaluate gender, age at cleft repair, age at ABG, and age at assessment with the HB index. RESULTS The overall HB scores were -6.77 and -4.25 in the E-ABG and L-ABG groups, respectively (p = 0.025). Regression analysis showed that only the age at cleft repair influenced the HB scores. CONCLUSION ABG carried out between 2 and 4 years of age does not seem to negatively affect the dental arch relationship at the age of 10 years in comparison to L-ABG.
Collapse
Affiliation(s)
| | - Lisa Bettelini
- Private Practice, Winkelstrasse 22, 1716 Plaffeien, Switzerland
| | - Andrzej Brudnicki
- Department of Paediatric Surgery (Head of the Department: Prof. Ewa Sawicka), Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Martin Rachwalski
- Department of Maxillofacial and Plastic Surgery (Head of the Department: Prof. Arnaud Picard), National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015 Paris, France
| | - Piotr S Fudalej
- Department of Orthodontics (Head of the Department: Doc. Milos Spidlen), Institute of Dentistry and Oral Sciences, Palacky University Olomouc, Palackeho 12, 771 00 Olomouc, Czech Republic; Department of Orthodontics and Dentofacial Orthopaedics (Head of the Department: Prof. Christos Katsaros), University of Bern, Freiburgstrasse 9, 3010 Bern, Switzerland.
| |
Collapse
|
7
|
Objective Assessment of the Unilateral Cleft Lip Nasal Deformity Using Three-Dimensional Stereophotogrammetry: Severity and Outcome. Plast Reconstr Surg 2018; 141:547e-558e. [PMID: 29257001 DOI: 10.1097/prs.0000000000004233] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Optimization of care to correct the unilateral cleft lip nasal deformity is hampered by lack of objective measures to quantify preoperative severity and outcome. The purpose of this study was to develop a consensus standard of nasal appearance using three-dimensional stereophotogrammetry; determine whether anthropometric measurements could be used to quantify severity and outcome; and determine whether preoperative severity predicts postoperative outcome. METHODS The authors collected facial three-dimensional images of 100 subjects in three groups: 45 infants before cleft lip repair; the same 45 infants after cleft lip repair; and 45 children aged 8 to 10 years with previous repairs. Five additional age-matched unaffected control subjects were included in each group. Seven expert surgeons ranked images in each group according to nasal appearance. The rank sum score was used as consensus standard. Anthropometric analysis was performed on each image and compared to the rank sum score. Preoperative rank and anthropometric measurements were compared to postoperative rank. RESULTS Interrater and intrarater reliability was excellent (intraclass correlation coefficient, >0.76; Pearson correlation, >0.75) on each of the three image sets. Columellar angle, nostril width ratio, and lateral lip height ratio were highly correlated with preoperative severity and moderately correlated with postoperative nasal appearance. Postoperative outcome was associated with preoperative severity (rank and anthropometric measurement). CONCLUSIONS Consensus ranking of preoperative severity and postoperative outcome can be achieved on three-dimensional images. Preoperative severity predicts postoperative outcomes. Columellar angle, nostril width ratio, and lateral lip height ratio are objective measures that correlate with consensus ratings by surgeons at multiple ages.
Collapse
|
8
|
Augmentation of the Median Tubercle with Dermis-Fat Graft in Children with Repaired Cleft Lip. Plast Reconstr Surg 2018; 141:540e-546e. [DOI: 10.1097/prs.0000000000004237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Haque S, Alam MK, Khamis MF. Treatment Outcome of Bangladeshi UCLP Patients Based on Both Phenotype and Postnatal Treatment Factors using Modified Huddart Bodenham (mHB) Index. Cleft Palate Craniofac J 2018; 55:966-973. [PMID: 27479096 DOI: 10.1597/15-293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the dental arch relationship (DAR) of nonsyndromic unilateral cleft lip and palate (UCLP) and to explore the various phenotype and postnatal treatment factors that are responsible for poor DAR. DESIGN Retrospective study. SETTING School of Dental Science, Universiti Sains Malaysia. SUBJECTS Eighty-four Bangladeshi children with nonsyndromic UCLP who received cheiloplasty and palatoplasty. MAIN OUTCOME MEASURES Dental models were taken at 5 to 12 years of age (man: 7.69), and dental arch relationships were assessed using modified Huddart/Bodenham index (mHB) by two raters. Kappa statistics was used to evaluate the intra- and interexaminer agreements, chi-square was used to assess the associations, and logistic regression analysis was used to explore the responsible factors that affect DAR. RESULTS The total mHB score (mean [SD]) was -8.261 (7.115). Intra- and interagreement was very good. Using crude and stepwise backward regression analysis, significant association was found between positive history of class III (P = .025, P = .030, respectively) and unfavorable DAR. Complete UCLP (P = .003) was also significantly correlated with unfavorable DAR. CONCLUSION This multivariate study suggested complete type of UCLP and positive history of class III had a significantly unfavorable effect on the DAR.
Collapse
|
10
|
Kornbluth M, Campbell RE, Daskalogiannakis J, Ross EJ, Glick PH, Russell KA, Doucet JC, Hathaway RR, Long RE, Sitzman TJ. Active Presurgical Infant Orthopedics for Unilateral Cleft Lip and Palate: Intercenter Outcome Comparison of Latham, Modified McNeil, and Nasoalveolar Molding. Cleft Palate Craniofac J 2018; 55:639-648. [PMID: 29461877 DOI: 10.1177/1055665618757367] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To compare dental arch relationship, craniofacial form, and nasolabial aesthetic outcomes among cleft centers using distinct methods of presurgical infant orthopedics (PSIO). DESIGN Retrospective cohort study. SETTING Four cleft centers in North America. PATIENTS One hundred ninety-one children with repaired complete unilateral cleft lip and palate (CUCLP). MAIN OUTCOME MEASURES Dental arch relationship was assessed using the GOSLON Yardstick. Craniofacial form was assessed by 12 cephalometric measurements. Nasolabial aesthetics were assessed using the Asher-McDade system. Assessments were performed between 6 and 12 years of age. RESULTS The center that used no PSIO achieved the most favorable dental arch relationship and maxillomandibular relationship, with a median GOSLON score of 2.3 ( P < .01) and an ANB angle of 5.1° ( P < .05). The proportion of children assigned a GOSLON score of 4 or 5, predictive of the need for orthognathic surgery in adolescence, was 16% at the center that used no PSIO and no secondary surgery, compared to 76% at the centers that used the Latham appliance and early secondary lip and nose surgery ( P < .01). The center that used no PSIO and no secondary surgery achieved significantly less favorable nasolabial aesthetic outcomes than the centers using Latham appliance or nasoalveolar molding (NAM) ( P < .01). CONCLUSIONS Effects of active PSIO are multifaceted and intertwined with use of revision surgery. In our study, centers using either the Latham appliance combined with early revision surgery or the NAM appliance without revision surgery achieved better nasolabial aesthetic outcomes but worse maxillary growth, compared to a center using no PSIO and secondary surgery.
Collapse
Affiliation(s)
- Michelle Kornbluth
- 1 Department of Dentistry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Richard E Campbell
- 2 Division of Pediatric Dentistry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - John Daskalogiannakis
- 1 Department of Dentistry, The Hospital for Sick Children, Toronto, Ontario, Canada.,3 Department of Orthodontics, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth J Ross
- 4 Department of Dentistry, Boston Children's Hospital, Boston, MA, USA
| | | | - Kathleen A Russell
- 6 Division of Orthodontics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jean-Charles Doucet
- 7 Division of Oral and Maxillofacial Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ronald R Hathaway
- 8 Division of Craniofacial Plastic and Reconstructive Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ross E Long
- 9 Lancaster Cleft Palate Clinic, Lancaster, PA, USA
| | - Thomas J Sitzman
- 10 Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| |
Collapse
|
11
|
Zin MNM, Alam MK, Haque S, Imanishi T, Toriya J, Osuga N, Razak NHA. The Assessment of Treatment Outcome by Evaluation of Dental Arch Relationships in Unilateral Cleft Lip and Palate Children using mHB Scoring System. J HARD TISSUE BIOL 2017. [DOI: 10.2485/jhtb.26.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mazida Najwa Md. Zin
- Department of Oral and Maxillofacial Surgery, School of Dental Science, Universiti Sains Malaysia
| | | | - Sanjida Haque
- Orthodontic Unit, School of Dental Science, Universiti Sains Malaysia
| | - Tohru Imanishi
- Department of Pediatric Dentistry, Matsumoto Dental University School of Dentistry
| | - Jin Toriya
- Department of Pediatric Dentistry, Matsumoto Dental University School of Dentistry
| | - Naoto Osuga
- Department of Pediatric Dentistry, Matsumoto Dental University School of Dentistry
| | - Noor Hayati Abd. Razak
- Department of Oral and Maxillofacial Surgery, School of Dental Science, Universiti Sains Malaysia
| |
Collapse
|
12
|
Commentary on Anthropometric Effect of Mucoperiosteal Nostril Floor Reconstruction in Complete Cleft Lip. J Craniofac Surg 2016; 27:27-8. [PMID: 26703064 DOI: 10.1097/scs.0000000000002343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
13
|
Ayub PV, Janson G, Gribel BF, Lara TS, Garib DG. Analysis of the maxillary dental arch after rapid maxillary expansion in patients with unilateral complete cleft lip and palate. Am J Orthod Dentofacial Orthop 2016; 149:705-15. [DOI: 10.1016/j.ajodo.2015.11.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 11/01/2015] [Accepted: 11/01/2015] [Indexed: 11/29/2022]
|