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Al-Dourobi K, Mermod T, Doan MT, Herzog G, Broome M, El Ezzi O, de Buys Roessingh A. What We Learned from Performing the Inverse Malek Procedure to Repair Bilateral Cleft Lips and Palates: A Single-Center Retrospective Study. J Clin Med 2024; 13:1939. [PMID: 38610704 PMCID: PMC11012878 DOI: 10.3390/jcm13071939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/16/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This study reviews the surgical and functional outcomes of children diagnosed with a bilateral cleft lip and palate and treated by the same surgical team following specific surgical protocols 18 years after surgery and during the follow-up. Methods: Based on a single-center retrospective design, demographic and surgical data were gathered by the authors from international institutions. Most of the data were quantitative in nature, and descriptive statistical and non-parametric tests were employed for analysis. All children born with a bilateral cleft from 1982 to 2002 were considered. Children affected by a syndrome were excluded. Complications and speech results were the main items measured. Results: Thirty patients were selected; 73.3% were treated using the inverse Malek procedure, and 26.7% underwent a modified two-stage procedure. Seventy percent developed an oronasal fistula. An alveolar bone graft was performed in 83%, and 53.3% underwent Le Fort osteotomy. Thirty-six percent required a pharyngeal flap, with good speech results. The median number of times general anesthesia was used among all the interventions considered was 5.5 (4.25-6). Conclusions: This study presents the long-term results of using the inverse Malek procedure to treat children with a bilateral cleft lip and palate. It is shown that this is related to a high risk of developing a fistula, but has good long-term speech results.
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Affiliation(s)
- Karim Al-Dourobi
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.)
| | - Tessa Mermod
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.)
| | - Marie-Thérèse Doan
- Children and Adolescent Surgery Department, Multidisciplinary Consultations of Facial Cleft, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland (G.H.)
| | - Georges Herzog
- Children and Adolescent Surgery Department, Multidisciplinary Consultations of Facial Cleft, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland (G.H.)
| | - Martin Broome
- Children and Adolescent Surgery Department, Multidisciplinary Consultations of Facial Cleft, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland (G.H.)
| | - Oumama El Ezzi
- Children and Adolescent Surgery Department, Multidisciplinary Consultations of Facial Cleft, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland (G.H.)
| | - Anthony de Buys Roessingh
- Children and Adolescent Surgery Department, Multidisciplinary Consultations of Facial Cleft, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland (G.H.)
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Omara M, Ahmed M, Shawky M, Ali S. Alveolar Cleft Reconstruction Using Double Iliac Corticocancellous Bone Plates Grafting Technique in Mixed Dentition Phase. Cleft Palate Craniofac J 2021; 59:1222-1227. [PMID: 34558331 DOI: 10.1177/10556656211042160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The primary goal of maxillary alveolar cleft reconstruction in patients with cleft lip/palate at the phase of mixed dentition is to build bone in the cleft area which in turn allows closure of the oronasal fistula, establishes arch continuity, and improve maxillary stability. This study aimed to evaluate the double iliac corticocancellous bone plates grafting technique for initial alveolar cleft grafting. DESIGN This prospective study was conducted on 12 consecutive patients with unilateral complete alveolar cleft and previous cleft lip and palate corrective surgery. INTERVENTION For all patients, the iliac crest graft was harvested and cut into 2 cortical bone plates and adapted labially and palatally. Both plates were fixed with screws then the gap between the 2 plates was filled with cancellous bone. The grafted side was compared to the contralateral side 9 months postoperatively regarding labio-palatal alveolar width and bone density, while the 9 months postoperative graft height was compared to the immediate postoperative height using computed tomography scans. RESULTS All grafted sides showed similarity to the contralateral sides regarding both alveolar width and bone density with minimal crestal bone resorption. CONCLUSION The double iliac corticocancellous bone plate grafting technique seems to be a reliable method for alveolar cleft reconstruction with adequate bone quality and contour.
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Affiliation(s)
- Mohammed Omara
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, 110152Cairo University, Cairo, Egypt
| | - Mamdouh Ahmed
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, 110152Cairo University, Cairo, Egypt
| | - Mohamed Shawky
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, 110152Cairo University, Cairo, Egypt
| | - Sherif Ali
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, 110152Cairo University, Cairo, Egypt
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Shetty V, Sreekumar C, Patteta NK, Bahl D, Sailer HF. Correlation between surgical protocols for palatoplasty and midfacial growth in cleft lip and palate patients: A long-term, single centre study. J Craniomaxillofac Surg 2021; 49:1010-1019. [PMID: 34238633 DOI: 10.1016/j.jcms.2021.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 05/26/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022] Open
Abstract
To evaluate and compare the outcomes of two different surgical protocols for palatoplasty for midfacial growth in patients with cleft lip and palate. A retrospective observational cohort study was conducted in 80 patients with cleft lip and palate, who were divided into two groups. Group 1 comprised patients who underwent operation between 9 and 11 months of age using the Bardach two-flap technique without a palatal pushback. Group 2 comprised patients who had undergone operation between 18 and 20 months of age using either a Bardach two-flap technique with a palatal pushback or a von Langenbeck technique. Patient follow-up was done between 8 and 9 years of age when they reported to the centre for secondary alveolar bone grafting. Post-surgical cephalometric measurements were taken for midfacial growth analysis. Group 1 underwent palatoplasty at significantly younger ages than Group 2 (p < 0.01). A statistically significant difference(p < 0.01) was found between the two groups of patients on comparison of cephalometric parameters such as SNA, ANB, CoA, NperpA ANS-PNS, N-ANS, N-Me, Witt's (AO-BO). Group 2 had more positive cephalometric values as compared to Group 1, thereby implying that there was less incidence of midfacial hypoplasia in patients treated at the age of 18-20 months. Between the types of palatoplasty techniques within Group 2, i.e., Bardach two-flap and von Langenbeck, there was no statistical difference found in the post-opertative cephalometric values, i.e., SNA, ANB, CoA, ANS-PNS, N-ANS, N-Me, Witt's (AO-BO) except for Nperp-A, which showed a statistical difference (p = 0.03). Within the limitations of the study which is only a single center experience it seems that palatal closure should be carried out at 18-20 months of age for better midfacial growth, leading to decreased incidence of maxillary hypoplasia at a later stage in life. Repair at less than 18 months of age is also associated with mid-facial hypoplasia.
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Affiliation(s)
- Vikram Shetty
- Nitte Meenakshi Institute of Craniofacial Surgery, Nitte Deemed to be University, India
| | - Chandni Sreekumar
- Dept. of Periodontics, Srinivas Inst. of Dental Sciences, RGUHS, India
| | - Nanda Kishore Patteta
- Dept. of Cleft and Craniofacial Orthodontics, Nitte Meenakshi Institute of Craniofacial Surgery, Nitte Deemed to be University, India.
| | - Devyani Bahl
- Dept. of Oral and Maxillofacial Surgery, A.B.Shetty Memorial Inst. of Dental Sciences, Nitte Deemed to be University, India
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Martires S, Kamat NV, Dhupar V. Orthosurgical Management of a Patient with Cleft Lip and Palate. Contemp Clin Dent 2020; 11:171-178. [PMID: 33110333 PMCID: PMC7583545 DOI: 10.4103/ccd.ccd_200_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/23/2018] [Accepted: 09/04/2018] [Indexed: 11/08/2022] Open
Abstract
A 31-year-old male patient reported with a chief complaint of a forwardly placed lower jaw. Oral examination revealed Angle's Class III relationship bilaterally and cephalometrically; the patient presented with a small-sized retrognathic maxilla and normal mandible. Orthosurgical treatment was carried out with 4 mm of maxillary advancement and 4 mm of mandibular setback to achieve ideal overjet, overbite, and intercuspation of teeth. The ANB angle showed a drastic change from −9.5° to 1° and a successful conversion of the skeletal profile from Class III to Class I. Orthosurgical treatment can thus be an effective means of treating a patient with cleft lip and palate but requires a detailed understanding of the case and a sound diagnosis to attain a successful outcome.
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Affiliation(s)
- Sergio Martires
- Department of Orthodontics and Dentofacial Orthopaedics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Nandini V Kamat
- Department of Orthodontics and Dentofacial Orthopaedics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Vikas Dhupar
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, Goa, India
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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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Abstract
OBJECTIVE The aim of this study is to describe the importance of osteodistraction with transpalatal distractors for treating transversal maxillary hypoplasia in patients with cleft and lip palate. METHODS The participants were 17 patients (9 females and 8 males) with cleft lip and palate. Among these, 10 presented unilateral cleft lip and palate, 4 bilateral cleft lip and palate, and 3 cleft palate only. RESULTS All patients experienced a satisfactory palatal expansion and crossbite correction. The mean lengthening was 12.7 mm. The average increase of intercanine distance, intermolar distance, maxillary transverse dimension (MTD), facial transverse dimension (FTD) was 12.16, 8.45, 1.77, and 1.67 mm, respectively. The clinical follow-up was 29.7 months (range: 6-61 months). CONCLUSION Palatal distraction is a safe and successful alternative for treating maxillary transversal alterations in patients with cleft lip and palate. This technique facilitates the establishment of an adequate transverse dimension of maxillary, and consequently a proper dental occlusion.
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Facial Growth Changes Induced by Orthodontic Treatment in Patients With Unilateral Cleft Lip and Palate. J Craniofac Surg 2018; 29:1495-1500. [DOI: 10.1097/scs.0000000000004800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Turri de Castro Ribeiro T, Petri Feitosa MC, Almeida Penhavel R, Zanda RS, Janson G, Mazzottini R, Garib DG. Extreme maxillomandibular discrepancy in unilateral cleft lip and palate: Longitudinal follow-up in a patient with mandibular prognathism. Am J Orthod Dentofacial Orthop 2018; 154:294-304. [PMID: 30075931 DOI: 10.1016/j.ajodo.2017.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 10/28/2022]
Abstract
Growth deficiency of the maxilla is a frequent finding in patients with complete unilateral cleft lip and palate. When the sagittal discrepancy is severe, orthodontic treatment combined with orthognathic surgery is required. This article reports the treatment of a girl born with unilateral cleft lip and palate who had lip and palate repair at 3 and 12 months of age, respectively. At 3 years of age, she already showed a severe anteroposterior maxillary deficiency with an anterior crossbite in the deciduous dentition. A Class III skeletal pattern progressively increased during the mixed dentition period. Mandibular prognathism coupled with an extremely hyperdivergent growth pattern was observed. An alveolar bone graft was performed at 10 years of age. At 16 years of age, the ANB angle was -13.7° with a negative overjet of -9.8 mm. Comprehensive orthodontic treatment was conducted with extraction of the mandibular first premolars and maxillary lateral incisors due to dental crowding. Orthognathic surgery was performed at 18.9 years of age involving maxillary advancement of 7.4 mm and mandibular setback of 6.6 mm. Facial and occlusal changes were dramatic. Final nose repair was conducted at 19.7 years of age. At 22 years of age and 3 years after debonding, stability of the occlusal and skeletal results was observed, clearly demonstrating that the objectives established for the rehabilitation have been achieved.
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Affiliation(s)
- Tiago Turri de Castro Ribeiro
- Dental Division, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Mariana Chaves Petri Feitosa
- Dental Division, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil.
| | - Rogério Almeida Penhavel
- Dental Division, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Renata Sathler Zanda
- Dental Division, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Reinaldo Mazzottini
- Department of Stomatology, Bauru Dental School and Dental Division of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Daniela G Garib
- Department of Orthodontics, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
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Abstract
No agreement exists on the most appropriate timing of orthodontic treatment in patients with cleft lip and palate. The aim of this study is to investigate the effect of early orthodontic treatment on development of the dental arches and alveolar bone.A dental casts analysis was performed on 28 children with cleft lip and palate before orthodontic treatment (T0; mean age, 6.5 ± 1.7) and at the end of active treatment (T1; mean age, 9.2 ± 2.1 years). The considered variables were: intercanine and intermolar distances; dental arch relationships, evaluated according to the modified Huddart/Bodenham system.The study group was divided into 2 samples according to the age at T0: Group A (age < 6 years) and Group B (age ≥ 6 years). A statistical comparison of the treatment effects between the 2 samples was performed.Patients in Group A exhibited a greater increase of intercanine distance (8 mm versus 2.7 mm; P<0.001), intermolar distance (7.2 mm versus 5 mm; P = 0.06), and Huddart/Bodenham score (7.1 versus 3; P < 0.05) when compared with patients in Group B.Early orthodontic treatment strongly improved the dental arch relationship, since subjects starting the therapy before the age of 6 had a better response in terms of anterior maxillary expansion.
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The Difference in Cervical Vertebral Skeletal Maturation between Cleft Lip/Palate and Non-Cleft Lip/Palate Orthodontic Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5405376. [PMID: 29619373 PMCID: PMC5830296 DOI: 10.1155/2018/5405376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/04/2017] [Indexed: 11/17/2022]
Abstract
Objective The aim was to evaluate differences in the cervical vertebral skeletal maturity of unilateral cleft lip and palate (UCLP) and non-cleft lip/palate (non-CLP) Saudi male orthodontic patients. Method This cross-sectional multicenter study took place at the dental school, King Saud University and King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, between October 2014 and September 2015. The records of Saudi male orthodontic patients with UCLP (n = 69) were collected. Cervical vertebral maturation was assessed using their cephalometric radiographs. The records of 138 age-matched non-CLP Saudi male orthodontic patients served as controls. Results There was a significant difference in skeletal maturity between the UCLP and non-CLP groups, as evident in the delayed skeletal development among the UCLP participants. Moreover, pubertal growth spurt onset was significantly earlier in the non-cleft participants in comparison with the UCLP participants (p = 0.009). Conclusions There is delayed skeletal maturity among the UCLP Saudi male population in comparison with their non-CLP age-matched peers.
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Flinn W, Long RE, Garattini G, Semb G. A Multicenter Outcomes Assessment of Five-Year-Old Patients with Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2017; 43:253-8. [PMID: 16681397 DOI: 10.1597/04-093.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Compare 5-year-old dental arch relationships of patients from three centers with differing primary protocols. Design Retrospective study of treatment outcomes using blinded evaluation of dental study casts. Setting Three major cleft-craniofacial centers; one (center A) is a free-standing institution, and two (centers B and C) are university hospitals. Patients 118 (A = 41; B = 33; C = 44) consecutively treated 5-year-old patients with complete, nonsyndromic unilateral cleft lip and palate. Interventions Centers A and C completed primary repair without presurgical orthopedics by 18 months (center A in three surgeries and center C in two surgeries). Center B used passive presurgical orthopedics with lip/soft palate repair at 6 months and gingivo-alveoloplasty/hard palate repair at 18 to 36 months. Main Outcome Measure Averaged ratings of dental casts using the 5-year yardstick were computed for each patient. The Wilcoxon two-sample test was used to compare means; a chi-square test was used to compare distributions. Results Intra- and interexaminer reliability tests showed excellent reliability (>.90). Mean scores were not significantly different. Distribution of scores differed significantly. Center A had the highest percentage of good scores and the lowest percentage of poor scores (72% versus 6.5%), followed by center B (63% versus 6.6%) and center C (59% versus 16.3%). Conclusions Centers A and B had comparable scores and completely different protocols in surgical technique, timing, sequencing, and nonuse/use of appliances. Center C's results were slightly lower than those of 1 and 3, but the center had the protocol with the least burden of treatment (only two surgeries, without use of appliances).
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Affiliation(s)
- Wanda Flinn
- Lancaster Cleft Palate Clinic, Lancaster, Pennsylvania 17602, USA
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Lilja J, Mars M, Elander A, Enocson L, Hagberg C, Worrell E, Batra P, Friede H. Analysis of Dental Arch Relationships in Swedish Unilateral Cleft Lip and Palate Subjects: 20-Year Longitudinal Consecutive Series Treated with Delayed Hard Palate Closure. Cleft Palate Craniofac J 2017; 43:606-11. [PMID: 16986983 DOI: 10.1597/05-069] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To evaluate the dental arch relationships for a consecutive series from Goteborg, Sweden, who had delayed hard palate closure. Design: Retrospective study. Setting: Sahlgrenska University Hospital, Goteborg, Sweden. Patients: The dental study models of 104 consecutive unilateral cleft lip and palate subjects. The study cohort was born between 1979 and 1994. Longitudinal records were available at ages 5 (n = 94), 10 (n = 97), 16 (n = 59), and 19 years (n = 46). Five assessors rated models according to the GOSLON Yardstick on two separate occasions each. Interventions: These patients had been operated upon according to the Goteborg protocol of delayed hard palate closure (at age 8 years). Results: 85% of subjects were rated in groups 1 and 2 (excellent or very good outcome), 12% were rated in group 3 (satisfactory), and 3% were assigned to group 4 (poor). No patients presented in Group 5 (very poor). Weighted kappa statistics for double determination of Yardstick allocation for five assessors demonstrated values between .65 and .90 for interrater agreement (good/very good) and between .70 and .90 for intrarater agreement (very good). Conclusions: Delayed hard palate closure as practiced in Goteborg since 1979 has produced the best GOSLON Yardstick ratings in a consecutive series of patients ever recorded worldwide, since the Yardstick was first used in 1983. However, it is noteworthy that a new protocol has been introduced in Goteborg since 1994, in which hard palate closure is done at 3 years due to concerns regarding speech.
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Affiliation(s)
- Jan Lilja
- Sahlgrenska University Hospital, Goteborg, Sweden
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Van Nhan V, Van Son L, Tuan TA, Son NT, Hai TD, Lanh LD, Ha NM, Phong LD. A New Technique in Alveolar Cleft Bone Grafting for Dental Implant Placement in Patients With Cleft Lip and Palate. Cleft Palate Craniofac J 2017; 55:180-188. [PMID: 29351041 DOI: 10.1177/1055665617723633] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate 2 iliac corticocancellous-block grafting techniques for dental implant placement in residual alveolar clefts. DESIGN Nonrandomized prospective clinical trial between March 2010 and December 2014. SETTING National Hospital of Odonto-Stomatology, Hanoi, Vietnam. PARTICIPANTS Thirty-two patients (23 female, 9 male; mean age, 21.28 years; range, 16-31 years) with unilateral complete alveolar cleft after reconstructive surgery for cleft lip and palate (CLP). INTERVENTIONS Harvested iliac crest bone was cut into 2 corticocancellous blocks. The smaller block was adapted against the sutured nasal mucoperiosteum and overlaid with cancellous bone; the larger one overlapped the labial cleft margin and was fixed with screws. Endosteal dental implants were placed after 4 to 6 months, and final restorations were delivered 6 months later. MAIN OUTCOME MEASURES Flap statuses were assessed clinically. Bone formation was assessed using the Enemark scale. Cone-beam computed tomography was used for graft height and width measurements. Implant health was assessed by the Misch criteria. RESULTS The mean postgrafting follow-up period was 36.7 ± 10.4 (range, 18-53) months. Three patients (9.4%) showed flap dehiscence but no infection 7 days after bone grafting. Twenty-nine patients (90.6%) had 75% to 100% bone fill (Enemark score of 1). The mean graft height and width were 11.4 ± 2.4 and 6.1 ± 1.0 mm, respectively. Sufficient bone for implant placement was noted in 29 patients (90.6%); the others required partially fixed prostheses. All implants functioned for at least 18 months. CONCLUSION The proposed technique is reliable to reconstruct the alveolar cleft for implant placement in CLP patients.
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Affiliation(s)
- Vo Van Nhan
- 1 Nhan Tam Dental Maxillofacial Speciality Hospital, Hong Bang University International, HoChiMinh City, Vietnam
| | - Le Van Son
- 2 Oral and Maxillofacial Surgery Department, Hanoi Medical University, Hanoi, Vietnam
| | - Ta Anh Tuan
- 3 General Dentistry Department, 108 Institute of Clinical Medical and Pharmaceutical Sciences, Hanoi, Vietnam
| | - Nguyen Tai Son
- 4 Oral and Maxillofacial Surgery, 108 Institute of Clinical Medical and Pharmaceutical Sciences, Hanoi, Vietnam
| | - Trinh Dinh Hai
- 5 Implant Department, National Hospital of Odonto-Stomatology, Hanoi, Vietnam
| | - Le Duc Lanh
- 6 Implant Department, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy, HoChiMinh City, Vietnam
| | - Nguyen Manh Ha
- 7 Head of Oral and Maxillofacial Surgery Department, Vietnam National Hospital of Odonto-Stomatology, Ha Noi, Vietnam
| | - Lam Dai Phong
- 8 Oral Radiology Department, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy, HoChiMinh City, Vietnam
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Russell K, Long RE, Daskalogiannakis J, Mercado A, Hathaway R, Semb G, Shaw W. Reliability of the SWAG—The Standardized Way to Assess Grafts Method for Alveolar Bone Grafting in Patients with Cleft Lip and Palate. Cleft Palate Craniofac J 2017; 54:680-686. [DOI: 10.1597/14-214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The objective of this study was to test a new method, a Standardized Way to Assess Grafts (SWAG), to rate alveolar bone graft (ABG) outcomes for patients with cleft lip and palate. Design This was a retrospective comparison using the SWAG scale. Setting This study took place in four cleft palate centers with different treatment protocols. Methods A total of 160 maxillary occlusal radiographs taken 3 to 18 months post-ABG for sequentially treated patients with cleft lip and palate were assessed using the SWAG scale. Radiographs were scanned, standardized, blinded, and rated by 6 calibrated orthodontists to assess vertical thirds, bony root coverage, and complete bony fill. All radiographs were rated twice, 24 hours apart, by the same raters. Main Outcomes Intra- and interrater reliabilities were assessed. Results Intrarater reliability was good to very good (.760; .652–.834), and interrater reliability was moderate to good (.606; .569–.681), comparable to previously published methods. Conclusions Rater reliabilities were shown to be comparable to or better than existing methods. The SWAG method was validated for ABG assessments in the mixed and permanent dentitions based on reliabilities in an intercenter outcome comparison.
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Affiliation(s)
- Kathleen Russell
- Division of Orthodontics, Dalhousie University, Staff Orthodontist and Chair, Cleft Palate Team, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Ross E. Long
- Lancaster Cleft Palate Clinic, Department of Surgery, Penn State College of Medicine, 223 North Lime Street, Lancaster, Pennsylvania
| | - John Daskalogiannakis
- SickKids Hospital, Department of Orthodontics, University of Toronto, Toronto, Ontario, Canada
| | - Ana Mercado
- Division of Orthodontics, College of Dentistry, The Ohio State University, 305 W. 12th Avenue, Postle Hall, Columbus, Ohio
| | - Ronald Hathaway
- Craniofacial Center, Peyton Manning Children's Hospital at St. Vincent, Indianapolis, Indiana
| | - Gunvor Semb
- University of Oslo, Senior Lecturer in Craniofacial Anomalies, University of Manchester, Manchester, UK
| | - William Shaw
- Orthodontics and Dentofacial Development, University of Manchester, Manchester, UK
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Reducing posttreatment relapse in cleft lip palatal expansion using an injectable estrogen-nanodiamond hydrogel. Proc Natl Acad Sci U S A 2017; 114:E7218-E7225. [PMID: 28808036 DOI: 10.1073/pnas.1704027114] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Patients with cleft lip and/or palate (CLP), who undergo numerous medical interventions from infancy, can suffer from lifelong debilitation caused by underdeveloped maxillae. Conventional treatment approaches use maxillary expansion techniques to develop normal speech, achieve functional occlusion for nutrition intake, and improve esthetics. However, as patients with CLP congenitally lack bone in the cleft site with diminished capacity for bone formation in the expanded palate, more than 80% of the patient population experiences significant postexpansion relapse. While such relapse has been a long-standing battle in craniofacial care of patients, currently there are no available strategies to address this pervasive problem. Estrogen, 17β-estradiol (E2), is a powerful therapeutic agent that plays a critical role in bone homeostasis. However, E2's clinical application is less appreciated due to several limitations, including its pleiotropic effects and short half-life. Here, we developed a treatment strategy using an injectable system with photo-cross-linkable hydrogel (G) and nanodiamond (ND) technology to facilitate the targeted and sustained delivery of E2 to promote bone formation. In a preclinical expansion/relapse model, this functionalized E2/ND/G complex substantially reduced postexpansion relapse by nearly threefold through enhancements in sutural remodeling compared with unmodified E2 administration. The E2/ND/G group demonstrated greater bone volume by twofold and higher osteoblast number by threefold, compared with the control group. The E2/ND/G platform maximized the beneficial effects of E2 through its extended release with superior efficacy and safety at the local level. This broadly applicable E2 delivery platform shows promise as an adjuvant therapy in craniofacial care of patients.
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Effects of Primary Alveolar Grafting on Alveolar Bone Thickness in Patients With Cleft Lip and Palate. J Craniofac Surg 2017; 28:1337-1341. [DOI: 10.1097/scs.0000000000003735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cheng N, Park J, Olson J, Kwon T, Lee D, Lim R, Ha S, Kim R, Zhang X, Ting K, Tetradis S, Hong C. Effects of Bisphosphonate Administration on Cleft Bone Graft in a Rat Model. Cleft Palate Craniofac J 2017; 54:687-698. [PMID: 28094562 DOI: 10.1597/15-356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Bone grafts in patients with cleft lip and palate can undergo a significant amount of resorption. The aim of this study was to investigate the effects of bisphosphonates (BPs) on the success of bone grafts in rats. DESIGN Thirty-five female 15-week-old Fischer F344 Inbred rats were divided into the following experimental groups, each receiving bone grafts to repair an intraoral CSD: (1) Graft/saline: systemic administration of saline and (2) systemic administration of zoledronic acid immediately following surgery (graft/BP/T0), (3) 1 week postoperatively (graft/BP/T1), and (4) 3 weeks postoperatively (graft/BP/T2). As an additional control, the defect was left empty without bone graft. MAIN OUTCOME MEASURES Microcomputed tomography and histologic analyses were performed in addition to evaluation of osteoclasts through tartrate-resistant acid phosphatase staining. RESULTS Bone volume fraction (bone volume/tissue volume) for the delayed BP treatment groups (graft/BP/T1 = 45.4% ± 8.8%; graft/BP/T2 = 46.1% ± 12.4%) were significantly greater than that for the graft/saline group (31.0% ± 7.9%) and the graft/BP/T0 (27.6% ± 5.9%) 6 weeks postoperatively (P < .05). Hematoxylin and eosin staining confirmed an evident increase in bone volume and fusion of defect margins with existing palatal bone in the graft/BP/T1 and graft/BP/T2 groups. The graft/BP/T0 group showed the lowest bone volume with signs of acute inflammation. CONCLUSIONS Delayed BP administration following cleft bone graft surgery led to significant increase in bone volume and integration compared with saline controls. However, BP injection immediately after the surgery did not enhance bone volume, and rather, may negatively affect bone graft incorporation.
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Analysis of the dentoalveolar effects of slow and rapid maxillary expansion in complete bilateral cleft lip and palate patients: a randomized clinical trial. Clin Oral Investig 2015; 20:1837-47. [PMID: 26620733 DOI: 10.1007/s00784-015-1675-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
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Cleft Lip and Palate Care in Nigeria: Current Status of Orthodontic Residents' Training in the Management of Children With Cleft Lip and Palate. J Craniofac Surg 2015; 26:1106-8. [PMID: 26080136 DOI: 10.1097/scs.0000000000001670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to assess and achieve an overview of the current status of training of orthodontic resident doctors working in Nigeria with regards to the management of children affected with cleft lip and palate (CL/P). Semistructured questionnaires containing 10 categories of questions relating to CL/P care were sent to 20 orthodontic resident doctors training to become specialists and working at 3 hospital training centers in Nigeria. Sixteen out of 20 (80%) questionnaires were eventually completed by the doctors and returned. Results were analyzed and reported as follows; 15 (94%) of the resident doctors had no orthodontic clinical experience in the management of children with CL/P and had never fitted a presurgical orthopedic appliance prior to the time the research was conducted. All the 16 resident doctors (100%) claimed to have been informed and taught in CL/P management by attending formal lectures and presenting seminars topics. Majority 15 (94%) of the resident doctors still did not have the required experience and research skills in the field of CL/P, while 14 (87.5%) of them had never attended craniofacial conferences before now. This study has revealed shortcomings in training of orthodontic residents as it concerns the management of children affected with CL/P in Nigeria. Trainers and orthodontic training institutions in Nigeria may need to restructure their training program to allow for more in depth training as it concerns management of children affected with CL/P.
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Jabbari F, Skoog V, Reiser E, Hakelius M, Nowinski D. Optimization of Dental Status Improves Long-Term Outcome after Alveolar Bone Grafting in Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2015; 52:210-8. [DOI: 10.1597/13-118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the importance of dental status for long-term outcome after alveolar bone grafting in patients with unilateral cleft lip and palate. Design Retrospective longitudinal study. Setting Cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. Patients A total of 67 consecutive patients with unilateral complete cleft lip and palate. Interventions Secondary alveolar bone grafting, prior to the eruption of the permanent canine, was performed at the average age of 10.0 years (range, 8.5 to 12.0 years). Main Outcome Measures Alveolar bone height was evaluated with the modified Bergland index at 1 and 10 years after surgery. Results Of the patients, 97% had modified Bergland index grade I and the remaining 3% had modified Bergland index grade II at 1 year after surgery. At 10 years' follow-up, 43% showed modified Bergland index grade I; 55%, modified Bergland index grade II; and 2% (one patient), modified Bergland index grade III. The degree of dental anomalies in the cleft area, such as enamel hypoplasia, incisor rotation, incisor inclination, canine inclination, and oral hygiene registered preoperatively, all correlated negatively to the modified Bergland index at 10 years after surgery. Enamel hypoplasia (ρ = 0.70195, P < .0001), followed by canine inclination (ρ = 0.55429, P < .0001), showed the strongest correlation to reduced bone height in the cleft area. Conclusions In patients with unilateral cleft lip and palate, excellent results from secondary alveolar bone grafting in terms of bone height in the alveolar cleft tend to decrease with time. This seems to be correlated with factors that might to some extent be treated preoperatively through adequate planning and execution of the orthodontic treatment.
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Affiliation(s)
- Fatima Jabbari
- Department of Surgical Sciences and Department of Plastic and Maxillofacial Surgery, Uppsala University
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Valdemar Skoog
- Consultant Plastic and Reconstructive/Craniofacial Surgeon, Chairman of Cranio-Maxillo-Facial Unit, Akademiska Hospital, Uppsala, Sweden
| | - Eicka Reiser
- Department of Surgical Sciences and Department of Plastic and Maxillofacial Surgery, Uppsala University
| | - Malin Hakelius
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Daniel Nowinski
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Rocha R, Ritter DE, Locks A, Ribeiro GL. Maxillary segment surgical advancement for treatment of cleft lip and palate: Case report. J World Fed Orthod 2013. [DOI: 10.1016/j.ejwf.2013.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rocha R, Ritter DE, Locks A, de Paula LK, Santana RM. Ideal treatment protocol for cleft lip and palate patient from mixed to permanent dentition. Am J Orthod Dentofacial Orthop 2012; 141:S140-8. [PMID: 22449594 DOI: 10.1016/j.ajodo.2011.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 03/01/2011] [Accepted: 03/01/2011] [Indexed: 10/28/2022]
Abstract
A girl with an Angle Class III malocclusion, anterior and posterior crossbites, a concave profile, and cleft lip and palate sought orthodontic treatment. She was treated with a multidisciplinary therapeutic protocol including orthodontic and surgical procedures. The proposed objectives of occlusion, normal function, and balanced profile were achieved, and these results remained stable 4 years after the treatment.
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Affiliation(s)
- Roberto Rocha
- Department of Orthodontics, School of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
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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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Locke M, Bishop K. An assessment of the contribution of UK specialists in restorative dentistry to cleft lip and palate services. Br Dent J 2011; 210:E20. [DOI: 10.1038/sj.bdj.2011.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2010] [Indexed: 11/09/2022]
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Long RE, Hathaway R, Daskalogiannakis J, Mercado A, Russell K, Cohen M, Semb G, Shaw W. The Americleft study: an inter-center study of treatment outcomes for patients with unilateral cleft lip and palate part 1. Principles and study design. Cleft Palate Craniofac J 2011; 48:239-43. [PMID: 21219224 DOI: 10.1597/09-180.1] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The Americleft study is a North American initiative to undertake an intercenter outcome study for patients with repaired complete unilateral cleft lip and palate from five well-established North American cleft centers. DESIGN Retrospective cohort study. SETTING Five cleft palate centers in North America. METHODS This is the first paper in a series of five that outlines the overall goals of the study and sets the basis for the clinical outcome studies that are reported in the following four papers. The five centers' samples and treatment protocols as well as the methods used for each study are reported. The challenges encountered and possible mechanisms to resolve them and reduce methodological error with intercenter studies are also reviewed.
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Affiliation(s)
- Ross E Long
- Department of Surgery, Penn State College of Medicine, Lancaster, Pennsylvania, USA
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Aizenbud D. Kita H, Kochi S, Kamiya N, et al. Alveolar ridge notching as a predictor for secondary bone grafting in incomplete alveolar clefts. Cleft Palate Craniofac J 2004; 41:575-6. [PMID: 15352867 DOI: 10.1597/04050.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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