Comparison between the palatal configurations in complete and incomplete unilateral cleft lip and palate infants under 18 months of age

Treatment outcomes of pre-surgical infant orthopedics in patients with non-syndromic cleft lip and/or palate: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Non-syndromic clefts lip and/or palate (CL/P) defects may have manifold significant and detrimental consequences for the affected individuals and their family environment. Although the use of pre-surgical infant orthopedics (PSIO) was introduced as a means to improve management and treatment outcomes, there still remains a controversy.

OBJECTIVE

To investigate the effectiveness of PSIO in patients with non-syndromic CL/P and evaluate the quality of the available evidence.

SEARCH METHODS

Search without restrictions, together with hand searching, until May 2016.

SELECTION CRITERIA

Randomized clinical trials investigating the effects of pre-surgical infant orthopedic appliances.

DATA COLLECTION AND ANALYSIS

Following study retrieval and selection, data extraction and individual study risk of bias assessment using the Cochrane Risk of Bias Tool took place. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach.

RESULTS

Finally 20 papers (3 unique trials) were identified, involving a total of 118 patients with unilateral complete CL/P and 16 with cleft of the soft and at least two thirds of the hard palate. Eight publications were considered as being of low, four of unclear and eight of high risk of bias. In general, the investigated appliances did not present significant effects when compared to each other or to no treatment in terms of feeding and general body growth, facial esthetics, cephalometric variables, maxillary dentoalveolar variables and dental arch relationships, speech and language evaluation, caregiver-reported outcomes, economic evaluation, as well as, adverse effects and problems. Overall, the quality of the available evidence was considered low.

CONCLUSIONS

The aforementioned findings could provide initial guidance in the clinical setting. However, given the multitude of parameters, which may have affected the results, good practice would suggest further research, in order to reach more robust relevant recommendations for management decisions in individual cases.

Nasoalveolar molding in a case of incomplete cleft lip: Is it worth doing?

The purpose of this study was to evaluate the effects of presurgical nasoalveolar molding in an infant with incomplete cleft lip and alveolar notch. The patient was a 15-day-old female infant with a two-thirds vertical separation of the left side of the upper lip, with an intact nasal sill. A modified molding appliance was made to improve nasal esthetics and correct the alveolar notch. Although the nasal and alveolar region abnormalities were not serious, the molding appliance improved the nasal and lip esthetics and was stable during the 4-year follow-up.

Alteration of maxillary and mandibular growth of adult patients with unoperated isolated cleft palate

OBJECTIVE

The objective of this study was to investigate the effects of cleft palate itself on the growth of maxilla and mandible.

PATIENTS AND METHODS

Fifty-two adult female patients with unoperated isolated cleft palate and 52 adult female individuals with normal occlusion were included in our study. Computer software was used for lateral cephalometry measurement. Manual measurement was performed for dental cast measurements, and sample t test analysis was applied to analyze the differences between the 2 groups using SPSS 17.0.

RESULTS

The sella-nasion-subspinale point angle, subspinale-nasion-supramentale point angle, and maxillary arch length of the cleft group were significantly smaller than those of the control group (P < 0.01). Both maxillary and mandibular posterior dental arch widths of the cleft group were significantly larger compared with the control group (P < 0.01), whereas the sella-nasion-supramentale point angle, mandible arch length, palate height, and palate shelf inclination did not differ between the 2 groups. The measurements did not differ between the submucosal cleft and the overt cleft patients.

CONCLUSIONS

Cleft palate itself has adverse effects on the maxilla growth with shorter maxillary arch length and wider posterior dental arch width.

Width and elevation of the palatal shelves in unoperated unilateral and bilateral cleft lip and palate patients in the permanent dentition

Patients with cleft left lip and palate (CLP) normally require extensive surgery from an early age up to the end of adolescence. These surgeries affect the growth of the maxillofacial complex. The degree to which the cleft itself affects growth of the maxillofacial complex remains poorly understood. By analysing the width and elevation of the palatal shelves in unoperated adolescents and adults with unilateral and bilateral cleft lip and palate (UCLP and BCLP, respectively) and a non-cleft control group, it is possible to gain more insight into the real intrinsic growth potential of the maxillary structures. In this study, dental casts of the full permanent dentition of individuals with unrepaired UCLP (n = 68) and BCLP (n = 13) and non-cleft controls (n = 24) from the same area of Indonesia were digitized three-dimensionally. Maxillary arch width in the canine, premolar and molar regions, and the width and elevation of the palatal shelves were measured. Results showed that in patients with UCLP, the width of the palatal shelves on the cleft side in all regions, and on the non-cleft side in the canine/first premolar region, was significantly smaller compared with the control group. BCLP subjects showed similar deviations. In the UCLP group, the palatal shelves were rotated cranially and positioned more vertically. In the BCLP group, the palatal shelves were inclined by almost 10 ° more than the control group. The width of the palatal shelf and width of the maxillary arch positively correlated in the canine and first premolar regions for both the cleft and non-cleft side in patients with UCLP, and in the canine region for patients with BCLP. This means that the wider the palatal shelf, the wider the maxillary arch. The elevation of palatal shelves correlated with the maxillary arch width in all regions in patients with UCLP, and only in the premolar region in the control group. Thus, the wider the arch width, the smaller the elevation angle (the maxillary shelves are less vertical). No correlations between palatal shelf elevation and maxillary arch width were found in the BCLP group. This shows that the intrinsic growth potential in patients with UCLP and BCLP is affected by a smaller palatal shelf width and larger elevation of the shelves. These deviations may result in a wider cleft.

A comparative study on the measurements of palatal shelf area and gradient for adult patients with unoperated cleft palate

OBJECTIVE

To determine the maxillary growth potential of cleft palate patients compared with the normal population.

METHODS

By using a three-dimensional computed tomography scanning and imaging system, the gradient and surface area of the palatal shelves were measured and analyzed statistically among 30 adults with normal occlusion, 30 adult patients with operated unilateral complete cleft lip and palate, and 30 adults with unoperated unilateral complete cleft lip and palate.

RESULTS

In comparison with the control group, for the unoperated unilateral complete cleft lip and palate subjects, the gradient of the palatal shelves at both the cleft and noncleft sides was larger, meaning that the palatal shelves were rotated cranially and were more vertically positioned. The palatal surface area was significantly smaller in the unoperated and operated unilateral complete cleft lip and palate groups than in the noncleft control group; although, there was no significant difference between the unoperated and operated unilateral complete cleft lip and palate groups.

CONCLUSIONS

There is an intrinsic tissue deficiency in the palate/maxilla of unilateral complete cleft lip and palate patients.

Three-dimensional morphology of the palate in patients with bilateral complete cleft lip and palate at the stage of permanent dentition

OBJECTIVE

Three-dimensional analysis of palate size and shape in 30 patients with complete bilateral cleft lip and palate (BCLPc) at the stage of permanent dentition.

DESIGN

Cross-sectional study based on laser scanning.

SUBJECTS

Thirty dental casts of boys approximately 15 years old with BCLPc and 28 dental casts of healthy boys of the same age.

INTERVENTIONS

Arched-lip suture with periosteoplasty and push-back of the palate with pharyngeal-flap surgery.

MAIN OUTCOME MEASURES

Data on palate height in the 210 defined locations and on palate widths and profile area in 10 transverse sections.

RESULTS

The palate in patients with BCLPc was conical and narrower than in control study subjects, much more anteriorly than posteriorly. From the canines posteriorly, the palate was of almost constant height of 10 mm in the midline, being higher than in control study subjects at this location and lower more posteriorly (by 24% to 29% between molars). The area of transverse sections was reduced as compared with control study subjects from the first premolars posteriorly and reached more than 40% between molars. The length of the palate up to the first molars was not changed.

CONCLUSION

BCLPc subjects exhibited narrow, low, and flat palate. Palate size and shape differences indicate a substantial reduction of the space for the tongue.

Three-dimensional morphology of the palate in subjects with isolated cleft palate at the stage of permanent dentition

OBJECTIVE

Three-dimensional analysis of palate size and shape in patients with isolated cleft palate at the stage of permanent dentition.

DESIGN

Cross-sectional study using Fourier transform profilometry.

SUBJECTS

Twenty-nine randomly selected dental casts of approximately 15-year-old boys with isolated cleft palate and 28 dental casts of normal boys of the same age.

INTERVENTIONS

All patients were operated on by the same method (pushback and pharyngeal flap surgery) at a mean age of 4.5 years.

MAIN OUTCOME MEASURES

Data on the palate height in 210 defined locations (pixels).

RESULTS

The palate in isolated clefts is narrower throughout its whole extent and lower from the level of the first premolars. The difference, as compared with controls, increases in a posterior direction. At the level of the first molars, palatal height is reduced by one-quarter, the area of the transversal section by more than one-third. The shaping of the palate vault is, on average, symmetrical with a marked interindividual variability. Palatal height does not depend on the width of the dentoalveolar arch, and the height of the primary palate is not reduced.

CONCLUSION

The smaller width and reduced height from the level of the first premolars posteriorly confirm the substantially reduced space available for the tongue in patients with isolated cleft palate. Deviations are on the average symmetrical, and the anterior part of the palate is not shallower.