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Willershausen I, Krautkremer N, Ströbel A, Abu-Tair T, Paulsen F, Strobel K, Kopp M, May MS, Uder M, Krautkremer F, Gölz L. Evaluation of hard palate and cleft morphology in neonates with Pierre Robin Sequence and Cleft Palate Only. Orthod Craniofac Res 2024. [PMID: 38783751 DOI: 10.1111/ocr.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES This study aimed to establish a fully digital measurement protocol for standardizing the description of hard palate and cleft morphology in neonates with an isolated cleft palate (CPO) and Pierre Robin sequence (PRS). MATERIALS AND METHODS A total of 20 digitized plaster models of neonates with CPO and 20 digitized plaster models of neonates with PRS were retrospectively investigated. For the control group, the hard palate was segmented from 21 pre-existing 1.5 T MRI datasets of neonates and exported as an STL file. The digital models were marked with predefined reference points by three raters. Distance, angular, and area measurements were performed using Blender and MeshLab. RESULTS Neonates with CPO (20.20 ± 2.33 mm) and PRS (21.41 ± 1.81 mm) had a significantly shorter hard palate than the control group (23.44 ± 2.24 mm) (CPO vs. control: P < .001; PRS vs. control: P = .014). Notably, neonates with PRS (33.05 ± 1.95 mm) demonstrated a significantly wider intertuberosity distance than those with CPO (30.52 ± 2.28 mm) (P = .012). Furthermore, there were also significant differences measured between the cleft and control groups (25.22 ± 2.50 mm) (P < .001). CONCLUSIONS The data from this study demonstrate the feasibility of using MRI datasets to generate digital models of the hard palate. The presence of a cleft palate leads to pronounced adaptations of the total palatal surface area, dorsal width, and length of the hard palate. Mandibular retrognathia and altered tongue position in PRS, as opposed to CPO, might further impact palatal morphology and intertuberosity distance.
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Affiliation(s)
- Ines Willershausen
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Nils Krautkremer
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technische Universität München, Munich, Germany
| | - Armin Ströbel
- Center for Clinical Studies (CCS), Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Tariq Abu-Tair
- Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Karin Strobel
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Markus Kopp
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Stefan May
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Franziska Krautkremer
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Lina Gölz
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Zheng J, Kuang W, Yuan S, He H, Yuan W. Three-dimensional Analysis of Maxillary Morphology in Infants with Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2024:10556656241228903. [PMID: 38414427 DOI: 10.1177/10556656241228903] [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: 02/29/2024] Open
Abstract
OBJECTIVE To three-dimensionally (3D) analyze the maxillary morphology of infants with unilateral cleft lip and palate (UCLP) and preliminarily classify the alveolar arch to assist in personalization of sequence therapy. DESIGN Retrospective study. SETTING Patients with UCLP referred to outpatients' clinic. PARTICIPANTS 84 nonsyndromic infants with complete UCLP were recruited (58 boys, 26 girls, mean age 29.48 days). MAIN OUTCOME MEASURE Morphometric analysis was conducted on 3D maxillary models. Principal component analysis (PCA) and cluster analysis were combined to classify maxillary phenotypes preliminarily. The Wilcoxon Signed Rank test and the Kruskal-Wallis test were used to compare differences between variables. A P value less than .05 was considered statistically significant. RESULTS The maxilla was divided into three types: narrow, homogenous and broad, accounting for 9.52%, 23.81% and 66.67% respectively. The alveolar cleft site (median value) was located in 61% of the total length of the alveolar arch. In the comparison of anterior and total alveolar lengths, the non-cleft side had longer alveolar bone than the affected side, a difference of approximately 2 mm. Pairwise comparisons of variables describing alveolar symmetry revealed significant differences in all subjects; whereas type C had poorer arch symmetry than types A and B, mainly in terms of anterior and overall symmetry. CONCLUSIONS In infants with UCLP, the maxillary alveolar arch was inherently asymmetrical with partially bone missing (about 2 mm). Significant differences in alveolar bone morphology and symmetry exist between different types of infants, with individuals with broad clefts (type C, the largest proportion) having the worst maxillary development.
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Affiliation(s)
- Jie Zheng
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Wenying Kuang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Shiyu Yuan
- School of Clinical Medicine, Zhengzhou University, Zhengzhou, China
| | - Hong He
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Wenjun Yuan
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
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Chaisooktaksin N, Chimruang J, Worasakwutiphong S, Tansalarak R. Three-dimensional Changes of Maxillary Alveolar Morphology After Using Modified Nasoalveolar Molding in Patients with Complete Unilateral Cleft lip and Palate. Cleft Palate Craniofac J 2022:10556656221086816. [PMID: 35285744 DOI: 10.1177/10556656221086816] [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 This study aimed to evaluate the three-dimensional changes in maxillary alveolar morphology after using modified NAM in patients with complete unilateral cleft lip and palate. DESIGN This is a retrospective study. SETTING The study was carried out in the dental hospital, Faculty of Dentistry of Naresuan University, Phitsanulok, which serves as a tertiary care center. PATIENTS The population sample consisted of 19 patients with nonsyndromic complete unilateral cleft lip and palate. INTERVENTION All patients received the modified NAM treatment based on the treatment protocol of the Naresuan University Cleft and Craniofacial Center, Thailand. MAIN OUTCOME MEASURE Dental models obtained at pre-treatment (T0) and post-treatment (T1) were scanned to construct the digital models. The maxillary digital models that showed dimensional changes between T0 and T1 were measured using a computer graphic software. RESULTS The modified NAM resulted in a significant decrease in the anterior cleft width, posterior cleft width, and anterior arch width. Conversely, it caused a significant increase in the length of the lesser cleft segment and the greater segment rotation. However, the change in the height of both segments and posterior arch width was not found to be significant. CONCLUSIONS The modified NAM was an effective device for reducing the alveolar cleft width while improving the alignment of alveolar cleft segments.
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Affiliation(s)
- Nuntabhorn Chaisooktaksin
- Department of Preventive Dentistry, Faculty of Dentistry, 59212Naresuan University, Phitsanulok 65000, Thailand
| | - Jutharat Chimruang
- Department of Preventive Dentistry, Faculty of Dentistry, 59212Naresuan University, Phitsanulok 65000, Thailand.,Naresuan University Cleft and Craniofacial Center, Phitsanulok 65000, Thailand
| | - Saran Worasakwutiphong
- Department of Surgery, Faculty of Medicine, 59212Naresuan University, Phitsanulok 65000, Thailand.,Naresuan University Cleft and Craniofacial Center, Phitsanulok 65000, Thailand
| | - Ratchawan Tansalarak
- Department of Preventive Dentistry, Faculty of Dentistry, 59212Naresuan University, Phitsanulok 65000, Thailand.,Naresuan University Cleft and Craniofacial Center, Phitsanulok 65000, Thailand
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4
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Digital Volumetric Monitoring of Palate Growth in Children With Cleft Lip and Palate. J Craniofac Surg 2021; 33:e143-e145. [PMID: 34636766 DOI: 10.1097/scs.0000000000008137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT This study aimed to evaluate longitudinally the volume of the dental arches in children with unilateral cleft lip and palate before and after the rehabilitative plastic surgeries. This is a longitudinal retrospective study was composed by 102 digitized dental casts of children with unilateral complete cleft lip (G1) and cleft lip and palate (G2). The palate volume was evaluated at 3 periods: preoperative (T1), postoperative 1 (T2), and postoperative 2 (T3). The intra- and inter-examiner reliability was analyzed by Wilcoxon test/Dahlberg formula and interclass correlation coefficient, respectively. The intragroup comparison was analyzed by Wilcoxon test and Friedman test followed by post-hoc Dunn test. Mann-Whitney test was applied for the intergroup comparison (α = 5%). G1 had a significant growth at T2 (P = 0.031). G2 demonstrated a positive development at T2, but decreased at T3 (P = 0.003). The intergroup analysis revealed that G2 showed a greater volume at T1 and T2 (P < 0.0001 and P = 0.0024, respectively). T2-T1 exhibited no statistically significant difference (P = 0.262). In conclusion, there was a volumetric increase in the dental arches after cheiloplasty followed by a reduction after palatoplasty. Further investigations are necessary to validate the preliminary results of the present study.
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Ambrosio ECP, Sforza C, Carrara CFC, Machado MAAM, Oliveira TM. Innovative method to assess maxillary arch morphology in oral cleft: 3d-3d superimposition technique. Braz Dent J 2021; 32:37-44. [PMID: 34614059 DOI: 10.1590/0103-6440202104148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/21/2021] [Indexed: 11/21/2022] Open
Abstract
This study aimed to analyze the maxillary growth and development of children with oral clefts using the innovative method of 3D-3D superimposition technique. Children with unilateral complete cleft lip (UCL) and unilateral cleft lip and palate (UCLP) participated in the study. The impressions of the dental arches were executed 1 day before and 1 year after lip repair surgery. A 3D laser scanner digitized the dental models and the stereophotogrammetry system software analyzed the 3D-3D superimpositions in two groups of matches (same child, UCL and UCLP) and one group of mismatches (different individuals). The differences were evaluated by Root Mean Square (RMS) and expressed in millimeters (mm). Kruskal-Wallis test followed by post-hoc Dunn test and Mann-Whitney test were assessed to compare the groups (α=5%). RMS was 1.34 mm (± 0.37) in UCL group, 1.41 mm (± 0.32) in UCLP group, and 3.38 mm (± 1.28) in mismatches group. RMS was significantly greater in mismatches than in matches groups (p<0.0001). No statistically significant differences occurred between genders. The 3D-3D superimposition technique showed the maxillary development after lip repair surgery in the anterior region of the palate. Thus, it is suggested that the cleft amplitude and the palatal segments proportion influenced the morphological heterogeneity and, consequently, the development and maxillary growth of children with orofacial cleft.
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Affiliation(s)
- Eloá Cristina Passucci Ambrosio
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, , Bauru São Paulo, Brazil
| | - Chiarella Sforza
- Department of Biomedical Sciences for Health, Functional Anatomy Research Center (FARC), Faculty of Medicine and Surgery, University of Milan , , Lombardia Milan, Italy
| | | | | | - Thais Marchini Oliveira
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, , Bauru São Paulo, Brazil.,Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
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6
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Continuous circular closure in unilateral cleft lip and plate repair in one surgery. J Craniomaxillofac Surg 2021; 50:76-85. [PMID: 34896005 DOI: 10.1016/j.jcms.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 06/05/2021] [Accepted: 07/31/2021] [Indexed: 12/17/2022] Open
Abstract
The study aims at assessing wound healing and safety of single-stage two-layers continuous closure in patients with unilateral cleft lip and palate (UCLP). In this retrospective, descriptive cohort study, we assessed wound healing without fistula formation at 1, 3, and 6 months after a single-stage two-layer UCLP repair, in which the midline suture is continuously circular all along the oral and nasal sides. We examined lengths of hospital stay and the incidence of intra- and postoperative adverse events. Furthermore, we compared the cleft width at birth and on the day of surgery, after presurgical orthopaedics. Eleven UCLP patients underwent one cleft surgery between July 2016 and June 2018 at the age of 8-9 months. Full primary healing occurred in all patients without fistulas. Median length of post-operative hospital stay was 5 days (range = 4-9 days). No intra- or postoperative adverse events above Grade I (according to ClassIntra and Clavien-Dindo, respectively) occurred. Median and interquartile range (IQR) of the palatal cleft width decreased significantly from birth to surgery, i.e., from 12.0 mm (10.8-13.6 mm) to 5.0 mm (4.0-7.5 mm) anteriorly and from 14.0 mm (11.5-15.0 mm) to 7.3 mm (6.0-8.5 mm) posteriorly (p = 0.0033 in both cases). Given these preliminary results, the concept of single-stage continuous circular closure in UCLP has potential for further investigation. However, it remains to be proven that there are no relevant adverse effects such as inhibition of maxillary growth. Registered in clinicaltrials.gov:NCT04108416.
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Benitez BK, Brudnicki A, Nalabothu P, Jackowski JAV, Bruder E, Mueller AA. Histologic Aspect of the Curved Vomerine Mucosa in Cleft Lip and Palate. Cleft Palate Craniofac J 2021; 59:1048-1055. [PMID: 34291694 PMCID: PMC9272516 DOI: 10.1177/10556656211031419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Common surgical techniques aim to turn the entire vomerine mucosa
with vomer flaps either to the oral side or to the nasal side.
The latter approach is widely performed due to the similarity in
color to the nasal mucosa. However, we lack a histologic
description of the curved vomerine mucosa in cleft lip and
palate malformations. Methods: We histologically examined an excess of curved vomerine mucosa in 8
patients using hematoxylin–eosin, periodic acid–Schiff, Elastin
van Gieson, and Alcian blue stains. Tissue samples were obtained
during surgery at 8 months of age. Results: Our histological analysis of the mucoperiosteum overlying the
curved vomer revealed characteristics consistent with those of
an oral mucosa or a squamous metaplasia of the nasal mucosa, as
exhibited by a stratified squamous epithelium containing
numerous seromucous glands. Some areas showed a palisaded
arrangement of the basal cells compatible with metaplasia of
respiratory epithelium, but no goblet cells or respiratory cilia
were identified. Abundant fibrosis and rich vascularity were
present. Conclusion: The vomer mucosa showed no specific signs of nasal mucosa. These
findings should be considered in presurgical cleft orthopedics
and palatal surgery for further refinement. Shifting the vomer
mucosa according to a fixed physiologic belief should not
overrule other important aspects of cleft repair such as primary
healing and establishing optimal form and function of palatal
roof and nasal floor.
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Affiliation(s)
- Benito K Benitez
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Switzerland.,Department of Clinical Research, University of Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Andrzej Brudnicki
- Department of Maxillofacial Surgery, Clinic of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland
| | - Prasad Nalabothu
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Switzerland.,Department of Clinical Research, University of Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | | | - Elisabeth Bruder
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel and University of Basel, Switzerland
| | - Andreas Albert Mueller
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Switzerland.,Department of Clinical Research, University of Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
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8
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Anthropometric Parameters of Nasomaxillary Complex in 2, 4, 6, and 12-Month-Old Children as a Reference for Cleft Lip and Palate Reconstructive Surgery. J Craniofac Surg 2021; 32:597-599. [PMID: 33704989 DOI: 10.1097/scs.0000000000006830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The purpose of this study was to analyze the morphology of the nasomaxillary complex of Iranian healthy infants of 2, 4, 6, and 12-month-old.In this cross-sectional study, 232 healthy Fars infants of 2, 4, 6, and 12-month-old referred to Mashhad health centers were evaluated. Photographic images were taken from the infants' frontal view at rest position. Anthropometric landmarks including width of the mouth, nose, columella, width and height of the philtrum, and height of the upper lip were measured by Photoshop software.The authors did not find any considerable differences in nasolabial morphology of Fars children between boys and girls, except for columellar width and the width of superior philtrum at all intervals. The mean columellar width decreased with increasing age in both sexes. The width of the lower philtrum decreased from 2 to 4 months in both sexes, but increased from 4 to 6 months. In girls, the mean height of the right and left philtrum and height of the upper lip increased by increasing age from 2 to 4 months. But it consistently reduced from 4 months to 6 and 12-month-old. In boys, the mean height of the right and left philtrum and height of the upper lip decreased from 2 to 4 months. It showed a mild increase from 4 to 6 months, and a relatively large reduction from 6 to 12 months.This study provides useful information for reconstructive surgeries of the nasolabial region in the population studied.
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Abreu A, Lima MH, Hatten E, Klein L, Levy-Bercowski D. Intraoral Digital Impression for Speech Aid/Obturator in Children: Report of 2 Cases. Cleft Palate Craniofac J 2021; 59:262-267. [PMID: 33761802 DOI: 10.1177/10556656211002686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cleft patients may develop an abnormal opening (fistula) between the oral and the nasal cavities. Surgical repair minimizes the adverse effect on speech and feeding. However, an obturator prosthesis is a nonsurgical approach to help close the communication. The purpose of the case report presented is to show the clinical use of an intraoral digital impression in the fabrication of obturator/speech aid appliances in children with cleft lip and palate deformity. Minimal adjustments were needed, and patients and caregivers responded positively. Prostheses demonstrated good stability and retention at delivery. The use of digital technology seems to have several benefits as an alternative method for capturing impressions, especially in young children with cleft lip and palate deformity.
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Affiliation(s)
- Amara Abreu
- Department of Restorative Sciences, Dental College of Georgia, 1421Augusta University, GA, USA
| | - Maria Helena Lima
- Section of Plastic and Reconstructive Surgery, 1421Augusta University, GA, USA.,Craniofacial Center, Children's Hospital of Georgia, Augusta, GA, USA
| | - Eric Hatten
- Department of Orthodontics, Dental College of Georgia, 1421Augusta University, GA, USA
| | - Laura Klein
- Dental College of Georgia, 1421Augusta University, GA, USA
| | - Daniel Levy-Bercowski
- Craniofacial Center, Children's Hospital of Georgia, Augusta, GA, USA.,Department of Orthodontics, Dental College of Georgia, 1421Augusta University, GA, USA
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Palatal growth changes in newborns with unilateral and bilateral cleft lip and palate from birth until 12 months after early neonatal cheiloplasty using morphometric assessment. Clin Oral Investig 2021; 25:3809-3821. [PMID: 33409695 DOI: 10.1007/s00784-020-03711-9] [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: 07/13/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare palatal growth changes in infants with complete unilateral (UCLP) or bilateral (BCLP) cleft lip and palate during the first year of life. MATERIALS AND METHODS Upper dental arches of 68 neonates with UCLP and BCLP were evaluated using 2D and 3D morphometry based on dental casts obtained in two age categories (T0 before early neonatal cheiloplasty-UCLP 4 ± 3 days, BCLP 6 ± 5 days; T1 before palatoplasty-UCLP 10 ± 2 months, BCLP 12 ± 3 months). RESULTS Intensive palatal growth was manifested in both directions of the palate. Palatal growth in the anterior direction was not restricted, despite the intercanine (CC´) and anterior (LL´) widths being significantly narrowed in the BCLP group (CC´ p = 0.019, LL´ p = 0.009). The posterior dental arches were significantly enlarged (UCLP p ≤ 0.001; BCLP p ≤ 0.001). The negative effect of cleft severity on palatal length was not confirmed (p = 0.802). Variability of the palate was immense mainly in BCLP infants (T0); however, it decreased in both cleft types, confirming the formative effect of palatal growth leading to alveolar cleft closure (UCLP p ≤ 0.001; BCLP p = 0.006 on the right, 0.005 on the left). CONCLUSIONS Both analyzed cleft groups (UCLP, BCLP) grew favorably during the first year of life, and the palatal growth was not limited in any direction. CLINICAL RELEVANCE Geometric morphometry allowed a comprehensive analysis of the palate, which can contribute to the improvement of surgical methods.
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Novel Three-Dimensional Coordinate System to Analyze Alveolar Molding Effects of Pre-Surgical Nasoalveolar Molding on Infants With Non-Syndromic Unilateral Cleft Lip and Palate. J Craniofac Surg 2020; 31:653-657. [PMID: 31985599 DOI: 10.1097/scs.0000000000006148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is to establish a stable 3-dimensional (3D) coordinate system for investigating the alveolar molding effects of pre-surgical nasoalveolar molding (PNAM) on non-syndromic unilateral cleft lip and palate (UCLP) patients, basing on the Frankfort Horizontal (FH) plane.Twenty-one non-syndromic UCLP neonates who sought medical advice in the department of Orthodontics, from 2016.5 to 2017.10 were enrolled in the present study. All neonates were subjected to PNAM before the cleft lip repair. The treatment duration was 75.76 days. Silicone rubber models were obtained and scanned using a 3D laser scanner pre- and post-PNAM treatment. A 3D coordinate system based on the FH reference plane was built utilizing Rhino3D software to record the landmark 3D coordinates, to measure the distance, angle, and length variables. The Paired Student's t test and the Pearson correlation coefficient were used to calculate reproducibility and reliability of the landmark localization for repeated measurements. Changes of the measurement variables were analyzed by the Paired Student's t test.This study revealed a high reproducibility and reliability for most of the landmarks. By the end of PNAM treatment, the cleft gap was reduced with the malformation of alveolar segments aligned normally and the anterior points of both alveolar segments were rotated to the cleft side.Utilizing the FH plane to set up a rigorous and stable 3D system is meaningful. PNAM therapy is effective in reducing the severity of the maxillary deformity not only on the non-cleft side, but also on the cleft side.
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Zheng J, He H, Kuang W, Yuan W. Presurgical nasoalveolar molding with 3D printing for a patient with unilateral cleft lip, alveolus, and palate. Am J Orthod Dentofacial Orthop 2019; 156:412-419. [PMID: 31474271 DOI: 10.1016/j.ajodo.2018.04.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/01/2018] [Accepted: 04/01/2018] [Indexed: 11/19/2022]
Abstract
An 8-day-old male infant with unilateral cleft lip, alveolus, and palate had a wide alveolar defect, soft tissue deformity, and a markedly sunken nasal wing at the cleft side. The patient was treated with a series of 3D-printed molding plates and synchronously with a nasal hook. The cleft edges moved closer by 9 mm at the alveolar ridge and the nasal wing was lifted considerably. Split-type 3D printing of presurgical nasoalveolar molding helped to reduce the cleft gap, improve the arch form, approximate lip segments, and distinctly improve the morphology of the nose by correcting the flattened nasal wings.
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Affiliation(s)
- Jie Zheng
- Department of Orthodontics, School and Hospital of Stomatology, State Key Laboratory Breeding Base of Basic Science of Stomatology, and Key Laboratory for Oral Biomedicine of Ministry of Education, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Hong He
- Department of Orthodontics, School and Hospital of Stomatology, State Key Laboratory Breeding Base of Basic Science of Stomatology, and Key Laboratory for Oral Biomedicine of Ministry of Education, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Wenying Kuang
- Department of Orthodontics, School and Hospital of Stomatology, State Key Laboratory Breeding Base of Basic Science of Stomatology, and Key Laboratory for Oral Biomedicine of Ministry of Education, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Wenjun Yuan
- Department of Orthodontics, School and Hospital of Stomatology, State Key Laboratory Breeding Base of Basic Science of Stomatology, and Key Laboratory for Oral Biomedicine of Ministry of Education, Wuhan University, Wuhan, Hubei, People's Republic of China.
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13
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Burgaz MA, Cakan DG, Yılmaz RBN. Three-dimensional evaluation of alveolar changes induced by nasoalveolar molding in infants with unilateral cleft lip and palate: A case-control study. Korean J Orthod 2019; 49:286-298. [PMID: 31598485 PMCID: PMC6769263 DOI: 10.4041/kjod.2019.49.5.286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The objectives of this study were to evaluate linear and volumetric alveolar changes induced by nasoalveolar molding (NAM) in infants with complete unilateral cleft lip and palate (UCLP) and compare the maxillary dimensions after NAM with the normal dimensions in infants without clefts. METHODS A total of 26 infants with UCLP treated by NAM (mean age before and after NAM: 14.20 ± 8.09 days and 118.16 ± 10.06 days, respectively) comprised the treatment group, while 26 infants without clefts (mean age: 115.81 ± 8.71 days) comprised the control group. Changes in the maxillary dimensions following NAM were measured on three-dimensional models using Mimics software, version 17.0. RESULTS During NAM, there was a decrease in the cleft widths, maxillary arch depths, and rotation of the greater segment. While the anterior alveolar arch width exhibited a significant decrease, the posterior arch width was mostly maintained. There were no changes in the anterior vertical deviations of the alveolar segments. The alveolar crest lengths, arch circumference, and bilateral posterior volumetric measures exhibited an increase. After NAM, the anterior arch width was comparable between the treatment and control groups, whereas the posterior arch width and anterior vertical deviations were greater in the treatment group than in the control group. The maxillary arch depths, alveolar crest lengths, and maxillary volumes were smaller in the NAM group than in the control group. CONCLUSIONS During NAM in infants with UCLP, the cleft width and anteroposterior and transverse alveolar dimensions exhibited a decrease while the vertical dimensions were maintained. Compared with infants without clefts, those with UCLP treated by NAM exhibited sagittal and vertical alveolar growth deficiencies and tissue insufficiency.
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Affiliation(s)
| | - Derya Germec Cakan
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - R. Burcu Nur Yılmaz
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
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Patel J, Winters J, Walters M. Intraoral Digital Impression Technique for a Neonate With Bilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2019; 56:1120-1123. [DOI: 10.1177/1055665619835082] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Dental casts are an important aspect in the treatment planning, documentation, and analysis of the dental arch forms of infants with cleft lip and palate (CLP). Impression taking in a neonate is a technique-sensitive procedure, which can result in foreign body dislodgement and carries a small risk of aspiration and airway obstruction. The advent of digital dental technologies and intraoral scanning may facilitate safer, more effective, and accurate impressions for CLP infants. Design: A digital intraoral scan of a 3-month-old with bilateral CLP (BCLP) was compared with a conventional alginate impression taken prior to primary lip repair. Setting: Princess Margaret Hospital for Children. Main Outcome Measures: To test the applicability and accuracy of digital impression taking for a neonate with BCLP and palate using digital morphometrics. Results: The average deviation of points ranged above and below the plane of superimposition from +0.78 mm to −0.42 mm with a maximum range of +2.80 mm to −2.80 mm and standard deviation of 0.88 mm. The premaxillary segment showed the greatest degree of variation. Conclusions: This is to our knowledge the first report that illustrates the use of a digital impression system to scan the oral structures of a neonate with BCLP. Digital scanning was found to be fast, accurate, and safe, when compared to a conventional alginate impression technique.
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Affiliation(s)
- Jilen Patel
- UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
- Paediatric Dentistry, Department of Dental Medicine, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - John Winters
- Paediatric Dentistry, Department of Dental Medicine, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Mark Walters
- Cleft Lip and Palate Unit, Perth Children’s Hospital, Nedlands, Western Australia, Australia
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15
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Bruggink R, Baan F, Kramer GJC, Maal TJJ, Kuijpers-Jagtman AM, Bergé SJ, Bronkhorst EM, Ongkosuwito EM. Three dimensional maxillary growth modeling in newborns. Clin Oral Investig 2019; 23:3705-3712. [PMID: 30635787 DOI: 10.1007/s00784-018-2791-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this study was to develop an accurate and intuitive semi-automatic segmentation technique to calculate an average maxillary arch and palatal growth profile for healthy newborns in their first year of life. MATERIALS AND METHODS Seventy babies born between 1985 and 1988 were included in this study. Each child had five impressions made in the first year after birth that were digitalized. A semi-automatic segmentation tool was developed and used to assess the maxillary dimensions. Finally, random effect models were built to describe the growth and build a simulation population of 10,000 newborns. The segmentation was tested for inter- and intra-observer variability. RESULTS The Pearson correlation coefficient for each of the variables was between 0.94 and 1.00, indicating high inter-observer agreement. The paired sample t test showed that, except for the tuberosity distance, there were small, but significant differences in the landmark placements between observers. Intra-observer repeatability was high, with Pearson correlation coefficients ranging from 0.87 to 1.00 for all measurements, and the mean differences were not significant. A third or second degree growth curve could be successfully made for each parameter. CONCLUSIONS These findings indicated this method could be used for objective clinical evaluation of maxillary growth. CLINICAL RELEVANCE The resulting growth models can be used for growth studies in healthy newborns and for growth and treatment outcome studies in children with cleft lip and palate or other craniofacial anomalies.
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Affiliation(s)
- R Bruggink
- Department of Dentistry, section of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands. .,Radboudumc 3DLab, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - F Baan
- Department of Dentistry, section of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands.,Radboudumc 3DLab, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - G J C Kramer
- Department of Orthodontics, Academic Center for Dentistry Amsterdam ACTA, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - T J J Maal
- Radboudumc 3DLab, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - A M Kuijpers-Jagtman
- Department of Dentistry, section of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands
| | - S J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Amalia Cleft and Craniofacial Centre, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - E M Bronkhorst
- Department of Dentistry, section of Preventive and Restorative Dentistry, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - E M Ongkosuwito
- Department of Dentistry, section of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands.,Amalia Cleft and Craniofacial Centre, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Oosterkamp BCM, van der Meer WJ, Rutenfrans M, Dijkstra PU. Reliability of Linear Measurements on a Virtual Bilateral Cleft Lip and Palate Model. Cleft Palate Craniofac J 2017; 43:519-23. [PMID: 16986985 DOI: 10.1597/05-078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To assess the reliability and validity of measurements performed on three-dimensional virtual models of neonatal bilateral cleft lip and palate patients, compared with measurements performed on plaster cast models. Materials and Methods: Ten high-quality plaster cast models of bilateral cleft lip and palate patients were scanned with an LDI-scanner to obtain a three-dimensional virtual model. Linear measurements were performed on the plaster cast models using a digital caliper and also on the three-dimensional virtual model using Viscam RP version 2.1 software. The measurements were performed by two observers on two occasions. Results: Intraclass correlations ranging from .81 to .96 were found for all measurements except the measurement between the constructed reference point pr and reference point i (intraclass correlation = .40). A post hoc procedure in which top-view screen prints of the three-dimensional virtual model were used to perform the measurement between reference points pr and i demonstrated an intraclass coefficient of .90. Conclusions: Three-dimensional virtual models obtained by laser scanning neonatal cast models of bilateral cleft lip and palate patients can be used reliably and validly to perform linear measurements between existing reference points on the surface of the model using Viscam RP version 2.1 software. Measurements between reference points constructed outside the surface of the model cannot be validly performed on the three-dimensional virtual model with the software used in this study. For these measurements, top-view screen prints of the three-dimensional virtual model can be used.
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Affiliation(s)
- Barbara C M Oosterkamp
- Department of Orthodontics, University Medical Centre Groningen, Groningen, the Netherlands.
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17
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Trefný P, Smahel Z, Formánek P, Peterka M. Three-Dimensional Analysis of Maxillary Dental Casts Using Fourier Transform Profilometry: Precision and Reliability of the Measurement. Cleft Palate Craniofac J 2017; 41:20-6. [PMID: 14697074 DOI: 10.1597/02-097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Fourier transform profilometry was used for the three-dimensional measurement of maxillary dental casts to analyze the size and shape of the palate. The objective of this study was to test the accuracy of the measuring system and determine the precision and reliability of the measurement Methods Images of dental casts were analyzed using newly developed measuring software. Based on five landmarks located on the alveolar ridge, the measuring software constructed 10 transversal sections of the palate. In each section profile, the width, area, and 23 height variables were assessed. Subjects Maxillary dental stone casts of 25 healthy girls, 14.1 to 15.3 years of age, were studied. Results The technical error of measurement exceeded 5% of the size of the measurement only in variables with means less than approximately 3 mm. In fact, such small absolute dimensions were exhibited only by the palate height in anterior profile 2 and the palate height at the margins of other profiles. Reliability of the measurements was found to be very high for the width and area of the profiles. For height measurements, the coefficient of reliability was slightly lower at the profile margins than near the midline. Nevertheless, only three height variables showed a coefficient of reliability lower than 0.90. The coefficients of reliability of other height measurements of profiles 3 through 10 were only sporadically lower than 0.97. Conclusion With regard to the accuracy of the measuring system as well as the precision and reliability of the measurement, this method proved to be a suitable tool for studying palatal morphology.
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Affiliation(s)
- Pavel Trefný
- Institute of Dental Research, General Faculty Hospital, Prague, Czech Republic.
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Oosterkamp BCM, van Oort RP, Dijkstra PU, Stellingsma K, Bierman MWJ, de Bont LGM. Effect of an Intraoral Retrusion Plate on Maxillary Arch Dimensions in Complete Bilateral Cleft Lip and Palate Patients. Cleft Palate Craniofac J 2017; 42:239-44. [PMID: 15865456 DOI: 10.1597/03-109.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to analyze maxillary arch dimensions in patients with complete bilateral cleft lip and palate treated with an intraoral retrusion plate prior to lip closure. Patients The effects of the intraoral retrusion plate were evaluated on serially obtained maxillary casts of 14 patients with complete bilateral cleft lip and palate. Results The Student's t test for dependent observations showed a significant decrease in distance between the premaxilla and the cleft lateral segments during active treatment. This decrease correlated with an increase in deviation of the premaxilla in relation to the vomer. For each millimeter decrease in distance between the premaxilla and the cleft lateral segments, an average increase in deviation of 4.0 degrees was found. Left and right cleft widths decreased significantly, premaxillary width increased significantly, and transverse dimensions did not change significantly. Conclusion From this study it can be concluded that active presurgical treatment with an intraoral retrusion plate induces a significant decrease in distance between the premaxilla and the lateral segments. This decrease is frequently accompanied by an increase in deviation of the premaxilla relative to the vomer.
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Three-dimensional analysis of maxillary development in patients with unilateral cleft lip and palate during the first six years of life. J Orofac Orthop 2016; 76:391-404. [PMID: 26123734 DOI: 10.1007/s00056-015-0299-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of this work was to analyse early upper-jaw development in patients with unilateral cleft lip and palate (UCLP) treated using two different concepts and to compare shape and size developments between these two groups and a group of noncleft patients. MATERIALS AND METHODS A total of 204 maxillary casts available for this study from 50 UCLP patients were analyzed for upper-jaw development based on three-dimensional measurements performed with a Reflex Microscope from birth up to 71 months of age. Thirty-five of these 50 patients were part of an early treatment group (two-stage cleft closure with single-stage palatoplasty at an age of 10-14 months) and 15 were part of a late treatment group (two-stage cleft closure with palatoplasty at an age of 4-7 years). The control group included 39 casts of 17 noncleft patients. RESULTS Analysis of shape and size between the patients in the three groups yielded statistically significant differences between the cleft and the noncleft patients. In both treatment groups, we made observations typically associated with cleft formation like lateralization, asymmetry of the greater and lesser cleft segments, and pronounced vertical deviations of the segments. Viewed in all dimensions, however, the patients in the early treatment group approached the control group more closely, although a statistically significant difference was still observed. CONCLUSION Our results suggest that the timing of hard-palate closure is not a decisive factor for upper-jaw development. Intrinsic factors (initial cleft width, presence of tooth buds) and the surgeon's skills appear to have a much more defining role.
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Tsetsilas M, Konermann AC, Keilig L, Reimann S, Jäger A, Bourauel C. Symmetric and asymmetric expansion of molars using a Burstone-type transpalatal arch. Biomechanical and clinical analysis. J Orofac Orthop 2016; 76:377-90. [PMID: 26250453 DOI: 10.1007/s00056-015-0298-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES A transpalatal arch (TPA) directly connecting the maxillary first molars can be used in passive (for stabilization) and active (for molar or segment movement) modes. Activation may be symmetric or asymmetric. This study was performed to analyze the effectiveness of TPAs for transverse expansion treatment by measuring both the force systems they deliver and the clinical tooth movements thus achieved. MATERIALS AND METHODS Ten patients (six with symmetric and four with asymmetric transverse discrepancies) were treated using a TPA made of titanium-molybdenum alloy (TMA) and fitted with 0.032" × 0.032" Burstone lingual brackets. The force systems exerted by these TPAs and the resultant tooth movements were first simulated and measured inside the orthodontic measurement and simulation system (OMSS). All TPAs, whether used in the symmetric or asymmetric activation mode, were adjusted to an expansive force of 4 N. After a treatment of 12 weeks, their effectiveness was analyzed by comparing the clinical tooth movements to the movements simulated in the OMSS. RESULTS Clinically, the symmetric treatments resulted in a mean correction of 4.5 ± 1.0 mm and a mean of buccal crown tipping of 10.1°, compared to 9.6° for the movements simulated in the OMSS. The four cases of unilateral crossbite were treated with an asymmetrically activated TPA (including a force on one side and a combination of force and negative torque on the other side). The intended unilateral expansion was achieved in all four cases. Vertical side effects were acceptably small in both the symmetric and the asymmetric treatment cases. The tooth movements could be implemented as planned in all 10 patients, whereby in 5 patients complete correction of the occlusal width discrepancy was achieved by the end of the 12-week treatment. CONCLUSION Given this combination of good efficacy and minor side effects, the TMA/TPA appliance may be recommended as a suitable approach to correct transverse discrepancies. Recommendations expressed in previous studies for the use of Burstone-type TMA/TPA in these situations is confirmed by our study.
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Affiliation(s)
- Michaela Tsetsilas
- Department of Orthodontics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | | | - Ludger Keilig
- Endowed Professorship for Oral Medical Technology, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.
| | - Susanne Reimann
- Endowed Professorship for Oral Medical Technology, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Andreas Jäger
- Department of Orthodontics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Christoph Bourauel
- Endowed Professorship for Oral Medical Technology, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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Carrara CFC, Ambrosio ECP, Mello BZF, Jorge PK, Soares S, Machado MAAM, Oliveira TM. Three-dimensional evaluation of surgical techniques in neonates with orofacial cleft. Ann Maxillofac Surg 2016; 6:246-250. [PMID: 28299266 PMCID: PMC5343636 DOI: 10.4103/2231-0746.200350] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Individuals with cleft lip and palate have many anatomic and functional alterations compromising esthetics, hearing, speech, occlusion, and development/craniofacial growth. The rehabilitative treatment of these patients is very challenging and starts at birth aiming at the best treatment for all functional demands. This study aimed to evaluate the dimensional alterations of the dental arches of neonates with cleft lip and palate after two different primary surgical techniques. MATERIALS AND METHODS The sample comprised 114 digital models of children aged from 3 to 36 months, with unilateral complete cleft lip and palate divided into two groups. Two different phases were evaluated: precheiloplasty and 1 year after palatoplasty. The evaluation was performed through the digital models of each child obtained by scanning digitalization (3D Scanner). Dental arches measurements were accomplished through Appliance Designer software. The following measurements were assessed: dental arch area, anterior amplitude of the cleft, total length of dental arch, intercanine distance, and intertuberosity distance. t-test was applied to compare differences between groups. RESULTS No statistically significant differences were observed between groups at precheiloplasty phase. At 1 year after palatoplasty, the groups differed in the total length of dental arch (P = 0.002), with greater values for Group I. CONCLUSION This study suggests that the results of the different surgical techniques may alter the growth and development of the dental arches of neonates with cleft lip and palate.
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Affiliation(s)
| | - Eloá Cristina Passucci Ambrosio
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | - Bianca Zeponi Fernandes Mello
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | - Paula Karine Jorge
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | - Simone Soares
- Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Thais Marchini Oliveira
- Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
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Shintaku Y, Tanikawa C, Iida S, Aikawa T, Kogo M, Yamashiro T. Maxillary Expansion and Midline Correction by Asymmetric Transverse Distraction Osteogenesis in a Patient With Unilateral Cleft Lip/Palate: A Case Report. Cleft Palate Craniofac J 2014; 52:618-24. [PMID: 25531734 DOI: 10.1597/13-278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This case report presents the management of a female patient with unilateral cleft lip and palate presenting with skeletal Class III malocclusion and a narrow upper dental arch with a midline deviation. The treatment plan involved asymmetric transverse distraction osteogenesis of the maxilla to make the upper dental midline coincident with the facial midline. After the treatment, a good facial profile and a close intercuspation of teeth were achieved. Occlusion remained stable with normal overjet and overbite after 2-year retention.
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Maggiulli F, Hay N, Mars M, Worrell E, Green J, Sommerlad B. Early effect of vomerine flap closure of the hard palate at the time of lip repair on the alveolar gap and other maxillary dimensions. Cleft Palate Craniofac J 2013; 51:43-8. [PMID: 23651320 DOI: 10.1597/11-297] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Comparison of the effects of vomerine flap (VF) closure of the hard palate at the time of lip repair with non-closure of the hard palate in subjects with unilateral cleft lip and palate (UCLP). DESIGN Retrospective, single-blinded, cohort study. SETTING Study model sets of 40 consecutive, non-syndromic, infants with complete UCLP operated on between 1988 and 1998. PATIENTS All subjects were operated on by a single consultant plastic surgeon immediately before and after the unit's change of protocol (1993), when VF closure of the hard palate was incorporated at the time of lip repair. Subjects were divided into two groups: VF ( n = 18) and non-VF (n = 22), which acted as a control group. Each subject had maxillary impressions taken before lip repair at 3 months (VF mean age = 11.7 weeks; non-VF mean age = 13.4 weeks) and before palate repair at 6 months (VF mean age = 22.8 weeks; non-VF mean age = 24.0 weeks). MAIN OUTCOME MEASURES Seven predetermined landmarks and four maxillary dimensions were computed following single-blinded analysis using a reflex microscope. RESULTS Repeatability tests showed good measurement precision. The operator measurement errors were 0.00018 mm in a horizontal plane (X and Y) and 0.00028 in the vertical plane (Z). The VF group showed significant changes in the alveolar cleft width. There were no statistically significant changes in any arch-form variable between the VF and non-VF groups. CONCLUSION The decrease of alveolar arch gap width at palate repair (6 months) in the VF group was significantly more than the decrease observed in the non-VF group, and there was no significant decrease in the, anterior and posterior arch width or anteroposterior length of the hard palate in the VF group compared with the non-VF group.
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Power SM, Matic DB. Critical analysis of consecutive unilateral cleft lip repairs: determining ideal sample size. Cleft Palate Craniofac J 2012; 50:144-9. [PMID: 22428541 DOI: 10.1597/11-104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : Cleft surgeons often show 10 consecutive lip repairs to reduce presentation bias, however the validity remains unknown. The purpose of this study is to determine the number of consecutive cases that represent average outcomes. Secondary objectives are to determine if outcomes correlate with cleft severity and to calculate interrater reliability. Design : Consecutive preoperative and 2-year postoperative photographs of the unilateral cleft lip-nose complex were randomized and evaluated by cleft surgeons. Parametric analysis was performed according to chronologic, consecutive order. The mean standard deviation over all raters enabled calculation of expected 95% confidence intervals around a mean tested for various sample sizes. Setting : Meeting of the American Cleft Palate-Craniofacial Association in 2009. Patients, Participants : Ten senior cleft surgeons evaluated 39 consecutive lip repairs. Main Outcome Measures : Preoperative severity and postoperative outcomes were evaluated using descriptive and quantitative scales. Results : Intraclass correlation coefficients for cleft severity and postoperative evaluations were 0.65 and 0.21, respectively. Outcomes did not correlate with cleft severity (P = .28). Calculations for 10 consecutive cases demonstrated wide 95% confidence intervals, spanning two points on both postoperative grading scales. Ninety-five percent confidence intervals narrowed within one qualitative grade (±0.30) and one point (±0.50) on the 10-point scale for 27 consecutive cases. Conclusions : Larger numbers of consecutive cases (n > 27) are increasingly representative of average results, but less practical in presentation format. Ten consecutive cases lack statistical support. Cleft surgeons showed low interrater reliability for postoperative assessments, which may reflect personal bias when evaluating another surgeon's results.
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Hak MS, Sasaguri M, Sulaiman FK, Hardono ET, Suzuki A, Nakamura S, Ohishi M. Longitudinal Study of Effect of Hotz's Plate and Lip Adhesion on Maxillary Growth in Bilateral Cleft Lip and Palate Patients. Cleft Palate Craniofac J 2012; 49:230-6. [DOI: 10.1597/10-042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the effects of infant orthopedic treatment and lip adhesion on maxillary growth of patients with bilateral cleft lip and palate (BCLP). Design Prospective longitudinal study. Setting The present study was conducted at the Cleft Lip and Palate Center, Harapan Kita Children and Maternity Hospital, Indonesia, and the Department of Oral and Maxillofacial Surgery, Kyushu University Hospital, Japan. Subjects The study sample consisted of 53 patients with complete BCLP and 10 noncleft patients with other diseases. Patients with BCLP were divided into three groups: H (-), 11 patients treated without Hotz's plate; H (+), 24 treated with Hotz's plate; and LA-H, 18 treated with lip adhesion and Hotz's plate. Methods Serial dental casts were obtained from each BCLP child at the following four time points: first visit, labioplasty, palatoplasty, and 5 years of age. Each maxillary dental cast was scanned, and the linear and angular dimensions were measured. Results and Conclusion Lip adhesion showed a temporary negative effect. In all patients with BCLP, the surgeries affected the growth of the anterior arch width until the age of 5 years. Collapse of the premaxilla following labioplasty in the H (-) group affected the growth of dental arch length until the age of 5 years. Treatment using Hotz's plate prevented collapse of the premaxilla, and the growth of the arch length was comparable to that observed in the noncleft group.
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Affiliation(s)
| | - Masaaki Sasaguri
- Division of Oral and Maxillofacial Surgical Sciences, Faculty of Dentistry, Kyushu University, Fukuoka, Japan
| | | | | | - Akira Suzuki
- Division of Oral Health, Growth and Development, Faculty of Dentistry, Kyushu University, Fukuoka, Japan
| | - Seiji Nakamura
- Division of Oral and Maxillofacial Surgical Sciences, Faculty of Dentistry, Kyushu University, Fukuoka, Japan
| | - Masamichi Ohishi
- Division of Oral and Maxillofacial Surgical Sciences, Faculty of Dentistry, Kyushu University, Fukuoka, Japan
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Adali N, Mars M, Petrie A, Noar J, Sommerlad B. Presurgical Orthopedics Has No Effect on Archform in Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2012; 49:5-13. [PMID: 21823827 DOI: 10.1597/11-030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Evaluation of the effect of presurgical orthopedics on maxillary archform up to 6 months of age. Design Retrospective, single-blinded, case-control study. Participants Study model sets of 75 infants with consecutive, nonsyndromic, complete unilateral cleft lip and palate (excluding Simonart bands) from 1995 to 2005. Interventions All patients (PSO group, n = 14; non-PSO group, n = 61) received lip repair/vomer flap at 3 months and soft palate repair at 6 months by the same consultant surgeon. The two groups were comparable at birth ( p > .01) in all archform variables. Main Outcome Measures Sixteen variables were computed, following single-blinded analysis using the Reflex Microscope to describe the archform in the transverse, anteroposterior, and vertical dimensions and the arch circumference. Data were analyzed using a repeated-measures hierarchical analysis of variance with a significance level of 1%. Results Repeatability studies showed good measurement precision. Presurgical orthopedics produced no statistically significant mean change in any archform variable when compared with the non-PSO group. The difference in the mean reduction in the alveolar cleft width between the groups was 0.69 mm (95% confidence interval, −0.89 to 2.28 mm, p = .52). Lip repair produced greater change in archform than did presurgical orthopedics, reducing the mean alveolar cleft width by 4.45 mm (95% confidence interval, 3.53 to 5.37 mm; p < .001). Conclusions There was no evidence that presurgical orthopedics produced any significant effect on archform, raising questions for its continued use in this context. Lip repair had a greater impact on arch dimensions than did presurgical orthopedics.
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Affiliation(s)
- Nazan Adali
- University College London Hospitals (UCLH) National Health Service (NHS) Foundation Trust, UCL Eastman Dental Institute, London, United Kingdom
| | - Michael Mars
- North Thames Cleft Centre, Great Ormond Street Hospital for Children, United Kingdom
| | - Aviva Petrie
- UCL Eastman Dental Institute, London, United Kingdom
| | - Joe Noar
- Orthodontic Unit, Division of Craniofacial and Developmental Sciences, UCLH NHS Foundation Trust, UCL Eastman Dental Institute, West Hertfordshire Hospital Trust, United Kingdom
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Bejdová S, Krajíček V, Peterka M, Trefný P, Velemínská J. Variability in palatal shape and size in patients with bilateral complete cleft lip and palate assessed using dense surface model construction and 3D geometric morphometrics. J Craniomaxillofac Surg 2011; 40:201-8. [PMID: 21612940 DOI: 10.1016/j.jcms.2011.04.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 12/28/2010] [Accepted: 04/27/2011] [Indexed: 10/18/2022] Open
Abstract
Bilateral complete cleft lip and palate (BCLP) is the most severe of the common orofacial clefts and is associated with the greatest deformity during development. The aim of this study was to use geometric morphometrics to evaluate palatal shape and size variability in patients with BCLP in comparison to nonclefted Czech boys. The variability of palatal size and shape in BCLP patients was greater when compared with the nonclefted population. Though palate variability in BCLP was wide, nonclefted palatal shapes were generally different (a high, wide and vaulted palate) and fell almost outside the range of BCLP variability. The palatal size and shape of BCLP patients (range from 12.1 to 16.5 years) was not correlated with age. A comparison of the mean shapes of the clefted and nonclefted groups showed that the BCLP palate is flatter and narrower. The most notable size difference was found in the area between the maxilla and premaxilla. This phenomenon is associated with the persisting separation of the premaxilla from the rest of the palate. The shape of the palatal configuration of the premaxilla and adjacent area was concave in the nonclefted group and convex in BCLP patients.
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Affiliation(s)
- Sárka Bejdová
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University in Prague, Viničná 7, Prague 2, Czech Republic.
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Smahel Z, Velemínská J, Trefný P, Müllerová Z. Three-dimensional morphology of the palate in patients with bilateral complete cleft lip and palate at the stage of permanent dentition. Cleft Palate Craniofac J 2009; 46:399-408. [PMID: 19697468 DOI: 10.1597/07-199.1] [Citation(s) in RCA: 14] [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 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.
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Affiliation(s)
- Zbynek Smahel
- Department of Anthropology, Faculty of Science, Charles University, Vinicná 7, 128 44 Prague 2, Czech Republic.
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Comparison of the Spatial Landmark Scatter of Various 3D Digitalization Methods. J Orofac Orthop 2009; 70:247-63. [DOI: 10.1007/s00056-009-0902-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 03/30/2009] [Indexed: 10/20/2022]
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Braumann B, Keilig L, Stellzig-Eisenhauer A, Bourauel C, Bergé S, Jäger A. Patterns of maxillary alveolar arch growth changes of infants with unilateral cleft lip and palate: preliminary findings. Cleft Palate Craniofac J 2003; 40:363-72. [PMID: 12846602 DOI: 10.1597/1545-1569_2003_040_0363_pomaag_2.0.co_2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Because of significant differences in pathomorphology at birth, it may be that a better treatment outcome prognosis exists for patients with incomplete versus complete cleft forms. Can reaction patterns be extracted from changes in maxillary dimensions of different cleft forms within the first year of life to support this hypothesis? SUBJECTS Chronologically consecutive casts of the maxilla (1 week and 3, 6, and 12 months of life) of 15 patients with complete unilateral cleft lip and palate (cUCLP) and 13 patients with incomplete unilateral cleft lip and palate (iUCLP). All patients were treated with passive palatal plates. Cheiloplasty was performed at 6 months of age. No primary osteoplastic surgery was carried out. INTERVENTIONS Following digitizing with a three-dimensional laser scanner, all cast surfaces were computer reconstructed, aligned, and superimposed. Distances between the surfaces were determined and expressed graphically. Computer-aided determination of defined maxillary dimensions was performed. The volumes of segmented surfaces were determined and compared. RESULTS Within the first year of life, decreased sagittal but increased transverse alveolar growth for patients with iUCLP was found. The increase in alveolar crest length in patients with iUCLP was 50% less within the first year of life than in patients with cUCLP. In the same patients, the volumes of the molar segments were, on average, larger at each registration stage and the increase in these volumes larger within the first year of life. CONCLUSION Conclusions regarding the direction and extent of growth cannot be drawn from the visible level of severity of the malformation.
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Affiliation(s)
- Bert Braumann
- Department of Orthodontics, Clinic for Oral and Maxillofacial Surgery, Center for Dentistry, University of Bonn, Bonn, Germany.
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