Patterns of maxillary alveolar arch growth changes of infants with unilateral cleft lip and palate: preliminary findings

Three-dimensional evaluation of alveolar changes induced by nasoalveolar molding in infants with unilateral cleft lip and palate: A case-control study

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.

Evaluation of the Effects of Cheiloplasty on Maxillary Arch in UCLP Infants Using Three-Dimensional Digital Models

OBJECTIVE

To analyze and identify changes in the maxillary dental arch before and after cheiloplasty in a group of unilateral complete cleft lip and palate (UCLP) infants.

DESIGN

This is a cohort study.

MATERIAL AND METHOD

Study models from 16 infants with nonsyndromic UCLP, who were treated at Khon Kaen University, were taken before (T1) and after cheiloplasty (T2). The dental models underwent a process of scanning through a 3D scanner, from which 9 linear and 2 angular landmarks were evaluated. Paired t test was used to compare the measurement statistically between T1 and T2.

RESULTS

Alveolar cleft gap (G-L), anterior basal angle (∠GC-CC'), and anterior arch curvature angle on greater segment (∠GIC) were significantly decreased (P < .05). Contrarily, anterior ridge length of greater segment (C-I), anterior ridge length of lesser segment (L-C'), and posterior arch width (T-T') were significantly increased (P < .05) after cheiloplasty. While, anterior portion of greater segment (I-G), anterior arch width (C-C'), anterior arch depth (I⊥CC'), arch length (G⊥TT'), and arch circumference (T-C-I-G-L-C'-T') showed no significant difference. The measurements were tested using the Intraclass correlation coefficient. The coefficients indicated high reliability.

CONCLUSION

Cleft gap significantly decreased after lip repair, and the anterior part of maxillary dental arch was also bent palatally after cheiloplasty without any other intervention except cheiloplasty. More studies are needed to assess the amount of lip pressure. If any convincing force is presented, an appliance to prevent undesirable pressure is indicated.

Three-dimensional imaging methods to quantify soft and hard tissues change after cleft-related treatment during growth in patients with cleft lip and/or cleft palate: a systematic review

OBJECTIVES:

To assess the use of three-dimensional (3D) imaging methods to quantify the changes in soft- and hard-tissues in cleft patients after cleft-related treatment during growth.

METHODS:

PubMed, EMBASE, Web of Science and the Cochrane Library were searched up to 1 June 2018. Included publications were those using 3D imaging to quantify soft- and hard-tissue changes after cleft-related treatments in patients with any type of cleft, during growth. Data extraction and qualitative analysis were performed by two reviewers. The methodological quality of each study was reviewed using the QUADAS-2 tool.

RESULTS:

From 4 databases, 2315 articles were found. Full texts of 422 articles were analyzed and finally 12 articles were included for qualitative analysis. CT was performed in the majority of studies for hard-tissue quantification. Stereophotogrammetry, Laser scanner and 3D digitizer were identified as viable methods to quantify both soft- and hard-tissue changes, depending on whether the scan was made of the facial surface or the cast surface. Most studies conducted imaging analysis without registration between multitemporal images, which is the reason why they did not fulfil the inclusion criteria.

CONCLUSIONS:

Although several imaging modalities have the potential to quantify cleft-related treatment follow-up, there is an urgent need to assess the imaging methods and related analyses allowing to standardise a 3D imaging protocol to quantify hard- and soft-tissue treatment follow-up.

Precision of Landmark Positioning on Digitized Models from Patients with Cleft Lip and Palate

Objective

To quantify the precision of landmark positioning on digitized casts of patients with unilateral cleft lip and palate.

Patients

Forty plaster models of newborns up to 8 months of age were selected from the archive of the Department of Orthodontics of the University of Heidelberg.

Material and Method

The plaster-cast models were digitized with a Micromeasure 70 three-dimensional laser scanner (Micromeasure, Bischoffen, Germany). The laser scanner used in this study operates with a precision of 0.15 mm on the x- and y-axes and 0.06 mm on the z-axis. In the intraobserver study, a single observer placed anatomical landmarks in four rounds, with at least 4 weeks between each round. In the interobserver study, four different observers each placed the same landmarks once. For the two different studies, an ideal location for each landmark was calculated by averaging the landmark positions of the four rounds or observers. The distance between each of the four landmark positions and the ideal landmark was measured.

Results

A 95% confidence interval for the landmark positioning error was calculated. For the intraobserver investigation, this error was 0.34 to 1.30 mm, and for the interobserver investigation it was 0.7 to 2.00 mm.

Conclusion

Because both investigations displayed comparable error intervals, it was concluded that different observers could perform landmark positioning for the same studies.

Evaluation of the intercanine distance in newborns with cleft lip and palate using 3D digital casts

OBJECTIVE

The purpose of this present study was to compare, by means of 3D digital casts, the anterior transverse dimension of the dental arch of newborns with and without cleft lip and palate.

MATERIAL AND METHODS

The sample was composed of ninety-four children aged from 3 to 9 months divided into three study groups: Group I - children without craniofacial deformities (control group); Group II - children with unilateral cleft lip and palate; Group III - children with bilateral cleft lip and palate. Impressions were executed before lip and palate repair in patients with clefts. Dental casts were digitized using a 3D scanner linked to a computer. Measurements of the intercanine distance were measured on the digital casts. Intergroup comparisons were performed using ANOVA (p<0.05).

RESULTS

The results showed a mean of 36.5 mm for unilateral cleft lip and palate group, 34.8 mm for bilateral cleft lip and palate group and 27.52 mm for the control group. There was a statistically significant difference between the control group and both groups of patients with cleft lip and palate. There was no statistically significant difference between complete unilateral and bilateral cleft lip and palate groups.

CONCLUSIONS

Patients with complete cleft lip and palate were born with an increased anterior dimension of the maxillary dental arch compared to non cleft patients.

Early dimensional changes in maxillary cleft size and arch dimensions of children with cleft lip and palate and cleft palate

Objective : To study early changes in cleft size and maxillary arch dimensions and to evaluate these changes in relation to performed surgical procedures. Design : Retrospective longitudinal study. Setting : The Cleft Lip and Palate Center, Uppsala University Hospital, Sweden. Patients : Dental study models of 79 consecutive children (28 with unilateral cleft lip and palate, 39 with cleft palate, and 12 with Pierre Robin sequence) were analyzed. Interventions : Lip repair at 3 to 4 months, soft palate repair at 6 to 10 months, and hard palate repair at 25 to 26 months of age. Main Outcome Measures : Cleft size was measured before each surgical intervention up to 2 years and arch dimensions were measured before each surgical intervention and at 5 years. Results : Cleft widths decreased from infancy up to 2 years, but the anteroposterior cleft length in cleft palate was unchanged. Arch widths between cuspid points (C-C1) and tuberosity points (T-T1) and also the change over time in C-C1 and T-T1 differed significantly between the groups from infancy up to 5 years. Conclusions : Cleft widths decreased after lip closure and/or soft palate closure. The children with unilateral cleft lip and palate had wider maxillary arch dimensions than the children with cleft palate or Pierre Robin sequence during the first years of life, but after hard palate closure the transverse growth was reduced in the children with unilateral cleft lip and palate. At 5 years the children with unilateral cleft lip and palate had similar maxillary widths as the children with cleft palate and/or Pierre Robin sequence.

Comparative osseous and soft tissue morphology following cleft lip repair

OBJECTIVE

To quantify comparative improvement between osseous and soft tissue asymmetry following primary lip repair.

DESIGN

Retrospective analysis of preoperative and postoperative computed tomography scans of infants with unilateral cleft lip and palate. Sixteen soft tissue landmarks were placed using an exploratory two-/three-dimensional image processing system and compared for asymmetry.

PATIENTS

Computed tomography scans were obtained on 26 patients (13 boys, 13 girls) of Chinese ethnicity (mean age = 0.25 years) prior to Millard lip repair. Nineteen of these contributed to follow-up comparative studies prior to palatoplasty at a mean age of 0.92 years. There were 18 left-sided and eight right-sided clefts.

MAIN OUTCOME MEASURE

Euclidean distance matrix asymmetry analysis was used to determine the amount of soft tissue asymmetry pre- and postlip repair. Similar analyses of the same scans were performed for 41 osseous landmarks.

RESULTS

Soft tissue landmarks had 36/39 (92%) preoperative and 13/39 (33%) postoperative asymmetric pairs. Osseous distances demonstrated 77/125 (61%) asymmetric pairs preoperatively and 60/125 (48%) postoperatively. Soft tissue and osseous distances of the lip region demonstrated 32% and 39% postoperative asymmetry, respectively. Soft tissue and osseous distances of the nasal region demonstrated 52% and 72% postoperative asymmetry, respectively. Soft tissue and osseous distances of the facial landmarks demonstrated 24% and 34% postoperative asymmetry, respectively.

CONCLUSIONS

Primary lip repair appears to effect gains in symmetry in soft tissue and provides sufficient molding forces to cause correlating symmetry changes in underlying osseous structures.