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1
Motohashi, Nobuyoshi, Takayuki Kuroda, Leopoldino Capelozza Filho, and José Alberto De Souza Freitas. "P-A Cephalometric Analysis of Nonoperated Adult Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 31, no. 3 (May 1994): 193–200. http://dx.doi.org/10.1597/1545-1569_1994_031_0193_pacaon_2.3.co_2.
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P-A cephalometric analysis was performed on the craniofacial morphology in 88 Brazilian men with nonoperated and operated cleft lip and palate. For the comparative study, these subjects were divided into the following four groups: (1) 31 nonoperated unilateral cleft lip and palate (UCLP), (2) 24 nonoperated bilateral cleft lip and palate (BCLP), (3) 16 operated UCLP, (4) 17 operated BCLP. Thirty Brazilian men without cleft lip and palate were used as control subjects. In comparison with the control subjects, nonoperated BCLP and UCLP showed remarkable facial deformity characterized by Increased width of various facial parts. Facial morphology of surgically treated BCLP and UCLP, however, was very similar to that of noncleft subjects, apart from the Immediate cleft region. There was no remarkable difference in the facial morphology between nonoperated BCLP and UCLP, except for the cleft width and the deviation of nasal septum base, while the only significant difference between operated BCLP and UCLP was in the cleft width.
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Farkas, Leslie G., Karel Hajniš, and Jeffrey C. Posnick. "Anthropometric and Anthroposcopic Findings of the Nasal and Facial Region in Cleft Patients before and after Primary Lip and Palate Repair." Cleft Palate-Craniofacial Journal 30, no. 1 (January 1993): 1–12. http://dx.doi.org/10.1597/1545-1569_1993_030_0001_aaafot_2.3.co_2.
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Two populations were studied and compared to determine the effects of cleft lip and palate surgery on the nose and face. In the first, three anthropometric measurements, two nasal and one facial, were taken before primary lip repair from infants with complete unilateral cleft lip and palate (UCLP) and with bilateral cleft lip and palate (BCLP). In the second, ten measurements were taken from the nose and face of patients surgically treated for UCLP and BCLP. The high frequency of noses disproportionately wide in relation to their height in both cleft types before primary lip repair greatly decreased after surgery. Among the residual deformities after surgery for UCLP, nostril floor width asymmetry was the most frequent, followed by columella length asymmetry, flat nasal bridge, wide soft nose, flat nasal tip, and small nasal tip protrusion. In the BCLP patients, nostril floor width asymmetry was also the most common stigma, followed by flat nasal tip, wide soft nose, columella length asymmetry, flat nasal bridge and bilaterally angled alae, and small nasal tip protrusion. A subnormally flat upper face inclination was observed in UCLP and BCLP patients. Quantitative determination of these nasal stigmata in cleft lip and palate patients who have undergone primary lip repair provides valuable information for surgical correction of the cleft soft-tissue deformities.
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Fukushiro, Ana Paula, and Inge Elly Kiemle Trindade. "Nasal Airway Dimensions of Adults with Cleft Lip and Palate: Differences among Cleft Types." Cleft Palate-Craniofacial Journal 42, no. 4 (July 2005): 396–402. http://dx.doi.org/10.1597/03-081.1.
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Objective To determine the nasal airway dimensions in adults with repaired cleft lip and palate by rhinomanometry and to analyze the reduction associated with different types of clefts. Model A prospective analysis comparing three types of previously repaired clefts: bilateral cleft lip and palate (BCLP), unilateral cleft lip and palate (UCLP), and isolated cleft palate (CP) at the 5% level of significance. Setting Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil. Participants Fifty-three subjects aged 18 to 35 years (17 BCLP, 16 UCLP, 20 CP) and a group of 20 individuals without cleft (N). Variables Minimum cross-sectional nasal area assessed by posterior (PR) and anterior (AR) rhinomanometry and nasopharyngeal area assessed by modified AR. Results Mean (± 1 SD) nasal areas obtained by PR were: 0.47 ± 0.16 cm2 (BCLP), 0.57 ± 0.19 cm2 (UCLP), 0.61 ± 0.13 cm2 (CP), and 0.60 ± 0.10 cm2 (N). The mean value for the BCLP group was significantly smaller than that for the N and CP groups. The remaining values did not differ from one another. The proportion of subjects with subnormal areas obtained by PR was 41%, 19%, and 0% for groups BCLP, UCLP, and CP, respectively. Similar results were obtained by AR. All subjects presented a nasopharyngeal area larger than 0.80 cm2, denoting absence of obstruction in the nasopharynx. Conclusions In adulthood BCLP is the type of cleft associated with a greater reduction of nasal airway, compared with UCLP and CP, suggesting that adults with BCLP are at a greater risk for nasal obstruction.
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Heidbüchel, Kiki L. W. M., Anne M. Kuijpers-Jagtman, Ricardo Ophof, and Rian J. M. Van Hooft. "Dental Maturity in Children with a Complete Bilateral Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 39, no. 5 (September 2002): 509–12. http://dx.doi.org/10.1597/1545-1569_2002_039_0509_dmicwa_2.0.co_2.
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Objective: Dental age in children with a bilateral cleft lip and palate (BCLP) was assessed and compared with children without cleft. Design: Dental age was estimated for 74 children with a complete BCLP (54 boys and 20 girls) from 364 orthopantomograms. Nonlinear regression curves were made between 5 and 14 years of age for boys and girls separately. A comparison was made with a sample of Dutch children (91 girls and 90 boys) without oral clefts for three different age groups, namely 5, 9.5, and 14 years of age. Setting: Data collection was carried out at the Cleft Palate Center, University Medical Center Nijmegen (The Netherlands). A sample from the Nijmegen Growth Study was used as a normative sample. Results: At 5 years of age, boys with a BCLP were significantly delayed in dental age compared to boys without cleft. After that age, no significant differences in dental age were found. For girls with a BCLP, no difference in dental age with the girls without cleft could be found. Conclusion: Dental age in BCLP showed a tendency to be delayed at 5 years of age. At the ages of 9.5 and 14 years of age, no differences were found. Further investigation on the development of individual teeth is suggested to gain more insight into the origin of this delay.
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Honda, Yasuo, Akira Suzuki, Masamichi Ohishi, and Hideo Tashiro. "Longitudinal Study on the Changes of Maxillary Arch Dimensions in Japanese Children with Cleft Lip and/or Palate: Infancy to 4 Years of Age." Cleft Palate-Craniofacial Journal 32, no. 2 (March 1995): 149–55. http://dx.doi.org/10.1597/1545-1569_1995_032_0149_lsotco_2.3.co_2.
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The focus of this study was an analysis of maxillary arch growth changes prior to the time of cheiloplasty up to 4 years of age. Serial dental casts were obtained and measured in 95 children with cleft lip and palate, or both: 7 unilateral cleft lip and alveolus (CLA), 52 unilateral cleft lip and palate (UCLP), 24 bilateral cleft lip and palate (BCLP), and 12 isolated cleft palate (CP). The children were treated at the Kyushu University Dental Hospital. The results are as follows: (1) Prior to cheiloplasty, the maxillary buccal segments in the subjects with cleft lip and palate showed lateral displacement. The premaxilla in BCLP subjects was protruded. (2) Cheiloplasty influenced maxillary anterior arch width, but not posterior width. The operation caused posterior displacement of the premaxilla in BCLP subjects. (3) Palatoplasty affected the growth of the maxillary arch in the transverse and anteroposterior dimensions. (4) A variety of growth patterns observed in the patients (e.g., increasing or decreasing of the maxillary arch dimensions) suggests that maxillary arch dimensions were affected not only by surgery, but also by other individual factors such as genetic facial pattern and severity of the cleft.
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Aras, Isil, and Servet Dogan. "Comparative Evaluation of the Pharyngeal Airways and Related Soft Tissues of Unilateral and Bilateral Cleft Lip and Palate Patients with the Noncleft Individuals." Cleft Palate-Craniofacial Journal 54, no. 1 (January 2017): 53–59. http://dx.doi.org/10.1597/15-055.
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Aim This study is a comparison of pharyngeal airways and associated soft tissues of unilateral and bilateral cleft lip and palate patients with the noncleft individuals. Materials and Methods Twenty-four unilateral cleft lip and palate patients (UCLP), 21 bilateral cleft lip and palate patients (BCLP), and 26 noncleft patients (NC) between ages 15 to 17 were included in the study. Eleven linear, 1 angular, and 1 proportional measurements were carried out on pretreatment lateral cephalometric head films of these individuals. Results The nasopharyngeal depths were markedly reduced in BCLP when compared with the NC (P < .001) and UCLP (P < .01) with a significant difference (P < .01) also among UCLP and NC. Minimum space behind the tongue concerning BCLP and UCLP were significantly lower compared to the NC (P < .001 and P < .01, respectively). In pairwise comparison among the clefts, BCLP showed significant (P < .05) narrowing of this distance. Tongue heights and velar lengths were significantly (P < .001) lower in cleft groups compared to the controls. Similarly, the hyoid bone was positioned in a significantly (P < .01) anterior and inferior direction in cleft patients. Comparison of the mean ratio of velar length to nasopharyngeal depth of the three groups revealed significant (P < .001) inadequacies in cleft patients with significantly (P < .05) more severely reduced values in BCLP. Conclusion Pharyngeal airways and involved soft tissues of cleft patients show serious inadequacies compared to controls, with significant diversities among cleft types pertaining to some of the parameters investigated. It should be kept in mind that these variations can influence function in terms of respiration and phonation.
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Al-Fahdawi, Mahmood Abd, Marwa Abdelwahab El-Kassaby, Mary Medhat Farid, and Mona Abou El-Fotouh. "Cone Beam Computed Tomography Analysis of Oropharyngeal Airway in Preadolescent Nonsyndromic Bilateral and Unilateral Cleft Lip and Palate Patients." Cleft Palate-Craniofacial Journal 55, no. 6 (February 22, 2018): 883–90. http://dx.doi.org/10.1597/15-322.
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Objective: The objective of this study was to assess the volume, area, and dimensions of the oropharyngeal airway (OPA) in a previously repaired nonsyndromic unilateral cleft lip and palate (UCLP) versus bilateral cleft lip and palate (BCLP) patients when compared with noncleft controls using cone beam computed tomography (CBCT). Design: This was a retrospective case-control study. Setting: The Cleft Care Center and outpatient clinic that are affiliated to our faculty were the settings for the study. Participants: A total of 58 CBCT scans were selected of preadolescent individuals: 14 BCLP, 20 UCLP, and 24 age- and gender-matched noncleft controls. Variables: Variables were volume, cross-sectional area (CSA), midsagittal area (MSA), and dimensions of OPA. Statistical analysis: One-way analysis of variance and post hoc tests were used to compare variables. Statistical significance was set at P ≤ .05. Results: UCLP showed significantly smaller superior oropharyngeal airway volume than both controls and BCLP ( P ≤ .05). BCLP showed significantly larger CSA at soft palate plane and significantly larger MSA than both UCLP and controls ( P < .05). Conclusions: UCLP patients at the studied age and stage of previously repaired clefts have significantly less superior oropharyngeal airway volume than both controls and BCLP patients. This confirms that preadolescents with UCLP are at greater risk for superior oropharyngeal airway obstruction when compared with those BCLP and controls. Furthermore, BCLP patients showed significantly larger CSA at soft palate plane and MSA than both controls and UCLP patients. These variations in OPA characteristics of cleft patients can influence function in terms of respiration and vocalization.
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Kim, Soung Min, Young Joon Lee, Sang Shin Lee, Yeon Sook Kim, Suk Keun Lee, Il Bong Kim, and Je Geun Chi. "Abnormal Maxillary Trapezoid Pattern in Human Fetal Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 45, no. 2 (March 2008): 131–40. http://dx.doi.org/10.1597/06-077.1.
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Objective: To elucidate abnormal growth patterns of human fetal maxillae with cleft lip and palate (CLP). Subject: A total of 71 fetal maxillae with CLP were obtained from aborted human fetuses. Method: Dimensions of the maxillary trapezoid (MT), formed by the maxillary primary growth centers (MxPGC), were taken from radiographic images. The CLP dimensions were compared with maxillary trapezoid dimensions of normal fetuses from a previous study (Lee et al., 1992). Main Outcome Measures: Cleft lip subjects without a cleft palate, unilateral cleft lip-alveolar cleft or cleft palate (UCL+A/UCLP), and bilateral cleft lip-alveolar cleft or cleft palate (BCL+A/BCLP) displayed abnormal MT patterns. MT abnormalities were most marked in the BCL+A/BCLP cohort. Results: The MT growth of prenatal CLP maxillae was severely arrested, resulting in abnormal MT shape on palatal radiograms. BCL+A/BCLP subjects had a more protruded nasal septum than subjects with other types of CLPs, while UCL+A/UCLP subjects showed severe deviation of the protruded nasal septum toward the noncleft side. Cleft lip-only subjects also exhibited abnormal MT growth. Conclusion: MT is primarily involved in CLPs, so that the MT shape could be utilized as a sensitive indicator for the analysis of maxillary malformation in different types of CLPs.
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Lisson, Jörg A., Ilka Hanke, and Joachim Tränkmann. "Changes of Vertical Skeletal Morphology in Patients with Complete Unilateral and Bilateral Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 42, no. 5 (September 2005): 490–94. http://dx.doi.org/10.1597/04-025.1.
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Objective The aim of this retrospective investigation was to qualify and quantify changes of the vertical skeletal morphology during puberty in cleft patients compared with an age-matched noncleft control. Methods Patients with unilateral cleft lip and palate (UCLP; n = 12) and bilateral cleft lip and palate (BCLP; n = 11) who fulfilled strict inclusion criteria according to the Hanover treatment protocol were evaluated by means of cephalometric analysis. Lateral cephalograms were analyzed for each cleft patient at age 10 and 15 and compared with corresponding data of a noncleft control (n = 20). Results and Conclusions It was concluded that a vertical growth impairment of the maxilla is found in patients with cleft lip and palate. The maxilla of cleft patients shows a significant clockwise rotation, whereas the inclination of the mandible shows little difference. Consequently, there is a skeletal superposition of the jaws. The posterior height of the maxilla is significantly shorter in patients both with UCLP and BCLP at T0 and T1. An increase of the anterior height of the mandible is found in the cleft groups.
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Da Silva Filho, Omar Gabriel, Rita De Cássia Moura Carvalho Lauris, Leopoldino Capelozza Filho, and Gunvor Semb. "Craniofacial Morphology in Adult Patients with Unoperated Complete Bilateral Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 35, no. 2 (March 1998): 111–19. http://dx.doi.org/10.1597/1545-1569_1998_035_0111_cmiapw_2.3.co_2.
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Objective This report is a retrospective study that compares the craniofacial morphology of adult subjects with unoperated bilateral complete cleft lip and palate (BCLP) with that of a noncleft group. Methods The study was performed on standardized lateral cephalograms obtained at the Hospital for Research and Rehabilitation of Cleft Lip and Palate, University of São Paulo, Brazil. The research group consisted of 28 subjects (20 males, 8 females) with unoperated BCLP, ranging in age from 15 to 41 years. The control group was matched to the cleft group with regard to gender and age. The findings were analyzed on the basis of the two-way analysis of variance (ANOVA) for cleft and gender. Results The most striking difference between the groups was the extremely prominent premaxilla in the cleft group that gave the BCLP face a very convex profile. The mandible exhibited a vertical growth pattern that resulted in a steep mandibular plane, an obtuse gonial angle and a long lower face height. The posterior face height was reduced. The cranial base dimensions were smaller, but there was no difference in cranial base angulation. Conclusions These findings confirm that in subjects with unoperated BCLP, the initial characteristics of the cleft malformation persist during growth.
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Ras, Frank, Laura van Aalten, Arina Janse, Shell Mobers, and Birte Prahl-Andersen. "Sagittal Position of the Left and Right Maxillary Segment in Children with Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 34, no. 5 (September 1997): 438–42. http://dx.doi.org/10.1597/1545-1569_1997_034_0438_spotla_2.3.co_2.
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Objective: The purpose of the present study was to investigate left-right differences in the sagittal position of the maxillary segments in children with cleft lip and palate. Method: The sample consisted of children with operated cleft lip or cleft lip and alveolus [CL/CLA (n=16) mean age, 9.3 yr], operated unilateral cleft lip and palate [UCLP (n=27) mean age, 9.1 yr], and operated bilateral cleft lip and palate [ [BCLP(n = 17) mean age, 9.5 yr]. Computed tomography (CT) horizontal slices of the maxilla were obtained and used to determine the sagittal position of the left and right segment of the maxilla in relation to the mandibular rami and the cranial base. Significant effects were analyzed with multivariate analyses of variance (MANOVA). Results and Conclusions: It was concluded that, in contrast to children having CL/CLA or UCLP, children with BCLP showed left-right differences in the sagittal position of the maxillary segments. The segment on the left side was more posteriorly positioned compared to the right side. Because the same results were obtained in relation to the mandibular rami as well as in relation to the cranial base, it can be assumed that the position of these rami are not affected by the different types of oral clefts.
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Jochen, Schwarz Steffen, Brandenburg Leonard Simon, Weingart Julia Vera, Schupp Wiebke, Füssinger Marc Anton, Stocker Sophia Aurelia, and Metzger Marc Christian. "Successful Management of Cleft Lip and Palate Malformation without Pre-Surgical Infant Orthopedics." Journal of Clinical Pediatric Dentistry 45, no. 3 (June 30, 2021): 204–7. http://dx.doi.org/10.17796/1053-4625-45.3.10.
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Objective: To investigate the effect of lip closure on reduction of cleft palates when no pre-surgical infant orthopedics (PSIO) are used. Study design: Retrospective patient chart-review in our department for Cranio-Maxillofacial Surgery at the University Medical Centre Freiburg, Germany. 19 patients at the age of 5.9 ± 2.1 months with surgical treatment of uni- (UCLP), or bilateral cleft lip and palate (BCLP) without any use of PSIO were included. Results: Early soft tissue correction of the lip leads to an effective reduction of the maxillary arch without any use of PSIO. The presented conventional and digital measurements appeared to be reliable. A successful reduction of the cleft width (UCLP = 3.88 ± 2.42mm, BCLP = 7.33 ± 5.00mm), the width of the alveolar arch (1.91 ± 1.36mm) and the sagittal depth of the alveolar arch (3.07 ± 2.71 mm) could be achieved with the presented workflow. Conclusions: Cleft reduction was obtainable without PSIO when lip closure after Tennison-Randall was performed.
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Medeiros, Alexandra Sárzyla, Marcia Ribeiro Gomide, Beatriz Costa, Cleide Felicio De Carvalho Carrara, and Lucimara Teixeira Das Neves. "Prevalence of Intranasal Ectopic Teeth in Children with Complete Unilateral and Bilateral Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 37, no. 3 (May 2000): 271–73. http://dx.doi.org/10.1597/1545-1569_2000_037_0271_poieti_2.3.co_2.
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Objective The objective of this study was to determine the prevalence of ectopic eruption of intranasal teeth. Design This was a retrospective study, where records of children with repaired cleft lip and palate were analyzed. Setting The study was conducted at a large craniofacial center, the Hospital for Rehabilitation of Craniofacial Anomalies, USP, Bauru, São Paulo, Brazil. Subjects The sample consisted of 815 records from patients with bilateral cleft lip and palate (BCLP) and 1495 records from patients with unilateral cleft lip and palate (UCLP). The age of the subjects was 5 to 10 years old and the groups included both males and females. Results The results showed that 0.61% of the children with BCLP and 0.40% of those with UCLP had an intranasal tooth. The prevalence of an intranasal tooth for the whole group was 0.48%, and it appeared to be more common in females.
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Rawashdeh, Ma'amon A., and Ikhlas Fawaz Bani Bakir. "The Crown Size and Sexual Dimorphism of Permanent Teeth in Jordanian Cleft Lip and Palate Patients." Cleft Palate-Craniofacial Journal 44, no. 2 (March 2007): 155–62. http://dx.doi.org/10.1597/05-197.1.
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Objective: To provide a detailed description of crown size dimensions in the permanent dentition of Jordanian cleft lip and palate patients and to compare the findings with those of other populations. Method: The mesiodistal crown diameters of the permanent teeth of 47 patients with unilateral cleft lip and palate (UCLP), 25 patients with bilateral cleft lip and palate (BCLP), and 74 controls were measured. Results: The cleft group (UCLP and BCLP patients) generally demonstrated a smaller tooth size for both the maxillary and mandibular arches than did the control group. A sexual dimorphism pattern with males having larger teeth than females was observed for controls and UCLP patients. More males with BCLP had smaller teeth than did females. In the maxilla, the UCLP cleft-side teeth showed the largest percentage (4%) of sexual dimorphism, whereas the BCLP teeth achieved the highest percentage (3.4%) in the mandible. The UCLP cleft-side maxillary lateral incisors (13.2%) and BCLP mandibular canines (6%) displayed greater sexual dimorphism in crown size than did any other tooth class. Conclusions: Tooth size reduction occurred across all permanent tooth types and among early and late-forming teeth in cleft patients compared with the controls. This reduction was more pronounced in the maxillary incisor field. Males with UCLP and control males had larger teeth than did females, whereas a reversal of the normal dimorphism pattern was observed in patients with BCLP.
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Mazaheri, Mohammad, Athanasios E. Athanasiou, and Ross E. Long. "Comparison of Velopharyngeal Growth Patterns between Cleft Lip and/or Palate Patients Requiring or Not Requiring Pharyngeal Flap Surgery." Cleft Palate-Craniofacial Journal 31, no. 6 (November 1994): 452–60. http://dx.doi.org/10.1597/1545-1569_1994_031_0452_covgpb_2.3.co_2.
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This investigation compares the patterns of velopharyngeal growth in cleft lip and/or palate patients. Those who had velopharyngeal competence and acceptable speech are compared with those who presented with velopharyngeal incompetence requiring pharyngeal flap surgery or prosthesis later. Lateral cephalograms of 30 cleft palate only (CPO), 35 unilateral cleft lip and palate (UCLP), and 20 bilateral cleft lip and palate (BCLP) children of the Lancaster Cleft Palate Clinic were studied. These records were taken at 6 month intervals during the first 2 postnatal years and annually thereafter up to 6 years of age. Soft tissue landmark points in the velopharyngeal region were digitized. Length and thickness of the soft palate and height and depth of the nasopharynx were measured. Evaluation of the growth curves of these four cephalometric variables indicated only two significant differences between children who later required pharyngeal flap surgery and those who did not. These differences were found in the growth in length of the soft palate of the CPO group and in the growth in depth of the nasopharynx of the BCLP group. Based on the present cephalometric data, it is Impossible to predict at an early age those cleft lip and/or palate patients who will later require pharyngeal flaps.
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Yamanishi, Tadashi, Juntaro Nishio, Shigenori Miya, Nobuhiko Okamoto, Akihito Takahashi, Yasuhisa Toribe, Takao Mukai, and Chie Kobayashi. "12q Interstitial Deletion with Bilateral Cleft Lip and Palate: Case Report and Literature Review." Cleft Palate-Craniofacial Journal 45, no. 3 (May 2008): 325–28. http://dx.doi.org/10.1597/07-061.1.
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The authors report the case of a Japanese girl with interstitial deletion of chromosome 12q15–q21.2 who had multiple congenital anomalies including bilateral cleft lip and palate (BCLP) with intrauterine onset of growth retardation and severe psychomotor developmental delay. Only two other patients with a similar deletion have been reported previously. However, these two patients showed such different clinical features that defining the karyotype-phenotype correlation has remained unfeasible. The additional case presented here reveals that two of the three cases with an overlapping deletion in 12q show the phenotype of BCLP, suggesting the correlation between this area of gene deletion and cleft lip and palate.
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Heidbüchel, Kiki L. W. M., Anne Marie Kuijpers-Jagtman, and Hans Peter M. Freihofer. "Facial Growth in Patients with Bilateral Cleft Lip and Palate: A Cephalometric Study." Cleft Palate-Craniofacial Journal 31, no. 3 (May 1994): 210–16. http://dx.doi.org/10.1597/1545-1569_1994_031_0210_fgipwb_2.3.co_2.
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In this study, sagittal facial growth of bilateral cleft lip and palate (BCLP) patients between 6 and 20 years of age is analyzed. The data of Nljmegen were derived from 131 lateral cephalograms taken in 21 BCLP patients who were treated In the Cleft Lip and Palate Center of the University Hospital of Nljmegen. Reported data of 90 BCLP patients treated at the Center of Oslo were used as a reference for comparison. Results of this Investigation showed mandibular growth to be similar in both centers. In the premaxillary region some differences were found: The Nljmegen patients presented a more protrusive premaxilla than those at Oslo. The upper front teeth and hence, the premaxilla, were more retroclined In the Nljmegen sample. There were also statistically significant differences in the soft tissue profile. The mean z-score was positive for the nasolabial angle and negative for the angle N'-Sn-Pg'. At 18 years of age, these differences are still apparent. In comparison with Broadbent's values of normal individuals, the SNPg-angle was smaller and the mandibular angle greater in Nljmegen and Oslo. The profiles of the BCLP patients are more convex in Nljmegen and more concave in Oslo than In the noncleft group. Finally, the different treatment strategies of the Cleft Lip and Palate Centers of Nljmegen and Oslo are compared and discussed In terms of their long-term results.
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Lauris, Rita de Cássia Moura Carvalho, Leopoldino Capelozza Filho, Louise Resti Calil, José Roberto Pereira Lauris, Guilherme Janson, and Daniela Gamba Garib. "Facial profile esthetics in operated children with bilateral cleft lip and palate." Dental Press Journal of Orthodontics 22, no. 4 (August 2017): 41–46. http://dx.doi.org/10.1590/2177-6709.22.4.041-046.oar.
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ABSTRACT Objective: The aim of this study was to evaluate the facial profile esthetics of rehabilitated children with complete bilateral cleft lip and palate (BCLP), comparing the judgment of professionals related and not related to cleft rehabilitation and laypersons. Methods: Thirty children in the mixed dentition (24 male; 6 female) with a mean age of 7.8 years were evaluated using facial profile photographs by 25 examiners: 5 orthodontists and 5 plastic surgeons with experience in cleft care, 5 orthodontists and 5 plastic surgeons without experience in oral cleft rehabilitation and 5 graduated laymen. Their facial profiles were classified into esthetically unpleasant (grade 1 to 3), esthetically acceptable (grade 4 to 6), and esthetically pleasant (grade 7 to 9). Intraexaminer and interexaminer errors were evaluated using Spearman correlation coefficient and Kendall’s test, respectively. Inter-rater differences were analyzed using Friedman test and Student-Newman-Keuls test for multiple comparisons. Results: Orthodontists dealing with oral clefts rehabilitation considered the majority of the sample as esthetically pleasant. Plastic surgeons of the cleft team and laypersons classified most of the sample as esthetically acceptable. Most of the orthodontists and plastic surgeons not related to cleft care evaluated the facial profile as esthetically unpleasant. The structures associated to unpleasant profiles were the nose, the midface and the upper lip. Conclusions: The facial profile of children with BCLP was classified as esthetically acceptable by laypersons. Professionals related to cleft rehabilitation were more lenient and those not related to cleft care were stricter to facial esthetics than laypersons.
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Yezioro-Rubinsky, Salomón, Javier H. Eslava-Schmalbach, Liliana Otero, Sara A. Rodríguez-Aguirre, Ángela M. Duque, Flora M. Campos, Juan P. Gómez, et al. "Dental Anomalies in Permanent Teeth Associated With Nonsyndromic Cleft Lip and Palate in a Group of Colombian Children." Cleft Palate-Craniofacial Journal 57, no. 1 (July 8, 2019): 73–79. http://dx.doi.org/10.1177/1055665619861498.
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Objectives: To assess the risk of dental anomaly presentation in permanent teeth in a group of Colombian children with nonsyndromic cleft lip and palate (NSCLP) and to determine the frequency of the anomalies according to the cleft type. Methods: An analytical matched case–control study was conducted with 210 controls and 210 patients with NSCLP. The patients were classified into 3 groups: complete right unilateral cleft lip and palate (RCLP), complete left unilateral cleft lip and palate (LCLP), and complete bilateral cleft lip and palate (BCLP). Univariate and multivariate Poisson regression models were used to analyze paired samples (Bonferroni adjustment, P ≤ .002). Results: A high risk of finding agenesis of the maxillary lateral incisors, supernumerary teeth, microdontia of the maxillary lateral incisors, and rotation of the maxillary central incisors adjacent to the cleft ( P < .0001) was observed in the patients with NSCLP. One or more dental anomalies were found in 98% of patients with BCLP, in 96% of those with LCLP, and in 87% of those with RCLP. Most of the anomalies were located on the cleft area. The incidence relative risk (IRR) of anomalies was highest in patients with BCLP (IRR: 10.5; 95% confidence interval [CI]: 6.76-16.3), followed by in those with LCLP (IRR: 8.51; 95% CI: 5.64-12.8). Conclusions: Most dental anomalies were found in the cleft area; this was expected because the cleft area was the most affected in the patients included in this study.
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Shrestha, Abhishekhi, Masahiro Takahashi, Tetsutaro Yamaguchi, Mohamed Adel, Mayu Furuhata, Yu Hikita, Hiroshi Yoshida, Takatoshi Nakawaki, and Koutaro Maki. "Three-dimensional Evaluation of Mandibular Volume in Patients with Cleft Lip and Palate During the Deciduous Dentition Period." Angle Orthodontist 90, no. 1 (August 12, 2019): 85–91. http://dx.doi.org/10.2319/112618-831.1.
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ABSTRACT Objectives To examine the relationship between mandibular volume and craniofacial morphology in patients with cleft lip and palate using cone beam computed tomography (CBCT) and to compare these findings with control (noncleft) patients undergoing CBCT for other purposes during the deciduous dentition period. Materials and Methods Eighty-four patients were categorized into the unilateral cleft lip and alveolus (UCLA) group (n = 25; mean age, 4.60 ± 0.40 years), unilateral cleft lip and palate (UCLP) group (n = 23; mean age, 4.52 ± 0.39 years), bilateral cleft lip and palate (BCLP) group (n = 22; mean age, 4.54 ± 0.37 years), and control group without cleft (n = 14; mean age, 5.19 ± 0.52 years). Mandibular volume and craniofacial cephalometric measurements were obtained using CBCT. All measurements were assessed by analysis of covariance (ANCOVA) using Bonferroni post hoc pairwise comparison tests. Results ANCOVA revealed no statistically significant differences in mandibular volume among the groups. SNA° and ANB° were significantly larger in the UCLA and BCLP groups than in the control group. SN-MP° was smallest in the UCLA group. Co-A in the UCLP group was shorter than in the UCLA and BCLP groups. Go-Gn was shortest in the UCLP and BCLP groups compared with the control group. Conclusions Three-dimensional evaluation of craniofacial morphology using CBCT can provide valuable information on malocclusion and other dentoskeletal problems among patients with CLP.
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Harrison, Lucas M., Rami R. Hallac, and Christopher A. Derderian. "Three-Dimensional Analysis of Bilateral Cleft Lip and Palate Nasal Deformity." Cleft Palate-Craniofacial Journal 58, no. 1 (July 21, 2020): 105–13. http://dx.doi.org/10.1177/1055665620940190.
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Objective: This cross-sectional study utilizes 3-dimensional analysis to assess nasal morphology in patients with bilateral cleft lip and palate (BCLP) compared to controls across the timeline of cleft care. Design: Retrospective comparative cross-sectional study. Setting: Tertiary pediatric academic institution. Patients and Participants: One hundred and twelve patients with BCLP and an equal number of age and sex-matched control participants. Main Outcome Measure(s): Nasolabial angle, nasal length, nasal protrusion, columella length, columella width, nasal tip width, alar width, and alar base width were collected at each time point. The measurements were collected pre-nasoalveolar molding (NAM) therapy, post-NAM therapy, post-primary cleft rhinoplasty, 1 year, 5 years, 10 years, and 15 years of age. Results: Nasolabial angle and nasal tip width were significantly different from controls from pre-NAM through 15 years of age time points. Nasal length was not significantly different at any time point. Alar width and alar base width were significantly different from pre-NAM through 10 years of age time points. Nasal protrusion, columella length, and columella width were significantly different from pre-NAM through 5 years of age time points. Conclusions: This study demonstrates that three-dimensional photogrammetry is effective in assessing the changes in nasal morphology that occur throughout the course of care in patients with BCLP from before cleft lip repair to the completion of nasal growth.
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Sato-Wakabayashi, Michiru, Maristela Sayuri Inoue-Arai, Takashi Ono, Ei-ichi Honda, Tohru Kurabayashi, and Keiji Moriyama. "Combined Fmri and MRI Movie in the Evaluation of Articulation in Subjects with and without Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 45, no. 3 (May 2008): 309–14. http://dx.doi.org/10.1597/07-070.
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Objective: This study was undertaken to explore the application of functional magnetic resonance imaging (fMRI) and MRI movies in the evaluation of articulatory function in subjects with and without cleft lip and palate (CLP). Design: The authors examined brain activation and the dynamic movement of articulators during bilabial and velar plosives using fMRI and MRI movies. Subjects: Two subjects, one with unilateral cleft lip and palate (UCLP) and one with bilateral cleft lip and palate (BCLP), and 12 non-CLP volunteers. Results: Activation foci were found in the precentral gyrus, thalamus, and cerebellum in non-CLP volunteers. In comparison, similar regions were activated in the UCLP subject during both plosives, whereas the regions activated in the BCLP subject were different, particularly during the velar plosive. The dynamic movement of articulators in the UCLP subject was comparable to that in a non-CLP volunteer but different from that in the BCLP subject. Conclusions: The results suggest that these two MRI modalities may be a promising evaluation methodology for articulatory function in CLP from central and peripheral perspectives.
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Smyth, Alistair G., and Jianhua Wu. "Cleft Palate Outcomes and Prognostic Impact of Palatal Fistula on Subsequent Velopharyngeal Function—A Retrospective Cohort Study." Cleft Palate-Craniofacial Journal 56, no. 8 (February 12, 2019): 1008–12. http://dx.doi.org/10.1177/1055665619829388.
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Objective: To assess outcomes from cleft palate repair and define the level of impact of palatal fistula on subsequent velopharyngeal function. Design: A retrospective cohort study. Setting: A regional specialist cleft lip and palate center within United Kingdom. Patients, Participants: Nonsyndromic infants born between 2002 and 2009 undergoing cleft palate primary surgery by a single surgeon with audited outcomes at 5 years of age. Four hundred ten infants underwent cleft palate surgery within this period and 271 infants met the inclusion criteria. Interventions: Cleft palate repair including levator palati muscle repositioning with or without lateral palatal release. Main Outcome Measures: Postoperative fistula development and velopharyngeal function at 5 years of age. Results: Lateral palatal incisions were required in 57% (156/271) of all cases. The fistula rate was 10.3% (28/271). Adequate palatal function with no significant velopharyngeal insufficiency (VPI) was achieved in 79% of patients (213/271) after primary surgery only. Palatal fistula was significantly associated with subsequent VPI (risk ratio = 3.03, 95% confidence interval: 1.95-4.69; P < .001). The rate of VPI increased from 18% to 54% when healing was complicated by fistula. Bilateral cleft lip and palate (BCLP) repair complicated by fistula had the highest incidence of VPI (71%). Conclusions: Cleft palate repair with levator muscle repositioning is an effective procedure with good outcomes. The prognostic impact of palatal fistula on subsequent velopharyngeal function is defined with a highly significant 3-fold increase in VPI. Early repair of palatal fistula should be considered, particularly for large fistula and in BCLP cases.
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Hak, Muhammad Syafrudin, Masaaki Sasaguri, Farida Kamil Sulaiman, Enny Tyasandarwati Hardono, Akira Suzuki, Seiji Nakamura, and Masamichi Ohishi. "Longitudinal Study of Effect of Hotz's Plate and Lip Adhesion on Maxillary Growth in Bilateral Cleft Lip and Palate Patients." Cleft Palate-Craniofacial Journal 49, no. 2 (March 2012): 230–36. http://dx.doi.org/10.1597/10-042.
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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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Handžić-Ćuk, Jadranka, Višeslav Ćuk, Miroslav Gluhinić, Ranko Rišavi, and Smiljana štajner-Katušić. "Tympanometric findings in cleft palate patients: influence of age and cleft type." Journal of Laryngology & Otology 115, no. 2 (February 2001): 91–96. http://dx.doi.org/10.1258/0022215011907668.
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Tympanometry was analysed according to cleft type with respect to age in 239 cleft palate patients (57 with bilateral cleft lip and palate (BCLP)), 122 with unilateral cleft lip and palate (UCLP) and 60 with isolated cleft palate (ICP)). The frequency of type B tympanograms was 46.5 per cent in the BCLP group, 50.6 per cent in the UCLP group and 58.3 per cent in the ICP group. Type A tympanograms were more frequently observed in older patients (median age 11 years) in comparison to type B (median age five years; p<0.001) and type C (median age six years; p<0.001). The total sample showed an age-related decrease in the frequency of type B tympanograms (rs = −0.3942; p<0.001). The frequency of type A tympanograms increased significantly with age (rs = 0.4263; p<0.001), whereas type C was not correlated with age. In the UCLP group, the frequency of type B tympanograms decreased with age (rs = −0.4430; p<0.001), the decrease being faster than in the BCLP group (rs = −0.3186; p = 0.001) and the ICP group (rs = −0.3378; p<0.0001)). Type B tympanograms had the highest correlation with a hearing loss of 21–40 dB at mean hearing level at speech frequencies (MHLSF) (rs = 0.4574; p<0.001), a lower correlation with a hearing loss of 11–20 dB (rs = 0.2184; p = 0.02) and the lowest correlation with hearing loss above 40 dB. At the ages of one to three, the frequency of type B is higher in UCLP patients than in the BCLP and ICP groups, decreasing at seven to 12, increasing again at 13 to 15, and thereafter showing a continuous decrease. In the BCLP group, the frequency of type B increased significantly at the ages of four to six and then decreased continuously from seven to 18. In ICP patients, the changes in the frequency of type B with age are not significant until the age of 15; at the age of seven, it is higher than in the BCLP and ICP groups. The type C tympanogram is not typically found in cleft palate patients and its frequency is not correlated with age.It can be presumed that each type of cleft lip and palate, due to its characteristic conditions in the epipharynx, will favour a different mode of pathophysiological development of middle-ear disease.
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Lehner, Bernhard, Joerg Wiltfang, Karin Strobel-Schwarthoff, Michaela Benz, Ursula Hirschfelder, and Friedrich-Wilhelm Neukam. "Influence of Early Hard Palate Closure in Unilateral and Bilateral Cleft Lip and Palate on Maxillary Transverse Growth during the First Four Years of Age." Cleft Palate-Craniofacial Journal 40, no. 2 (March 2003): 126–30. http://dx.doi.org/10.1597/1545-1569_2003_040_0126_ioehpc_2.0.co_2.
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Objective To evaluate and compare the effects of early primary closure of the hard palate on the anterior and posterior width of the maxillary arch in children with bilateral (BCLP) and unilateral (UCLP) cleft lip and palate during the first 4 years of life. Design A retrospective, mixed-longitudinal study. Setting Cleft Palate Center of the University of Erlangen-Nuremberg. Subjects and Methods The present investigation analyzes longitudinally 42 children with UCLP and 8 children with BCLP between 1996 and 2000 with early simultaneous primary closure of lip and hard palate (4 to 5 months). Palatal arch width was measured on dental casts with a computer-controlled three-dimensional digitizing system, and their growth velocities were calculated from consecutive periods (mean follow-up 39 months). Differences in growth velocities were compared with those of 25 children with UCLP and 15 children with BCLP with delayed closure of hard palate (12 to 14 months). Results and Conclusions There was no significant difference in terms of anterior and posterior maxillary width between early and delayed closure of hard palate within the first 4 years of life.
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Tindlund, Rolf S., and Per Rygh. "Maxillary Protraction: Different Effects on Facial Morphology in Unilateral and Bilateral Cleft Lip and Palate Patients." Cleft Palate-Craniofacial Journal 30, no. 2 (March 1993): 208–21. http://dx.doi.org/10.1597/1545-1569_1993_030_0208_mpdeof_2.3.co_2.
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Since 1977 patients with anterior/posterior crossbites in the care of the Bergen CLP team have undergone an interceptive orthopedic protraction phase during the deciduous and mixed dentition period. Eighty-seven cases with complete clefts (63 unilateral and 24 bilateral) displaying anterior crossbite (negative overjet) were treated to normal occlusion. A fixed quad-helix appliance was used in combination with a facial mask. In the unilateral complete cleft lip and palate (UCLP) group, mean age at start of treatment was 6 years 10 months and mean duration was 12 months. In the bilateral complete cleft lip and palate (BCLP) group, mean age at start of treatment was 7 years and mean duration 15 months. The protraction force was 700 g. The sagittal changes during protraction in the UCLP and BCLP groups were compared, and related to the growth changes in a group of noncleft children at the same age. Dentofacial treatment effect was different in the UCLP and BCLP groups. Significant increase of maxillary prognathism (angle s-n-ss) was found only in the UCLP group, whereas the treatment effect in the BCLP group was mainly dentoalveolar. However, after protraction there was no longer a significant difference in maxillary prognathism between the two CLP groups, and the sagittal position of the upper molars was normalized in both groups. The upper incisors remained retroclined in both groups, significantly more in the BCLP group. Increase of the upper facial height (n-sp”) and clockwise rotation of the occlusal line were significantly greater in the BCLP group. The computerized occlusal line was unsuitable as a reference standard for the evaluation of sagittal dentofacial treatment changes when the occlusal line was rotated during treatment.
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Klintö, Kristina, Evelina Falk, Sara Wilhelmsson, Björn Schönmeyr, and Magnus Becker. "Speech in 5-Year-Olds With Cleft Palate With or Without Cleft Lip Treated With Primary Palatal Surgery With Muscle Reconstruction According to Sommerlad." Cleft Palate-Craniofacial Journal 55, no. 10 (April 3, 2018): 1399–408. http://dx.doi.org/10.1177/1055665618768541.
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Objective: To evaluate speech in 5-year-olds with cleft palate with or without cleft lip (CP±L) treated with primary palatal surgery in 1 stage with muscle reconstruction according to Sommerlad at about 12 months of age. Design: Retrospective study. Setting: Primary care university hospital. Participants: Eight 5-year-olds with cleft soft palate (SP), 22 with cleft soft/hard palate (SHP), 33 with unilateral cleft lip and palate, and 17 with bilateral CLP (BCLP). Main Outcome Measures: Percent oral consonants correct (POCC), percent consonants correct adjusted for age (PCC-A), percent oral errors, percent nonoral errors, and variables related to velopharyngeal function were analyzed from assessments of audio recordings by 3 independent speech-language pathologists. Results: The median POCC was 75.4% (range: 22.7%-98.9%), median PCC-A 96.9% (range: 36.9%-100%), median percent oral errors 3.4% (range: 0%-40.7%), and median percent nonoral errors 0% (range: 0%-20%), with significantly poorer results in children with more extensive clefts. The SP group had significantly less occurrence of audible nasal air leakage than the SHP and the BCLP groups. Before age 5 years, 1.3% of the children underwent fistula surgery and 6.3% secondary speech improving surgery. At age 5 years, 15% of the total group was perceived as having incompetent velopharyngeal function. Conclusions: Speech was poorer in many children with more extensive clefts. Children with CP±L had poorer speech compared to normative data of peers without CP±L, but the results indicated relatively good speech compared to speech of children with CP±L in previous studies.
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Heidbuchel, Kiki L. W. M., Anne M. Kuijpers-Jagtman, Gem J. C. Kramer, and Birte Prahl-Andersen. "Maxillary Arch Dimensions in Bilateral Cleft Lip and Palate from Birth until Four Years of Age in Boys." Cleft Palate-Craniofacial Journal 35, no. 3 (May 1998): 233–39. http://dx.doi.org/10.1597/1545-1569_1998_035_0233_madibc_2.3.co_2.
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Objective To describe the development of maxillary arch dimensions in children with bilateral cleft lip and palate (BCLP) during the first 4 years of life and to compare it with that in noncleft children. Design This was a retrospective, mixed-longitudinal study. Setting The study was conducted at the Cleft Palate Center of the University Hospital of Nijmegen. Subjects The sample consisted of 26 boys with BCLP who were born between 1976 and 1990 and treated at the University Hospital of Nijmegen. Data for a control group of 34 noncleft boys were collected at the University Hospital of Amsterdam. Method Palatal arch dimensions were digitized on dental casts. A comparison between BCLP and noncleft dimensions was made at fixed time intervals. Results At birth, anterior and posterior arch widths as well as arch depths were significantly larger in children with BCLP. After 7 months (lip closure), anterior arch width and arch depth diminished considerably in the cleft group. After 12 months (palatoplasty), a slight decrease in posterior arch width was observed, and arch depths showed slight catch-up growth. At 4 years of age, anterior arch width was significantly narrower and anterior arch depth was shorter in children with BCLP than in control subjects. Posterior arch width was significantly wider. Conclusions During the first 4 years of life, maxillary arch dimensions in children with BCLP show a unique development that is significantly different from that in noncleft children.
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Suzuki, Akira, Mieko Watanabe, Masayuki Nakano, and Yasuhide Takahama. "Maxillary Lateral Incisors of Subjects with Cleft Lip and/or Palate: Part 2." Cleft Palate-Craniofacial Journal 29, no. 4 (July 1992): 380–84. http://dx.doi.org/10.1597/1545-1569_1992_029_0380_mliosw_2.3.co_2.
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Maxillary lateral incisors on the alveolar cleft were investigated in 431 cleft children registered in the Department of Orthodontics, Kyushu University Dental Hospital. The majority of primary maxillary lateral incisors were located on the distal side of the alveolar cleft in both unilateral cleft lip and alveolus (UCLA) and unilateral cleft lip and palate (UCLP) subjects. Permanent teeth in UCLA tend to be located distally, but in UCLP they tend to be congenially absent (p < .01). The majority of primary teeth had normal shapes; the majority of permanent teeth were of intermediate type or were missing congenially. One third of the UCLA and one half of the UCLP subjects who had primary maxillary lateral incisors were not followed by permanent replacements. The location of the majority of permanent maxillary lateral incisors tallied with that of the primary ones except in four UCLA, ten UCLP, and two bilateral cleft lip and palate (BCLP) subjects. Four UCLA and ten UCLP subjects who had primary lateral incisors on the distal side were followed by their permanent successors on the mesial side. Three UCLP and one BCLP subjects had permanent maxillary lateral incisors even though they had no temporary predecessors.
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Uğar, Dilek A., and Gunvor Semb. "The Prevalence of Anomalies of the Upper Cervical Vertebrae in Subjects with Cleft Lip, Cleft Palate, or Both." Cleft Palate-Craniofacial Journal 38, no. 5 (September 2001): 498–503. http://dx.doi.org/10.1597/1545-1569_2001_038_0498_tpoaot_2.0.co_2.
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Objective: The purpose of this study was to examine the prevalence of cervical vertebral anomalies in individuals with cleft palate only (CPO) and bilateral (BCLP) and unilateral (UCLP) complete cleft lip and palate and make a comparison with a group without cleft. Setting: This retrospective comparison was performed at the Dental Unit, Department of Plastic Surgery, National Hospital and at the Department of Orthodontics, Faculty of Dentistry, University of Oslo, Oslo, Norway. Material and Methods: Six hundred eleven subjects (334 boys, 277 girls) with three different cleft subtypes at age 6 years or older and 264 children (121 boys, 143 girls) without clefts were included in this study. Their lateral cephalometric radiographs were studied for cervical vertebral anomalies and categorized into posterior arch deficiencies or fusions. Results: In the total cleft sample, 111 subjects (18.2%) had cervical vertebral anomalies; of these, 10 subjects had more than one anomaly. Posterior arch deficiency was found in 7.7% and fusions in 12.1%. In the sample without cleft, 9.1% had cervical vertebral anomalies, 5% posterior arch deficiency, and 4.1% fusions. When the cleft sample was divided into the three cleft subtypes, the prevalence of cervical vertebral anomalies was 25.6% in the CPO group, 16.3% in the BCLP group, and 11.1% in the UCLP group. Differences were statistically significant between the CPO and the group without cleft for both posterior arch deficiency and fusion anomalies (p < .01). Conclusion: Cervical vertebral anomalies occur more frequently in individuals with clefts as compared with those without clefts. This was statistically significant for the CPO group.
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Kamakura, S., T. Yamaguchi, S. Kochi, A. Sato, and K. Motegi. "Preliminary Report of Two-Stage Secondary Alveolar Bone Grafting for Patients with Bilateral Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 40, no. 5 (September 2003): 449–52. http://dx.doi.org/10.1597/1545-1569_2003_040_0449_protsa_2.0.co_2.
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Objective To overcome the difficulties of one-stage secondary alveolar bone grafting for patients with bilateral cleft lip and palate (BCLP) who have a broad alveolar cleft, the value of two-stage alveolar bone grafting was examined. Patients Three patients (2 girls and 1 boy) with BCLP were treated by two-stage alveolar bone grafting. The procedure consisted of a first-stage surgery (mean age 8 year 6 months ± 7.8 months), which consisted of alveolar bone grafting for one side of the BCLP, and second-stage surgery for the contralateral side several months later. For the postoperative assessment, radiographs of the operated site were examined. Results The average amount of implanted bone per operation and per patient was 6.8 ± 1.1 g and 13.7 ± 1.0 g, respectively. Postoperative clinical and radiographic examinations revealed that an appreciable alveolar bone ridge had formed, and there were no major complications. Conclusions Two-stage alveolar bone grafting, which makes it possible to reduce the amount of implanted bone, could be an optional surgical procedure for patients with BCLP and a broad alveolar cleft.
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Yatabe-Ioshida, Marilia Sayako, Letícia Dominguez Campos, Renato Yassukata Yaedu, and Ivy Kiemle Trindade-Suedam. "Upper Airway 3D Changes of Patients With Cleft Lip and Palate After Orthognathic Surgery." Cleft Palate-Craniofacial Journal 56, no. 3 (May 30, 2018): 314–20. http://dx.doi.org/10.1177/1055665618778622.
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Objectives: The purpose of this study was to 3-dimensionally assess the airway characteristics of patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) who underwent orthognathic surgery. Design: This was a retrospective study. Setting: The study took place at a national referral center for cleft lip and palate rehabilitation. Patients and Participants: The sample comprised cone-beam computed tomography (CBCT) scans obtained before and after orthognathic surgery of 15 individuals (30 CBCT scans), divided into 2 groups: UCLP group (n = 9 patients/18 CBCT scans) and BCLP group (n = 6/12 CBCT scans). All patients had a nonsyndromic UCLP or BCLP and a skeletal class III malocclusion at the preoperative period. Interventions: Airway volume, pharyngeal minimal cross-sectional area (mCSA), location of mCSA, sella-nasion-A point (SNA) and sella-nasion-B point (SNB) angles, and condylion-A point and condyloid-gnathion linear measurements were assessed in open-source software (ITK-SNAP and SlicerCMF). Main Outcome Measure: Airway dimensions of patients with UCLP and BCLP increase after orthognathic surgery. Results: After orthognathic surgery, UCLP group showed a significant 20% increase in nasopharynx volume. Although not significant, BCLP group also showed an increase of 18% in the same region. Minimal cross-sectional area remained dimensionally stable after surgery and was all located in the oropharynx region, on both groups. Additionally, a positive correlation was observed between volume and mCSA on both groups. Conclusion: Overall, individuals with UCLP and BCLP showed an increase in the upper airway after orthognathic surgery and this might explain the breathing and sleep improvements reported by the patients after the surgery.
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Kramer, Gem J. C., Jan B. Hoeksma, and Birte Prahl-Andersen. "Early Palatal Changes after Initial Palatal Surgery in Children with Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 33, no. 2 (March 1996): 104–11. http://dx.doi.org/10.1597/1545-1569_1996_033_0104_epcaip_2.3.co_2.
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Early palatal growth and development after primary palatal closure was studied in children with different types of cleft lip and palate (CLP). Palatal dimensions were measured on dental casts taken at fixed ages, from 9 months to 4 years of age. The results showed that soft and hard palatal closure in one stage had a significant impeding influence on posterior sagittal palatal growth compared to closure of the soft palate only. Timing of surgery possibly had a small temporary restrictive effect on posterior transverse palatal growth and development. Type and severity of the oral cleft had a significant effect on transverse palatal development and anterior sagittal dimensions. Anterior arch width was reduced in children with a complete unilateral (U) CLP or bilateral (B) CLP. The palates of the latter children had consistently larger anterior arch depths. Compared to normal children, palates of cleft children changed anteriorly from wider at 9 months of age to narrower at 4 years of age. Arch depths were smaller in cleft children except for anterior arch depths in children with complete BCLP.
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Gandedkar, Narayan H., Chai Kiat Chng, Mohammad Abdul Basheer, Por Yong Chen, and Vincent Kok Leng Yeow. "Comparative Evaluation of the Pharyngeal Airway Space in Unilateral and Bilateral Cleft Lip and Palate Individuals with Noncleft Individuals: A Cone Beam Computed Tomography Study." Cleft Palate-Craniofacial Journal 54, no. 5 (September 2017): 509–16. http://dx.doi.org/10.1597/16-013.
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Objective To evaluate the pharyngeal airway space changes in complete unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) individuals, and compare with age and sex-matched noncleft (NC) control subjects. Design Retrospective study. Setting Cleft and Craniofacial Centre, KK Women's and Children's Hospital, Singapore. Materials and Methods Twenty UCLP (mean age: 13.4 ± 0.5 years), 18 BCLP (mean age: 13.5 ± 0.5 years) and 20 skeletal Class I subjects (mean age: 13.4 ± 0.6 years) were included in the study. Cone beam computed tomography scans were assessed for pharyngeal airway space (PAS) (oropharyngeal, nasopharyngeal, total airway space volume), and compared with PAS of age and sex-matched skeletal Class I NC individuals. Results Pharyngeal airway space showed statistically significant differences in the UCLP, BCLP, and NC control subjects. Oropharyngeal (9338 ± 1108 mm3, P < .05), nasopharyngeal (2911 ± 401 mm3, P < .05), and total airway space (12 250 ± 1185 mm3, P < .05) volumes of BCLP individuals showed significant reduction in comparison to UCLP and NC. There were no gender differences of PAS in any of the groups tested ( P > .05). Conclusion The pharyngeal airway space was significantly reduced in the BCLP group than were those in UCLP and control groups. This reduced PAS should be taken into account when planning treatment for these individuals.
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Oosterkamp, Barbara C. M., Hendrik J. Remmelink, Gerard J. Pruim, Aarnoud Hoekema, and Pieter U. Dijkstra. "Craniofacial, Craniocervical, and Pharyngeal Morphology in Bilateral Cleft Lip and Palate and Obstructive Sleep Apnea Patients." Cleft Palate-Craniofacial Journal 44, no. 1 (January 2007): 1–7. http://dx.doi.org/10.1597/05-175.
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Objective: The aim of this study was to analyze craniofacial, craniocervical, and pharyngeal morphology in surgically treated bilateral cleft lip and palate (BCLP) men, untreated men with obstructive sleep apnea (OSA), and a reference group of men. Subjects and methods: Lateral cephalograms were obtained of 27 male BCLP patients (mean age 29.0 ± 8.3 years), 27 untreated male OSA patients (mean age 38.6 ± 5.3 years), and 27 male controls serving as a reference group (mean age 30.8 ± 9.2 years). Tracings were made, and 26 variables representing craniofacial, craniocervical, and pharyngeal dimensions were obtained using Viewbox 3.1.1.6. software. The groups were compared using a one-way analysis of variance. Results: Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients was similar except for a significantly more retrusive maxilla in the BCLP group. Compared to the reference group, the BCLP and OSA groups had significantly larger craniocervical angulations, smaller depth of the oropharynx at the tip of the velum, and a more inferiorly positioned hyoid bone. Significantly larger vertical dimensions were found in the BCLP group compared to the reference group. Conclusions: Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients demonstrate substantial similarities except for a significantly more retrusive maxilla in the BCLP group. It is suggested that airway obstruction and postural adaptation to the obstruction may possibly be related to the aberrant craniofacial, craniocervical, and pharyngeal morphology in OSA and in BCLP patients.
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Celikoglu, M., SK Buyuk, AE Sekerci, K. Cantekin, and C. Candirli. "Maxillary Dental Anomalies in Patients with Cleft Lip and Palate: A Cone Beam Computed Tomography Study." Journal of Clinical Pediatric Dentistry 39, no. 2 (January 1, 2015): 183–86. http://dx.doi.org/10.17796/jcpd.39.2.t623u7495h07522r.
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Objective: To compare the frequency of maxillary dental anomalies in patients affected by unilateral (UCLP) and bilateral (BCLP) cleft lip with palate and to determine whether statistical differences were present or not between cleft and normal sides in UCLP group by using cone beam computed tomography (CBCT). In addition, the frequency of those dental anomalies was compared with previous studies presenting the same population without cleft Study Design: Fifty non-syndromic patients affected by UCLP (28 patients) and BCLP (22 patients) were selected for analysis of dental anomalies by means of CBCT. The frequency of maxillary dental anomalies including tooth agenesis, microdontia of lateral incisor, ectopic eruption and impaction of canine and supernumerary tooth were examined. Pearson chi-square and Fisher's exact tests were performed for statistical comparisons. Results: All patients affected by UCLP and BCLP were found to have at least one maxillary dental anomaly. The most frequently observed dental anomaly was tooth agenesis (92.5% and 86.4%, respectively) in UCLP and BCLP groups. Tooth agenesis and canine impaction were observed more commonly in the cleft side (75.0% and 35.7%, respectively) than in the normal side (57.1% and 14.3%, respectively) in UCLP group (p≯0.05). All dental anomalies were found to be higher in both cleft groups than in general populations not affected by cleft. Conclusion: Since patients affected by UCLP and BCLP had at least one dental anomaly and higher dental anomaly frequency as compared to patients without cleft, those patients should be examined carefully prior to orthodontic treatment.
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Patel, Jilen, John Winters, and Mark Walters. "Intraoral Digital Impression Technique for a Neonate With Bilateral Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 56, no. 8 (March 11, 2019): 1120–23. http://dx.doi.org/10.1177/1055665619835082.
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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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Lai, Moon Cheung, Nigel M. King, and Hai Ming Wong. "Abnormalities of Maxillary Anterior Teeth in Chinese Children with Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 46, no. 1 (January 2009): 58–64. http://dx.doi.org/10.1597/07-077.1.
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Objective: To retrospectively study the anterior maxilla of southern Chinese children with complete cleft lip and palate (CLP) for the prevalence of different kinds of dental anomalies, position and rotation of the teeth, and the asymmetry of dental development. Patients: 195 southern Chinese children with CLP aged between 3 and 17 years. Methods and Materials: Dental records and study casts were studied as were the radiographs from which the dental development was determined. Results: The tooth prevalence of cleft side permanent lateral incisor was 19.2% in unilateral CLP (UCLP) children and 20.5% in bilateral CLP (BCLP) children. The cleft side central incisors were rotated in 78.1% and 95.9% of the teeth in UCLP and BCLP children, respectively. Of the permanent canines, 43.4% were positioned mesially on the cleft side in UCLP children, while for BCLP children 69.7% of the teeth were in a normal position. In addition, the mesially positioned canines were often associated with an absence of the permanent lateral incisor while the distally positioned canines were always associated with the presence of supernumeraries in the cleft region. The permanent teeth on the cleft side showed significantly delayed development compared with their antimeres on the noncleft side; however, the delayed permanent lateral incisors did complete their formation normally. Conclusion: This group of Chinese children with CLP demonstrated statistically significant higher prevalences of hypodontia, microdontia, and delayed dental development on the cleft side than the noncleft side.
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da Silva Filho, Omar Gabriel, José Valladares Neto, Leopoldino Capelloza Filho, and JoséAlberto de Souza Freitas. "Influence of Lip Repair on Craniofacial Morphology of Patients with Complete Bilateral Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 40, no. 2 (March 2003): 144–53. http://dx.doi.org/10.1597/1545-1569_2003_040_0144_iolroc_2.0.co_2.
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Objective The aim of this study was to compare two groups of adult male patients with complete bilateral cleft lip and palate (BCLP) on the basis of lateral cephalometric radiographs. Patients The first group of adult male patients with complete BCLP was comprised of 13 unoperated patients with an average age of 21 years. The second group was comprised of 14 patients with an average age of 21 years 7 months, who had been operated only on the lip prior to 2 years of age. Design The following measurements were evaluated: angle and length of cranial base; maxillary spatial positioning and length; mandibular spatial positioning; morphology and length; maxillomandibular relationship; vertical facial length; dental positioning; interdental arch relationship; and soft profile. Results The results suggest that lip repair has a significant influence on certain areas of the craniofacial complex, mainly the premaxilla and the upper incisors. Conclusions The most significant findings consequent to lip repair consisted of reduction of the premaxillary anterior projection and lingual tipping of the upper incisors. Retropositioning of the premaxilla, especially in the alveolar part, is a desired effect of lip repair in complete BCLP. Such effect on the projected premaxilla is usually beneficial, except when the exceedingly severe lip pressure, unfavorable growth pattern, or both retropositions the midface profile beyond acceptable sagittal limits.
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Dalben, Gisele da Silva, Daniela Gamba Garib, Rayane de Oliveira Pinto, Antonio Richieri-Costa, and Luís Antônio de Assis Taveira. "Craniofacial Morphology in Patients With Opitz G/BBB Syndrome." Cleft Palate-Craniofacial Journal 56, no. 10 (June 19, 2019): 1366–72. http://dx.doi.org/10.1177/1055665619857001.
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Objective: To compare the cephalometric characteristics of patients with and without Opitz G/BBB syndrome type I. Design: Cross-sectional, case–control study. Setting: Tertiary cleft center in Brazil. Participants: Eighteen individuals with Opitz G/BBB syndrome with complete bilateral cleft lip and palate (BCLP), compared to 18 individuals with nonsyndromic complete cleft lip and palate and 18 individuals without malformations, matched for gender and age. Interventions: Pretreatment lateral cephalograms of all patients were manually traced and digitized for achievement of linear and angular measurements. Main Outcome Measures: Analysis of variance or Kruskal-Wallis followed by Tukey tests were used for intergroup comparisons at a significance level of P < .05. Results: Individuals with Opitz G/BBB syndrome exhibited alterations in SNGn, P-Co, and N’-Pr/Po-Or that were not attributable to BCLP. Co-Go, Sella-Nasion-Supramentale, ANB (maxillo-mandibular relationship), and anterior nasal spine-posterior nasal spine (ANS-PNS)/U1A-U1T were significantly different in both G/BBB and BCLP groups compared to control, but not different between G/BBB and BCLP groups. Anterior nasal spine-posterior nasal spine/Go-Gn, ANS-PNS, V-Upper pharyngeal wall, and U-lower pharyngeal wall were different in nonsyndromic BLCP compared to nonsyndromic controls and Opitz G/BBB group. Conclusion: Patients with Opitz G/BBB syndrome exhibited some unique cephalometric alterations compared to patients with nonsyndromic complete BCLP and controls.
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Garib, Daniela Gamba, Marília Sayako Yatabe, Terumi Okada Ozawa, and Omar Gabriel da Silva Filho. "Alveolar Bone Morphology in Patients with Bilateral Complete Cleft Lip and Palate in the Mixed Dentition: Cone Beam Computed Tomography Evaluation." Cleft Palate-Craniofacial Journal 49, no. 2 (March 2012): 208–14. http://dx.doi.org/10.1597/10-198.
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Objectives To verify the thickness and level of alveolar bone around the teeth adjacent to the cleft by means of cone beam computed tomography (CBCT) in patients with complete bilateral cleft lip and palate prior to bone graft surgery and orthodontic intervention. Method The sample comprised 10 patients with complete bilateral cleft lip and palate (five boys and five girls) in the mixed dentition. The mean age was 9.5 years, and all subjects showed a G3 interarch relationship according to the Bauru index. The thickness of alveolar bone surrounding the maxillary incisors and the maxillary canines was measured in CBCT axial section using the software iCAT Xoran System. The distance between the alveolar bone crest and the cement-enamel junction (CEJ) was measured in cross sections. Results The tomography images showed a thin alveolar bone plate around teeth adjacent to clefts. No bone dehiscence was observed in teeth adjacent to clefts during the mixed dentition. A slight increase in the distance between the alveolar bone crest and the CEJ was observed in the mesial and lingual aspects of canines adjacent to cleft. Conclusion In patients with BCLP in the mixed dentition, teeth adjacent to the alveolar cleft are covered by a thin alveolar bone plate. However, the level of alveolar bone crest around these teeth seems to be normal, and no bone dehiscence was identified at this age.
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Vedung, Sigfrid. "Pharyngeal Flaps after One- and Two-stage Repair of the Cleft Palate: A 25-Year Review of 520 Patients." Cleft Palate-Craniofacial Journal 32, no. 3 (May 1995): 206–16. http://dx.doi.org/10.1597/1545-1569_1995_032_0206_pfaoat_2.3.co_2.
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Between 1962 and 1976, a one-stage surgical procedure was performed on 328 cases of cleft lip and palate or isolated cleft palate. From 1977 to 1986, a two-stage surgical procedure was performed on 192 patients. After one-stage repair, 22 (6.7%) required a pharyngeal flap at the age of 6 years, and 13 (7%) required a flap after two-stage repair. When the patients were 14 years or older, 56 (17%) needed a flap after one-stage repair, and 14 (24%) required a flap after two-stage repair. Two-stage repair at 24 months and 5.2 years resulted in more patients in need of pharyngeal flaps than those who had repair at 12 to 18 months and 3 years. In both groups, at age 10, the incidence of flaps was approximately 20% after closure of isolated cleft palate involving the hard palate, with 11 to 12% in patients with unilateral cleft lip and palate (UCLP) or clefts of the soft palate only, and 14 to 16% in patients with bilateral cleft lip and palate (BCLP). The pharyngeal flap was more often used in girls than in boys, especially in cases with CP only. Approximately 85% of the flaps were carried out before the age of 10 years, and only a few flaps may have been related to involution of the adenoid. The incidence of fistulas was higher after one-stage repair of cleft lip and palate (CLP) (p < .05) and lower in patients with CP only (p < .05), compared with the results after two-stage repair. Pharyngeal flaps were slightly more common after two-stage repair. The possible advantages of two-stage repair in relationship to maxillary growth, which may justify the second operation, will be investigated when the patients are older.
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Kobayashi, Shinji, Kazunori Yasumura, Takashi Hirakawa, Toshihiko Fukawa, and Jiro Maegawa. "Evaluation of Congenital Maxillary Growth Using Computed Tomography in Patients With Bilateral Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 57, no. 3 (September 15, 2019): 282–87. http://dx.doi.org/10.1177/1055665619874979.
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Objective: To analyze congenital lateral maxillary growth for patients with bilateral cleft lip and palate (BCLP). Design: A retrospective study. Setting: Kanagawa Children’s Medical Center. Materials: Images from computed tomography (CT) of patients with BCLP and control patients that were previously used for treatment. Main Outcome Measures: The following landmarks were used: A, the posterior most point of the piriform aperture; B, the superior most point of the acoustic meatus; C, the point at which line A-B intersects the line drawn perpendicular from line A-B to the maxillary tuberosity; and D, the apical most point of the nasal bone. The following distances were then measured using these landmarks: (1) A-B distance; (2) A-C distance; (3) A-C/A-B; (4) the angle between lines A-B and A-D (∠BAD); and (5) B-D distance. Result: Mean A-B and A-C distances and A-C/A-B were significantly smaller in the BCLP group than in the control group ( P < .01 each). Mean ∠BAD was significantly larger in the BCLP group than in the control group ( P < .01). Mean B-D distance did not differ significantly between groups. Conclusions: Our results indicated that the lateral maxillary segments of patients with BCLP were more posterior than those of the control group, and segment length was shorter compared to the control group on 3D-CT analysis. The lateral maxillary segments of patients with BCLP were basically suggested to originally be underdeveloped.
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Scott, Rupert, Julia Scott, Sami Stagnell, Steve Robinson, and Tim Flood. "Outcomes of 44 Consecutive Complete Bilateral Cleft Lip and Palate Patients Treated with Secondary Alveolar Bone Grafting and Premaxillary Osteotomy." Cleft Palate-Craniofacial Journal 54, no. 3 (May 2017): 249–55. http://dx.doi.org/10.1597/15-162.
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Objective To report the surgical outcomes of secondary alveolar bone grafting with premaxillary osteotomy in a single surgeon cohort of complete bilateral cleft lip and palate patients. Design Retrospective review of 44 consecutive patients using hospital notes and radiographs. Setting Single specialist cleft lip and palate center, UK. Patients Consecutive patients with complete bilateral cleft lip and palate who were being treated with secondary alveolar bone grafting incorporating premaxillary osteotomy. Outcome Measures Assessment of success of bone graft by Kindelan score; canine eruption; closure of fistulae and assessment of morbidity. Results Between January 6, 2000, and August 8, 2013, 44 patients with complete BCLP underwent secondary ABG with a premaxillary osteotomy as a one-stage procedure. The mean follow-up was 7.3 years (range 1.4 to 14.6). Eighty-five percent of ABGs were successful (a Kindelan score of 1 or 2), and canine eruption was 89%. Failure of the ABG occurred in 7%. Fistulae recurrence rate was 11%, all of which were asymptomatic. No premaxillae were devitalized. Conclusion Incorporating a premaxillary osteotomy into the secondary ABG surgical protocol can be a safe technique that gives excellent surgical exposure for fistula repair.
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Casal, Carmen, Alejandro Rivera, Germán Rubio, Joan Sentís-Vilalta, Alfonso Alonso, and Cosme Gay-Escoda. "Examination of Craniofacial Morphology in 10-Month to 5-Year-Old Children with Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 34, no. 6 (November 1997): 490–97. http://dx.doi.org/10.1597/1545-1569_1997_034_0490_eocmim_2.3.co_2.
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Objective: The purpose of this study was to assess craniofacial growth In children from 10 months to 5 years of age with cleft lip and/or palate and to develop a systematic method of cephalometric measurements. Design: A case-control study. Setting: Craniofacial unit of a teaching hospital for children. Patients: A consecutive series of the first 22 patients with cleft lip and/or palate who underwent early reconstructive treatment [isolated cleft lip (CL) 6; isolated cleft palate (CP) 7; unilateral cleft lip and palate (UCLP) 7; and bilateral complete cleft lip and palate (BCLP) 2] (mean age, 27.9 months) and 22 age- and sex-matched noncleft children. Interventions: Lateral cephalometric headfilms of the children were taken using a pediatric cephalostat. Main Outcome Measures: Cephalometric landmarks were measured according to Ricketts cephalometry. Results: As compared with controls, CL patients had a lingual position and inclination of maxillary and mandibular incisors, an increase of interincisal angle and a decrease of incisor overjet, an increase in facial convexity, and a decrease in facial depth and mandible body length. In CP patients, palatal plane inclination and mandible arch were significantly reduced. In UCLP patients, there was a decrease in molar relation and incisor overbite, an increase in interincisal angle, reduced position and inclination of maxillary incisors and inclination of mandibular incisors, an increase in facial convexity, and lower facial height. Conclusions: Based on the absence of midface growth reduction, these short-term results suggest a tendency toward normal maxillomandibular growth.
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Tortora, Chiara, Maria C. Meazzini, Giovanna Garattini, and Roberto Brusati. "Prevalence of Abnormalities in Dental Structure, Position, and Eruption Pattern in a Population of Unilateral and Bilateral Cleft Lip and Palate Patients." Cleft Palate-Craniofacial Journal 45, no. 2 (March 2008): 154–62. http://dx.doi.org/10.1597/06-218.1.
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Objective: To evaluate the dental characteristics of patients subjected to a protocol that included early secondary gingivoalveoloplasty (ESGAP). Design: Panoramic radiographs of 87 patients with unilateral cleft lip and palate (UCLP) and 29 with bilateral cleft lip and palate (BCLP) were evaluated. Missing and supernumerary teeth were also quantified on the cleft and noncleft side and in the maxilla and mandible. Crown and root malformations and tooth rotations were quantified. A subsample in permanent dentition was extrapolated to analyze canine eruption patterns. Results: A total of 48.8% of the UCLP patients presented with missing permanent lateral incisors in the cleft area and 6.1% contralaterally. A total of 4.9% presented with missing second maxillary premolars on the cleft site and 1.2% contralaterally. A total of 7.3% presented with supernumerary lateral incisors, and 45% of the BCLP cleft sites presented with missing lateral incisors, while 25% of the cleft sites presented second maxillary premolars agenesis. Five percent of the cleft sites presented with supernumerary lateral incisors. Evaluation of the subsample in permanent dentition showed that 15.5% had a canine retention and 4.4% of the canines had to be surgically exposed. A significant association was observed between canine inclination and retention but not with absence of the lateral incisor. Conclusions: The frequency of dental anomalies in this sample was similar to other cleft populations. As surgical trauma has been suggested to damage forming teeth, the results of this study indicated that ESGAP has no detrimental influence on subsequent dental development.
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Batra, Puneet, Gopala Krishna Annavarapv, Ashish Chopra, Amit Srivastava, Partha Sadhu, and Keyur Mevda. "Use of Bauru Yardstick in Patients With Complete Bilateral Cleft Lip and Palate at an Indian Center." Cleft Palate-Craniofacial Journal 55, no. 4 (December 14, 2017): 602–6. http://dx.doi.org/10.1177/1055665617730360.
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Objective: To evaluate dental arch relationship in treated bilateral cleft lip and palate (BCLP) cases at an Indian cleft center using the Bauru yardstick. Patients and methods: Digital photographs of the dental cast of 50 consecutively treated patients (28 males and 22 females) with nonsyndromic BCLP at an Indian cleft center were rated by 2 examiners as per the Bauru yardstick for the 12-year-old age group. The average age group was 12 ± 0.62 years. All cases were treated with same surgical protocol. Results: The inter-examiner agreement between the 3 examiners was found to be very high, with weighted kappa values ranging from 0.894 to 0.951. The intraexaminer agreement between the 2 examinations for all the examiners was also found to be very high, with weighted kappa values ranging from 0.894 to 0.931. Seventy-eight percent of patients were rated with a Bauru yardstick score of 1+2. In addition, 10% of patients were rated with a score of 3, 8% as 4, and 4% as 5. The overall Bauru yardstick score for the center was 2.36. Conclusion: The protocol followed for the repair of BCLP cases by the center was found to be a good regimen in regard to the Bauru yardstick score.
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Titiz, Serap, and Isil Aras. "Modifications in Presurgical Nasoalveolar Molding Treatment of Bilateral Cleft Lip and Palate Patients With Severely Malpositioned Premaxillae." Cleft Palate-Craniofacial Journal 55, no. 9 (March 26, 2018): 1316–20. http://dx.doi.org/10.1177/1055665618765781.
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Objective: The aim of this study was to evaluate a modified presurgical nasoalveolar molding (PNAM) treatment for patients with bilateral cleft lip and palate (BCLP) with severely malpositioned premaxillae. Setting: This study was conducted at the Faculty of Dentistry, Department of Orthodontics, Ege University, Bornova, Izmir, Turkey. Method: Retention arms were manufactured using a mold that we developed, and prefabricated retraction apparatuses were applied to the plaster model obtained from the patient. During the acrylic curing process, the flanges of the appliances were elongated into the sulcus without including the premaxilla. The premaxilla was aligned with the midline with an elastic band system, and the lip hanger was constructed with 0.023-in stainless steel wire. Elastic bands were stretched between the retraction apparatuses and the lip hanger based on the desired force. Nasal stents were added to the retention arms when the cleft width was reduced to less than 6 mm. Conclusion: The modified PNAM treatment enabled faster derotation of the premaxilla and earlier initiation of retraction. The prefabricated retraction apparatus and retention arm provided efficient PNAM for patients with BCLP.
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Mishima, Katsuaki, Toshio Sugahara, Yoshihide Mori, Katsuhiro Minami, and Masayoshi Sakuda. "Effects of Presurgical Orthopedic Treatment in Infants with Complete Bilateral Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 35, no. 3 (May 1998): 227–32. http://dx.doi.org/10.1597/1545-1569_1998_035_0227_eopoti_2.3.co_2.
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Objective To align the protruding premaxilla in infants with bilateral cleft lip and palate (BCLP), an intraoral appliance (i.e., Hotz plate) and an extraoral appliance consisting of a band covering the head and elastics are used as a presurgical orthopedic treatment in our clinic. The aim of this study was to analyze the configuration and position of the premaxilla and the vomer in infants with BCLP and to investigate the factors generating deviation and bending of the vomer and twisting of the premaxilla. Patients Palatal casts were obtained serially from 10 infants with complete BCLP from 1 to 3 months of age. Measurements These casts were automatically measured using a highly accurate contact-type measuring apparatus. After three-dimensional wire frame models generated from the serial casts were automatically superimposed, the magnitude and direction of the shift were calculated. A discriminant analysis was used for investigation of predictor variables generating the twisting or bending vomer. Results and Conclusions The vomer was found to be bent in two infants and the premaxilla was twisted in three infants. In the infants whose vomers were bent, the magnitude of the posterior shift of the premaxilla was greater than that of the inferior shift. A discriminant analysis indicated that at 1 month of age, a greater inclination and a smaller deviation of the vomer and a longer distance between the cleft edges of the lateral segments had a tendency to be associated with bending of the vomer or twisting of the premaxilla.