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PubMed2000

The impact of antenatal diagnosis on the effectiveness and timing of counselling for cleft lip and palate.

Birth of a cleft child is emotionally distressing to the parents. The opportunity for forewarning the parents is now possible with antenatal ultrasound diagnosis of the cleft. This has opened up a new chapter of antenatal counselling. We present a retrospective postal study of 124 primary cleft lip and/or palate repairs operated over the last 5 years. In our study, 30% were diagnosed antenatally and received antenatal counselling. The rest received postnatal counselling. Of those who had an antenatal diagnosis 85% felt that the diagnosis prepared them psychologically for the birth of the cleft child. A total of 92% (n = 23) of parents who had antenatal as well as postnatal counselling, as compared with 71% (n = 46) of those counselled only postnatally, said the information given to them by the counselling cleft team was detailed and satisfactory. The majority of those who felt counselling was confusing had only postnatal counselling. Of those who had antenatal diagnosis 92% said that they had never contemplated termination of pregnancy. Only one parent had actually terminated her pregnancy due solely to the antenatal diagnosis of a bilateral cleft lip and palate. Our study has highlighted the importance of antenatal diagnosis of cleft and the importance of antenatal counselling for the delivery of a cleft child to be a positive experience.

Cleft Lip↗

PubMed1995

Preparation of feeding obturators for infants with cleft lip and palate.

Clefts of the lip and palate are the commonest congenital craniofacial malformations in children. Sucking is impaired in infants born with complete clefts of the lip and palate. Feeding obturators improve feeding thereby contributing to weight gain and a thriving state of health, a prerequisite for surgical repair of the defects. A pediatric dentist may be required to fabricate the obturator. A method for constructing the appliance is presented. The severity of the clefts varies so much that stock trays are not always useful for the impression of the infant's maxillary arch. A preliminary impression is taken by introducing a thermoplastic impression material with the index and middle fingers as the tray. A model is produced from which a custom tray is constructed. The final maxillary impression is taken using an irreversible hydrocolloid with the child in an upright position. An obturator is constructed on the stone model by sprinkling soft autopolymerizing acrylic resin on the palate extending well into the mucobuccal fold area. The cured appliance is trimmed and polished prior to insertion.

Cleft Lip↗

PubMed1992

History of cleft lip nasal repair.

Surgery of the cleft lip nasal tip has lagged behind cleft lip surgery. In fact, in most early illustrations it was not even noted. Since the development of cosmetic rhinoplasty an endless array of techniques have been published. Unfortunately there are few studies of the gross anatomy.

Cleft Lip↗

PubMed2005

Report of altered sensation in patients with cleft lip.

OBJECTIVE: To determine whether patients with cleft lip have normal perioral sensation. DESIGN: Each subject was carefully questioned about the following: sensation in the face at rest, light touch of different areas, and sensation in natural situations (e.g., exposure to cold weather) that reveal sensory abnormalities. A cotton-tip applicator stick was stroked lightly across the facial skin. The subject's descriptions of the evoked sensations were used to identify and outline areas with abnormal sensation. SETTING: Data were obtained from subjects participating in a longitudinal, university-based study of the functional outcomes of lip revision surgery. PATIENTS: Seventeen patients with cleft lip and 12 control subjects (aged 7 to 22 years, mean 12.9 years) participated. RESULTS: In contrast to control subjects, 9 of 16 patients (56%) reported loss in sensation, described as decreased touch, scratch, tickle, or tingle intensity. Six other patients (38%) reported additional sensation, described as increased scratch, tickle, or tingle intensity. In eight patients, the altered sensation was restricted to the skin area flanking and including the visible scar, encompassing no more than 25% of the total area bound by the inferior nose, nasolabial grooves and inferior vermilion. In seven patients (unilateral cleft), the altered area extended to the contralateral, noncleft side of the upper lip or onto the philtrum. CONCLUSIONS: In contrast to the literature, sensation in the upper lip of many patients with cleft lip is not normal. Loss in sensation is exhibited most commonly and limited largely to the skin overlying tissues traumatized during reconstructive surgery.

Adolescent↗

PubMed2005

[Analysis of psychological condition of parents with cleft lip and/or palate children].

OBJECTIVE: To evaluate the psychological situations of cleft lip and/or palate children's parents, to discuss the relationship between psychological situations and cleft types, and to provide clinical treatment to improve the psychological situations of these parents. METHODS: 100 parents whose children were proceeded the primary surgery treatment were selected as the study group, and other 34 parents whose children were normal as the control group. All parents were inquired and tested by the life event scale (LES) and self-rating anxiety scale (SAS). RESULTS: The LES total scores of the cleft lip and/or palate patients' parents were significantly high compared with the normal (P < 0.05). The SAS total scores of the cleft lip and/or palate patients' parents had no significant difference with the control group (P > 0.05). The scores of cleft lip and/or palate patients' parents were the highest and the scores of cleft palate patients' parents were the lowest. CONCLUSION: Most of the cleft lip and/or palate patients' parents were disturbed by a negative psychological situation. Some kind of negative psychological situation may manifest some body symptoms. Meanwhile,the three subgroups' data had the significant difference, which indicated that parents may much more care about the appearance abnormality.

Child↗

PubMed2005

The central lip flap and nasal mucosal rotation advancement: important aspects of composite correction of the bilateral cleft lip nose deformity.

The columella, nasal tip, lip relationship in the secondary bilateral cleft deformity remains an enigma and a great challenge for the cleft surgeon. A subset of patients with bilateral cleft lip still require columellar lengthening and nasal correction, despite the advances in preoperative orthopedics and primary nasal corrections. An approach to correct this deformity is described. This consists of (1) lengthening the columella by a central lip advancement flap; (2) open rhinoplasty, allowing definitive repositioning of lower lateral cartilages, ear cartilage grafting to the tip and columella when necessary; (3) nasal mucosal advancement; (4) alar base narrowing; and (5) reconstruction of the orbicularis oris as required. Depending on the individual assessment of the patients, some of these steps were not performed, leaving the nasal mucosal advancement the most important aspect of the reconstruction. In a consecutive series of 72 patients with repaired bilateral cleft lip and palate, 17 patients have been treated with nasal mucosal rotation advancement and followed up for a maximum period of 10 years. With the use of this technique, the secondary bilateral cleft lip nose deformity has been successfully corrected.

Adolescent↗

PubMed1986

Cervical vertebral anomalies in cleft lip and palate.

A survey was made of the upper cervical vertebrae in children with cleft lip and palate in order to determine the prevalence of cervical vertebral anomalies. The cleft sample consisted of 105 patients attending for orthodontic treatment. It was subdivided into cleft lip (CL), cleft palate (CP), unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) subgroups. A control was comprised of 120 orthodontic patients. The cervical vertebral anomalies were classified into two types, posterior arch deficiency (PAD) and fusion anomalies (FUS). The results confirmed that the cervical vertebral anomalies occurred significantly more often in the cleft sample (13%) than in the controls (0.8%), p less than 0.001. The total prevalence of cervical vertebral anomalies was similar in the four cleft sub-samples, but the occurrence of each of the two types of cervical vertebral anomalies showed a more differentiated pattern. Posterior arch deficiency occurred significantly more often in cleft palate (CP), (16%) than in controls p less than 0.001, but fusions did not occur more frequently in any cleft groups than in controls.

Axis, Cervical Vertebra↗

PubMed2006

Management of bilateral cleft lip and nasal deformity.

PURPOSE OF REVIEW: Management of bilateral cleft lip and nasal deformity can be a challenging task. This paper provides an overview of bilateral cleft lip and nasal deformity with an updated review of current management issues in the literature. RECENT FINDINGS: The Centers for Disease Control and Prevention recently reported that orofacial clefts are now the most common birth defect. While this statistic may be disheartening, the increased prevalence brings the problem to light at the forefront of the medical community, thus gaining more support and resources. Many techniques have been described for repair of bilateral cleft lip and nasal deformity. A recent advancement in presurgical orthopedics is the use of nasoalveolar molding to narrow wide clefts. SUMMARY: Surgical management of bilateral cleft lip and nasal deformity poses a challenge to the skill and judgment of the cleft surgeon. Although techniques continue to evolve over the decades, the basic principles of cleft surgery remain the same. The main principles are to achieve an appropriate philtral size and shape, to position the cartilages in a more optimal position, and to attain muscular continuity and symmetry for optimal appearance and function. Thus, while keeping the basic principles in mind, management of bilateral cleft lip and nasal deformity becomes a valuable and rewarding experience for the surgeon, patient and caregiver.

Cleft Lip↗

PubMed1998

Median cleft lip with associated midline sinuses.

Midline upper lip sinuses alone are rare entitities, with less than 25 cases reported previously. Midline upper lip sinuses with associated cleft lip are even more rare. A patient report of median cleft lip with associated upper lip sinuses in a 16-year-old boy is presented. Controversy exists as to whether these abnormalities are related. This report demonstrates the plausibility of a cause-and-effect relationship between midline clefts and sinuses.

Adolescent↗

PubMed1997

Soft tissue profile changes of reverse headgear treatment in Chinese boys with complete unilateral cleft lip and palate.

Midface retrusion in cleft lip and palate patients often results in personal, social, and psychological problems, along with the functional difficulty. Hence, soft tissue profile improvement in early childhood is of obvious importance. The purpose of this study was to investigate the soft tissue changes that occur during reverse headgear treatment in a homogeneous sample of Chinese boys born with unilateral complete cleft lip and palate. Boys with a similar congenital deformity and presenting similar skeletal morphology and maturity status were included for comparison. After 7.8 months of reverse headgear treatment, the soft tissue profile improved significantly as the concave tendency associated with maxillary deficiency decreased. The sagittal maxillomandibular lip relationship and the Holdaway angle increased significantly by 4.25 and 3.94 degrees, respectively.

Cephalometry↗

PubMed2001

Fetal cleft lip and palate: sonographic diagnosis, chromosomal abnormalities, associated anomalies and postnatal outcome in 70 fetuses.

OBJECTIVE: The aim of this study was to determine the relationship between facial clefts, associated malformations and chromosomal abnormalities. STUDY DESIGN: Sonograms of 70 fetuses with cleft lip with or without cleft palate were prospectively and retrospectively evaluated in our tertiary referral center for the nature of the cleft lip or palate and for the nature of the associated anomalies. Additionally, karyotyping was performed in 63 of the 70 patients (90%). RESULTS: The frequency of additional anomalies and the mortality rate in this selected population varied with the type of cleft. None of the fetuses presenting an isolated cleft lip had additional anomalies and all survived. All fetuses presenting a median facial cleft had concurrent anomalies (particularly of the central nervous system (90%)) and a fatal outcome. Associated defects were more frequent in fetuses with bilateral clefts (72%) than in those with unilateral clefts (48%). Fetuses with a unilateral cleft lip with or without cleft palate had a better survival rate (52%) than those with a bilateral cleft lip with or without cleft palate (35%). The frequency and type of chromosomal abnormalities varied with the type of cleft. The highest rate of chromosomal abnormalities was found in fetuses with median clefts (82%). CONCLUSIONS: Although no conclusions regarding the prevalence of chromosomal or other anomalies in patients with a cleft lip with or without cleft palate in the general population could be drawn, the study revealed a strong relationship between the type of facial cleft, associated malformations, chromosomal abnormalities and fetal outcome.

Abnormalities, Multiple↗

PubMed2002

Cytophotometrical and immunohistochemical analysis of soft palate muscles of children with isolated cleft palate and combined cleft lip and palate.

Palatal muscle biopsies from the cleft margin of children were subjected to cytophotometrical and immunohistochemical analysis. Muscle fiber types were classified according to the enzyme activity of myofibrillic adenosine triphosphatase, glycerol-3-phosphate-dehydrogenase and succinate dehydrogenase assessed cytophotometrically. Fiber type-related immunoreactivity of nitric oxide synthase (NOS) isoforms I, II, III, as a physiological modulator of skeletal muscle function, was related to the oxidative and glycolytic activity of the muscle fibers. Fast oxidative glycolytic fibers with high oxidative activity showed strong NOS I immunoreactivity, whereas fast glycolytic fibers with high glycolytic activity were stronger immunolabelled for NOS III. NOS II expression was similar in all fiber types. No differences in NOS immunoreactivity were found between the two investigated forms of deformity. Additionally to the usual skeletal muscle fiber types, a slow tonic fiber type was for the first time identified in cleft palate muscles. Comparison of two forms of cleft palate, isolated cleft palate and combined cleft lip and palate has shown decreased enzyme activities in muscle fibers of palatal muscles from combined cleft lip and palate. Fast oxidative glycolytic fibers were mainly effected. Cytophotometrical and immunohistochemical analysis indicated a depressed performance of the cleft palatal muscles from combined cleft lip and palate as a stronger deformity compared with isolated cleft palate.

Adenosine Triphosphatases↗

PubMed2004

Augmentation by autologous adipose tissue in cleft lip and nose. Final esthetic touches in clefts: part I.

Although patients with a cleft lip and palate undergo many surgeries and other therapeutic procedures in the course of their treatment, many are still deeply concerned with their handicap and continue searching for perfection in their appearance. Augmentation using the subject's own fat cells involves minor invasion, is readily available, is an unpretentious method regarding time and cost, and has no contraindications. This method can serve to supplement a hypotrophic scarred upper lip and nasal columella, and by improving the volume, it induces a more natural contour, which reduces the stigmatizing deformity as well as the visibility of externally apparent scars. Using this approach, five patients with a complete cleft have been treated. The median follow-up interval is 22 months (through January 2003). The procedure and postoperative course had a pleasing outcome and were without any complications. The disadvantage was the temporary effect of the outcome, which necessitated repeated application every 7 months on average.

Adipose Tissue↗

PubMed2003

A split-mouth study on periodontal and microbial parameters in children with complete unilateral cleft lip and palate.

BACKGROUND: Complete unilateral cleft lip and palate (UCLP) is a hereditary or multifactorial malformation that can be corrected successfully with a combined orthodontic, surgical and restorative treatment. Such multidisciplinary treatment takes many years and demands a lot of attention to both patients' teeth and periodontium. OBJECTIVES: This split-mouth study aimed to compare the periodontal health as well as the microbial parameters between cleft and non-cleft region. MATERIAL AND METHODS: 75 patients (52 males, 23 females) between 8 and 20 years with a complete unilateral cleft lip and palate (before (n = 30), during (n = 34) and after (n = 11) the active orthodontic treatment) volunteered for this study. Four regions were defined for the split-mouth comparison: teeth neighbouring cleft (site 1), tooth in cleft (site 2), and the corresponding contra-lateral teeth, respectively, in the unaffected quadrants (sites 3 and 4). At all sites the following periodontal parameters were recorded: plaque and gingivitis indices, pocket depth, attachment loss, bleeding on probing, tooth mobility (visual and Periotest), radiographic bone loss and gingival width. In addition, three pooled subgingival plaque samples were taken (around tooth in cleft, teeth facing the cleft, and contra-lateral teeth of the latter). RESULTS: The differences between the teeth neighbouring the cleft and the corresponding contra-lateral opponents were of borderline significance (P <or= 0.05) for the plaque index, the approximal probing depths and the attachment loss (teeth facing the cleft always had slightly higher parameters). When the tooth in the cleft was compared to the contra-lateral tooth, differences were only found for both the approximal probing depths, attachment loss and bone loss, which were significantly higher for the tooth in the cleft. The microbial analysis did not reveal differences between the different sites, neither in the proportion of aerobic and anaerobic bacteria (differences < 0.5 log), nor in the detection frequency of periopathogens. CONCLUSIONS: These data indicate that the periodontium in UCLP patients can cope well with a long-term orthodontic treatment, even in unfavourable conditions (like absence of attached gingiva and poor oral hygiene).

Adolescent↗

PubMed2005

Prevalence of cleft lip and palate in a hospital-based population in the Sudan.

UNLABELLED: Cleft lip and palate represents one of the most common developmental deformities seen in oral surgery clinics. It is usually associated with problems which include not only cosmetic and dental abnormalities, but also speech, hearing and facial growth difficulties. OBJECTIVES: The purpose of the present study was to determine the prevalence of cleft lip and palate in births taking place in hospitals in the Sudan. METHODS: The records of 15,890 Sudanese new-borns delivered at three hospitals during the period from 1997 to 2000 were examined. RESULTS: Thirteen cases of cleft lip and palate were found, demonstrating a prevalence of 0.9 per 1000. There were more girls than boys, with a male:female ratio of 3:10. Fifty-four per cent of the cases had cleft lip with cleft palate, 30% had only cleft palate and the remaining 16% had cleft lip alone. CONCLUSIONS: The present study was confined to hospital-based births in one city, and the true incidence of cleft lip and/or palate in the Sudan is not yet known. Findings differ from reports from other countries in terms of suggesting a higher incidence in girls.

Cleft Lip↗

PubMed1978

A simplified technique for correction of the cleft lip nasal deformity.

The cleft lip nasal deformity is a result of imbalance of the structures caused by a collapsed alar cartilage, a widened nostril floor, and a lowered nasal orifice. This deformity can be corrected most readily by repositioning and supporting the collapsed alar cartilage of the cleft side. A technique has been developed to achieve this by releasing the ala from the nasolabial fold, elevating and supporting the alar cartilage, and repositioning the alar rim on its new deepithelialized base. One- to two-year follow-up of seven patients who underwent such repair has demonstrated satisfactory correction of the deformity.

Cleft Lip↗

PubMed1998

Primary repair of an incomplete unilateral cleft lip: avoiding an elongated lip and achieving a straight suture line.

The methods designed for the repair of a complete cleft lip should not be used to repair an incomplete cleft lip. This results too often in the postoperative drooping of the white lip on the affected side because in most incomplete cleft lips there is more tissue on the cleft side than in complete cleft lip. We present and discuss the refinements we made in our original technique for complete cleft lip in order to adapt it to incomplete cleft lip repair. The skin design at the white skin roll follows Cronin's method with an incision perpendicular to the vermilion border. The suture that pulls the edges of the angular incisions together pushes on the white skin roll caudally. This ensures that the peak of the Cupid's bow on the cleft side does not droop postoperatively. It also ensures that it does not take on an acute angle and that the vermilion border will be a continuous line without a break. We do not create a triangular flap at the vermilion border, but we raise a triangular flap at the alar base on the cleft side and advance it to the bottom of the columella. This creates the nostril sill and corrects the flared alar base. The resulting suture line is completely straight and runs along the philtral column. In this way, the postoperative elongation of the white lip on the cleft side can be prevented.

Cleft Lip↗

PubMed1982

Radical muscle mobilisation in the surgical repair of a unilateral cleft lip.

The embryological basis of a unilateral cleft lip is briefly outlined. The hypothetical effects of radical mobilisation of the orbicularis oris in a unilateral cleft lip are postulated. The actual clinical effects of such a mobilisation are noted in four cases. The role that radical muscle mobilisation might play in the surgical repair of a unilateral cleft lip is discussed. The need for a longer follow-up of the patients treated in this way is recognised.

Adolescent↗