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PubMed1982

Developmental alterations associated with spontaneous cleft lip and palate in CL/Fr mice.

Cleft lip with or without associated cleft palate [CL(P)], one of the most common human malformations, is believed to be caused by a combination of genetic and environmental factors. To study the morphological manifestations of genetic factors in this interaction, we compared the embryonic development of the CL/Fr mouse strain (with a mean incidence of 36% spontaneous CL(P) in our colony) with that of the C57B1/6J mouse strain (with no CL(P) in our colony). Results from our scanning electron microscopic study demonstrated that, when compared with C57B1/6J embryos, CL/Fr embryos have several developmental differences including: 1) altered facial geometry, 2) depressed ability of the surface epithelium of primary-palate primordia to participate in the fusion process, and 3) variable hypoplasia of the lateral nasal prominences. We suggest that all of these alterations may contribute to the pathogenesis of CL(P) in the CL/Fr mouse strain.

Animals↗

PubMed2004

Retrospective revelations: twenty orthodontically treated individuals with unilateral cleft lip and palate.

AIM: Twenty patients with unilateral cleft lip and palate, orthodontically treated from the full primary or early transitional dentition stages until retention and dismissal, were recalled later in adult life to evaluate the status of their occlusion and facial appearance. METHODS: Cephalometric radiographs, photographs, and casts were attained as final records. In several instances, final records were obtained by orthodontic colleagues at the patient's current residence. Evaluation of the longitudinal records provided retrospective insight pertinent to the growth and positional relationships of the jaws' contiguous structures and the dentition. RESULTS: Orthodontic results are linked with observations related to the nasomaxillary complex: the anterior cranial base, tissue deficiency, the maxillary and mandibular dentition, and time modifications in skeletal facial growth. At adult ages, the patients with unilateral cleft lip and palate had acceptable facial profiles and acceptable alignment of the anterior dentition. Variances noted in mandibular pattern of growth explain attainment of acceptable relationships. In many cases, tissue deficiency in the anterior cleft region was compensated for with fixed partial dentures and removable prosthetic appliances. Posterior crossbites, although few in number, were proportionately more prevalent in this unilateral cleft lip and palate patient population than was anticipated; possible reasons are presented, taking into consideration congenital contingencies and therapeutic overlays.

Adult↗

PubMed1989

Does maternal cigarette smoking during pregnancy cause cleft lip and palate in offspring?

To investigate the relationship between maternal cigarette smoking and the risk of oral clefts in offspring, we examined data from the Atlanta Birth Defects Case-Control Study, which included 238 cases of cleft lip with or without cleft palate and 107 cases of cleft palate ascertained by the Metropolitan Atlanta Congenital Defects Program from 1968 through 1980. In all, 2809 infants who served as controls were frequency matched to cases by race, period of birth, and hospital of birth. Maternal periconceptional exposures to smoking were investigated through use of a structured questionnaire. Smoking exposure was defined as reported maternal smoking during the periconceptional period (from 3 months before conception to 3 months after pregnancy began). Offspring of smoking mothers were 1.6 and 2.0 times more likely than offspring of nonsmoking mothers to have isolated cleft lip with or without cleft palate and cleft palate, respectively. On the other hand, offspring of smoking mothers were not at increased risk of having cleft palate or cleft lip with or without cleft palate that are associated with other defects. Adjustment for potential confounding variables did not alter these results. A relatively modest effect of smoking may be explained by the presence of underlying etiologic heterogeneity in oral clefts and differential susceptibility to smoking. Because of the inconsistencies in the literature on the relationship between smoking and oral clefts, these results suggest the need to refine oral clefts into more homogeneous subgroups in epidemiologic studies of these defects.

Adult↗

PubMed1991

[Comparison of different types of cleft lip and palate in regards to dental anomalies and sexual incidence].

The present study addresses two questions. Does the incidence of dental anomalies differ among the four following types of cleft lip and palate: the isolated cleft palate, the unilateral cleft lip and palate, (right or left), and the bilateral cleft lip and palate. Furthermore is the sexual incidence comparable among the four above mentioned types? Radiographic records and complete family history of clefting of 156 patients with a complete cleft lip and palate were obtained from the Cleft Lip and Palate Teams of Ste-Justine Hospital. Patients in which the cleft was part of a syndrome were excluded from the study. According to the analysis of the data, the incidence of dental anomalies was relatively high, specifically as high as 92% for the bilateral cleft lip and palate. The sexual incidence differed among the four types.

Anodontia↗

PubMed2001

Correction of cleft lip nasal deformity in Orientals using a refined reverse-U incision and V-Y plasty.

A total of 45 patients with cleft lip nasal deformities were operated on between September 1997 and December 1999. We reviewed 35 of them. Out of these, 31 patients had unilateral cleft lip nasal deformities and four patients had bilateral cleft lip nasal deformities. The age range of the patients was from 3 years to 56 years. A reverse-U incision with V-Y plasty was used in 20 patients with mild to moderate unilateral cleft lip nasal deformities. An open rhinoplasty incision combined with the reverse-U incision and V-Y plasty was used in 11 patients with severe unilateral cleft lip nasal deformities. A bilateral reverse-U incision and a trans-columellar incision were used in the four patients with bilateral cleft lip nasal deformities. After advancement of the mucochondrial flap, alar transfixion sutures were used to ensure firm contact between the nasal skin and the redraped reverse-U flap. A composite graft for columellar lengthening was used in six cases of severe unilateral cleft lip nasal deformity and the four cases of bilateral cleft lip nasal deformity. Ancillary procedures included correction of a lateral displacement of the alar base, lip scar revision, a cartilage graft for tip augmentation, iliac bone grafting for correction of hypoplasia of the maxilla or for an alveolar cleft and corrective rhinoplasty. A self-made nasal retainer was applied for 6 months in all patients to maintain the corrected contour of the nostril. The follow-up period ranged from 11 months to 26 months, with an average of 18 months. The final results were evaluated based on the degree of symmetry of the nostrils, the redraping of the alar-columellar web and the exposure of the nostrils. Good results were obtained in 29 patients where alar-columellar web deformities were either absent or minimal and a satisfactory symmetry of the nostrils was achieved. Four patients had fair results and two patients had poor results. In conclusion, we suggest that the reverse-U incision with V-Y plasty is a useful method for achieving symmetry of the nostrils in cleft lip nasal deformities in Orientals. In addition, this technique provides ample advancement and repositioning of the mucochondrial flap and simultaneous correction of the nasal vestibular web.

Adolescent↗

PubMed1999

Appraisal and coping in adults with cleft lip: associations with well-being and social anxiety.

The appraisal patterns and coping strategies of adults born with a cleft lip or cleft lip and palate were assessed in relation to measures of psychological well-being and social anxiety. A sample of 51 adults was recruited via the Cleft Lip and Palate Association. Data were collated using a questionnaire incorporating open questions and standardized measures. The focus was upon appraisal of the cleft, perceptions of consequences--both positive and negative--on personal and social dimensions, together with measurements of sense of coherence, psychological well-being, satisfaction with life and coping responses utilized in stressful situations. There was wide variability in the participants' reports of negative affect as a component of psychological well-being, suggesting that there may be small numbers of individuals with quite extreme responses. Seventy-five per cent reported difficulties which they attributed to their cleft. Perceiving positive gains as a result of the cleft and having a positive appraisal of facial appearance was associated with well-being. Patterns in coping strategies were also associated with emotional adjustment. Personal appraisals of both having a cleft and facial appearance may be more important in determining emotional well-being than the current medical emphasis on the aesthetics of surgical outcomes.

Adaptation, Psychological↗

PubMed1991

Incontinentia pigmenti associated with bilateral cleft lip and palate.

Incontinentia pigmenti (Bloch-Sulzberger syndrome) is an uncommon genodermatosis mainly affecting females. It consists of characteristic skin manifestations associated in 79.8% of patients with other systemic manifestations. Of these there have been five cases of palatal or lip abnormalities, none being bilateral cleft lip and palate. We describe a unique case of incontinentia pigmenti associated with a bilateral cleft lip and palate.

Cleft Lip↗

PubMed1985

Clinical evaluation of microform cleft lip surgery.

The definition of microform cleft lip and the dilemma surrounding its surgical correction were reviewed. A modified Williams method for assessing cleft lips was employed by two panels (each of four evaluators) with 24 patients who had similar deformities and corrective operations. In 20 patients the results appear to have justified the surgery, but in the remaining 4, who were less seriously deformed, the perceived improvement was minimal or even nonexistent. The perceptions and wishes of the parents and patient must also be considered in determining the success of this procedure, which was not done in this study.

Child↗

PubMed1979

Cigarette smoking as an etiologic factor in cleft lip and palate.

A case-control study has been made on smoking habits in women who, during 1975, gave birth to infants with closure defects of the central nervous system (ASB) or with cleft lip or cleft palate (CLP). For each case, two control subjects with nonmalformed infants were selected and matched for delivery unit, time of delivery, maternal age, and maternal parity. Smoking habits were routinely included in hospital records at first visit to a maternity health clinic during pregnancy. Data were studied for 66 cases of CLP, 66 cases of ASB, and 261 control subjects. Significantly more women who had infants with CLP smoked than did control women, but women with ASB infants showed a normal smoking pattern. Drug use did not explain the findings. It is suggested that maternal smoking is one of many factors of importance in the etiology of cleft lip and cleft palate in humans.

Birth Weight↗

PubMed2005

Unilateral complete cleft lip repair: orthotopic positioning of skin flaps.

The ideally repaired cleft lip should provide a symmetrical Cupid's bow, philtrum, and minimal scar. In the appearance of the upper lip, the philtrum plays a key role. The most popular method for unilateral cleft lip repair is the rotation-advancement technique introduced by Millard. This technique requires the rotation of the noncleft side flap in unilateral cleft lip. As the vertical discrepancy between the peaks of Cupid's bow is increased, the scarring becomes more evident. Also, where it crosses the philtral column in the oblique extension of the upper lip, it becomes apparent for the eye to notice. Thus, many surgeons have tried to modify this technique to improve the symmetry of the philtral columns. The philtral dimple is composed of centrally located thin dense subcutaneous tissue bordered by thick loose subcutaneous tissue producing the philtral columns laterally. The aim of this surgical modification is to form a more natural looking philtrum using its original anatomical structure. The tissue defect after rotation of the noncleft side flap is filled with the C flap, not the advancement skin flap from the cleft side. The C flap helps to form the upper philtral column into a more straight appearance. The skin flaps of the cleft side and noncleft side are placed either side of the philtral column, and the skin flap from the columella is not used for the repair of the philtrum. Twenty-five patients with unilateral complete cleft lip were repaired using this technique from 1996 to 1999. Adequate alignment of the Cupid's bow and symmetric philtral appearance were obtainable.

Cleft Lip↗

PubMed2006

[Study on repair approach of bilateral cleft lips and nose deformity].

OBJECTIVE: To detect the operative technique and aesthetic problem of reconstruction to deformity of bilateral cleft lip. METHODS: From March 2003 to December 2004, 26 patients with bilateral cleft lip were treated, aged 10 months to 11 years. Of 26 patients, there were 13 bilateral complete cleft lip and palate, 9 bilateral incomplete cleft lip and 4 mixed cleft lip with unilateral complete cleft palate. The chief design principle was keeping the length of prolabium. During operation, sufficient dissociation was made in the base of the ala base and orbicularis oris muscle to reconstruct these structures. The circle suture was made for the bilateral orbicularis oris muscle. The shape of vermilion was achieved by lateral red lip muscle flap and simultaneous simple rhinoplasty was performed. RESULTS: Primary healing of the incisions was achieved in all cases. After the 10 days-3 months follow-up, the results were satisfactory in the width and chubbiness of the nose bottom, the shapes of nostril and Cuspid's bow were good without whistle deformity. The appearance of upper lip was good in either dynamic or static state. CONCLUSION: Excellent shapes and function of the nose and lip, and opportunity for two-stage repair could be obtained with this method, which being believed important methods for the primary repair of bilateral cleft lip.

Child↗

PubMed2001

[Factors involved in intelligent development of children with cleft lip and palate].

OBJECTIVE: The objective of this study was to investigate the possible factors involved in intelligent development of children with cleft Lip and palate. METHODS: The intelligence quotient (IQ) and developmental quotient (DQ) of 152 children with cleft lip and palate under 14 years old were conducted, and the control group was made up of 80 healthy children. The considered factors included degrees of deformation, situation of perinatal period, way of feeding, psychological conditions of the children, general situation of their parents and education of these children. The data were statistically analyzed and compared. RESULTS: The IQ value of these children generally was normal, but the mean value was still lower than that of the control group (P < 0.01). The mean IQ value of the group of children with only cleft lip or cleft palate was higher than that of the group with both cleft lip and cleft palate, and the mean IQ value of these children with II degree deformity was higher than that of children with III degree deformity. The mean IQ value of these children feed with mother's milk was higher than that of those feed with artificial milk. These children more than 5 years old were disturbed psychologically, and their parents were also with pressure. CONCLUSION: The intelligent development of children with cleft lip and palate is affected by many factors, including types and degrees of deformity, feeding ways, illnesses and social psychological factors in different periods of development. Therefore, it is very important to take steps before 5 years old, including correctly feeding, repairing the deformity as early as possible, preventing the illnesses, necessary psychological treatment, improving social environment.

Adolescent↗

PubMed2006

A three-dimensional computed tomographic analysis of the cervical spine in unoperated infants with cleft lip and palate.

OBJECTIVE: To investigate anatomical variations and abnormalities of cervical spine morphology in unoperated infants with cleft lip and palate. DESIGN: Retrospective cross-sectional investigation of infants born with nonsyndromic cleft lip and palate using computed tomography scans acquired for investigation of a spectrum of clinical conditions. SETTING: Computed tomography scan data were obtained from 29 unoperated cleft lip and palate infants and 12 noncleft infants of Malay origin, ages 0 to 12 months. METHODS: Observational study of cervical spine computed tomography scans. Heights of cervical vertebral bodies (C2-C7) and intervertebral spaces were measured from landmarks identified from computed tomography reformats and three-dimensional computed tomography reconstructions. Linear modeling of heights and spaces, with age as a covariate, was undertaken to identify differences between the samples. RESULTS: Anomalous features observed in the cleft lip and palate sample included short posterior arch of C1 (2/29), abnormal development of the anterior arch of C1 (2/29), and fusions of the posterior arch of C2 and C3 (2/29). No anomalies of the cervical spine were observed in the noncleft sample. Although the heights of three cervical vertebral bodies were significantly smaller and two intervertebral spaces were significantly larger in infants with cleft lip and palate compared with noncleft infants (p < .05), overall length of the cervical spine did not differ significantly between the samples. CONCLUSION: There was evidence for subtle upper spinal anomalies in the infant cleft lip and palate population. Our finding of reduced size of some cervical vertebral bodies may reflect delayed upper spinal development in infants with cleft lip and palate.

Cervical Vertebrae↗

PubMed2000

Position, shape, and dimension of the maxilla in unoperated cleft lip and palate patients: review of the literature.

The inhibition of growth and development resulting from surgical treatment of the cleft lip and palate is a widely discussed topic. Various studies have been conducted in search of answers as to how the untreated upper jaw develops, focusing on individuals with untreated cleft lip and palate as found in so-called Third World countries. This study offers the opportunity to compile literature dealing with the research and description of untreated unilateral cleft lip and palate. The focus was to take a closer look at groups of individuals with complete unilateral cleft lip and palate, who had received no surgical treatment at all, as well as groups who had received surgical treatment of only the cleft lip. The upper jaw of untreated cleft lip and palate patients most often adopts a protruded position without enlarging the maxilla itself. The horizontal dimension tends to be reduced, whereas the vertical dimension is normal. The upper jaw of patients with unilateral cleft lip and palate who received surgical treatment of the lip more often adopted a retruded position. The model analysis showed no clear-cut tendencies. There seemed to be a degree of regional variation. Considering the relatively small number of recruitable individuals with untreated cleft lip and palate, the introduction of a standard method of evaluation is desirable. This would significantly facilitate the comparison of different studies with each other in the future. The first steps in this direction have already been initiated.

Child↗

PubMed1997

Functional results with the team care of cleft lip and palate patients in Bergen, Norway. The Bergen Cleft Palate-Craniofacial Team, Norway.

There is international consensus about some fundamental elements concerning treatment of cleft lip and palate (CLP): (1) multidisciplinary teamwork, (2) centralization, (3) team continuity, (4) long-term treatment planning (from birth to adulthood), (5) documentation, (6) evaluation, (7) follow-up studies, (8) research and (9) quality assurance. Every year 120-140 children are born with CLP in Norway (2 per 1,000 live births). For more than four decades the treatment of CLP has been centralized to the University Clinics in Oslo and Bergen. The cost of treatment as well as the travel expenditures for patients born with facial clefts are paid by the Norwegian government (social security). In a speech study of 180 6-year-old children with CLP/CP first operated in Bergen during 1973-1981, normal resonance was found in 76.7% of the children, moderate hypernasality in 11.7%, while 11.6% had marked hypernasality.

Adolescent↗

PubMed1988

The prevalence of cleft lip and plate in Japanese.

To determine the prevalence of cleft lip and palate (CL/P) among the Japanese, 43,821 babies born between 1 January, 1985, and 31 December, 1985, were investigated. Sixty-four infants (0.146%) were found to demonstrate these abnormalities, a birth prevalence rate of 1.46/1000. Among 326 infants in whom it was possible to classify the types of cleft, born between 1 January, 1981, and 31 December, 1985, there were 111 (34.0%) with cleft lip (CL), 154 (47.3%) with cleft lip and palate (CLP) and 61 (18.7%) with cleft palate (CP).

Cleft Lip↗

PubMed1984

On the importance of muscle repair in secondary cleft lip deformity.

Generally the evolution of cleft lip repair has included a transition from those methods with primary emphasis on the skin design with intricate flaps, going to further elaborations of carefully designed skin and muscle units but with minimal muscle dissection or intentional reorientation, on to those with greater emphasis on extensive muscle dissection with specific realignment of the orbicularis oris muscle. These latter methods assign to the skin a more complementary role in the plan of correction. This article joins others in which it is now felt that extended dissection and surgical reorientation should be done to include associated involved muscles of the lip, nose, and medial face. In particular, attention to the details of muscle repair as completely as possible, extending to the entire oro-naso-facial complex, seems pertinent in the matter of secondary correction of cleft lip deformities. A review of the anatomy involved, certain surgical philosophy, and examples of illustrated cases are included in this article.

Adolescent↗

PubMed1998

Conversational skills of preschool and school-age children with cleft lip and palate.

OBJECTIVE: The purpose of this study was to examine the conversational skills of preschool and school-age children with cleft lip and palate. DESIGN: The children were audio- and videotaped during interactions with an unfamiliar adult. In addition, standardized measures of speech and language were administered, and ratings of resonance were obtained. Comparisons were made between the children with cleft lip and palate and their same-age peers on measures of conversational participation and a standardized test of pragmatic skills. PARTICIPANTS: Participants were 20 children with unilateral cleft lip and palate (10 preschoolers and 10 school-age children) recruited from the Craniofacial Team at Rainbow Babies and Children's Hospital, Cleveland (OH) and 20 noncleft peers matched for gender, age, and socioeconomic status. MAIN OUTCOME MEASURES: Separate comparisons were made for the preschool children with cleft lip and palate and their noncleft peers, and the school-age children with cleft lip and palate and their noncleft peers on eight measures of conversational assertiveness/responsiveness and the standardized tests of pragmatics. Next, each child with cleft lip and palate was classified for level of conversational participation. RESULTS: Paired t tests revealed no significant differences between the preschool and school-age children with cleft lip and palate and their noncleft peers in level of conversational participation. However, individual child comparisons revealed less assertive profiles of conversational participation for 50% of the preschool and 20% of the school-age children with cleft lip and palate. CONCLUSIONS: Children with cleft lip and palate may show a less assertive style of conversational participation, at least during the preschool years. Therefore, craniofacial team evaluations should include examination of conversational competency, particularly for children who are demonstrating difficulty with other aspects of speech, language, or social development.

Child↗