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PubMed1984

Bilateral cleft lip and palate: presurgical treatment.

Patients with bilateral cleft lip and cleft palate problems may present with severe tissue disparities. A good surgical repair without tension may be difficult to achieve. With proper presurgical orthodontic management the tissues can be brought into good relationships, permitting a one-stage surgical repair under optimal conditions. An appliance can be used to secure the lateral arches in proper position. Then external gradual traction can reposition the lateral arch and central arch segment relationships, establishing a more normal arch. After lip repair the "artificial palate" denture is worn until palate repair. The common types of situations encountered are categorized and illustrated with case reports. Not only is this approach more advantageous surgically, but it also helps feeding, provides and maintains good early arch form, and theoretically could contribute to speech. It avoids lip adhesions and can be accomplished within the time that is usually allowed before lip repair.

Cleft Lip↗

PubMed2002

[Intra-uterine model of cleft lip and scarless wound healing of fetal rats].

OBJECTIVE: To properly evaluate the benefits of in utero repair of cleft lip, an animal model of cleft lip was developed and the fetal scarless wound healing was observed in SD rat fetus. METHODS: Through a maternal celiotomy and hysterotomy, twenty excisional cleft was created in the upper lip of rat fetus. Another group of 20 rat fetus were given full-thickness incisional wounds in the upper lips. The fetus with cleft lip were returned into utero for further development till birth.Wound specimens from the incisional wounds in the other group were removed successively 12, 24, 48, 72h postwounding for histological examination. RESULTS: The fetus with excisional wound demonstrated a complete cleft lip after birth. In contrast, the wound in the fetus with incisional wounds regenerated with normal architecture histologically, indistinguishable from the surrounding normal skin. CONCLUSION: The results of this preliminary study indicates that the fetal rat cleft lip is technically feasible with an excellent survival rate. Healing occurs without scar formation. This model will be used to document facial growth following in utero repair of a cleft lip.

English Abstract↗

PubMed1984

Reconstruction of vermilion in unilateral and bilateral cleft lips.

The white skin roll is a useful term to describe the cutaneo-vermilion border of the lip. The muco-vermilion border line parallels the white skin roll and is described as the red line. The lip vermilion should be constructed so that these lines are parallel and widest at the base of the philtral column. It is suggested that the triangular lateral lip vermilion flap be used in unilateral cleft lips. In bilateral cleft lips, a white skin roll vermilion-mucosal muscle flap is used for reconstruction of vermilion.

Cleft Lip↗

PubMed2000

[Classification of secondary nasal deformities associated with unilateral cleft lip].

OBJECTIVE: To classify secondary deformities of cleft lip noses. METHODS: 56 patients with secondary nasal deformities of cleft lip were chosen at random. Cartilages of those noses were dissected and measured when correcting nasal deformity in order to find the relationship between anatomical anomaly of nasal cartilages and nasal deformity. RESULTS: Three grades of anatomical anomalies of the nasal framework were found. Grade I, the morphological anomaly occurs at lower third of the diseased side only. Grade II, the lower third of the another side is involved in addition. Grade III, the dorsum nasi is also deviated. CONCLUSIONS: This classification may be employed as a practical guide for surgical planning.

Adolescent↗

PubMed2006

Description of the methodology used in an ongoing pediatric care interventional study of children born with cleft lip and palate in South America [NCT00097149].

BACKGROUND: The contribution of birth defects, including cleft lip and palate, to neonatal and infant mortality and morbidity is substantial. As other mortality and morbidity causes including infections, hygiene, prematurity, and nutrition are eradicated in less developed countries, the burden of birth defects will increase proportionally. METHODS/DESIGN: We are using cleft lip and palate as a sentinel birth defect to evaluate its burden on neonatal and infant health and to assess the effectiveness of systematic pediatric care during the first month and first two years of life in decreasing this burden. The neonatal intervention, consisting of weekly pediatric evaluation and referral to appropriate care, is delivered to about 696 infants born with cleft lip and/or palate in 47 hospitals in South America. Neonatal mortality in this group will be compared to that in a retrospective control group of about 464 infants born with cleft lip and/or palate in the same hospitals. The subgroup of infants with isolated clefts of both the lip and palate (about 264) is also randomized into two groups, intervened and non-intervened, and further followed up over 2 years. Intervened cases are evaluated by pediatricians every three months and referred for appropriate care. The intervened and non-intervened cases will be compared over study outcomes to evaluate the intervention effectiveness. Non-intervened cases are matched and compared to healthy controls to assess the burden of cleft lip and palate. Outcomes include child's neurological and physical development and family social and economic conditions. DISCUSSION: Large-scale clinical trials to improve infant health in developing countries are commonly suggested, making it important to share the methods used in ongoing studies with other investigators implementing similar research. We describe here the content of our ongoing pediatric care study in South America. We hope that this may help researchers targeting this area to plan their studies more effectively and encourage the development of similar research efforts to target other birth defects or infant outcomes such as prematurity and low birth weight.

Cleft Lip↗

PubMedDate not supplied

Secondary rhinoplasty in nasal deformity associated with the unilateral cleft lip.

The secondary nasal deformity of the unilateral cleft lip involves a retrodisplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, and other deficiencies. The sliding-flap cheilorhinoplasty effectively corrects these deformities using a laterally based chondrocutaneous flap. We modified this technique by using an open rhinoplasty approach with the laterally based chondrocutaneous sliding flap. Columellar struts and shield grafts were some of the techniques combined with this approach to produce optimal results. In a total of 7 patients, we performed both the original sliding-flap cheilorhinoplasty and the modified open rhinoplasty, which are described and discussed herein. The laterally based sliding-flap cheilorhinoplasty is an effective technique for correcting both the secondary nasal deformity and the lip scar associated with the unilateral cleft lip.

Adolescent↗

PubMed1993

Orthognathic surgery in the cleft lip and palate patient.

Orthognathic surgery for the cleft lip and palate patient should be designed to achieve good facial aesthetics and a stable, functional occlusion. Maxillary and mandibular osteotomies, which benefit cleft lip and palate patients with associated dentofacial deformities, should be modified to meet the needs of the individual patient. Soft-tissue correction of the upper lip and nose adds to the overall aesthetic result, but should be performed as a separate procedure.

Adolescent↗

PubMed2006

[Characteristic craniofacial features in a group of unilateral cleft lip and palate patients in Chile].

INTRODUCTION: Craniofacial growth in cleft lip and palate patients is controversial. Structural alterations of the face in these patients could be due to the surgical treatment combined with the primary variations of the cranial base morphology. Our objective was to ana-lyze the morphology of the craniofacial skeleton in a group of unilateral cleft lip and palate Chilean patients. MATERIAL AND METHOD: We studied 43 non syndromic operated unilateral complete cleft lip and palate patients. Ages ranged from 10 to 18 years for both genders. This cohort was compared with a control group of 40 non cleft patients, matched for age and sex, using Delaire's structural and architectural craniofacial analysis on lateral radiographs and performed by the same operator. RESULTS: Cleft patients presented with significantly different configurations of the craniofacial skeleton, specifically a flatter basi-cranium, a reduced posterior maxillary height, a retrusive maxilla deficient in length with an associated crossbite.

Adolescent↗

PubMed1998

[The adolescent with cleft lip and palate].

Research studies afford an in-depth look at the problems experienced by adolescents born with a cleft lip, a cleft palate or cleft lip and palate. If not addressed, their problems can multiply with each successive stage of development. An interdisciplinary team, where the adolescents themselves play an important role, is one of the best means of helping them come to terms with the consequences of the abnormality. The nurse should be a key member of the team. To help adolescents cope with their situation now and in the future, the author promotes a holistic and humanistic approach. Here, she sees nurses creating therapeutic alliances as educators. She recommends that nurses assert themselves more as professionals and as essential resources. Her doctoral thesis proposes a training model to this effect.

Adaptation, Psychological↗

PubMed2000

A protocol for safe anasthesia for cleft lip and palate surgery in developing countries.

A project to perform surgical correction of cleft lips and palates was carried out in Uganda in 1998. Twenty centres were visited and 336 cleft lips and 41 cleft palates were repaired. The age of the patients ranged from 2 weeks to 60 years. Many of the centres visited were remote and lacked even the most basic equipment. Patients were anasthetised using ketamine, ether or halothane according to a protocol that we developed. There was no anasthetic mortality and only one case of significant morbidity. We report our experience and discuss recommendations regarding the provision of anasthesia in remote circumstances based on our outcome. An additional benefit of the project was that we provided training to local medical personnel in anasthesia and surgery for cleft lips and palates.

Adolescent↗

PubMed1985

Bilateral cleft lip.

Directing the course of care for a patient with bilateral cleft lip problems is a great responsibility and challenge for the surgeon, and it requires full commitment, effort, and talent. The goal is to enable the patient to develop anatomically, functionally, and psychologically as normally as possible and to achieve and succeed in life according to natural abilities, unimpeded by the congenital deformity complex. An individualized and organized effort must continue until the child is grown. One important aspect of this effort is the technical cleft lip repair. No matter how well done, perfection is always a step away. Open minds and energetic young students should be reluctant to accept the "status quo"; they should be encouraged to accept this challenge and make contributions. Although many other "big, new" operations may be very dramatic, none will be more satisfying to the surgeon than the well-performed bilateral cleft lip repair. The surgeon must remember that the day of cleft lip repair is one of the single most important days of a person's life. The result will have meaning from that moment on!

Child, Preschool↗

PubMed1998

[The pathological action of surrounding connective tissues of alar cartilage in the cleft lip nose].

OBJECTIVE: This study was to explore the pathological action of the adjacent connective tissues of alar cartilage in unilateral cleft lip nose. METHODS: Anatomic-histological and pathoanatomical study was carried on 40 normal cadavers and 30 patients with secondary deformities of unilateral cleft lip during their operations. RESULTS: Six kinds of connective tissues with different histological features were found between the alar cartilage and adjacent skin, cartilage or bone. There was no histological difference in each connective tissue between the normal and the cleft lip nose. In the cleft lip nose, due to histological differences among the six connective tissues, there existed various changes of pathological dislocations between the alar cartilage and adjacent skin, cartilage or bone. CONCLUSION: The authors suggest that the surrounding connective tissues of the alar cartilage play an important role and be the intrinsic basis to produce the characteristic deformities of the cleft lip nose. The result is helpful in understanding the anatomical and histological features of the connective tissues around the alar cartilage and the deformities of the unilateral cleft lip nose so as to select a reasonable operation method.

Abnormalities, Multiple↗

PubMed1998

Epidemiology of cleft lip and palate in Thailand.

During the years 1989 to 1991, a survey for the epidemiology of cleft lip and palate was carried out in Thailand using detailed forms. One thousand ninety-six patients were recorded and 593 patients were operated during that period. All records were analyzed. Six hundred forty-seven patients (59%) lived in northeastern Thailand. Of the 593 operated patients, 26% had cleft lip only, 48% had cleft lip and palate, and 25% had cleft palate only. Men predominated all groups except for the cleft palate-only group. Twenty-six of 593 patients had associated congenital anomalies. Two hundred thirty-seven of 1,096 patients had a history of cleft lip and palate in their first- and second-degree relatives (21.62%). Five hundred seventy-eight of 1,096 mothers (52.74%) had a history of taking drugs. Analgesics were among the drugs taken most often.

Abnormalities, Drug-Induced↗

PubMed2002

Correlation of cleft type with incidence of perioperative respiratory complications in infants with cleft lip and palate.

BACKGROUND: A retrospective survey of 339 infants who had undergone primary plastic surgery for cleft lip and palate was performed to evaluate the concomitant preoperative assessment based on severity grading of the common cold and the correlation of cleft type with the incidence of perioperative respiratory complications. METHODS: We assessed the severity of common cold symptoms in the preoperative period using the Common Cold Score, which comprises 10 symptoms and findings. We then determined the association of the incidence of perioperative respiratory complications with the increasing severity of common cold symptoms and also compared the complication incidence in the three cleft types in healthy infants without a common cold. RESULTS: The incidence of perioperative respiratory complications was greater in the group with a suspected presence of a common cold. Infants with severer cleft, who had bilateral cleft lip and palate, even without common cold symptoms, had a significantly higher incidence of perioperative respiratory complications (8.9%) than infants with simple cleft lip (1.7%, P < 0.05). CONCLUSIONS: Clinicians should consider postponing primary plastic surgery for cleft lip and palate in infants with a suspected presence of a common cold. Our results also suggest that the presence of a wide cleft is a risk factor for causing perioperative respiratory complications in infants with cleft lip and palate. We believe that a careful preoperative assessment of common cold symptoms in these infants can decrease the incidence of perioperative respiratory complications.

Anesthesia↗

PubMed1999

Cleft lip: a histochemical and ultrastructural analysis of lip muscles.

AIMS: In order to evaluate the pathogenesis of cleft-lip in relation to both the anatomical and structural anomalies of the mesenchymal tissues, the authors concluded that the presence of structural anomalies in the examined tissues could not explain the malformation, but might be a consequence of it. Delayed muscular development, asymmetrical distribution of the muscular fibres and their anomalous insertion suggest that the anatomical/functional loss clinically detectable in the orbicular muscle could be the result of a perinatal dysmorphological process rather than of a simple mesenchymal hypoplasia. METHODS: Schendel et al. suggested that a metabolic defect in the mitochondrial function could cause a deficiency in cell migration and proliferation responsible for the malformation in question. To establish whether the pathogenesis of the cleft-lip is associated with an alteration in mitochondrial functionality, eight patients affected by unilateral cleft-lip were subjected to a biopsy of the orbicular muscle during the course of reparative surgery. RESULTS: The results obtained showed: 1) a great variation in the size of muscle fibres; 2) the absence of ragged red fibres; 3) a normal oxidative function in the muscle fibres examined; 4) the absence of typologically significant groupings positive for myofibral ATPases. Furthermore, the morphology of the mitochondria was preserved in all cases and neither inclusions nor morphological or volumetric changes were detected. CONCLUSIONS: This preliminary data did not confirm the constant presence of mitochondrial pathology responsible for the malformation in question. In our opinion, the growth deficiency of the maxillary segment could be ascribed to the cicatrization of the surgical repair of the cleft-lip.

Adenosine Triphosphatases↗

PubMed1992

[Guidance to parent of black babies with a cleft lip and palate].

There are indications that the parents of babies with a cleft lip and palate often require more information regarding their baby's birth defect than what is given to them. In South Africa shortcomings exist in the literature covering the specific requirements of parents of black cleft lip and palate babies. In this study the unique requirements of parents of black cleft lip and palate babies was determined and, based on these results, an information pamphlet was prepared for this population group. Based on the results obtained with the help of fifteen participants it was established, firstly, that the needs of black South-African parents of children with a cleft lip and palate are similar to the needs of parents of babies with the same birth defect world-wide. Secondly, it was established that the information pamphlet which was compiled as part of the study made a positive contribution to parent guidance conducted with the participants. Important therapeutic implications were also reflected by the results.

Black or African American↗

PubMed1991

Growth status of children treated for unilateral cleft lip and palate.

Cephalometric distances, angles, and proportions were evaluated for 32 children 5 to 8 years of age treated for unilateral cleft lip and palate. The children were age and sex matched with untreated controls with normal skeletal relationships. The unilateral cleft lip and palate sample was treated by the same surgeon and orthodontist using the same techniques and appliances. Measures of overall facial proportions, facial convexity, and prognathism were not significantly different between the two groups. The primary group differences pertain to the posterior aspect of the maxilla, which is vertically short in the unilateral cleft lip and palate sample. Horizontally, the maxilla of the unilateral cleft lip and palate children was significantly longer, producing a steeper palatal plane. In addition, the zygoma and orbits of unilateral cleft lip and palate children were somewhat retruded; the posterior cranial base and total mandibular length also were longer in the unilateral cleft lip and palate children.

Analysis of Variance↗

PubMed1987

Nostril sill augmentation in secondary cleft lip.

In most cases, after successful correction of primary cleft lip deformity, some problems remain to be solved. One of them is nostril sill depression, which should not be overlooked in cleft lip repair. However, there have been few reports on the anatomy of the depressed nostril sill and methods for augmenting the sill depression. The anatomy of the depressed nostril sill, its relationship to surrounding tissue, and the gross features of nostril sill depression in cleft lip deformity were reviewed, and a method in which a scar flap and a suture-fixation technique are used was developed for augmenting the depression. The clinical results of this method in 16 patients are presented.

Cicatrix↗