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PubMed1979

The immediate postoperative care of a child with cleft lip: time-proved suggestions.

An excellent cleft lip repair demands and depends upon good postoperative care. The strain caused by crying can be minimized by eliminating restraints and by early hospital dismissal. Protein and vitamin C are important in healing. A nongreasy pressure dressing capable of absorbing serum is applied for the first night only, then the suture line is sponged with cold water after each feeding. Following suture removal, effective bridging is achieved by applying perforated Zonas adhesive directly to the wound. The care outlined has been used successfully for 93 cleft lip patients over 24 years. Both sides of bilateral clefts were closed at one operation. Two patients among 18 with bilateral clefts had one side break down; 1 patient had a partial breakdown on both sides. This same postoperative routine has been used successfully when operating under less than ideal circumstances in primitive areas. Good postoperative care consists of attention to many little details, none of which are important by themselves but which, when added together, give perfection.

Bandages↗
PubMed1996

Difficult laryngoscopy in cleft lip and palate surgery.

We studied prospectively 800 paediatric patients undergoing repair of cleft lip and palate to determine the predictors of difficult laryngoscopy. The incidence of difficult laryngoscopy (Cormack and Lehane grade III and IV) was 2.95% in patients with unilateral cleft lip, 45.76% in bilateral cleft lip and 34.61% in patients with retrognathia. Tracheal intubation was successful in 99% of patients in whom laryngoscopy was difficult. There was a significant association between age and laryngoscopic view (P < 0.01).

Age Factors↗
PubMed1990

[Corrective surgery of cleft lip].

This paper presents a statistical review of corrective surgery for cleft lip, as performed at the Maxillofacial Surgery wards of the Pediatrics Hospital, National Medical Center, and the General Hospital, La Raza Medical Center, Institute of Social Security of Mexico. Frequency of occurrence, as well as most commonly used classifications, are described and correlated with results reaped from our study, which covered from March 1984 to March 1989, with surgeries performed on 116 patients suffering from unilateral and bilateral cleft lip; 120 plastic reconstructive maneuvers were performed by the Millard advance rotation technique or the modified Tennison Randall technique with triangular flaps, with Le Mesurier's square flaps approach for unilateral fissures and the Verdeja and Cronin techniques for bilateral clefts, thus defining criteria for treating children with cleft lip and cleft palate.

Cleft Lip↗
PubMed2003

Repair of bilateral cleft lip: review, revisions, and reflections.

Rarely does the appearance of a child with a repaired bilateral cleft lip compare favorably with that of a child with a repaired unilateral cleft lip. However, there has been a major change in operative strategy during the past decade, and as a result, the typical bilateral cleft nasolabial stigmata are no longer so obvious. The senior author restates the principles for correction of bilateral cleft lip and nasal deformity, and underscores the essential role of preoperative premaxillary positioning. He reviews his method of single-stage closure of the cleft primary palate, including three-dimensional adjustments based on predicted four-dimensional changes. Operative modifications are described for variations of bilateral cleft lip. The authors emphasize the surgeon's obligation for periodic assessment. In a consecutive series of 50 patients with repaired bilateral complete cleft lip/palate, the revision-rate was 33% as compared with 12.5% if the secondary palate is intact. No revisions were necessary for philtral size or columellar length. The authors propose that nasolabial appearance and speech are the priorities in habilitation of the child with bilateral cleft lip/palate rather than the traditional emphasis on maxillary growth.

Alveoloplasty↗
PubMed1990

Cleft lip and palate in Aicardi syndrome.

Cleft lip and palate were described previously in two patients with Aicardi syndrome; this report presents a third similarly affected child. Thus, facial clefts may be an occasional manifestation of Aicardi syndrome.

Abnormalities, Multiple↗
PubMed1999

Upper lip measurements at the time of surgery and follow-up after modified rotation-advancement flap repair in unilateral cleft lip patients.

The purpose of this prospective study was to determine whether unilateral cleft lip repaired by the rotation-advancement flap will grow short on the repaired side. This study involved 56 patients with nonsyndromic unilateral cleft lip (31 with complete and 25 with incomplete cleft lip) who underwent a rotation-advancement flap repair by a single surgeon between 1989 and 1997. Eleven patients were lost to follow-up. Forty-five patients have been followed for a varying period of between 8 and 84 months (mean = 37 months). The upper lip was measured immediately after the lip repair and follow-up using calipers. The growth ratios of vertical, horizontal, and nostril sill dimensions were compared between the cleft side and the noncleft side of the same face. Statistical analysis was performed to compare the growths between the cleft and noncleft sides. There was not a significant difference in the growth ratios of vertical (Wilcoxon signed rank test, p = 0.85) and horizontal dimensions (Student's t test, p = 0.18) between the cleft and noncleft sides. There was, however, a statistically significant difference in the growth ratios of nostril sill width between the cleft and noncleft sides (Student's t test, p = 0.02). Our findings indicated that a repaired unilateral cleft retained the vertical and horizontal dimensions determined at the time of the initial repair.

Cleft Lip↗
PubMedDate not supplied

Pattern of cleft lip and palate [corrected] in Benin City, Nigeria.

OBJECTIVE: To study the pattern of cleft lip and/or palate (CL/P) in Benin City, Nigeria and to compare the findings with reports from other parts of the world. The results of this study may be used to improve the welfare of affected patients. DESIGN: A descriptive study. SETTING: The University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria. SUBJECTS: 103 ethnic Nigerian patients with cleft lip and/or palate. MAIN OUTCOME MEASURES: Consecutive ethnic Nigerian patients presenting with CL/P were studied. Patients' data collected included age, sex, ethnic group, type of CL/P and the laterality pattern. Descriptive statistics were generated for all the variables recorded. RESULTS: There were 49.5% females and 50.5 % males; 95.1% were children and 4.9% were adults. The ethnic groups most often affected were Urhobo 29.1%, Bini 27.1% and Ibo 17.4%. The combined cleft lip and palate 60.2% was the commonest type of cleft. There were 28.2% patients with cleft lip only. More (7.8%) females were affected by the isolated cleft palate deformity. Twenty five patients had exceeded the time of repair. Their reasons were ignorance (36%) and financial constraints (64%) CONCLUSION: The data from this study is consistent with studies from other parts of the world. However, a high proportion of patients did not have access to early treatment due to ignorance and financial constraints. Public enlightenment and financial assistance for the indigent patient is recommended.

Adolescent↗
PubMed2002

Gene/environment causes of cleft lip and/or palate.

Craniofacial anomalies, and in particular cleft lip and palate, are major human birth defects with a worldwide frequency of 1 in 700 and substantial clinical impact. A wide range of studies in developmental biology has contributed to a better knowledge of how both genes and environmental exposures impact head organogenesis. Specific causes have now been identified for some forms of cleft lip and palate, and we are at the beginning of a time in which the common nonsyndromic forms may also have specific etiologies identified. Mouse models have an especially important role in disclosing cleft etiologies and providing models for environmental cotriggers or interventions. An overview of the gene-environment contributions to nonsyndromic forms of clefting and their implications for developmental biology and clinical counseling is presented.

Animals↗
PubMed2000

[Cleft lip and palate: the adolescent and his family].

Cleft lip or palate: The impact on adolescents and their families. Applying Bronfenbrenner's theory on human development (1979), this article aims to provide a better understanding of the family's impact on adolescents born with a cleft lip or palate. Results focusing on the family microsystem reveal that parents can be either a source of stress or a source of support for their teenager. A description of two teenagers' life experience, when faced with similar problems, highlights the disparity between their journeys. Data indicate the importance of family support in the development of individuals born with a malformation.

Adaptation, Psychological↗
PubMed2000

Long-term outcome of cleft lip nasal reconstruction in childhood.

This study documents the pattern of unilateral cleft lip nasal reconstruction in the practice of one surgeon at a tertiary cleft center, evaluating the long-term appearance outcome of single-operation unilateral cleft lip nasal reconstruction in childhood. A retrospective medical record review was performed for all patients with a diagnosis of unilateral cleft lip and age greater than 15 years. Operative notes were reviewed, recording 15 variables identifying specific rhinoplastic maneuvers. Nasal appearance outcome analysis was performed for all patients who underwent only one nasal surgery before 12 years of age (n = 19). Standard frontal whole face photographic images were presented as opposing pairs in a looseleaf binder to two panels, 1 of 10 lay persons and 1 of 10 plastic surgeons. Each pair consisted of photographs of the same patient at different ages in one of three combinations: preoperative-perioperative, perioperative-longest postoperative, or preoperative-longest postoperative. Participants were asked to compare the appearance of the noses in the two photographs and assign a rating based on a 5-point Likert scale. Statistical analyses were performed on the data collected in the aesthetic analysis. The effect of surgery upon nasal appearance was assessed by comparing the preoperative and perioperative photographs. The effect of growth was assessed by comparing the perioperative and long-term postoperative photographs. The combined effect of surgery and growth was assessed by comparing the preoperative and long-term postoperative photographs. The data were assessed by lay and professional evaluators, together and separately, to determine whether differences existed. The majority of patients did not undergo revisional nasal surgery, whereas those who did usually had one nasal operation. Most revisional nasal surgery was performed in conjunction with other cleft-related secondary surgery. A majority of lay and professional evaluators perceived revisional nasal surgery as improving nasal appearance in the short-term and to a lesser degree in the long-term, as compared with the preoperative state. Evaluations of revisional nasal surgery are generally constant between the short-term and long-term postoperative images. Lay evaluations may be contaminated by a general decline in attractiveness with aging. Patient preference should be a major factor in the decision for nasal revision surgery. Multiple means of assessing nasal appearance outcome need to be used to validate results. Nasal appearance outcomes need to be correlated with outcomes with respect to nasal morphology and function as well as patient and parent satisfaction.

Adolescent↗
PubMed2005

Visual and statistical modeling of facial movement in patients with cleft lip and palate.

OBJECTIVE: To analyze and display facial movement data from noncleft subjects and from patients with cleft lip and palate by using a new dynamic approach. The hypothesis was that there are differences in facial movement between the patients with cleft lip and palate and the noncleft subjects. SETTING: Subjects were recruited from the University of North Carolina School of Dentistry Orthodontic and Craniofacial Clinics. PATIENTS, PARTICIPANTS: Sixteen patients with cleft lip and palate and eight noncleft "control" subjects. INTERVENTIONS: Video recordings and measurements in three dimensions of facial movement. MAIN OUTCOME MEASURES: Principal component (PC) scores for each of six animations or movements and dynamic modeling of mean animations. STATISTICS: Multivariate statistics were used to test for significant differences in the PC mean scores between the patient groups and the noncleft groups. RESULTS: No statistically significant differences were found in PC mean scores between the patient groups and the noncleft groups; however, the variability of the effect of clefting on the soft tissues during animation was noted when the noncleft data were used to establish a "normal" scale of movement. Compensatory movements were seen in some of the patients with cleft lip and palate, and the compensation was not unidirectional. CONCLUSION: Measures of mean movement differences as summarized by PC scores between patients with cleft lip and palate and noncleft subjects may be misleading because of extreme variations about the mean in the patient group that may neutralize group differences. It may be more appropriate to compare patients to a noncleft normal scale of movement.

Adolescent↗
PubMed1997

Examination of craniofacial morphology in 10-month to 5-year-old children with cleft lip and palate.

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.

Case-Control Studies↗
PubMed1988

Analysis of the lengthening effect of the muscle repair in functional cleft lip repair.

In 14 patients undergoing functional cleft lip repair, changes in the lengths of the key lip segments were measured preoperatively, after the muscle layer was repaired, and after the skin was repaired using pieces of wire bent to follow the curves of the lip in three dimensions. The cleft side of the lip was shorter than the normal side in the vertical and horizontal dimensions. Freeing the muscle from its dermal insertions, splitting it, and advancing it into the medial side of the cleft lengthened the cleft side of the lip vertically and horizontally. The Z-plasty skin repair further lengthened the cleft side of the lip in the vertical dimension. The lengthening effect of the muscle repair appears to be the result of the loose skin redraping over the dissected muscle and further explains elimination of the orbicularis bulge and superior scar formation in the functional cleft lip repair.

Cleft Lip↗
PubMed2005

Natal teeth: a potential impediment to nasoalveolar molding in infants with cleft lip and palate.

The purpose of this article is to describe two cases of bilateral cleft lip and palate with natal/neonatal teeth. Clinical features, prevalence, possible complications, and treatment modalities are discussed. Two patients with cleft lip and palate and natal/neonatal teeth are described. The first patient was a 4-week-old infant with bilateral cleft lip and palate. On initial inspection an odontogenic vestige was noticed on the right lateral border of the premaxillary segment, bordering the cleft. The second patient was a newborn with a vestige on the right side of the premaxilla. At 20 days, another swelling representing a neonatal tooth on the left side was found. Because the teeth interfered with the fabrication and application of the nasoalveolar molding (NAM) appliance, they were removed from both patients. In the first patient, at 1 week after extraction, the NAM device was placed without difficulty. At 8 months, the infant had adapted well to the NAM device and nursed without problems. The second patient did not follow-up for the placement of the NAM device. In patients with cleft lip and palate with natal/neonatal teeth who require NAM, the tooth must be removed to facilitate the fabrication and placement of the device. Natal/neonatal teeth must be extracted with caution because the tooth buds of neighboring teeth may be damaged and remnants of the dental papillae may be left behind. Although general anesthesia is not always indicated for the removal of these teeth, in cases in which the premaxilla is loose, such as the current cases, general anesthesia is warranted.

Cleft Lip↗
PubMed2002

Feeding behaviour of infants with cleft lip and palate.

AIM: To determine whether the feeding behaviour of infants with cleft lip and palate is improved with a type-P teat, which is widely used in Japan by such infants, compared with a standard teat. The difference in intra-oral movements between the type-P teat, modified for the evaluation of feeding behaviour, and an unmodified type-P teat was also compared using ultrasonography. METHODS: In part 1 of the study, 15 infants aged 2 to 3 mo and 7 infants aged 2 wk were evaluated for sucking pressure, expression pressure, frequency and duration of sucking. All the infants had a complete unilateral cleft lip and palate without any other abnormalities. In part 2, an ultrasonographic analysis of intra-oral movement was done for 5 infants enrolled in part 1 of the study. RESULTS: Sucking pressure did not occur in all infants. It was found that feeding efficiency improved with the type-P teat compared with the standard teat. The expression pressure with the type-P teat was significantly higher than that with the standard teat, and the feeding frequency with the type-P teat was lower than that with the standard teat. CONCLUSION: A type-P teat is suitable for infants with cleft lip and palate who have sucking difficulties. However, a type-P nipple with a squeezable bottle does not fully solve the feeding problems of infants with cleft lip and palate. New artificial teats that allow a higher expression pressure are desirable, and the measurement of the expression pressure may be helpful in the evaluation of artificial nipples.

Cleft Lip↗
PubMed1993

Fetal cleft lip and palate: sonographic diagnosis and postnatal outcome.

This is a retrospective analysis of neonatal outcome in 32 fetuses diagnosed over a 3 1/2-year period as having cleft lip and palate by ultrasonographic examination. Unilateral versus bilateral complete cleft lip was accurately diagnosed in fetuses after 16 weeks' gestation. Incomplete cleft lip was more easily detected after 27 weeks' gestation. In only three newborns was the severity of the cleft overappraised. In no instance was a complete cleft lip mistakenly diagnosed as an incomplete form. The fetuses with labial clefting also were categorized sonographically as those without associated abnormalities (n = 15) and those with other detectable anomalies (n = 17), of which 5 had autosomal trisomy. One neonate assessed in utero to have an isolated unilateral incomplete cleft lip had vertebral/rib anomalies and died soon after birth of unsuspected pulmonic stenosis. This study confirms the accuracy of prenatal sonographic examination and underscores the high incidence of spontaneous fetal loss (terathanasia) that occurs whenever cleft lip/palate is associated with aneuploidy or other malformations.

Abnormalities, Multiple↗
PubMed1995

Periodontal and prosthetic treatment of a cleft lip and palate patient: a case report.

Although cleft lip and palate patients are usually treated by a multidisciplinary team involving physicians and dentists, their periodontal condition may be over-looked. Crowded or malpositioned teeth, hypertrophic gingiva, orthodontic appliances, and prosthetic replacements can impede proper plaque removal and thus perpetuate periodontal disease. It is important to incorporate periodontal treatment into the comprehensive treatment as early as possible. This case report discusses the periodontal surgical procedures involved in eliminating a residual ridge defect and the fitting of the final prosthetic reconstruction. Also, the importance of the identification and management of periodontal conditions characteristic of cleft lip and palate patients before and after surgical, orthodontic, and prosthetic rehabilitation will be emphasized.

Adult↗