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PubMed2005

The use of overdentures in children with cleft lip and palate: a report of two cases.

The treatment of children with cleft lip and palate is complex. Advances in primary surgery and the advent of alveolar bone grafting have resulted in the reduction of prosthetic intervention. However, in patients where surgery is contraindicated or has been unsuccessful, an alternative treatment is required. Overdentures are a simple, conservative and reversible non-surgical alternative for children with cleft lip and palate. We present two cases with severe complete bilateral cleft lip and palate that were managed in this way.

Anodontia↗

PubMed1998

[Cleft lip and palate--prenatal diagnosis and counseling].

The most frequent congenital developmental defect in the orofacial region are, no doubt, facial clefts which are a serious stress for health professionals and the population. Depending on the type of cleft, the prevalence is between 1 : 1000-2800 births. According to contemporary views in the etiology of orofacial clefts participate genetic as well as environmental factors. That means that specific genetic factors create a certain "sensitivity" for specific factors of the external environment which act as a trigger mechanism and combined they produce the cleft. Cleft lip can be diagnosed already during the 13th week of gestation, while a cleft palate is not necessarily apparent till after the 18th week of gestation as the maxilla is in the process of joining. Presentation of the foetal face and its profile is thus important in particular during the second trimester of gestation and should be part of ultrasonographic screening between the 18th and 20th week of gestation. As more than 8% of facial clefts are associated with chromosomal abnormalities, in all affected foetuses karyotyping is done. The prognosis of satisfactory cosmetic and functional repair in cleft lip and in cleft lip and palate is favourable. In case of associated malformations all depends on the type and severity of these associated defects or on the diagnosis of the syndrome. If median clefts are extensive or associated with cerebral anomalies, the prognosis is as a rule poor. Prenatal diagnosis and management of defects of the orofacial area calls for collaboration of the obstetrician, neonatologist and plastic surgeon already in the stage when the defect is detected to give the expectant mother an opportunity to obtain accurate and unbiased information on possible treatment and prognosis for the foetus.

Cleft Lip↗

PubMed2004

Orthopedic intrusion of premaxilla with distraction devices before alveolar bone grafting in patients with bilateral cleft lip and palate.

Surgical repositioning of the downward displaced premaxilla in bilateral cleft lip and palate patients remains a controversial and perplexing issue because of its detrimental effects on the growth of the premaxilla. The purpose of this prospective clinical study was to introduce and evaluate the treatment results of an innovative technique for nonsurgically intruding the downward displaced premaxilla. Eight consecutive cases of bilateral cleft lip and palate at the age of mixed dentition were included for the correction of their premaxillary deformities. A pair of intraoral tooth-borne distraction devices was used for the orthopedic intrusion. Serial lateral and posteroanterior cephalometric radiographs were taken periodically for evaluating the growth of the premaxilla 1 year before the intrusion, changes during the intrusion, and growth/relapse up to 1 year after the intrusion. There was no overgrowth of the premaxilla or overeruption of the maxillary incisors during the 1-year observing period before the orthopedic intrusion. The treatment results revealed that the downward displaced premaxillae were all corrected within 1 month. Cephalometrically, 46 percent of the correction resulted from a true orthopedic intrusion and another 54 percent from a dentoalveolar effect in which the maxillary incisors were intruded and the premaxillary dentoalveolus was shortened. The cephalometric evaluations also implied that what occurred during the orthopedic intrusion was mostly the sutural contraction osteogenesis/osteolysis in the vomeropremaxillary suture combined with slightly mechanical upward displacement of the vomeronasal septum complex and nasal bones. The orthopedic intrusion of the premaxilla with distraction devices is an effective nonsurgical method for correcting the downward displaced premaxilla before alveolar bone grafting in patients with bilateral cleft lip and palate, and the results remained stable after 1 year.

Child↗

PubMed2002

Correction of severe secondary cleft lip nasal deformity using a composite graft: current approach and review.

In the case of a severe tissue deficiency with a secondary cleft lip nasal deformity, a composite graft can be useful for columellar lengthening or to create symmetrical nostrils. The current study used composite grafts to correct secondary cleft lip nasal deformities with a severe tissue deficiency or severe nostril asymmetry. A total of 19 patients who were born with complete cleft type were operated between 1995 and 1999. Of these patients, 10 were men and 9 were women, and the age distribution was 7 to 35 years old. In 9 patients with unilateral cleft lip nasal deformities and in 6 patients with bilateral cleft lip nasal deformities, columellar lengthening was performed using a composite graft taken from the helix in 14 patients and the contralateral alar rim in 1 patient. In 4 patients with severely asymmetrical nostrils resulting from a short alar rim in unilateral cleft lip nasal deformities, the ear helix was used in 2 patients, whereas in the other two patients, the alar rim of the unaffected side was transferred to the affected side to create a symmetrical nostril by reducing the length of the ala on the unaffected side. The follow-up period ranged from 1 to 3 years, and results were as follows: Four days after the graft, the composite tissue exhibited a pinkish color, and complete survival was confirmed after 7 days. The absorption rate was approximately 10% and the color mismatch became minimal with time. Composite tissue from the ear was found to be useful for full-layer reconstruction of the ala and columella because of its stiffness, thin nature, and similarity. Composite tissue from the alar rim on the contralateral side was also determined to be a good material for full-layer reconstruction of the deficient ala.

Adolescent↗

PubMed1989

Birth prevalence of cleft lip and palate in British Columbia between 1952 and 1986: stability of rates.

We examined the birth prevalence of cleft lip with or without cleft palate and of isolated cleft palate in British Columbia between 1952 and 1986 using the data of the BC Health Surveillance Registry. The rates fluctuated over the study period, but linear trend analysis showed no increase or decrease for cleft lip with or without cleft palate; however, there was a significant increase for isolated cleft palate, attributed to improved ascertainment around 1963-66. Given the possible effects of newer agents used in both silviculture and agriculture, as well as the general concern over drugs and other environmental agents, such a long-term monitoring program is important. Furthermore, if significant clustering occurs, good background data are essential for comparison. The general public's perception is that the rates of birth defects are increasing. Our findings should give some reassurance with respect to orofacial clefts.

British Columbia↗

PubMed2004

Early craniofacial morphology and growth in children with bilateral complete cleft lip and palate.

PURPOSE: Analysis of craniofacial morphology and growth in children with bilateral complete cleft lip and palate (BCCLP), compared with a control group with unilateral incomplete cleft lip (UICL), before any treatment as well as 20 months after lip closure. MATERIAL: The children were drawn from a group representing all Danish children with cleft born 1976 to 1981. Sixty-four children were included in the study (19 BCCLP and 45 UICL). The ages were 2 and 22 months at examinations 1 and 2, respectively. METHOD: The method of investigation was infant cephalometry in three projections. The craniofacial morphology was analyzed using linear, angular, and area variables. Growth was defined as the displacement vector from the coordinate of the corresponding landmark in the x-ray at examination 1 to its coordinate at examination 2, corrected for x-ray magnification. The growth of an anatomical region in a patient was assessed by investigating the growth pattern formed by a collection of individual growth vectors in that region. RESULTS: The BCCLP group differed significantly from the UICL group. The most striking findings in BCCLP were an extremely protruding premaxilla; markedly increased posterior maxillary width; increased width of the nasal cavity; short maxilla with reduced posterior height; short mandible; bimaxillary retrognathia; severe reduction in the size of the pharyngeal airway; and a more vertical facial growth pattern. CONCLUSION: Our findings indicate that a facial type including a wide and posterior short maxilla, short mandible, and bimaxillary retrognathia might be a liability factor that increases the probability of developing cleft lip and palate.

Case-Control Studies↗

PubMedDate not supplied

The oral and maxillofacial surgeon's role in the care of patients with cleft lip and palate deformities.

Perhaps no conditions other than cleft lip and palate and oral cancer assemble teams of dentists and physicians intensely focused on treatment and rehabilitation. The oral and maxillofacial surgeon's role is often pivotal especially in the 20-year term of care for the child born with a cleft lip and palate deformity (CLPD). Issues of basic orofacial functions of mastication, respiration and communication overlay human considerations of self-esteem and image. From the moment of birth the child with a CLPD is special and challenged. Early issues concern parent and family acceptance and insuring basic life functions. While not generally a part of the immediate surgical unit, the OMFS often provides surgical consultation, educational and emotional support for the family. A clear picture must be painted of the treatment that will unfold over the next two decades. Realistic optimism is the watchword. Indeed, today there is every reason to anticipate an outcome that will result in a balanced, functional and esthetic face.

Adolescent↗

PubMed2003

A surgical simulator for cleft lip planning and repair.

The objective of this project was to develop a computer-based surgical simulation system for cleft lip planning and repair. This system allows the user to interact with a virtual patient to perform the traditional steps of cleft-lip repair. The system interfaces to force-feedback (haptic) devices to track the user's motion and provide feedback during the procedure, while performing real-time soft-tissue simulation. An eleven-day old unilateral cleft-lip and palate patient was previously CT scanned for ancillary diagnostic purposes using standard imaging protocols and 1mm slices. High-resolution 3D meshes were automatically generated from this data using the ROVE software created in our lab. The resulting 3D meshes of bone and soft-tissue were instilled with physical properties of soft tissues for purposes of simulation. Once these preprocessing steps were completed, the patient's bone and soft-tissue data are presented on the computer screen in stereo and the user can freely view, rotate, and otherwise interact with the patient's data in real-time. The user is prompted to select anatomical landmarks on the patient data for preoperative planning purposes, then their locations are compared against that of a "gold standard" and a score, derived from their deviation from that standard and time required, is generated. The user can then move a haptic stylus and guide the motion of the virtual cutting tool. The soft tissues can thus be incised using this virtual cutting tool, moved using virtual forceps, and fused in order to perform any of the major procedures for cleft-lip repair. Real-time soft tissue deformation of the mesh realistically simulates normal tissues and haptic-rate (>1kHz) force-feedback is provided. The surgical result of the procedure can then be immediately visualized and the entire training process can be repeated at will. A short evaluation study was also performed. Two groups (nonmedical and plastic surgery residents) of six-people each performed the anatomical marking task of the simulator four times. Results showed that the plastic surgery residents scored consistently better than the people without medical background. Every person's score increased with practice, and the length of time needed to complete the eleven markings decreased. The data was compiled and showed which specific markers consistently took users the longest to identify as well as which locations were hardest to accurately mark. Our findings suggest that the simulator is a valuable training tool, giving residents a way to practice anatomical identification for cleft lip surgery without the risks associated with training on a live patient. Educators can also use the simulator to examine which markers are consistently problematic, and modify their training to address these needs.

Cleft Lip↗

PubMed1998

Oral and dental health status of children with cleft lip and/or palate.

OBJECTIVE: To ascertain the oral and dental health status of children with cleft lip and/or palate. DESIGN: Oral and dental examinations were carried out on 114 selected children with cleft lip and/or palate, using standard criteria and indices. SETTING: These children were examined at two cleft palate clinics in the United Kingdom. PATIENTS: All children examined were between the ages of 3 and 18 years. RESULTS: Sixty one (53.5%) of the subjects exhibited no evidence of previous caries experience, but as many as 20% exhibited active decay. The mean caries experience in the deciduous dentition (dmfs) was 2.3, and that in the permanent dentition (DMFS) was 0.9. Caries experience of the Caucasian children of the sample was lower (mean dmfs 1.9) than that of the Asian children (mean dmfs 5.5). The mean simplified debris index of the sample was 0.9, and the mean gingival bleeding index was 0.4. Children with cleft lip and palate had generally poorer oral and gingival health than those with isolated clefts of the lip or palate. CONCLUSION: Twenty percent of the sample had active decay. These children had poor oral health in the surgically repaired anterior segment.

Adolescent↗

PubMed1997

Linear growth characteristics of children with cleft lip and palate.

OBJECTIVE: To study the linear growth characteristics of children with isolated cleft lip (CL), cleft palate (CP), or both (CLP) and to determine whether this population is at risk for short stature. STUDY DESIGN: Retrospective chart review identified 324 patients with CL, CP, or CLP that displayed no additional congenital anomalies. Longitudinal height and growth rate analyses were performed on routine anthropometric measurements gathered from hospital and clinic records. One-sample t tests (p < 0.05) of average height percentiles were performed at yearly intervals. Analysis of variance was performed on clefting subgroups. RESULTS: From birth to 10 years of age, the average height of both male and female white patients is consistently near the 40th percentile. At yearly intervals, 60% of male and 70% of female average heights demonstrate statistical difference from the population mean. For all patients, 64% of male but only 36% of female growth rates, from 2.5 to 12 years of age, were above the population mean. CONCLUSIONS: White children from birth to 10 years of age with isolated CL, CP, or CLP demonstrated a mean height below the population mean. These data suggest that children with isolated clefting manifest an intrinsic tendency toward short stature. In addition, male patients display above-average growth rates, whereas female patients display below-average growth rates, from 2 to 18 years of age. The data imply that female patients may be at increased risk of overall short stature, whereas male patients may eventually obtain mean population height.

Age Distribution↗

PubMed1990

Secondary correction of bilateral cleft lip nose deformity.

For correction of the bilateral cleft lip nasal deformity, a modified bilateral reverse U incision is used in combination with a short, forked flap; by using this combination, satisfactory lengthening of the columella, preserving the natural pout of the lip, can be obtained. We have applied this method to 12 cases undergoing secondary repair of bilateral cleft lip in the past 3 years, and the results of this treatment, along with representative photographs of some of our patients, are presented herein.

Adolescent↗

PubMed2004

[Cleft lip and palate surgery in India].

10 cleft lip and palate temporary facilities were set up 1994-2003 in a Christian Hospital in Central India. 725 patients were operated upon. An analysis of the operations in regard to lip closure, closure of the soft and the hard palate, secondary cleft operations and cleft-related surgery is given. Differing therapy concepts in developed countries are discussed and compared to experiences of other third world volunteer medical groups.

Adolescent↗

PubMed1992

Latham's appliance for presurgical repositioning of the protruded premaxilla in bilateral cleft lip and palate.

Dislocation of the maxillary segments in cleft lip and palate still is a challenge to the surgeon and the orthodontist. The premaxillary protrusion in bilateral cleft lip and palate, complicates the treatment severely. Latham's appliance, inserted on average at 2-months-of-age, relocates the segments over 3-4 weeks. Removal of the appliance is immediately followed by functional surgery. The first operation comprises: (1) intra-alveolar veloplasty; (2) closure of the alveolar cleft with the help of a gingivo-periosteal-plasty; (3) lip adhesion and (4) insertion of ear tubes. This operating schedule establishes the functional matrix as early as possible. Midfacial growth as well as language and speech development are provided with the necessary preconditions as far as we understand this complex situation. Five cases, being representative of 41 cases, are outlined in detail. The longest follow up period is 3 years; no growth disturbance of the maxilla has been detected to date. Definitive lip and columella surgery is facilitated.

Child, Preschool↗

PubMed1991

[The use of the maxillary protractor in the treatment of cleft lip and palate: a report of two cases].

The patients who underwent reconstruction of cleft lip and palate had clinically abnormal characteristics such as cicatricial contracture in the cleft area, narrow arches, missing teeth, and fistula. Most of those patients showed severe class III malocclusion with underdevelopment of the maxillary complex. In such patients, the treatment objectives in orthodontics were mainly anterior and lateral expansions of the maxillary arches, and inhibition of mandibular growth. In recent years, the maxillary protractor has been used positively in the treatment of the underdeveloped maxillary complex. In this study, we report on two patients with cleft lip and palate, and underdevelopment of the maxillary complex. Maxillary protractors were used beneficially at the period of the dento-craniofacial growth spurt. In these two cases, improvement of disharmony was obtained in the antero-posterior relationship between the maxilla and the mandible. The effects of the treatment were forward movement of the maxilla and growth inhibition of the mandible. Accordingly, the use of the maxillary protractor for cleft lip and palate patients with underdeveloped maxilla at the period of the dento-craniofacial growth spurt was shown to be important.

Cleft Lip↗

PubMed1978

A comparative study of gonial angle and growth of the lower third molar in cleft lip and palate. An orthopantomographical study.

In children and young adults with cleft lip and palate, the gonial angle, the angle between the lower second molar and the mandibular plane, the angle between the longitudinal axes of the second and third molars as well as the timing of the development of the third molar were investigated on the right and left side from orthopantomograms. The results were compared with the corresponding results in a noncleft Finnish material. The series consisted of 100 randomly selected subjects aged from 10 to 24 years, 57 males and 43 females. One to three orthopantomograms were available for each subject, totalling 201. The results were examined in a cross-sectional and longitudinal material. The right and left gonial angles were not found to differ in the different cleft groups. Among subjects with cleft lip and palate the gonial angle was found to be larger in the different age groups than the corresponding values in the comparison material. In both materials, the gonial angle was found to decrease between the ages of 10 and 15 years. In males with cleft lip and palate the decrease in this angle, however, continued up to the age of 19. The anterior angle between the longitudinal axis of the lower second molar and the mandibular base line was about 10 degrees larger than in the comparison material, being slightly larger than that in the Angle's Class III occlusion type in the comparison material. When examined by degrees of development the development of the lower third molar was delayed approx. 0.9 years in males and 1.6 years in females compared with the corresponding times in the comparison material.

Adolescent↗

PubMed1994

P-A cephalometric analysis of nonoperated adult cleft lip and palate.

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.

Adolescent↗

PubMed2001

Basal cell carcinoma arising in a cleft lip repair scar.

BACKGROUND: A case of basal cell carcinoma (BCC) developing in the repair scar of a cleft lip is presented. OBJECTIVE: Primary BCCs arising in surgical scars are very rare and no known reported cases exist of a BCC developing in a surgically repaired cleft lip scar. METHODS: A 69-year-old white man presented with a 5 mm primary BCC on his upper lip at the site of his cleft lip repair scar. The diagnosis was made by a tangential biopsy that showed an ulcerated BCC. RESULTS: Review of the medical literature indicates that a scar may be an independent risk factor for developing BCC. CONCLUSION: BCC may rarely arise in a cleft lip repair scar.

Aged↗

PubMed2005

The change in the appearance of the vermilion border region caused by the difference of the design in symmetric bilateral incomplete cleft lip repair.

In the widely performed methods for repair of bilateral cleft lips, such as Mulliken and Trott methods, the formation of the median tubercle is done with the mucocutaneous flaps from the lateral lips. By this manoeuver, a visible horizontal scar just above the white skin roll of the philtral region tends to result, especially among Asian patients. To avoid the formation of this visible scar, we changed our design in such a way that mucosal flaps, instead of mucocutaneous flaps, are elevated from the lateral lips, and the prolabial white skin roll is preserved to become the final philtral white skin roll. By this change in design, the horizontal scar is shifted to the inferior edge of the vermilion border. In the past 8 years, we have performed this refined method along with the conventional one. In the present study, the five cases of symmetric bilateral incomplete cleft lip from each of the two groups are evaluated: one group with the mucocutaneous flaps and the other with the mucosal flaps. From the review of the cases, it was noted that when the philtral region is formed with the mucocutaneous flaps, the horizontal scar tends to be visible. On the other hand, when it is formed with the mucosal flaps, the scar is less conspicuous, although the white skin roll sometimes becomes less-defined. The refined method involving mucosal flaps from the lateral lips produces a better-accepted appearance concerning the prolabial horizontal scar in the symmetric bilateral incomplete cleft lip repair.

Child, Preschool↗