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PubMed2001

[Effects of unilateral cleft lip and palate prosthesis on the development of maxillary and facial soft tissue].

OBJECTIVE: The effect of unilateral cleft lip and palate prosthesis on the development of maxillary and facial soft tissue was investigated. METHODS: The standard cephalometric measurement was used in patients with complete unilateral cleft lip and palate operated in different periods. We obtained data by measurement. RESULTS: Hard tissue: ANS-X, PNS-X and N-ANS in the group of patients were statistically different from those of the normal control group, but in ANS-PNS and N-PO, there is no statistical difference in these two groups. Angles of hard tissue: There is statistical difference in < N. W. ANS and < SNA between the control and the group of patients. There is only statistical difference in < SNB between the D group and the control group. There is no difference among other groups. Ratios of hard tissue: The ratios of ANS-X/S-X and PNS-X/S-x in the control group were higher than those of the group of patients, and the ratios of S-Go/N-Po, Ar-Go/N-Po and N-Po/AN in the group of patients were higher than those of the control group. The ratio of NMC/SUBN: It is the highest ratio in the control group, and there is no difference between ratios in the control group and the C group, but there is statistical difference between the control and other patient groups (P < 0.05). CONCLUSION: Comparing with normal persons, the defect of maxillary length development is apparent in the patients with complete unilateral cleft lip and palate due to congenital development deformity. The figure of soft tissue in patients with unilateral cleft lip and palate is anastomotic with the figure of their hard tissue. The excavation of bony middle 1/3 in face results in paramorphia of soft tissue adhering on the bony tissue. We can conclude that in order to obtain better articulation function, the palatoplasty should be carried out early.

Adolescent↗

PubMed2005

Mucous-flap method for cleft-lip revision using transverse everted full-length lower-lip flap.

In patients who had undergone the first surgery for cleft lip and in whom the volume of tissue was smaller for the upper lip than for the lower lip, transfer of tissue from the lower lip using a full-length mucous flap allowed the tissue volume of the upper lip to be increased and external appearance of the lips to be improved. The subjects of this study were 6 patients who underwent this surgery between February and September 2001 and were followed for up to 3 years postoperatively. This surgery can be performed under topical anesthesia, without necessitating restriction on mouth opening and oral ingestion. Furthermore, it allows easy adjustment of the tissue volume in both upper and lower lips. This operative procedure is recommended for cases of cleft lip where surgical treatment has been performed before and the tissue volume is smaller in the upper prolabium than in the vermilion.

Adolescent↗

PubMed2000

[Pseudoprognathism frequency and masseter muscle activity in operated cleft lip patients].

BACKGROUND: As a consequence of a growth inhibition of middle third of the face, cleft lip surgery could lead to a pseudoprognathism. However, this is not always the case. Also, when facial architecture is changed, the activity of muscles such as the masseter could be disturbed. AIM: To study masseter electromyographic activity in operated cleft lip patients. MATERIAL AND METHODS: Forty two patients with cleft lip (25 male, aged 13 to 35 years old) were studied. All were operated during their first year of life. An electromyography of masseter muscle was performed and from a teleradiography, ANB and Gonion angles were obtained. Forty healthy subjects conformed the control group. RESULTS: The sample was divided in two groups. A group of 20 patients had a significantly lower EMG voltage than control subjects (662 +/- 228 and 1511 +/- 340 microV respectively, p < 0.001). Only seven patients had an anteriorly inverted bite with a mean ANB of + 1.7 and a mean molar relation of -4.8, figures that confirm the presence of pseudoprognathism. CONCLUSIONS: Eighty three percent of cleft lip patients do not have cephalometric parameters of pseudoprognathism and half of the patients have a lower masseter activity.

Adolescent↗

PubMed1987

[A new concept of normal and pathologic development of the primary palate. 2. The formal genesis of the open and covered cleft lip and jaw].

In part 1 of this work we have shown that in each mammalian embryo the nasal fin represents a masked physiological cleft lip and jaw. In this double-layered "Epithelmauer" the process of epithelium separation along the differentiation-line may undergo various fates: 1. It can completely fail to take place (resulting in total cleft lip and jaw) or can be interrupted (resulting in incomplete cleft). 2. The persisting oral epithelium of the nasal fin may be loosened and moved away with a little temporal retardation. Thereby the potential osteoblasts and myoblasts cannot meet and join at right time and they retract away from the midline epithelial seam. The minimal and subcutaneous cleft lip and the submucous clefts of the jaw and the mesenchymal bridges may result. 3. Only in very rare cases the cleft lip and jaw develop in another way, namely if the underdeveloped facial processes do not meet.

Animals↗

PubMedDate not supplied

Comparison of three nonradiographic methods of mixed dentition analysis in cleft lip and palate patients.

PURPOSE: The purpose of this study was to investigate whether the application of mixed dentition analyses in cleft lip and palate patients differed from noncleft patients and to investigate which method provided the most accurate prediction in cleft lip and palate patients. METHODS: Study casts of 30 cleft lip and palate patients and 30 noncleft patients were used in this study. Each patient had dental casts at two stages of dental development. The methods compared included the Moyers, the Tanaka & Johnston (T/J) and the Boston University (BU) prediction methods. RESULTS: Analyses for both groups indicated that the predicted values yielded by each method were significantly different from one another but were all significantly correlated with actual tooth size. Moyers 50% and BU had the smallest mean difference values and no significant difference between the predicted and actual values for both cleft and noncleft control groups. CONCLUSIONS: Types of cleft had no effect on the size of the mandibular permanent canines and premolars. The application of mixed dentition analyses in cleft lip and palate patients does not differ from noncleft patients. Both Moyers 50% and the BU method have high accuracy and correlation in prediction of unerupted teeth in both groups.

Age Factors↗

PubMed1990

Delayed dental development in children with isolated cleft lip and palate.

Although most cases of cleft lip and palate are free of other developmental defects, children with isolated cleft lip/palate are at enhanced risk of delayed growth and reduced final size. Three variables were assessed in the permanent dentition away from the cleft site: congenital absence by tooth type (which ranged from 0 to 7%) asymmetry in developmental staging (3 times more common in cleft lip/palate than in controls), and dental age (with a mean delay of 0.9 yr in cleft lip/palate relative to controls). The pervasive nature of these measures of reduced growth potential and developmental control, which were greatest in teeth forming during infancy, suggests that the cause of the compromised growth is the adverse early postnatal environment rather than conditions intrinsic to the individual.

Age Determination by Teeth↗

PubMed2005

A surgical simulator for planning and performing repair of cleft lips.

UNLABELLED: The objective of this project was to develop a computer-based surgical simulation system for planning and performing cleft lip repair. This system allows the user to interact with a virtual patient to perform the traditional steps of cleft-lip repair (rotation-advancement technique). MATERIALS AND METHODS: 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 11-day-old unilateral cleft lip, alveolus 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 developed in-house. 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's 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 (>1 kHz) 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 (non-medical and plastic surgery residents) of six persons each performed the anatomical marking task of the simulator four times. RESULTS: Results showed that the plastic surgery residents scored consistently better than the persons without medical background. Every person's score increased with practice, and the length of time needed to complete the 11 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. CONCLUSION: These 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↗

PubMed2003

Dento-alveolar development in unilateral cleft lip, alveolus and palate.

BACKGROUND AND OBJECTIVE: Palatal surgery for cleft lip, alveolus and palate is considered to have the most powerful negative impact on maxillary growth. The aim of this study was to compare dento-alveolar development of the permanent dentition and morphology of the palate after surgery in unilateral cleft lip, alveolus and palate patients following two types of palatoplasty: supraperiosteal flap vs mucoperiosteal flap technique. PATIENTS: Thirty-eight patients born between 1976 and 1983 with a complete unilateral cleft of lip, alveolus and palate were studied. Fifteen patients were treated with supraperiosteal flaps (SP group), and the other 23 patients with mucoperiosteal flaps (MP group). In this cross-sectional study, dental casts of stage IV A of Hellman's dental age in each patient were used. METHODS: The following distances were measured: (1). transverse distance C-C', (2). transverse distance M-M', (3). palatal length, (4). palatal height. RESULTS: No statistically differences were seen between the SP and MP groups regarding C-C' and M-M'. However, palatal length and palatal height were significantly greater in the SP than in the MP group. CONCLUSION: The technique that leaves no denuded palatal bone is considered to be advantageous for the development of the alveolar process.

Adolescent↗

PubMed2003

Secondary rhinoplasty using flying-bird and vestibular tornado incisions for unilateral cleft lip patients.

To correct the nasal deformity in cleft lip patients, a new procedure of open rhinoplasty using a "flying-bird" incision in the nostril tip with a vestibule "tornado"-shaped incision in the cleft side is presented. The newly designed vestibular incision produces effective vestibular advancement with the freed lower lateral cartilage. The flying-bird incision makes it possible to produce a suitable nostril tip appearance with symmetrical external nostril vestibules. If the vestibular defect after flap advancement is wide, a full-thickness skin graft is used to give priority for making a good external nostril shape. This procedure is useful for most cleft lip noses, particularly in cases of moderate to severe deformity.

Adolescent↗

PubMed1993

Bilateral cleft lip. An unorthodox management.

Successful repair of bilateral cleft lip requires attention to the soft-tissue anomalies of the lip and nose and the hard-tissue defects of the maxilla. An algorithm for the management of the infant with bilateral cleft lip is presented. A multidisciplinary approach that uses lip adhesion and passive alveolar molding plates to set the stage for subsequent definitive lip and columellar reconstruction is discussed. This approach differs from most others because of reliance on the mucosal circulation of the prolabium.

Adolescent↗

PubMed1993

Soft-tissue profile changes during widening and protraction of the maxilla in patients with cleft lip and palate compared with normal growth and development.

During the last 15 years, cleft lip and palate (CLP) patients with maxillary deficiency in the care of the Bergen CLP team have undergone an interceptive orthopedic treatment phase during the deciduous and mixed dentition period. The present study includes 68 patients who received maxillary transverse expansion by use of a modified quad-helix appliance and 98 cases given maxillary protraction by a facial mask. All cases were treated until an acceptable normal occlusion was attained. Lateral cephalograms were taken immediately before and after the active treatment periods. Sagittal changes of the soft-tissue profile during transverse expansion and protraction were analyzed separately for unilateral complete cleft lip and palate (UCLP) patients and bilateral complete cleft lip and palate (BCLP) patients. The soft-tissue profiles of the groups were compared to growth changes of noncleft age-matched children (NORM group). During the short period of maxillary transverse expansion (mean period, 3.5 months) no significant change of the soft-tissue profile was found, except in the protrusion of the lower lip in the BCLP group. During the period of maxillary protraction (mean periods, 12 months in the UCLP group and 15 months in the BCLP group) the soft-tissue profile improved significantly by reducing the characteristic tendency towards a concave profile in CLP patients with maxillary deficiency. Significant increases of the sagittal maxillomandibular lip relation (angle SS-N-SM: mean increase, 2.5 degrees) and the Holdaway-angle (H-angle: mean increase, 3.0 degrees) were found to be similar in the UCLP and BCLP groups. However, the use of different reference lines for evaluation of treatment effects upon the soft-tissue profile resulted in conflicting findings suggesting that anteriorly situated reference lines are more suitable for the evaluation of CLP patients. Thus, the esthetic line (E.line) indicated a favorable position of the lips after treatment; the subspinale-pogonion line (ss.pg) revealed an improved soft-tissue profile; the soft-tissue-facial line (N.PG) showed a retruded nose and upper lip; whereas basal references such as the nasionsella line (NSL) and the occlusal-line perpendicular (OLP) mainly showed major differences between the CLP groups and the NORM groups.

Cephalometry↗

PubMed2000

[Cleft lip and palate. Epidemiologic analysis: report of 60 cases].

The authors reviewed 60 cases of cleft lip and palate between November 1996 and May 1998. Any family history of cleft lip and palate and associated syndromes was noted, to detect a possible mode of transmission. A family history of cleft lip and palate was reported in 14 cases (23%). Possible autosomal dominant transmission was observed in this series. A syndromic form was observed in eight cases (13%), with one case of Van der Woude's Syndrome (VWS), and another of velo-cardiofacial Syndrome (VCFS). Molecular and chromosomal studies are indicated in both cases. A Pierre Robin sequence (PRS) was found in six cases.

Cleft Lip↗

PubMed1988

Effects of cleft lip and palate on the nasal airway in children.

Clefts of the lip and palate often produce significant nasal deformities and reduced nasal airway size. The purpose of this study was to assess how type of cleft affects nasal cross-sectional area and mode of breathing. The pressure-flow technique was used to estimate nasal airway size and modified inductive plethysmography was used to determine percent of nasal breathing in 60 children with cleft lip and palate aged 6 to 15 years. Ninety-five normal children served as controls. The data demonstrate that nasal size decreased among cleft types as follows: children with bilateral cleft lip and palate had largest airway, followed by unilateral cleft lip, cleft of the hard and soft palate, cleft of the soft palate, and unilateral cleft lip and palate. The data also indicated that most subjects with cleft were mouth breathers. Results of otolaryngologic examinations suggest that septal deformities affecting nasal valve function are responsible for much of the impairment, especially in the group with unilateral cleft lip and palate. The differences among groups appear to relate to developmental differences associated with the original defect and the surgical procedures used in primary repair.

Adolescent↗

PubMed1995

A family with unusual Waardenburg syndrome type I (WSI), cleft lip (palate), and Hirschsprung disease is not linked to PAX 3.

An unusual family with Waardenburg syndrome type 1 (WSI), cleft lip (palate), and Hirschsprung disease is not linked to the PAX 3 gene since there is an obligate crossover which has occurred between PAX 3 DNA markers and the disorder in this family. This family may also have anticipation of the WSI traits as the proband's grandmother is nonpenetrant, his mother has dystopia canthorum, and severe cleft lip (palate), while the proband has dystopia canthorum, severe cleft lip (palate), and Hirschsprung disease. Thus, a locus other than PAX 3 is implicated in this Waardenburg-like syndrome with Hirschsprung disease and cleft lip (palate).

Base Sequence↗

PubMed2002

Isolated soft tissue cleft lip: the influence on the nasal cavity and supernumerary laterals.

OBJECTIVE: The purpose of this investigation was to estimate the vertical deviation of the nasal floor and to register dental disturbances (i.e., hypo- and hyperdontia) in patients with an isolated soft tissue cleft lip. DESIGN: Thirty patients with isolated cleft lips were randomly selected from the files of the Department of Maxillo-Facial Surgery and Jaw Orthopedics. As a matched control group, 30 patients were selected from the files of the Department of Orthodontics. Panoramic radiographs were analyzed and the lowest point of the floor of the left and right nasal cavity was measured to the nearest 0.5 mm. The presence of supernumerary (deciduous or permanent) or missing lateral incisors was recorded from the patient's journals. RESULTS: The vertical position of the nasal floor differed significantly between the cleft and the non-cleft side (p < 0.001). Supernumerary, deciduous, and permanent laterals were recorded in 73% of the subjects in the cleft lip group (22 patients). In the control group, no differences were found between the position of the nasal floor on the left and right side and no supernumerary laterals were recorded. Missing laterals were not noted in any of the individuals investigated. CONCLUSIONS: Isolated cleft lips were in most cases associated with: (1) lowering of the nasal floor on the cleft side and (2) supernumerary primary or permanent lateral incisors on the cleft side. Panoramic radiographs can be used to detect differences in the vertical position of the floor of the nasal cavity in patients with isolated cleft lips and to diagnose supernumerary laterals.

Adolescent↗

PubMed1989

[Electromyographic study of masticatory dysfunction in patients with unilateral cleft lip and palate and reversed occlusion].

UNLABELLED: Masticatory dysfunction in patients with unilateral cleft lip and palate was studied on the basis of electromyograms of the masticatory muscles. The purpose of the study was to elucidate the origin of the dysfunction by means of comparisons among electromyograms of masticatory muscles in cases of normal occlusion, reversed occlusion and reversed occlusion caused by unilateral cleft lip and palate. Subjects were 10 cases of normal occlusion (10y2m-11y10m), 10 cases of reversed occlusion (7y2m-11y2m) and 20 cases of unilateral cleft lip and palate (8y0m-14y3m). In each subject, electromyograms of the masseter and anterior venters of the temporal muscles at the isometric-contraction phase were recorded by means of the surface-electrode method with mandible loads of 1-5 kg. The electromyograms were analyzed quantitatively by means of an electromyographic device called a Turn Counter. Relations between loads and amplitude as well as numbers of turns were examined. At the same time maximum masticatory pressure and occlusal contact points were measured and then examined in comparison with electromyographic findings. RESULTS: 1. Correlation coefficients between loads and amplitudes as well as numbers of turns decreased among the groups in this order: normal occlusion, reversed occlusion and cleft-caused reversed occlusion. Significant differences were observed between the normal-occlusive group and the reversed and cleft-caused reversed-occlusive groups. 2. No. difference was observed between the normal-occlusive and reversed-occlusive groups in terms of correlation coefficients between total sums of amplitudes and turns of the 4 masseter muscles (right and left masseters and anterior venters of the temporal muscles) and loads. Correlation coefficients in the cleft group were significantly smaller than those in the other 2 groups. 3. Because of great differences in regression coefficient among individuals, no synergic contraction pattern of the 4 mastication muscles (right and left masseter and temporal muscles) could be specified. 4. The A/T ratio of masseters in the cleft group was significantly smaller than those in the normal- and reversed-occlusive groups. 5. Under maximum load, the activity ratio of the 4 masseter and temporal muscles was 1:1 in the normal- and reversed-occlusive groups, whereas temporal-muscle activity predominated over masseter-muscle activity in the cleft group. 6. Maximum masticatory pressure decreased in the order: normal-occlusive, reversed-occlusive, and cleft caused occlusive. No correlation with electromyographic findings was observed.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗

PubMed1983

Characteristics of craniofacial structures of parents of children with cleft lip and/or palate.

We looked for possible differences in craniofacial morphology between parents of children with celft lip (CL) and/or cleft palate (CP) and normal controls. Fifty measurements were obtained from lateral and frontal roentgenographic cephalograms of these subjects. The means of all measurements were tested for significant statistical differences, and a discriminant analysis was carried out to distinguish the craniofacial structures in the experimental subjects from those in the controls. Facial shape of parents of children with CL and/or CP differed from that of control subjects. Shorter height and greater width in the upper face were the main characteristics of facial shape of parents of CL and/or CP children. Craniofacial morphology was considered to be related to susceptibility to these facial deformities.

Adult↗

PubMed1999

[Management of cleft lip and/or palate diagnosed in utero].

OBJECTIVE OF THE STUDY: To assess the usefulness of fetal karyotyping in the management of facial cleft lip with or without cleft palate diagnosed during pregnancy and to determine which etiologic and prognosis criteria are helpful to consider for prenatal counselling. MATERIAL AND METHODS: Retrospective study on 35 cases of facial cleft lip and/or palate prenatally diagnosed by ultrasound examination and managed in our fetal medicine unit from 1 January 1989 to 31 December 1996. Complete follow-up was obtained for all fetuses. RESULTS: In our series, the mean gestational age at diagnosis was 25 weeks. In 43% of the cases, additional sonographic anomalies were also recognized. These associated anomalies were more frequent when amniotic fluid quantity was abnormal. Fetal chromosomal determination was conducted in 2/3 of fetuses and numeric or structural abnormalities were found in 20% not related to the cleft size or type (lip and/or palate). All fetuses with isolated facial cleft were chromosomally normal. We report 4 midline clefts, all of them were associated with additional sonographic findings and 3 were part of an holoprosencephaly. CONCLUSION: Prenatal diagnosis of cleft lip and/or palate must draw attention to associated sonographic anomalies especially when amniotic fluid quantity is abnormal. Chromosomal karyotyping is not necessary when facial clefting is isolated except in cases diagnosed early in pregnancy. Midline clefts must draw attention on cerebral midline integrity.

Abnormalities, Multiple↗