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PubMed2005

Attitude of the canine in secondary bone-grafted and nongrafted patients with cleft lip and palate.

OBJECTIVE: To investigate the eruption pattern of the cleft-side canine regarding its pre-eruption position relative to the cleft in bone-grafted (BG) and nongrafted (NonBG) patients with cleft lip and palate. METHODS: Fifty-three patients with cleft lip and palate (21 BG, 32 NonBG) were examined by panoramic radiography and posteroanterior cephalography taken before and after canine eruption. Subjects were categorized into BG, NonBG, and control groups. Canines at the pre-eruption stage were categorized as close to (group 1) or distant from (group 2) the cleft area. The canine angle and its change between the two stages were evaluated. RESULTS: No significant differences were noted between the initial canine angle of the BG and NonBG groups. Although canines in the BG group erupted without a significant change in angle, the canine angle increased significantly (p < .0001) in the NonBG and control groups. In group 1, a greater change in canine angle was noted in the NonBG (p < .05) and control (p < .01) groups than in the BG group. In group 2, no significant difference was noted among the three groups. CONCLUSIONS: In BG patients, a canine located near the cleft appears to erupt at the same angle as it had before grafting. However, in NonBG patients, it erupts more vertically, guided by cortical bone. For canines distant from the cleft area, there is no significant difference in the change in angulation between NonBG and BG patients.

Alveolar Process↗
PubMed1991

Incidence of cleft lip, alveolus and palate forms.

The different cleft forms of 1,450 cleft lip, alveolus and/or palate patients have been analyzed. Randomized groups of 50 plus the next 50 patients and so forth have been examined. The resulting 29 groups reveal a maximum of 139 different clinical cleft forms. The prediction of a possible maximum was made with the exponential formula y = a. (1-eb.x). The tendency of the prognosis levels at a maximum of 169 different cleft forms in and above 4900 patients.

Alveolar Process↗
PubMed1999

Nonsurgical correction of nasal deformity in unilateral complete cleft lip: a 6-year follow-up.

Nasal deformity in unilateral cleft lip and palate patients increases with time, tongue malposition being one of the causes. Some authors have emphasized the role of nasal and adjacent facial musculature as active extrinsic agents. Another cause of alar deformity can be the lack of a proper foundation because of a maxillary hypoplasia in the region of the pyriform foramen. If alar collapse occurs, the septum bends convexly toward the cleft side. Tissues are soft and plastic during the neonatal period. Once the infant is about 3 months of age, it becomes difficult to correct the nasal deformity. Therefore, any resource used from the first day, and mainly during the first 15 days of life, will be useful to prevent the increasing deformity and to avoid the surgical correction. A controlled clinical trial was planned to compare the anthropometric measurements of the nasal region in two series of patients with unilateral complete cleft lip. In the first group, we included 44 patients who came to our clinic during the first 2 days of life and the second group consisted of 47 patients who were more than 15 days of age at the time of the first consultation. To provide control data for the evaluation of the results after 6 years of follow-up in both series of cleft patients, we also included a third group of 48 healthy 6-year-old children. A nasal component added to the occlusal prostheses was only used in the first group up to the time of surgery. The same surgeon performed a Millard II procedure with muscular reposition as described by Delaire in all the patients. Nasal measurements taken with a caliper, obtained directly from plaster models by using surface impressions of the babies, were confirmed by a laser three-dimensional measuring device. The statistical comparison between both series showed a significant increase of the columellar length in the first group. A 6-year follow-up to compare growth and cosmetic results of the nose revealed a better and permanent nasal nostril symmetry and no alar cartilage luxation in the patients who had had the nasal component. These results highlight the importance of the early treatment and allow us to suggest the nasal prostheses as a way to prevent the increasing nasal deformity, to help nasal remodeling, to obtain columellar elongation, and to avoid or decrease the need for primary surgery of the cleft nose.

Anthropometry↗
PubMed2001

Spatial image of school environment in children with cleft lip and/or palate.

To evaluate the adaptability of children with cleft lip and/or palate to school, their mental images of the school environment were investigated in a semantic differential method survey using 23 pairs of adjectives. The following eight places on and off the school grounds were chosen as environmental factors; classroom, gymnasium, school nurse's office, teachers' office, playground, hallway, road leading to school and road leading back home. 50 children with cleft lip and/or palate (ages 10-11 years) were enrolled in this study. These children had a feeling of liberation in the teachers' office and school nurse's office. However, they did not have an established feeling of relaxation or affinity in the classroom, gymnasium, playground, hallway, or on the road to and from school, the very locales that were the main areas of their school activity. This suggested that self-expression and adaptation were difficult for these children.

Adaptation, Psychological↗
PubMed2001

Prenatal diagnosis of cleft lip and palate.

A prospective study was conducted over a period of 8 years to compare the severity of the cleft lip and palate detected by ultrasound scanning of the foetus with the severity at birth. In the UK all pregnant women undergo a routine perabdominal ultrasound scan at 20 weeks' gestation. There were approximately 250000 scans performed in our catchment area during the study period. A total of 270 children were born with cleft lip and/or palate, of which 130 had cleft lip with or without cleft palate. Out of these, 23 were positively diagnosed by the ultrasound scan. The specificity was 100% and the sensitivity was 17.5%. Only two diagnoses led to termination of the pregnancy.

Cleft Lip↗
PubMed1994

[Cleft lip and palate: case-control study].

This study relates to a case-control analysis for the purpose of verifying the association between oral clefts and possible risk factors. The analysed variables were: place of mother's residence (urban/rural), pollution, parental diseases, mother's diseases during the first four months of pregnancy, intake of drugs related to this period, heredity, smoking habits, alcohol consumption and X-ray examinations during pregnancy or X-ray examinations prior to pregnancy. There were 450 cases of clefts of whom 354 had a cleft lip with or without cleft palate and 96 had a cleft palate. The relative risk (RR) for each variable by was estimated points and at a 95% of confidence interval and multivariate analysis was applied. As regards cleft lip with or without cleft palate, the risk factors are heredity (RR = 4.96), epilepsy in the mother (RR = 2.39) and the intake of drugs such as anti-inflammatory substance in the first four months of pregnancy (RR = 2.59). Related to cleft palate, the risk factors are heredity (RR = 2.82) and pollution (RR = 2.58).

Brazil↗
PubMed2004

[The investigation of behavior problem with secondary deformity of cleft lip].

OBJECTIVE: To investigate the behaviors of the children suffered from the secondary deformity after the repair of the cleft lip. METHODS: With the application of the PCPI, eighty patients with the secondary deformity after the repair of the cleft lip were selected in this study and 134 normal children was used for the control. RESULTS: In the age between 6 and 11 years, there were no significant difference of the behaviors between the children suffered from secondary deformity of cleft lip and the normal children,but in the age from 12 to 16, the children with the deformity showed more behavior problems with the social withdraw and the poor social relationships, compared with the normal children. CONCLUSION: The children with the secondary deformity after cleft lip repair in adolescence could have the tendency to suffer from the behavior problems, especially showing the social withdraw and the poor social relationships.

Adolescent↗
PubMed1991

Functional and esthetic rehabilitation of an adolescent cleft lip and palate patient.

Many patients with clefts that also affect the alveolar ridge present with congenital absence of the permanent maxillary lateral incisors. This paper describes the treatment of an adolescent cleft lip and palate patient whose missing and unesthetic maxillary incisors were replaced by a combination of fixed and removable partial dentures.

Adolescent↗
PubMed1984

African mask with cleft lip and palate.

An African mask depicting cleft lip and palate is described. This artifact has been used for entertainment by Fon tribe of Dohomey (Benin) in West Africa. The function and style of the mask is discussed.

Benin↗
PubMed2004

Parents' experiences of having a child with cleft lip and palate.

BACKGROUND: Giving birth to a child with cleft lip and palate (CLP) can be emotionally traumatic for parents. The facial appearance awakens feelings and reactions in the family and other people. Feeding these children in the neonatal period is known to be difficult. Previous research has mainly dealt with visual defects, feeding and speech problems. There is a lack of studies about parents' experiences of having a child with CLP. AIMS: This study was performed to investigate parents' experiences of having a child born with a cleft lip or CLP, and how they perceive encouragement and social and mental support from professionals, family and friends. METHOD: A phenomenographic approach was used. The study was performed at a university hospital in central Sweden. Twenty families (20 mothers and 12 fathers) were interviewed using guided interviews. FINDINGS: Two categories, consisting of three and two subcategories, emerged. Informants described their experiences of having a child with CLP, how they slowly adapted to this situation, the first meeting with their child, support from professionals, and reactions from family and other people. Parents commented on the craniofacial team with satisfaction. Due to a low level of knowledge, other professionals often had difficulty in handling the situation and a poor quality of advice on feeding was reported. Family and friends commented on the child positively or by being neutral, which was seen as a lack of interest. A visible scar on the face was seen as a problem, especially for girls. Most informants expressed anxiety about possible problems with speech. CONCLUSIONS: Parents did not look upon their child as handicapped but as having a congenital defect or 'flaw'. The findings of this study could be used in staff education to promote understanding of parents' experiences and how best to help them. They could also be used in the general media to improve public understanding. Future research could explore staff perceptions of this sensitive clinical area.

Adaptation, Psychological↗
PubMed2003

Three-dimensional nasal morphology in cleft lip and palate operated adult patients.

Nasal morphology was assessed three-dimensionally in 18 cleft lip and palate operated patients aged 19 to 27 years, and in 161 sex- and age-matched control subjects. Comparisons were performed by Student t and Watson-Williams' tests. No differences were found in nasal volume or surface. Nasal width, alar base width, and inferior width of the nostrils were significantly larger in male patients than in the reference men. The nasal bridge was shorter. Similar differences were found in the female patients. In addition, the right nostril was larger and the nasal height shorter. In men, the nasolabial and the nasal tip angles were smaller in the patients than in the reference subjects, whereas the facial convexity angle was larger in the patients. In conclusion, the nose of adult operated cleft lip and palate patients differed from that of normal control subjects. Surgical corrections of the cleft lip and palate failed to provide a completely normal appearance. The methods might be used to indicate where additional procedures might be performed to approximate a reference population.

Adult↗
PubMed1998

A comparative study of the lateral crus of alar cartilages in unilateral cleft lip nasal deformity.

To confirm whether or not the alar cartilage of the unilateral cleft lip nose is primarily hypoplastic as compared with the noncleft side, 35 unilateral cleft lip nasal patients who had no previous nasal surgery underwent direct measurement of the lateral crus of alar cartilage on both sides during their nasal tip plasties. Both lower lateral cartilages were dissected freely, and the thickness was measured at the intercrural, middle, and distal portions. The width was measured at the widest portion, and the length was measured from the intercrural point to the distal end. Two-mm-punch biopsies were obtained from each cartilage for histologic study. The lateral crus of the cleft side was no smaller than that of the noncleft side. Histologically, no difference was ascertained. In conclusion, we think the lateral crus of the alar cartilage of the cleft side is not hypoplastic. Therefore, external factors such as soft-tissue defect or external abnormal vector force are more attributable than intrinsic factors to the development of cleft lip nasal deformity.

Adolescent↗
PubMed1995

Skeletal growth after muscular reconstruction for cleft lip, alveolus and palate.

OBJECTIVE: To compare two treatments for unilateral cleft lip and palate. DESIGN: Follow-up study. SETTING: University department, Germany. SUBJECTS: 110 children with unilateral cleft lip and palate, 50 of whom were treated between 1980 and 1988 (group 1) and 60 of whom were treated between 1970 and 1979 (group 2). INTERVENTIONS: Group 1 had no dentofacial treatment before operation. At the age of 3 months they had musculoperiosteal reconstruction with no orthopaedic treatment postoperatively. At the age of 9-12 months they had the velar muscle reconstructed but no orthopaedic treatment to follow. Group 2 had dentofacial treatment before operation. At the age of 6 months they had their lips operated on by Millard's technique. Postoperatively they had dentofacial orthopaedic treatment followed, at the age of 2.5 years, by palatal surgery by the Campbell-Widmaier technique. This was followed by more dentofacial orthopaedic treatment. Main outcome measure--Growth of the midface skeleton. RESULTS: The course of the anterior tooth segment was similar in the two groups, as was the transverse development of the maxilla. Analyses of both dental casts and lateral cephalometric radiographs showed that the skeletal development in group 1 (who had undergone reconstruction of the perioral and perinasal muscles) was better than in group 2 (who had not) despite the fact that group 1 had had no orthopaedic growth stimulation. CONCLUSION: If the primary and secondary growth centres are not joined at the first operation and the midfacial muscles are not reconstructed, even orthopaedic growth stimulation will not compensate for the defect.

Alveolar Process↗
PubMed1988

A comparison of Millard's and LeMesurier's methods of repair of the complete unilateral cleft lip using a new symmetry index.

Millard's and LeMesurier's methods of cleft lip repair were compared by assessing the symmetry of six components of the repaired lip and nose of 100 children who were treated by the two methods. It was found that Millard's technique restores nostril height and the cupid's bow more effectively. LeMesurier's method, on the other hand, produces a better vermilion and philtral edge. These observations support the current view that no single method exists that is superior to any other. Rather, each has its advantages and disadvantages and, hence, may suit a particular type of defect. The Cleft Lip Component Symmetry Index (CLCSI) used in this study seems to be suitable for objective assessment of results of cleft lip repair.

Cephalometry↗
PubMed2005

Changes of vertical skeletal morphology in patients with complete unilateral and bilateral cleft lip and palate.

OBJECTIVE: The aim of this retrospective investigation was to qualify and quantify changes of the vertical skeletal morphology during puberty in cleft patients compared with an age-matched noncleft control. METHODS: Patients with unilateral cleft lip and palate (UCLP; n = 12) and bilateral cleft lip and palate (BCLP; n = 11) who fulfilled strict inclusion criteria according to the Hanover treatment protocol were evaluated by means of cephalometric analysis. Lateral cephalograms were analyzed for each cleft patient at age 10 and 15 and compared with corresponding data of a noncleft control (n = 20). RESULTS AND CONCLUSIONS: It was concluded that a vertical growth impairment of the maxilla is found in patients with cleft lip and palate. The maxilla of cleft patients shows a significant clockwise rotation, whereas the inclination of the mandible shows little difference. Consequently, there is a skeletal superposition of the jaws. The posterior height of the maxilla is significantly shorter in patients both with UCLP and BCLP at T(0) and T(1). An increase of the anterior height of the mandible is found in the cleft groups.

Adolescent↗
PubMed1999

Three-dimensional computed tomographic analysis of the primary nasal deformity in 3-month-old infants with complete unilateral cleft lip and palate.

The purpose of this study was to analyze the geometry of the primary cleft lip nasal deformity using three-dimensional computerized tomography in a group of 3-month-old infants with complete unilateral cleft lip and palate before surgical intervention. Coordinates and axes were reconfigured after the three-dimensional image was oriented into neutral position (Frankfurt horizontal, true anteroposterior, and vertical midline). Display and measurement of skin surface and osseous tissues were achieved by adjusting the computed tomographic thresholds. S-N, N-ANS, S-N-O, and S-N-ANS were measured from true lateral views. Biorbital (LO-LO), interorbital (MO-MO), intercanthal (en-en), and nasal (al-al) widths were measured from the anteroposterior view. The bony alveolar cleft width was measured from the inferior view. The study group was divided into two groups on the basis of skeletal alveolar cleft width: six patients with clefts narrower than 10 mm and six patients with clefts wider than 10 mm. Only the S-N-ANS angle differed between the two groups, i.e., it was greater in the group with the wider clefts (p < 0.05). Coordinates of six landmarks at the base of the nose [sellion (se), subnasale (sn), cleft-side and noncleft-side subalare (sbal-cl and sbal-ncl), and the most posterior point on the lateral piriform margins (PPA-CL and PPA-NCL)] were obtained for analysis of the nasal deformity. On average, the subnasale point was anterior to sellion and deviated to the noncleft side; the cleft-side sbal point was more medial, posterior, and inferior than the noncleft-side sbal point; and the PPA point on the cleft-side piriform margin was more lateral, posterior, and inferior than the PPA point on the noncleft side. These discrepancies were not universally observed. However, in all patients, four findings were observed without exception (p < 0.01): (1) subnasale (sn) was deviated to the noncleft side (mean distance from midline, 5.0 mm; range, 2 to 9.5 mm), (2) the cleft-side alar base (sbal-cl) was more posterior than the noncleft-side alar base (sbal-ncl) (mean difference, 3.6 mm; range, 1 to 5.5 mm), (3) the noncleft-side alar base (sbal-ncl) was further from the midline than the cleft-side alar base (sbal-cl) (mean difference in lateral distances of sbal-ncl and sbal-cl from the midline, 2.8 mm; range, 0.5 to 7 mm), and (4) the cleft-side piriform margin (PPA-CL) was more posterior than the noncleft side piriform margin (PPA-NCL) (mean difference, 2.1 mm; range, 0.5 to 4 mm). In conclusion, the nasal deformity in unilateral cleft lip and palate that has not been operated on is characterized by these four features and increased S-N-ANS angle with increased alveolar cleft width.

Cephalometry↗
PubMed1993

Clinical observations of cleft lip and palate.

In surgical management of cleft lip and palate, appreciation of the special anatomy and physiology of the human premaxilla is more important than the question of whether it is a separate bone. To take advantage of the potential of the premaxilla, both primary and secondary surgical procedures must strive to establish a nearly normal medial septal system and nasolabial musculature. To complement accurate muscle surgery of the lip and soft palate, the characteristics and functions of the mucoperiosteum that covers the palate must be respected. The quality of subsequent facial growth can be monitored with the architectural craniofacial cephalometric analysis. By adopting a physiologic approach to cephalometrics, the clinician can avoid some common errors of interpretation.

Cephalometry↗