Itinerário terapêutico de crianças com fissura labiopalatina / Itinerario terapéutico del niño con labio y paladar hendido / Therapeutic itinerary of children with cleft lip and palate

Resumo Objetivo conhecer o itinerário terapêutico de crianças com fissuras de lábio e/ou palato. Método estudo descritivo de natureza qualitativa realizado com famílias de crianças com fissura labiopalatina. A coleta de dados ocorreu entre junho e julho de 2022 por meio de entrevistas semiestruturadas, e aplicou-se a análise de conteúdo temática. Resultados participaram oito famílias e emergiram três categorias: I) Enfrentando o desconhecido: diagnóstico de fissura labiopalatina na criança - notaram-se sentimentos de choque, medo e incerteza que permeiam durante o diagnóstico precoce ou tardio; II) Um caminho árduo: pausas e recomeços durante o itinerário terapêutico - observou-se que as famílias percorreram caminhos diferentes devido à especificidade da configuração familiar e da própria fissura; III) Tecendo a rede de apoio para o cuidado - mostrou-se ser de extrema necessidade o apoio dos amigos, família, profissionais e instituições de saúde. Conclusões e implicações para prática o itinerário terapêutico de crianças com fissura labiopalatina é árduo e acompanhado de desafios, que se iniciam no diagnóstico e permanecem após o nascimento. Espera-se que os resultados deste estudo suscitem o diálogo entre os profissionais de saúde e se familiarizem com as necessidades dessa população e possam atuar nos diferentes pontos de atenção à saúde.

Resumen Objetivo conocer el itinerario terapéutico de los niños con labio hendido y/o paladar hendido. Método estudio cualitativo descriptivo realizado con familias de niños con labio y paladar hendido. La recolección de datos se realizó entre junio y julio de 2022 mediante entrevistas semiestructuradas, y se aplicó análisis de contenido temático. Resultados participaron ocho familias y surgieron tres categorías: I) Frente a lo desconocido: diagnóstico de labio y paladar hendido en niños: se observaron sentimientos de shock, miedo e incertidumbre que permean durante el diagnóstico temprano o tardío; II) Un camino arduo: pausas e inicios durante el itinerario terapéutico - se observó que las familias siguieron caminos diferentes debido a la especificidad de la configuración familiar y de la propia hendidura; III) Tejer la red de apoyo para la atención: el apoyo de amigos, familiares, profesionales e instituciones de salud resultó ser extremadamente necesario. Conclusiones e implicaciones para la práctica el itinerario terapéutico de los niños con labio y paladar hendido es arduo y está acompañado de desafíos, que comienzan desde el diagnóstico y continúan después del nacimiento. Se espera que los resultados de este estudio fomenten el diálogo entre los profesionales de la salud y conozcan las necesidades de esta población y puedan actuar en los diferentes puntos de la atención en salud.

Abstract Objective to understand the therapeutic itinerary of children with cleft lip and/or palate. Method a descriptive qualitative study carried out with families of children with cleft lip and palate. Data collection took place between June and July 2022 through semi-structured interviews, and thematic content analysis was applied. Results eight families participated and three categories emerged: I) Facing the unknown: diagnosis of cleft lip and palate in children - feelings of shock, fear and uncertainty were noted that permeate during early or late diagnosis; II) An arduous path: pauses and beginnings during the therapeutic itinerary - it was observed that the families followed different paths due to the specificity of the family configuration and the cleft itself; III) Weaving the support network for care - support from friends, family, professionals and health institutions proved to be extremely necessary. Conclusions and implications for practice the therapeutic itinerary of children with cleft lip and palate is arduous and followed by challenges, which begin at diagnosis and continue after birth. It is hoped that the results of this study will encourage dialogue among health professionals and become familiar with the needs of this population and be able to act at different points of health care.

Displasia frontonasal / Frontonasal dysplasia

Los trastornos del desarrollo son aquellos padecimientos que se manifiestan por defectos en la embriogénesis de la región afectada. La cara del ser humano comienza su formación alrededor de la cuarta semana de vida intrauterina y se manifiesta gracias a la fusión de cinco prominencias: dos pares conocidas como maxilar y mandibular, y una impar conocida como frontonasal. Cuando esta fusión no se lleva a cabo de una forma óptima, aparecen numerosas alteraciones del desarrollo como el labio y paladar hendido, y la displasia frontonasal. La displasia frontonasal produce frecuentemente afecciones oculares, nasales y orales. Dentro de las manifestaciones orales destacan una forma atípica de hendidura labial o palatina, afecciones dentales y alteraciones en el crecimiento de la cara. Dada la gran relación que este padecimiento tiene con la cavidad oral resulta importante que el odontólogo conozca la etiología y las características clínicas de este trastorno (AU)

Developmental disorders are those conditions that are manifested by defects in the embryogenesis of the affected region. The human face begins its formation around the fourth week of intrauterine life and is manifested thanks to the fusion of five prominences: two pairs known as maxillary and mandibular and odd one known as frontonasal. When this fusion is not carried out in an optimal way, numerous developmental alterations appear, such as cleft lip and palate and frontonasal dysplasia. Frontonasal dysplasia frequently produces ocular, nasal and oral affections. Among the oral manifestations, and atypical form of clef lip and/or palate, dental affections and alterations in the growth of the face stand out. Given the great relationship that this condition has with the oral cavity, it is important for the dentist to know the etiology and clinical characteristics of this disorder (AU)

Uso del modelador nasolabial (NAM) como tratamiento ortopédico prequirúrgico de paciente con labio y paladar hendido / Use of nasoalveolar molding (NAM) as a pre-surgical orthopedic treatment for patients with cleft lip and palate

Introducción: el labio y paladar hendido es la malformación craneofacial congénita más frecuente y es producida por una falla en la fusión de procesos faciales durante periodos iniciales en el desarrollo embrionario. Objetivo: el objetivo de la ortopedia prequirúrgica es facilitar la primera intervención para la corrección de esta condición de manera que disminuya el trauma quirúrgico, al obtener una menor formación de cicatrices y menor riesgo de complicaciones postquirúrgicas, además de ayudar a obtener una óptima deglución en el paciente para mejorar el aspecto nutricional en el bebé. Material y métodos: el paciente fue llevado a la clínica a las dos semanas de nacido para la toma de impresión y colocación de un aparato ortopédico; se le colocó el NAM (nasoalveolar molding), la cinta transport, además se realizaban citas una vez al mes para evaluar el stent nasal, activarlo y revisar que la colocación de la cinta estuviese correcta, así como para comprobar que la alimentación del bebé estuviera mejorando. Resultados: se observa una mejoría anatómica y fisiológica, también una disminución de la fisura labial de 6 mm y una remodelación nasal. Se notó una mejora en deglución y alimentación con ganancia de peso. Conclusiones: la ortopedia prequirúrgica con el NAM es una terapia aceptable y recomendable para los pacientes con labio y paladar hendido, ya que nos ayudan a generar mejores resultados quirúrgicos, además de colaborar con el aspecto nutricional del bebe (AU)

Introduction: cleft lip and palate is a craniofacial malformation most frequent congenital and is produced by a failure to fuse facial processes during early periods in embryonic development. Objective: the objective of pre-surgical orthopedics is to facilitate the first intervention for the correction of this condition, reducing surgical trauma, obtaining less scar formation and less risk of post-surgical complications, in addition to helping the patient obtain better swallowing to improve the nutritional aspect in the baby. Material and methods: the patient came to the clinic at two weeks of age for impression taking and placement of the orthopedic device. The NAM (nasoalveolar molding) and the transport tape were placed and appointments were made once a month to evaluate the nasal stent, activate it and check that the placement of the tape was correct, as well as to check that the baby's feeding was improving. Results: an anatomical and physiological improvement is observed, as well as a 6mm decrease in the cleft lip and nasal remodeling. An improvement in swallowing and feeding with weight gain was observed. Conclusions: pre-surgical orthopedics with NAM is an acceptable and recommended therapy for patients with cleft lip and palate since it helps us to generate better surgical results in addition to collaborating with the nutritional aspect of the baby (AU)

Investigación en fisuras faciales: quo vadis España? / Investigation in facial fissures: quo vadis Spain?

Las fisuras orofaciales representan un grupo heterogéneo de malformaciones congénitas que afectan a distintas estructuras de la cavidad oral y de la cara. Globalmente, los bebés con estos trastornos presentan una mayor morbilidad y mortalidad a lo largo de su vida en comparación con individuos no afectados. Por ello, los avances en la investigación biomédica resultan ineludibles. Así, el objetivo general de este trabajo fue llevar a cabo una revisión bibliográfica para analizar narrativamente los 10 principales estudios primarios sobre fisuras orofaciales llevados a cabo en España, publicados del 2018 hasta la actualidad. Según esto, a nivel institucional, destaca la Universidad Complutense de Madrid (UCM) con cuatro artículos publicados por el grupo de investigación UCM 920202. También sobresale la Universidad Rey Juan Carlos de Madrid, con tres artículos relacionados con diferentes aspectos de la personalidad y la calidad de vida de los pacientes fisurados, así como otras muchas variables cognitivo-emocionales. En relación con la Universidad de Valencia, encontramos dos artículos llevados a cabo en amplias muestras de pacientes con fisuras. Por último, en Barcelona resulta destacable un estudio observacional sobre problemas otorrinolaringológicos en pacientes operados de fisura palatina. En conclusión, si bien en los últimos años se han publicado varios artículos sobre distintos aspectos relacionados con las fisuras, aún queda mucho trabajo por hacer. España debería seguir potenciando proyectos con líneas de trabajo centradas en estas alteraciones del desarrollo craneofacial. Se necesitan estudios amplios, multicéntricos y colaborativos, para ahondar en los mecanismos etiológicos y, en última instancia, en las posibles herramientas para su prevención. Del mismo modo, se necesitan ayudas para dilucidar mejor las cuestiones relacionadas con los tratamientos en todas las dimensiones de la salud, preferentemente a partir de ensayos clínicos controlados aleatorizados, que faciliten la traslación de conocimientos y su accesibilidad universal dentro del sistema sanitario público español.

SUMMARY: Orofacial clefts represent a heterogeneous group of congenital malformations affecting different structures of the oral cavity and face. Overall, infants with these disorders have a higher lifetime morbidity and mortality compared to unaffected individuals. Therefore, advances in biomedical research are unavoidable. Thus, the overall objective of this work was to conduct a literature review to narratively analyse the 10 main primary studies on orofacial clefts carried out in Spain, published from 2018 to date. According to this review, at an institutional level, the Complutense University of Madrid (UCM) is notable with 4 articles published by the UCM 920202 research group. The Rey Juan Carlos University of Madrid also stands out, with three papers related to different aspects of the personality and quality of life of cleft patients, as well as many other cognitive-emotional variables. In relation to the University of Valencia, we found two studies carried out on large samples of cleft patients. Finally, in Barcelona, an observational study on otorhinolaryngological problems in cleft palate patients is noteworthy. In conclusion, although several studies have been published in recent years on different aspects related to clefts, there is still much work to be done. Spain should craniofacial development. Large, multicenter and collaborative studies are needed to delve deeper into the aetiological mechanisms and, ultimately, into the possible tools for their prevention. Similarly, support is needed to better elucidate questions related to treatments in all dimensions of health, preferably randomised controlled clinical trials, which facilitate the transfer of knowledge and its universal accessibility within the Spanish public health system.

Vírus e fissuras orofaciais: um histórico isolado e de associação / Viruses and orofacial clefts: an isolated and associational history / Virus y fisuras orofaciales: una historia aislada y asociativa

Os vírus são microrganismos comumente associados as doenças e infectam todos os seres vivos. Atuam de forma direta e indireta levando a pressão seletiva, com papel significativo e ainda em exploração no planeta. As fissuras orofaciais são anomalias congênitas de etiologia complexa e multifatorial, sendo as infecções virais durante a gestação um dos possíveis fatores etiológicos. A história da humanidade frente aos vírus e fissuras orofaciais de forma isolada é vasta, remontando a períodos antes de Cristo, seja por meio de leis para o controle de pragas e/ou por lendas de míticas criaturas deificadas e/ou demonizadas, cuja criação está fundamentada na Teoria Alegórica do surgimento das mitologias, demonstrando assim o interesse do ser humano e sua curiosidade em inovação e explicação destes assuntos. Considerando a relevância histórica, bem como a possível relação etiológica destes dois elementos, uma revisão da literatura foi realizada para apresentar a história mitológica e científica dos vírus e fissuras orofaciais, de forma isolada e associadas para fins de comparação. Para isso, foram utilizadas as bases PubMed/Medline, SciElo, LILACS e Portal Periódicos (CAPES) com os descritores: Virus, Anomalias/Anomalies, Virus and Anomalias/Virus and Anomalies, A History of viruses/História dos vírus, Virus and History/História and Virus, Virus and Myth/Virus and Mito, Anomalias and Mitos/Anomalies and Myths, Vampires and Virus/Vampiros and Virus. Enquanto o histórico mitológico é cheio de teorias contraditórias, o histórico cientifico acadêmico se revela coerente, porém resistente as novas áreas de atuação, não ponderando novas possibilidades e limitando a exploração científica, que só pôde ser alcançada nos séculos atuais. Quanto a associação, a linha de pesquisa relacionando vírus e fissuras orofaciais não possui nem meio século de existência, propiciando um grande campo a ser explorado e na mesma medida limitando os benefícios em prevenção que poderiam ser obtidos através destes estudos.

Viruses are microorganisms commonly associated with diseases that infect all living beings, they act directly and indirectly leading to selective pressure, their role on the planet is significant and still under exploration. Orofacial clefts are congenital anomalies that have a complex multifactorial etiology, with viral infections during pregnancy being one of the possible etiological factors. The history of humanity in the face of viruses and orofacial clefts in isolation is vast, dating back to periods before Christ, whether through laws for pest control and/or legends of mythical deified and/or demonized creatures, whose creation is fundamentalized in the Allegorical Theory of the emergence of mythologies, thus demonstrating the interest of human beings and their curiosity in innovation and explanation of these subjects. Considering the historical relevance, as well as the possible etiology relationship of these two elements, we carried out a literature review to present the mythological and scientific history of viruses and orofacial clefts, isolated and associated for comparison purposes. For this intent, the bases PubMed/Medline, SciElo, LILACS and Portal Periódicos (CAPES) were selected with the descriptors: A History of viruses/História dos vírus, Virus and History/História and Virus, Virus and Myth/Virus and Mito, Anomalias and Mitos/Anomalies and Myths, Vampires and Virus/Vampiros and Virus. While the mythological history is full of contradictory theories, the academic, scientific history proves to be consistent, but resistant to new areas of action, not considering new possibilities and limiting scientific exploration, which can only be achieved in the present centuries. As for the association, the line of research relating viruses and orofacial clefts does not even have half a century of existence, providing a large field to be explored and at the same time limiting the benefits of prevention that could be obtained through these studies.

Los virus son microorganismos comúnmente asociados a enfermedades que infectan a todos los seres vivos, actúan directa e indirectamente provocando presión selectiva, su papel en el planeta es significativo y aún en exploración. Las hendiduras orofaciales son anomalías congénitas que tienen una compleja etiología multifactorial, siendo las infecciones virales durante el embarazo uno de los posibles factores etiológicos. La historia de la humanidad frente a los virus y las hendiduras orofaciales de forma aislada es vasta, remontándose a períodos anteriores a Cristo, ya sea a través de leyes para el control de plagas y/o leyendas de criaturas míticas deificadas y/o demonizadas, cuya creación se fundamentaliza en la Teoría Alegórica del surgimiento de las mitologías, demostrando así el interés del ser humano y su curiosidad en la innovación y explicación de estos temas. Considerando la relevancia histórica, así como la posible relación etiológica de estos dos elementos, realizamos una revisión bibliográfica para presentar la historia mitológica y científica de los virus y las hendiduras orofaciales, aislados y asociados para fines de comparación. Para ello, se seleccionaron las bases PubMed/Medline, SciElo, LILACS y Portal Periódicos (CAPES) con los descriptores: A History of viruses/História dos vírus, Virus and History/História and Virus, Virus and Myth/Virus and Mito, Anomalias and Mitos/Anomalías y Mitos, Vampiros and Virus/Vampiros y Virus. Mientras que la historia mitológica está llena de teorías contradictorias, la historia académica, científica, se muestra coherente, pero resistente a nuevos campos de actuación, no considerando nuevas posibilidades y limitando la exploración científica, que sólo puede alcanzarse en los siglos actuales. En cuanto a la asociación, la línea de investigación que relaciona virus y hendiduras orofaciales no tiene ni medio siglo de existencia, proporcionando un gran campo a ser explorado y al mismo tiempo limitando los beneficios de prevención que podrían ser obtenidos a través de estos estudios.

Does the rehabilitation treatment predispose the patient with cleft to endodontic treatment?

Aim: to verify the relation between endodontic treatment of teeth adjacent to the cleft area and the rehabilitation of patients with unilateral cleft lip and palate, at the Hospital for Rehabilitation of Craniofacial Anomalies. Methods: the present split-mouth study was composed of 406 individuals with complete unilateral cleft lip and palate who had completed the rehabilitation process in a single tertiary cleft center (55.9% males). The information was collected from the dental history on the patients' records and radiographs. The frequency of endodontic treatment in the upper incisors and canines was calculated for the cleft and non-cleft sides. The comparison between sides was performed by the chi-square test (p <0.05). Results: endodontic treatment was more frequent in teeth adjacent to the cleft than in contralateral teeth. The frequency of endodontic treatment in at least one tooth adjacent to the cleft was 18.97%, and 11.6% on the contralateral side. It was observed that endodontic treatment was necessary in 63.5% of patients who had been submitted to orthodontic treatment, 42.4% of those rehabilitated with fixed partial dentures and 12.0% of patients who underwent dental reshaping of teeth adjacent to the cleft. The treatments performed included vital pulp therapy (46.1%), non-vital pulp therapy (46.8%) and endodontic retreatment (7.1%). Conclusion: in individuals with complete cleft lip and palate, teeth close to the bone defect area and used for rehabilitation treatment presented greater need of endodontic intervention

Higher maternal age is associated with higher occurrence of cleft lip/palate in neonates under intensive care

Aim: To assess the prevalence of cleft lip and/or cleft palate (CL/P) and associated variables in neonates admitted to neonatal intensive care units (ICU). Methods: Medical charts for neonates born and admitted to the ICU between 2012 and 2018 were reviewed. Obstetric and neonatal variables were collected by a trained researcher. In the case group, all neonates with CL/P were included. The control group was formed by matching sex, prematurity and month of birth using random number generation. Neonates with congenital malformations were excluded from the control group. Adjusted logistic regression was used (p<0.05). Results: The prevalence of CL/P was 0.43% (n=15). Five cases were excluded, as pairing was not possible. Twenty neonates were included in the control group. In the final multivariate model, CL/P was only associated with increased maternal age. For each year of increase in maternal age, neonates had a 35.2% higher chance of presenting CL/P (95% confidence interval: 1.021­1.792). Conclusions: Higher maternal age was associated with higher occurrence of CL/P in neonates admitted to the ICU. No other neonatal or maternal independent variables were associated with CL/P. Due to missing data, interpretation of study results must be approached with caution

Surgical effects of rehabilitation protocols on dental arch occlusion of children with cleft lip and palate

Aim: to evaluate the surgical effects of two rehabilitation protocols on dental arch occlusion of 5-year-old children with or without cleft lip and palate. Methods: this is a retrospective longitudinal study the sample comprised 45 digitized dental casts divided into followed groups: Group 1 (G1) ­ children who underwent to cheiloplasty (Millard technique) at 3 months and to one-stage palatoplasty (von Langenbeck technique) at 12 months; Group 2 (G2) ­ children who underwent to cheiloplasty (Millard technique) and two-stage palatoplasty (Hans Pichler technique for hard palate closure) at 3 months and at 12 months to soft palate closure (Sommerlad technique); and Group 3 (G3) ­ children without craniofacial anomalies. Linear measurements, area, and occlusion were evaluated by stereophotogrammetry software. Shapiro-Wilk test was used to verify normality. ANOVA followed by posthoc Tukey test and Kruskal-Wallis followed by posthoc Dunn tests were used to compared groups. Results: For the measures intercanine distance (C-C'), anterior length of dental arch (I-CC'), and total length of the dental arch (I­MM'), there were statistical differences between G1x G3 and G2xG3, the mean was smaller for G1 and G2. No statistically significant differences occurred in the intermolar distance and in the dental arch area among groups. The occlusion analysis revealed significant difference in the comparison of the three groups (p=0.0004). Conclusion: The surgical effects of two rehabilitation protocols affected the occlusion and the development of the anterior region of the maxilla of children with oral clefts when compared to children without oral clefts.

Fisura labio palatina: revisión de la literatura / Cleft lip and palate: literature review

La formación del paladar ocurre entre la quinta y undécima semana de vida intrauterina producto de la unión del paladar primario y secundario. Por otra parte, la formación del labio superior ocurre entre la quinta y sexta semana del desarrollo, y se configura en su parte media por la fusión de los procesos nasales mediales y lateralmente, a expensas de los procesos maxilares. La prevalencia de las fisuras labiales y/o fisura palatina varía según las distintas etnias, con cifras entre 0,7 hasta 1,1 casos por 1000 nacidos vivos. El objetivo de este trabajo fue realizar una revisión bibliográfica sobre aspectos epidemiológicos, mecanismos genéticos moleculares y ambientales que influyen en la ocurrencia de la fisura labial, fisura palatina y fisura labio palatina. La búsqueda bibliográfica se realizó en las bases de datos PUBMED, SCOPUS, SPRINGER, SCIENCEDIRECT utilizando los términos en inglés "cleft lip and palate", "cleft lip", "cleft palate" y "embriology". Entre los criterios de inclusión se consideraron estudios realizados en humanos y animales, publicados entre los años 2015 y 2021. La búsqueda arrojó un total de 407 trabajos, de los cuales tras un filtro por título y resumen quedaron un total de 38 artículos, en los cuales se realizó un análisis de texto completo para finalmente seleccionar 26 artículos que abarcan temas genéticos-moleculares, ambientales, epidemiológicos y sindrómicos. Además se incorporaron por búsqueda manual, 6 documentos asociados a libros de texto, y artículos científicos, sin considerar el criterio inclusión de tiempo. Dentro de esta revisión se describe la fuerte asociación entre las fisuras orales y las mutaciones de genes Msx1, sonic hedgehog, proteínas morfogenéticas óseas y factor de crecimiento fibroblástico durante la migración de las células de la cresta neural y la modelación y formación del paladar. La ausencia de ácido fólico durante el desarrollo del paladar y la presencia de hipoxia por exposición a humo, son los factores ambientales observados con mayor frecuencia en malformaciones orofaciales.

SUMMARY: Palate formation occurs between the fifth and eleventh week of intrauterine life as a result of the union of the primary and secondary palate. On the other hand, the formation of the upper lip occurs between the fifth and sixth week of development, and is configured in its middle part by the fusion of the medial and lateral nasal processes, at the expense of the maxillary processes. The prevalence of cleft lips and / or cleft palate varies according to the different ethnic groups, with figures ranging from 0.7 to 1.1 cases per 1000 live births. The aim of this work was to carry out a literature review on epidemiological aspects, molecular and environmental genetic mechanisms that influence the occurrence of cleft lip, cleft palate and its embriology. The literature search was carried out in the databases PUBMED, SCOPUS, SPRINGER, SCIENCEDIRECT using the English terms "cleft lip and palate", "cleft lip", "cleft palate" and "embryology". Inclusion criteria included studies carried out in humans and animals, published between 2015 and 2021. The search yielded a total of 407 works, of which after a filter by title and abstract, a total of 38 articles remained, in which a text analysis was carried out complete to finally select 26 articles that cover genetic-molecular, environmental, epidemiological and syndromic topics. In addition, 6 documents associated with textbooks and scientific articles were incorporated by manual search, without considering the inclusion criterion of time. This review describes the strong association between oral fissures and mutations of genes Msx1, sonic hedgehog, bone morphogenetic proteins and fibroblast growth factor during migration of neural crest cells and palate shaping and formation. Lack of folic acid during palae development dar and the presence of hypoxia due to exposure to smoke, are the environmental factors most frequently observed in orofacial malformations.

Dental treatment before surgery in a patient with cleft lip and palate: case report / Efeito do Cissus quadrangularis na cicatrização de fraturas em animais de laboratório

Introduction: orofacial clefts are common congenital malformations with an important social, psychological, and economic impact. The treatment of this condition may include different surgical procedures that previously require an adequate oral condition. Case report: we report a case of dental treatment before palatoplasty in a male patient of 17 years-old with bilateral cleft lip and palate and lesion in the jugal mucosa. Final considerations: the adequacy of the oral environment is a fundamental step in the treatment of patients with orofacial clefts and aims to restore oral health regardless of the degree of complexity of the dental treatment through the reduction of the pathogenic microbiota, elimination of retentive niches, instructions on diet and adequate oral hygiene and constant patient motivation.

Objetivos: as fissuras orofaciais são malformações congênitas comuns, com importante impacto social, psicológico e econômico. O tratamento dessa condição pode incluir vários procedimentos cirúrgicos que requerem previamente uma adequada condição bucal. Relato de caso: Relatamos o caso de tratamento odontológico prévio a palatoplastia em um paciente do gênero masculino de 17 anos de idade, com fissura transforame incisivo bilateral e lesão em mucosa jugal. Considerações finais: A adequação do meio bucal é uma etapa fundamental no tratamento de pacientes com fissuras orofaciais e visa restabelecer a saúde bucal independente do grau de complexidade do tratamento odontológico por meio da redução da microbiota patogênica, eliminação de nichos retentivos, orientações sobre dieta e higiene bucal adequada e motivação constante do paciente.

Modificación de Mulliken en la reparación de la fisura labial unilateral incompleta en Matanzas, 2016-2018 / Mulliken modification in the repair of incomplete unilateral cleft lip in Matanzas, 2016-2018

RESUMEN El impacto biológico, social, económico y psicológico que acarrea la fisura labial conlleva a aplicar nuevas modificaciones en la corrección quirúrgica de sus técnicas de tratamiento. El objetivo de esta investigación fue evaluar los resultados de la técnica quirúrgica de Rotación y Avance de Millard modificada por Mulliken en la corrección de la fisura labial unilateral incompleta en Matanzas. Se realizó un estudio de casos, longitudinal, prospectivo en el Hospital Docente Pediátrico «Eliseo Noel Caamaño¼ de Matanzas, entre 2016 y 2018. El universo estuvo constituido por menores de un año diagnosticados de fisura labial unilateral incompleta, que asistieron a la consulta de Cirugía Maxilofacial de dicho hospital, en el período en que se realizó la investigación y en los que para su tratamiento se empleó la técnica de Rotación y Avance de Millard modificada por Mulliken. Se trabajó con la totalidad del universo. Se utilizó estadística descriptiva. Los pacientes fueron intervenidos entre los 5 y 9 meses, predominó el color de piel blanca (75 %) y el sexo masculino (75 %). La altura labial y el ancho heminasal aumentaron más en el lado sano que en el fisurado. Al año de la intervención en el lado fisurado creció más el ancho transversal que en el sano en dos de los casos y también existió una diferencia mayor de 1 mm en la altura del bermellón. Se logró alcanzar simetría nasolabial en espejo del lado sano en todas las variables, excepto en la altura del bermellón en dos casos.

ABSTRACT The biological, social, economic and psychological impact caused by cleft lip leads to the application of new modifications in the surgical correction of its treatment techniques. The objective of this research was to evaluate the results of the Millard's rotation-advancement surgical technique modified by Mulliken in the correction of incomplete unilateral cleft lip in Matanzas. A longitudinal, prospective study was conducted at "Eliseo Noel Caamaño" Pediatric Teaching Hospital, in Matanzas between 2016 and 2018. The universe was made up of children under one year of age diagnosed with incomplete unilateral cleft lip, who come to the Maxillofacial Surgery consultation of this hospital, in the period in which the investigation was carried out and in whom, Millard 's rotation-advancement surgical technique modified by Mulliken was used for their treatment. We worked with the entire universe. Descriptive statistics was used. The patients underwent surgery between 5 and 9 months, white skin color (75%) and male gender (75%) predominated. Labial height and heminasal width increased more on the healthy side than on the cleft side. One year after the intervention, the transverse width grew more on the cleft side than on the healthy side in two of the cases, and there was also a difference greater than 1 mm in the vermilion height. Mirror-image nasolabial symmetry was achieved on the healthy side in all variables, except for vermilion height in two cases.

Análise Descritiva da Ocorrência de Fenda Orofacial ­ Série Histórica de 2007 a 2016 no Sul do Brasil / Descriptive Analysis of the Occurrence of Orofacial Cleft - Historical Series from 2007 to 2016 in Southern Brazil

Introdução: Entre a quarta e décima segunda semana de gestação, ocorre o desenvolvimento da cavidade bucal e da face. Caso aconteça alguma desordem nesse período, acarretará a formação de fissuras labiopalatinas, uma das mais frequentes anomalias congênitas orofaciais. Este estudo teve como objetivo analisar a tendência temporal de fissura labiopalatina no sul do Brasil, durante o período de 2007-2016, e caracterizar o perfil epidemiológico do recém-nascido e da mãe dos portadores dessa malformação. Métodos: Estudo descritivo de tipo ecológico, tendo como fonte de dados o Sistema de Informações de Nascidos Vivos (SINASC). Foram pesquisados 3203 nascimentos com fenda orofacial no sul do Brasil durante o período estudado. Resultados: Observou-se uma homogeneidade em relação à incidência dessa malformação nos três estados estudados ­ 8,39 casos a cada 10.000 nascimentos, com leve predomínio em Santa Catarina. Quanto ao perfil epidemiológico dos recém-nascidos, notou-se uma incidência 37% maior no sexo masculino do que no sexo feminino. Além disso, a incidência dessa malformação ocorreu mais em indivíduos com baixo peso ao nascer e em prematuros. Em relação ao perfil epidemiológico das mães dos recém-nascidos com fissura labiopalatina, a idade materna apresentou um pico bimodal, com incidência 21% maior em mulheres com menos de 14 anos do que com mais de 35 anos. Conclusão: Este estudo demonstrou fatores de risco para fissura labiopalatina como: sexo masculino, baixo peso ao nascer, parto cesário, pré-natal incompleto, prematuridade, extremos de idade materna e baixo grau de instrução materna.

Introduction: Between the fourth and twelfth week of gestation, the development of the oral cavity and face occurs. If any disorder occurs during this period, it will lead to cleft lip and palate formation, one of the most frequent congenital orofacial anomalies. This study aimed to analyze the temporal trend of cleft lip and palate in southern Brazil from 2007 to 2016 and to characterize the epidemiological profile of the newborn and the mother of carriers of this malformation. Methods: A descriptive study of ecological type using the Live Births Information System (SINASC) as a data source. A total of 3203 births with orofacial cleft were surveyed in southern Brazil during the period studied. Results: Homogeneity was observed regarding the incidence of this malformation in the three states studied - 8.39 cases per 10,000 births, with a slight predominance in Santa Catarina. Concerning the epidemiological profile of the newborns, we observed a 37% higher incidence in males than in females, and the incidence of this malformation occurred more in individuals with low birth weight and premature babies. Regarding the epidemiological profile of mothers of newborns with cleft lip and palate, maternal age showed a bimodal peak, with a 21% higher incidence in women aged under 14 than in those over 35. Conclusion: This study demonstrated risk factors for cleft lip and palate, such as male gender, low birth weight, cesarean delivery, incomplete prenatal care, prematurity, extremes of maternal age, and low maternal education.

Rinoplastia secundaria en pacientes con fisura labiopalatina / Secondary Rhinoplasty in Patients with Clef lip and Palate

Introducción: La deformidad nasal asociada con el labio leporino ha sido vista como uno de los problemas reconstructivos más desafiantes en la rinoplastia, hasta el momento no se ha acordado ningún método único para cuantificar el éxito del tratamiento. En el año 2006 se aprobó oficialmente el protocolo para el tratamiento de las deformidades nasales complejas del Hospital Clínico Quirúrgico "Hermanos Ameijeiras", que están incluidas, las deformidades nasales congénitas secundarias en el adulto, no se recogen antecedentes de resultados en este grupo de pacientes basados en mediciones objetivas. Objetivo: Evaluar los resultados estéticos de la rinoplastia secundaria en pacientes con fisura labiopalatina. Métodos: Se realizó un estudio analítico a través de mediciones nasales angulares y de áreas, comparadas en fotografías estandarizadas entre el pre y posoperatorio y se determinó el índice de asimetría según la fórmula de Nakamura. Un panel de expertos usó la escala de Asher McDade y realizó la evaluación subjetiva de las imágenes, que permitió calcular el índice estético antes y después del tratamiento. Resultados: Se obtuvo una reducción marcada de todos los índices de asimetría nasal entre el pre y posoperatorio, así como una mejoría del índice estético posoperatorio pasándose de una apariencia pobre a muy buena apariencia. Conclusiones: Con la aplicación del protocolo para el tratamiento de las deformidades nasales del paciente fisurado adulto del Hospital Clínico Quirúrgico "Hermanos Ameijeiras" se obtienen buenos resultados estéticos(AU)

Introduction: Nasal deformity associated with cleft lip has been seen as one of the most challenging reconstructive problems in rhinoplasty; up to date, no single method has been agreed upon to quantify management success. In 2006, the protocol for managing complex nasal deformities was officially approved by Hermanos Ameijeiras Clinical Surgical Hospital, which includes secondary congenital nasal deformities in adults; however, there is no history of outcomes in this group of patients based on objective measurements. Objective: To assess the aesthetic outcomes of secondary rhinoplasty in patients with cleft lip and palate. Methods: An analytical study was carried out through linear and angular nasal measurements, compared in standardized photographs between the pre- and postoperative period; while the asymmetry index was determined according to Nakamura's formula. A panel of experts used the Asher McDade scale and performed the subjective assessment of the images, which allowed calculation of the esthetic index before and after the procedure. Results: A marked reduction was obtained in all nasal asymmetry indexes between the pre- and postoperative periods; as well as an improvement in the postoperative aesthetic index, from a poor appearance to a very good appearance. Conclusions: With the application of the protocol for managing nasal deformities of the adult cleft patient of Hermanos Ameijeiras Clinical Surgical Hospital, good esthetic outcomes are obtained(AU)

Evaluation of palatal volume in children with cleft lip and palate: a comparison of two surgical protocols / Avaliação volumétrica do palato em crianças com fissura labiopalatina: comparação de dois protocolos cirúrgicos

Objective: Compare the palatal volume in children with unilateral cleft lip and palate before and after two surgical protocols. Material and Methods: Retrospective data collection was performed in a specialized hospital. The sample comprised 120 digitized dental models divided into, Group 1 (G1) ­ participants submitted to cheiloplasty at 3 months (Millard technique) and one-step palatoplasty at 12 months (von Langenbeck technique); Group 2 (G2) ­ participants submitted to cheiloplasty (Millard technique) and hard palate closure (Hans Pichler technique) at 3 months and soft palate closure at 12 months (Sommerlad technique). The dental models were evaluated at Time 1 (T1): before primary plastic surgeries, Time 2 (T2): 1st post-surgical phase, and Time 3 (T3): 2nd post-surgical phase. The volume was measured through stereophotogrammetry system software. Parametric and non-parametric statistical tests were applied (α=5%). Results: The intragroup analysis revealed that G1 had a statistically significant increase in volume at T2 followed by a reduction at T3 (p=0.003); G2 showed a statistically significant increase of dental arch volume between T1 and T2 (p=0.001). There was no statistically significant difference in the intergroup and gender analyses (p>0.05). Conclusion: The surgical protocol influenced the palatal volume of children with unilateral cleft lip and palate. This study suggested that two-step palatoplasty protocol has a tendency to be more appropriate.(AU)

Objetivo: Comparar o volume palatino em crianças com fissura unilateral de lábio e palato antes e após dois protocolos cirúrgicos. Material e Métodos: A coleta de dados retrospectiva foi efetuada em um hospital especializado. A amostra foi composta por 120 modelos dentários digitalizados divididos em, Grupo 1 (G1) ­ participantes submetidos a queiloplastia aos 3 meses de vida (técnida de Millard) e a palatoplastia em única etapa aos 12 meses (técnica de von Langenbeck); Grupo 2 (G2) ­ participantes submetidos a queiloplastia (técnica de Millard) e fechamento do palato duro (técnica de Hans Pichler) aos 3 meses de vida e fechamento do palate mole aos 12 meses (técnica de Sommerlad). Os modelos dentários foram avaliados em Tempo 1 (T1): antes das cirurgias plásticas primárias, Tempo 2 (T2):1ª fase pós-cirúrgica e Tempo 3 (T3): 2ª fase pós-cirúrgico. O volume foi mensurado por meio do software do sistema de estereofotogrametria. Testes estatísticos paramétricos e não-paramétricos foram utilizados (α=5%). Resultados: As análises intragrupos indicaram que G1 apresentou aumento estatisticamente significante em T2 seguido de redução em T3 (p=0.003). G2 apresentou crescimento estatisticamente significativo do volume palatino entre T1 e T2 (p=0.001). Não houve diferença estatisticamente significante nas análises intergrupos e entre gêneros (p>0.05). Conclusão: O protocolo cirúrgico influenciou o volume palatino das crianças com fissura unilateral de lábio e palato. Este estudo sugeriu que o protocolo da palatoplastia em duas etapas possui uma tendência de ser mais apropriado.(AU)

Éxito de la ortopedia prequirúrgica en pacientes con labio fisurado y paladar hendido ­ Revisión de alcance / Sucesso pré-cirúrgico em ortopedia em pacientes com fissura de labio e palato - Revisão da abordagem / Pre-surgical orthopedics success in patients with cleft lip and cleft palate - Scoping review

Resumen: Kerr McNeil, protesista escocés introdujo la ortopedia maxilar neonatal hace más de dos siglos, fue así que sugirió inicialmente que la reposición de los segmentos maxilares mediante aparatos ortopédicos producía una maxila aparentemente normal. Se han descrito distintos tipos de aparatología ortopédica prequirúgica, divididos en tres categorías: activos, semiactivos y pasivos. Objetivo: Realizar una búsqueda de la literatura en bases de datos indexadas sobre el éxito de la ortopedia prequirúrgica en pacientes con labio fisurado y paladar hendido. Metodología: Se realizó una búsqueda computarizada en las siguientes bases de datos electrónicas: PUBMED, SCIENCEDIRECT, PROQUEST, COCHRANE, OVIDSP SCOPUS, Y MEDLINE. Los buscadores booleanos utilizados en las diferentes bases de datos fueron OR, AND, NOT. Resultados: Trece artículos cumplieron con los criterios de elegibilidad y se incluyeron en esta revisión, 4 son estudios observacionales descriptivos longitudinales y prospectivos, 5 son reportes de casos clínicos, 1 es en estudio retrospectivo, 1 es una revisión Cochrane, 2 son casos y controles; el uso de la ortopedia dependía del caso de extensión y severidad según la fisura labiopalatina y el tiempo de uso debía ser desde el momento del nacimiento del bebé hasta los 3 meses de vida. Conclusión:La ortopedia prequirúrgica es exitosa si se usa desde el momento del nacimiento y hasta los tres meses de vida, ofreciendo resultados satisfactorios y de manera eficaz disminuyendo la hendidura palatina, la deformidad nasal y la fisura labial antes de practicar la queilorrafia y la palatorrafia.

Resumo: Kerr McNeil, um protesista escocês introduziu a ortopedia maxilar neonatal há dois séculos, estabelecendo o conceito de uso de peças ortopédicas para produzir uma maxila mais natural. Três tipos diferentes de ortopedia pré-cirúrgica foram descritos. São eles: ativo, semi-ativo e passivo. Objetivo: Realizar uma pesquisa em dados indexados sobre o sucesso do tratamento ortopédico pré-cirúrgico em pacientes com quadro de fissura labiopalatina. Metodologia: Foi realizada pesquisa informatizada em bancos de dados eletrônicos como: PUBMED, SCIENCEDIRECT, PROQUEST, COCHRANE, OVIDSP SCOPUS e MEDLINE. As pesquisas booleanas utilizadas nas bases de dados múltiplas foram OR, AND, NOT. Resultados: Treze artigos atenderam aos padrões de elegibilidade e foram incluídos nesta revisão. 4 (quatro) deles são estudos observacionais descritivos, longitudinais e prospectivos. 5 (cinco) são relatórios clínicos, 1 (um) é um estudo retrospectivo, 1 (um) é uma revisão Cochrane e 2 (dois) são casos clínicos e check ups. A implantação do tratamento ortopédico dependeu do tipo de extensão dos casos e da gravidade da fenda palatina. Conclusão: a ortopedia pré-cirúrgica tem sucesso se implementada ao nascimento até os 3 meses de idade. Assegura resultados satisfatórios diminuindo consideravelmente a fenda palatina, a malformação nasal e a fenda labial antes da realização dos procedimentos de Queilorrafia e Palatorrafia

Kerr McNeil, Scottish prosthetic introduced the Neonatal maxillary orthopedics two centuries ago setting the concept of using orthopedic parts to. Three different types of pre-surgical orthopedics have been described. These are: active, semi-active and passive. Objective: Perform a research in indexed data regarding the success of pre-surgical orthopedics treatment in patients with a condition of cleft lip and cleft palate. Methodology: A computer based research was performed at electronic data bases such as: PUBMED, SCIENCEDIRECT, PROQUEST, COCHRANE, OVIDSP SCOPUS, and MEDLINE. The Booleans researches used in the multiples data bases were OR, AND, NOT. Findings: Thirteen papers met the eligibility standards and were included in this review. 4 (four) of them are descriptive, longitudinal and prospective observational studies. 5 (five) are clinic reports, 1 (one) is a retrospective study, 1 (one) is a Cochrane review, and 2 (two) are clinic cases and check ups. The orthopedics treatment implementation depended on the kind of extension cases and severity of the cleft palate. Conclusion: the pre-surgical orthopedics is successful if it is implemented at birth up to 3 months of age. It assures satisfactory results decreasing considerably cleft palate, nasal malformation, and cleft lip before performing Cheilorrhaphy and Palatorrhaphy procedures. Key words: Cleft lip, cleft palate, orthopedic surgery, palatal obturators, nose deformities

Manejo ortopédico prequirúrgico de labio y paladar hendido unilateral: Reporte de casos con diferentes abordajes / Tratamento ortopédico pré-cirúrgico de fissura labiopalatina unilateral: relato de casos com diferentes abordagens / Presurgical orthopedic management of unilateral cleft lip and palate: Report of cases with different approaches

Pese a los avances de cirugía reconstructiva, el labio y paladara hendido unilateral (LPHU) representa un reto quirúrgico complejo cuando la brecha es mayor a 10 mm. En países de recursos limitados, la distancia geográfica, falta de centros de referencia multidisciplinarios, recursos económicos de las familias y actualmente, la pandemia; limita el acceso de pacientes al tratamiento prequirúrgico. El presente estudio descriptivo reporta 2 casos de LPHU completo, de similar tamaño por inspección visual profesional, sexo masculino, no asociados a síndrome. El propósito del mismo es hacer una revisión de dos técnicas de ortopedia prequirúrgica: Placa de Ortopedia Funcional Maxilar (OFM)-Moldeado Nasal (MN); y el Retractor Nasal (RN)-Taping, como alternativa de tratamiento a distancia. El paciente con placa OFM-MN fue tratado en el 2015, presencial, el paciente con RN-Taping, en el 2021 por telemedicina y un promotor de salud capacitado. Los resultados de simetría nasal y maxilar se midieron con software ImageJ, a través de 4 mediciones lineales y una angular, basadas en el método descrito por Barillas y de mediciones lineales realizadas a los modelos de yeso como las propuestas por Mazaheri. Las técnicas descritas para ambos pacientes lograron disminuir el ancho de la hendidura y moldear el cartílago alar del lado hendido. La técnica OFM-MN mostró ventajas en el desarrollo del arco maxilar promoviendo aumento de volumen de hueso y desarrollo en los tres planos del espacio sin colapso del arco. La técnica RN-Taping, restringió el arco maxilar, sin embargo, podría ser una alternativa de tratamiento a distancia.

Apesar dos avanços na cirurgia reconstrutiva, a fenda labiopalatina unilateral (LPHU) representa um desafio cirúrgico complexo quando o gap é maior que 10 mm. Em países com recursos limitados, distância geográfica, falta de centros de referência multidisciplinares, recursos econômicos das famílias e, atualmente, a pandemia; limita o acesso do paciente ao tratamento pré-cirúrgico. O presente estudo descritivo relata 2 casos de LPHU completa, de tamanho semelhante por inspeção visual profissional, do sexo masculino, não associada à síndrome. Seu objetivo é revisar duas técnicas ortopédicas pré-cirúrgicas: Placa Ortopédica Funcional Maxilar (OFM) - Moldagem Nasal (MN); e o Retrator Nasal (RN)-Taping, como alternativa de tratamento remoto. O paciente com placa OFM-MN foi atendido em 2015, pessoalmente, o paciente com RN-Taping, em 2021 por telemedicina e promotor de saúde treinado. Os resultados da simetria nasal e maxilar foram medidos com o software ImageJ, por meio de 4 medidas lineares e uma angular, com base no método descrito por Barillas e medidas lineares feitas nos modelos de gesso como os propostos por Mazaheri. As técnicas descritas para ambos os pacientes foram capazes de reduzir a largura da fenda e moldar a cartilagem alar do lado da fenda. A técnica OFM-MN apresentou vantagens no desenvolvimento do arco superior, promovendo aumento do volume ósseo e desenvolvimento nos três planos do espaço sem colapso do arco. A técnica RN-Tapingrestringiu a arcada superior, porém pode ser uma alternativa para tratamento remoto.

Despite the advances in reconstructive surgery, unilateral cleft lip and palate (UCLP) represents a complex surgical challenge when greater than 10 mm. In low resource settings, distance, lack of multidisciplinary centers, low income and currently, the pandemic; limits patients to access to presurgical treatment. This study reports 2 cases of complete UCLP, similar in size by professional visual inspection, male, not associated with any syndromes. The purpose is to review two presurgical orthopedic techniques: Maxillary Functional Orthopedic Plate (MFO) -Nasal Molding (NM) and Nasal Retractor (NR) -Taping as a teledentistry alternative. The patient with the FMO-NM plate was treated in 2015, in person; the NR-Taping patient, in 2021, by telemedicine and a trained health promoter. The results of nasal and maxillary symmetry were measured with ImageJ software, through 4 linear measurements and one angular, based on the method described by Barillas and linear measurements made on the plaster models such as those proposed by Mazaheri. The techniques described for both patients were able to reduce the width of the cleft and mold the alar cartilage on the cleft side. The OFM-MN technique showed advantages in the development of the maxillary arch by guiding growth and development in the three planes of the space without collapse of the arch. The NR-Taping technique restricted the maxillary arch but is an alternative to remote treatment

Depressão pós-parto em mães de bebês sem e com fissuras labiais, palatinas e labiopalatinas / Postpartum depression in mothers of babies without and with cleft lip and/or palate / Depresión postparto en las madres de bebés sin y con labio y/o paladar hendido

Depressão pós-parto (DPP) é um transtorno que afeta a saúde da mulher e a qualidade da relação mãe-bebê. Este estudo comparou a DPP de mães de bebês sem e com fissuras labiais, palatinas e labiopalatinas, e identificou as variáveis preditoras da DPP considerando a amostra como um todo. Participaram 120 mães, sendo 60 de bebês com fissuras e 60 de bebês sem condição de risco. Para a coleta foram utilizados: protocolo de entrevista e Escala de Depressão Pós-Parto de Edimburgo (EDPE). Resultados apontaram maior incidência de DPP em mães de bebês sem fissura (30%) do que em mães de bebês com fissura (20%). Porém, não houve diferenças estatisticamente significativas entre os grupos. As variáveis que explicaram a ocorrência de DPP foram: menor escolaridade materna, menor número de filhos, ausência de fissura no bebê, maior idade do bebê, e menor condição socioeconômica.

Postpartum depression (PPD) is a disorder that affects women's health and the quality of the mother-baby relationship. This study compared the PPD of mothers of babies without and with cleft lip and/or palate, and identified the predictor variables of PPD considering the sample as a whole. 120 mothers participated, 60 of babies with clefts and 60 of babies without risk condition. For data collection, were used the interview protocol and the Edinburgh Postnatal Depression Scale (EPDS). Results showed a higher incidence of PPD in mothers of babies without cleft (30%) than in mothers of babies with clefts (20%). However, there were no statistically significant differences between groups. The variables that explained the occurrence of PPD were: lower maternal education, fewer children, absence of cleft in the baby, older age of the baby, and lower socio economic status.

La depresión posparto (DPP) es un trastorno que afecta la salud de la mujer y la calidad de la relación madre-bebé. Este estudio comparó la DPP de madres de bebés sin y con labio y/o paladar hendido, e identificó las variables predictoras de DPP considerando la muestra en su conjunto. Participaron 120 madres, 60 de bebés con hendiduras y 60 de bebés sin condiciones de riesgo. Para la recolección de datos se utilizó el protocolo de entrevista y la Edinburgh Postnatal Depression Scale (EPDS). Los resultados mostraron una mayor incidencia de DPP en madres de bebés sin hendidura (30%) que en madres de bebés con hendidura (20%). Sin embargo, no hubo diferencias estadísticamente significativas entre los grupos. Las variables que explicaron la ocurrencia de DPP fueron: menor educación materna, menor número de hijos, ausencia de hendidura en el bebé, mayor edad del bebé y menor nivel socioeconómico.

Qualitative Assessment of Surgical Repair of Three Types of Unilateral Cleft Lip

Abstract Objective: To assess the effect of the three types of unilateral cleft lip (UCL) [cleft lip only, cleft lip and alveolus, and cleft lip alveolus and palate] on the outcome of the repair. Material and Methods: This study was a case series of effect of types of UCL on the outcome of the repair. Fifteen subjects each were in three UCL phenotypes groups. Evaluation of the scar, lip, and nose was done qualitatively by both parents/guardians and professionals using a modified form of the criteria described by Christofides et al. (2006). Results: In the assessment of the surgical scar, the parents found a difference between the three types of cleft in terms of texture, shape, and width of the scar and presence of columella deviation. The professional assessors, however, only found the three types of cleft to be different in the presence of alar flattening. Conclusion: Differences truly exist in the outcome of surgical repair of the three types of unilateral cleft lip, especially in the aesthetics of the nose and in the width and shape of the residual lip scar. Thus, it is important to consider this in the assessment of UCL repair because putting the subtypes together might have a negative impact on the assessment.

Crecimiento transversal del maxilar con uso de placa ortopédica prequirúrgica en pacientes con fisura labiopalatina / Transverse growth of the maxilla with the use of a presurgical orthopaedic plate in patients with cleft lip and palate

RESUMEN Introducción: la ortopedia prequirúrgica en el tratamiento de la fisura labiopalatina constituye una pauta terapéutica controversial. Los investigadores que están a favor plantean que favorece el cierre de la fisura lo cual facilita la cirugía, y otros apoyan el criterio de limitar el crecimiento maxilar y provocar su colapso. Objetivo: determinar los efectos morfológicos en el crecimiento transversal del maxilar durante el período de uso de la placa ortopédica prequirúrgica en niños con fisura labiopalatina atendidos en el Hospital Provincial Universitario «José Luis Miranda» de Villa Clara, en el período de marzo de 2015 a junio de 2019. Métodos: se realizó un estudio de intervención longitudinal. La muestra estuvo conformada por 34 niños previo consentimiento de sus padres o tutores. La información se obtuvo a través de: la entrevista, el examen clínico y mediciones; se aplicaron pruebas estadísticas como el test de Wilcoxon y el estadístico exacto de Fisher. Resultados: en la muestra estudiada predominaron los pacientes del sexo masculino y la fisura transforamen. Con el uso de la placa ortopédica prequirúrgica el maxilar mostró un crecimiento uniforme con un incremento de 5,6 mm de la distancia intercanina y de 5,2 mm de la distancia postgingival desde el nacimiento hasta la cirugía del paladar. La media de crecimiento entre el nacimiento y la cirugía del labio fue de 2,7 y 2,6 mm para la distancia intercanina y postgingival, respectivamente. Conclusiones: la ortopedia prequirúrgica favorece el crecimiento transversal del maxilar con un incremento uniforme de su ancho anterior y posterior.

ABSTRACT Introduction: presurgical orthopaedics in the treatment of cleft lip and palate constitutes a controversial therapeutic guideline. Researchers who are in favour state that it favours fissure closure which facilitates surgery, and others support the criterion of limiting maxillary growth and causing its collapse. Objective: to determine morphological effects on the transverse growth of the maxilla during the period of use of the presurgical orthopaedic plate in children with cleft lip and palate treated at "José Luis Miranda" Provincial University Hospital in Villa Clara from March 2015 to June 2019. Methods: a longitudinal intervention study was carried out. The sample consisted of 34 children with the prior consent of their parents or guardians. The information was obtained through interview, clinical examination and measurements; Wilcoxon's test and Fisher's exact test were applied as statistical tests. Results: male patients and transforamen fissure predominated in the studied sample. The maxilla showed, with the use of the presurgical orthopaedic plate, a uniform growth with an increase of 5.6 mm in the intercanine distance and a 5.2 mm increase in the post-gingival distance from birth to palate surgery. The mean growth between birth and lip surgery was 2.7 and 2.6 mm for intercanine and post-gingival distance, respectively. Conclusions: presurgical orthopaedics favours transverse growth of the maxilla with a uniform increase in its anterior and posterior width.

Psychosocial repercussions experienced by parents who care for infants with syndromic orofacial clefts / Repercussões psicossociais vivenciadas por pais cuidadores de lactentes com fissura orofacial sindrômicos

Abstract Objectives: to understand the psychosocial implications experienced by caregiving parents, resulting from the care of the child with cleft lip and/or palate associated with the syndrome. Methods: a cross-sectional and qualitative study, guided by the Consolidated Criteria for Reporting Qualitative Research tool, carried out between January and May 2019. Data collection was carried out through semi-structured interviews that were audio-recorded and transcribed in full. Thematic content analysis was used as the methodological framework and Symbolic Interactionism as the theoretical framework. Results: the participants were 16 caregiving parents. Four categories were listed: implications for diagnosis and treatment initiation, implications for financial issues and paid activities, implications for the care process, and implications for access to health resources. Conclusion: it was found that psychosocial implications experienced by these informal caregivers are multifaceted and complex, and that knowing them will enable planning and implementation of actions that contribute, in addition to the children's rehabilitation process, to the health and quality of life of those who care.

Resumo Objetivos: compreender as implicações psicossociais vivenciadas por pais cuidadores, decorrentes do cuidado do filho com fissura de lábio e/ou palato associada à síndrome. Métodos: estudo transversal, qualitativo, norteado pela diretriz Consolidated Criteria for Reporting Qualitative Research, realizado entre janeiro e maio de 2019. A coleta de dados realizou-se através de entrevista semiestruturada, que foi audiograda e transcrita na íntegra. Utilizou-se como referencial metodológico a Análise de Conteúdo Temática e como referencial teórico, o Interacionismo Simbólico. Resultados: participaram 16 pais cuidadores. Foram elencadas quatro categorias: implicações diante do diagnóstico e início do tratamento, implicações relacionadas às questões financeiras e de atividades remuneradas, implicações relacionadas ao processo de cuidar e implicações referentes ao acesso aos recursos de saúde. Conclusão: percebeu-se que as implicações psicossociais vivenciadas por esses cuidadores informais são multifacetadas e complexas, e conhece-las viabilizará o planejamento e a implementação de ações que contribuam, além do processo reabilitador das crianças, à saúde e qualidade de vida daqueles que cuidam.