Effectiveness of secondary furlow palatoplasty with buccal myomucosal flap in correction of velopharyngeal insufficiency in patients with cleft palate.

OBJECTIVES: The main purpose of this study was evaluation of the effectiveness of secondary furlow palatoplasty with buccal myomucosal flap (FPBF) for the treatment of velopharyngeal insufficiency (VPI) in patients with a cleft palate who were treated with two flap palatoplasty (TFP) in their primary palate repair. MATERIAL AND METHODS: Twenty-three medically free children aged 4-8 years with non-syndromic and previously repaired cleft palate via TFP participated in the study. All patients received secondary surgery following the technique of FPBF. Preoperative speech evaluation was done before the secondary repair and 3 months after the surgery using a hypernasal speech scale, speech intelligibility scale, and nasopharyngoscopy. RESULTS: A statistically significant improvement was observed regarding the degree of hypernasality and speech intelligibility while comparing the preoperative scores after the primary surgery to the postoperative scores after the secondary surgery. In addition, a statistically significant improvement was found in the nasopharyngoscopic assessment. CONCLUSIONS: The incorporation of a buccal myomucosal flap with Furlow palatoplasty was successful in improving hypernasality, speech intelligibility, and nasopharyngoscopic scores in patients with cleft palate. TRIAL REGISTRATION: clinicaltrials.gov (NCT05626933). CLINICAL RELEVANCE: This technique might be the surgical technique of choice while treating patients who are suffering from VPI after cleft palate repair.

Effects of two flap palatoplasty versus furlow palatoplasty with buccal myomucosal flap on maxillary arch dimensions in patients with cleft palate at the primary dentition stage: a cohort study.

OBJECTIVE: The objective of this study was to evaluate the effect of two flap palatoplasty (TFP) versus Furlow palatoplasty with buccal myomucosal flap (FPBF) on maxillary arch dimensions in children at the primary dentition stage with cleft palate, in comparison to matching subjects without any craniofacial anomalies. MATERIAL AND METHODS: This study included 28 subjects with an age range of 5-6 years; 10 non-cleft subjects were included in the control group, 9 patients treated with TFP, and 9 patients treated with FPBF. For the included patients, the maxillary models were scanned using a desktop scanner to produce virtual models, and the maxillary dimension measurements were virtually completed. The produced measurements were compared between the 3 groups. Maxillary models of the 28 participants were evaluated. RESULTS: Statistically insignificant differences were detected between the 3 groups for arch symmetry measurements. Differences were detected in the inter-canine width between the 2 surgical groups and non-cleft group. Both arch length and posterior palatal depth significantly differ while comparing the TFP to the control group, with no differences between FPBF and the non-cleft group. CONCLUSION: Furlow palatoplasty with buccal myomucosal flap might be considered a better surgical option than two flap palatoplasty for patients with cleft palate while evaluating maxillary arch dimensions at the primary dentition stage as a surgical outcome. CLINICAL RELEVANCE: This study gives insight into the surgical technique that has limited effect on the maxillary growth and dental arch dimension. Therefore, it decreases the need for orthodontic treatment and orthognathic surgery. TRIAL REGISTRATION: clinicaltrials.gov ( NCT05405738 ).

Preciseness of artificial intelligence for lateral cephalometric measurements.

BACKGROUND: The aim of the study was to assess the accuracy and efficiency of a new artificial intelligence (AI) method in performing lateral cephalometric radiographic measurements. MATERIALS AND METHODS: A total of 200 lateral cephalometric radiographs were assessed for quality and included. Three methods were used to perform the cephalometric measurements: (1) the AI method using WebCeph software (AssembleCircle Corp., Gyeonggi-do, Republic of Korea), (2) the modified AI method using WebCeph software after manual modification of the landmarks' position, and (3) using OnyxCeph software (Image Instruments GmbH, Chemnitz, Germany) by manual landmark identification and digital measurements generation. The results of the measurements produced by the three methods were compared, in addition to comparing the time required for the measurements' generation required for each method. RESULTS: Statistically significant differences were detected between the measurements resulting from the three used methods. Fewer differences were detected between the modified AI method and the OnyxCeph method. The AI method produced the measurements the fastest followed by the modified AI method and then the OnyxCeph method. CONCLUSIONS: Considering the used AI software, AI followed by manual tuning of the landmarks' position might be an accurate method in lateral cephalometric analysis. AI alone is still not fully reliable at locating the different landmarks on the lateral cephalometric radiographs.

Does Presurgical Taping Change Nose and Lip Aesthetics in Infants with Unilateral Cleft Lip and Palate? A Randomized Controlled Trial.

BACKGROUND: The aim of this randomized controlled trial was to assess the effectiveness of taping alone in changing nose and lip aesthetics in infants with unilateral complete cleft lip and palate before and after surgical lip repair. METHODS: The study design was a prospective, balanced, randomized, parallel-group, single-blinded, controlled trial. All the steps were carried out in the Department of Orthodontics of Cairo University in Egypt. Thirty-one infants with nonsyndromic unilateral complete cleft lip and palate were randomly assigned to either no treatment (control) or taping groups. In the taping group, all infants received horizontal tape between the two labial segments, aiming to decrease the cleft gap. No other interventions were performed in this group. Standardized photographs and videos were taken of the infants in both groups at the beginning of the treatment (T1), directly before surgical lip repair (T2), and 2 weeks after surgical lip repair (T3). Photographs and shots from videos were calibrated and used for outcome assessment. Blinded assessors carried out all the measurements digitally on the standardized photographs at T1, T2, and T3 using computer software. RESULTS: Significant changes in all the measurements were recorded in the taping group at T2 before surgical lip repair in comparison with the control group. At T3, no differences were found between the two groups. CONCLUSIONS: Taping is a successful intervention in changing nose and lip aesthetics before surgical lip repair. After surgical lip repair, both groups had matching aesthetics. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Is maxillary expansion effective in treatment of obstructive sleep apnoea syndrome? A systematic review of systematic reviews.

Background Maxillary expansion (ME) might be beneficial in improving airway dimensions and obstructive sleep apnoea syndrome (OSAS) in patients with constricted maxillae. The aim of this overview is to present clinicians with a summary of the evidence. Data from systematic reviews and meta-analyses were evaluated to investigate the effect of ME on OSAS.Methods An electronic search was commenced in five databases, in addition to a manual search until July 2021. Screening of articles started with title and abstract followed by full-text assessment. Systematic reviews with/without meta-analyses were included. Critical appraisal was done using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2, Level of Research Design scoring and criteria of body of evidence scores. The search, study selection and critical appraisal were completed by three reviewers.Results In total, 14 systematic reviews with/without meta-analyses were included. The quality of available evidence ranged between low to high, based on the overall quality evaluation.Conclusions Based on the available evidence, maxillary expansion might be able to improve the nasal airway volume and OSAS in both growing and adult patients in the short term. ME can be considered as one of the treatment options in cases with OSAS.

Canine root/cortical bone relation (CRCR) and the orthodontic tooth movement.

This observational study evaluates three-dimensionally the relation between the root of maxillary canine and overlying labial cortical plate of bone during orthodontic canine retraction. Eighty-four bilateral maxillary canines in 42 patients were retracted in the extraction space of first premolars, using conventional orthodontic NiTi retraction spring delivering 150gm. Three-dimensional evaluation at the cusp tip, root apex, and the overlying cortical bone was done based on Classification of Root/Cortical bone relation (CRCR) before and after canine retraction. 168 observations of the canines pre- and post-retraction showed a mean distal movement of the canine cusp tip of 3.78(± 2.05) mm, while the canine root apex was almost stationary. Scarcely, 5.4% of the canine roots and root apices persisted in the medullary bone during retraction, while 16.1% contacted the overlying cortical bone. Fenestration of the overlying cortical bone by the canine roots or root apices occurred in 78.6% of the sample. The unembellished intimacy between the canine root and apex to the overlying thick dense cortical bone might have the decelerating effect on the maxillary canine retraction. The natural bone plate labial to the maxillary canine root did not yield infront nor enlarge due to canine retraction, but else defeated the current orthodontic biomechanical implementation.

Effectiveness of a Novel 3D-Printed Nasoalveolar Molding Appliance (D-NAM) on Improving the Maxillary Arch Dimensions in Unilateral Cleft Lip and Palate Infants: A Randomized Controlled Trial.

OBJECTIVE: The aim of the current study was to introduce and measure the effectiveness of a new 3D-printed nasoalveolar molding (D-NAM) appliance on improving the maxillary arch dimensions (MADs) in infants with unilateral complete cleft lip and palate (UCLP) before surgical lip repair. DESIGN: A prospective, balanced, randomized, parallel groups, single-blinded, controlled trial. SETTING: All the steps of the current study were carried in the Department of Orthodontics, Cairo University in Egypt. PARTICIPANTS: Thirty-four, nonsyndromic infants with UCLP. INTERVENTIONS: The eligible infants were randomly assigned into either no-treatment (control) or to the new D-NAM groups. In D-NAM group, the maxillary models were 3D scanned into virtual models onto which segmentation and alveolar segments approximation were performed. Approximation movements were divided into 3 models representing 3 activation steps. On each of these models, virtual appliance construction was performed followed by 3D printing of the appliance. Nasal stent was added manually to the appliances of the second and third steps. Horizontal tapes were applied to infants in the D-NAM group only. MAIN OUTCOMES MEASURES: A Blinded assessors carried all the MADs measurements virtually on digital models collected at the beginning (T1) and after (T2) treatment. RESULTS: Clinically and/or statistically significant improvements in all the measured MADs were recorded in D-NAM group at T2 before surgical lip repair in comparison to control group. CONCLUSIONS: The introduced D-NAM/3D-printed appliance is a simple and efficient technique to improve the MADs in infants with UCLP before surgical lip repair.

Is Taping Alone an Efficient Presurgical Infant Orthopedic Approach in Infants With Unilateral Cleft Lip and Palate? A Randomized Controlled Trial.

OBJECTIVE: The aim of the current randomized controlled trial (RCT) was to assess the effectiveness of taping alone in changing the maxillary arch dimensions (MADs) in infants with unilateral complete cleft lip and palate (UCLP) before surgical lip repair. DESIGN: A prospective, balanced, randomized, parallel-group, single-blinded, controlled trial. SETTING: All the steps of the current study were carried in the Department of Orthodontics, Cairo University in Egypt. PARTICIPANTS: Thirty-one, nonsyndromic infants with UCLP. INTERVENTIONS: The eligible infants were randomly assigned to either no-treatment (control) or taping groups. In the taping group, all the infants received horizontal tape between the 2 labial segments aiming to decrease the cleft gap. No other interventions were performed to infants included in this group. Rubber base impressions were made to all the included infants in both groups at the beginning of the treatment (T1) and directly before surgical lip repair (T2). All the produced models were scanned using a desktop scanner producing digital models for outcome assessment. MAIN OUTCOMES MEASURES: A blinded assessor carried out all the MAD measurements virtually on the produced digital models at the beginning (T1) and after (T2) treatment. RESULTS: Clinically and/or statistically significant changes in all the measured MADs were recorded in the taping group at T2 before surgical lip repair in comparison to the control group. CONCLUSIONS: It seems that taping alone is an efficient tool in changing the MADs before surgical lip repair in infants with UCLP.