Classification of Cleft Lip/Palate: Then and Now.

Cleft lip and/or palate (CL/P) is phenotypically diverse, making classification difficult. This article explores the evolution of ideas regarding CL/P classification and includes the schemes described by Davis and Ritchie (1922) , Brophy (1923) , Veau (1931) , Fogh-Andersen (1943), Kernahan and Stark (1958) , Harkins et al. (1962) , Broadbent et al. (1968), Spina (1973) , and others. Based on these systems, a longhand structured form is proposed for describing CL/P in a way that is clear, comprehensive, and consistent. A complementary shorthand notation is also described to improve the utility and convenience of this structured form.

Clinician's Primer to ICD-10-CM Coding for Cleft Lip/Palate Care.

On October 1, 2015, the United States required use of the Clinical Modification of the International Classification of Diseases, 10th Revision (ICD-10-CM) for diagnostic coding. This primer was written to assist the cleft care community with understanding and use of ICD-10-CM for diagnostic coding related to cleft lip and/or palate (CL/P).

Operative and Immediate Postoperative Outcomes of Using a Latham-Type Dentomaxillary Appliance in Patients With Unilateral Complete Cleft Lip and Palate.

OBJECTIVE: The objective of this study is to examine the operative and immediate postoperative effects of the use of a dentomaxillary appliance (DMA). DESIGN: Retrospective chart review of 40 treated patients with unilateral complete cleft lip and palate who had a comprehensive set of pre-, peri-, and postoperative records. SETTING: Boston Children's Hospital. PATIENTS: Forty treated patients with unilateral complete cleft lip and palate. INTERVENTIONS: Use of DMA. MAIN OUTCOME MEASURES: Outcome variables of interest included cleft lip width reduction following use of DMA and odds of having primary gingivoperiostetoplasty (GPP). RESULTS: The study sample included 40 subjects (31 boys and 9 girls). The average age at the time of DMA insertion was 11 weeks. The average width of the alveolar cleft prior to DMA insertion was 10.77 mm. The mean cleft width reduction was 8.66 mm. Each 1-mm increase in pre-DMA cleft width was associated with a 0.631-mm reduction in cleft width (P < .001). Thirty-three patients (82.5%) had a GPP procedure. Each 1-mm increase in post-DMA width was associated with a lower odds of having a GPP (odds ratio = 0.32, 95% confidence interval = 0.14-0.77, P = .01). CONCLUSIONS: Post-DMA width was the significant factor associated with the performance of GPP. The use of DMA is associated with a significant reduction in the width of the cleft, and outcomes are predictable without any major adverse events or complications.

Dentofacial Orthopedics for the Cleft Patient: The Latham Approach.

Presurgical infant dentofacial orthopedic treatment (PSIOT) is a process by which cleft maxillary and soft tissue segments can be moved before surgical repair of lip. One of the PSIOT approaches used is the fixed PSIOT using Latham appliances. In this article, the authors provide an overview of this approach and the step-by-step process of placing these appliances intraorally. Prospective randomized clinical studies are necessary to definitively answer concerns surrounding the long-term effects of PSIOT.

A Comparison of Mixed Dentition Dental Development in Cleft Patients Treated With and Without the Latham-type Appliance.

PURPOSE: The purpose of this study was to retrospectively evaluate the Latham-type appliance's effect on the development and eruption of posterior teeth during the mixed dentition stage before palatal expansion and secondary alveolar bone graft(s). METHODS: The charts of complete cleft lip and palate (CLP) patients treated with and without the Latham-type appliance were screened using the following inclusion criteria: nonsyndromic; CLP; and available panoramic radiographs and clinical photographs in the mixed dentition prior to palatal expansion and secondary alveolar bone grafts. Surgical repair for Latham-type appliance patients followed the Latham-Millard protocol. The differences in outcomes were analyzed using Fisher's exact tests. RESULTS: The sample consisted of 65 patients treated with the appliance (Latham group) and 36 subjects who were not (non-Latham group). Similar incidences were found between the non-Latham group and the Latham group for maxillary second premolar agenesis (11 percent versus 10 percent) and enamel defects in the maxillary arch (17 percent versus 14 percent). The incidence of ectopic permanent maxillary first molars was higher in the Latham group than in the non-Latham group (28 percent versus one percent, P=0.01). CONCLUSIONS: A higher incidence of ectopic permanent maxillary first molars was found in patients treated with the Latham-type appliance.

Effect of infant surgical orthopedic treatment on facial growth in preadolescent children with unilateral and bilateral complete cleft lip and palate.

OBJECTIVE: To examine the impact of dentofacial infant orthopedic treatment (DFIO) on facial growth in preadolescent children with unilateral complete cleft lip and palate (UCCLP) and bilateral complete cleft lip and palate (BCCLP). METHODS: This is a retrospective study of patients with UCCLP and BCCLP treated at a single center. The treatment group had DFIO, and the control group did not have DFIO. Regression models were used to compare outcomes between the study and control groups. RESULTS: The study sample comprised 81 patients (54 had DFIO and 27 did not have DFIO). Among those with UCCLP, those who had DFIO had a shorter maxillary length (-2.12 mm; P = .04) and shorter lower anterior facial height (-2.77 mm; P = .04) compared with controls. Among those with BCCLP, there were no significant differences between the treatment and control groups. CONCLUSIONS: DFIO treatment could result in shorter maxillary length and lower anterior facial height in those with UCCLP.

FaceReview: supporting interactive exploration of linked heterogeneous datasets for unilateral cleft lip and palate.

Children with unilateral cleft lip and palate (UCLP) suffer from negative public perceptions. A better treatment strategy should be established to help them live an ordinary life with improved perceptions. To do that, it is important to understand the relationship between physical facial features and perceptual judgment. In this paper, we present FaceReview, a new visualization system to support interactive exploration of a heterogeneous multidimensional dataset with facial measurement data and subjective judgment data. To seamlessly link the two data, we design FaceReview based on information visualization techniques that are proven to be useful and therefore commonly used, such as brushing and linking, small multiples, and dynamic query. Our design decisions successfully support exploratory tasks of our collaborators. We present a case study to show the efficacy of FaceReview.

The effects of active infant orthopedics on occlusal relationships in unilateral complete cleft lip and palate.

OBJECTIVE: To evaluate the effects of active infant orthopedic treatment on dental arch relationships and determine the effect on maxillary growth in children born with unilateral complete cleft lip and palate (UCCLP). DESIGN: The GOSLON Yardstick was used to assess dental models taken on patients treated with and without active infant orthopedics. PATIENTS: Two groups of nonsyndromic Caucasian children born with UCCLP (total n = 40), all treated by the same surgeon and ranging from 5 to 10 years of age, were evaluated. INTERVENTIONS: One group had a Latham dentomaxillary alignment (DMA) appliance inserted at 5 to 6 weeks of age, after which a lip-nasal adhesion was performed at an average age of 3.5 months. This was followed by more definitive nasolabial repair at the average age of 5.9 months. Those patients treated without preoperative orthopedics underwent a lip-nasal adhesion at average age 1.5 months followed by nasolabial repair at average age 5.1 months. MAIN OUTCOME MEASURES: Randomized assessments using the GOSLON Yardstick were done independently at two separate times by three different examiners. Differences in GOSLON scores between the active orthopedic group and nonorthopedic group were evaluated by both categorical and continuous statistical analyses. RESULTS: The mean GOSLON score was 3.30 for the orthopedic group and 3.21 for the nonorthopedic group. There was no significant group difference in the modal scores of the two groups. CONCLUSIONS: This study showed that active infant orthopedics does not affect the dental arch relationships in preadolescent children with repaired UCCLP, compared with a similar group treated without orthopedic intervention at this center.