Effects of nasoalveolar molding on maxillary arch dimensions and malocclusion characteristics in primary dentition patients with cleft lip and palate.

BACKGROUND: Nasoalveolar molding (NAM) is a presurgical orthopedic technique used in the management of cleft lip and palate deformities. Despite the widespread use of NAM therapy, there is a need for further investigation to assess its specific effects on arch dimensions and malocclusion characteristics. AIM: To evaluate the effects of NAM therapy on maxillary arch dimensions and malocclusion characteristics in patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). DESIGN: Patients in primary dentition were referred to the Institutional Department of Orthodontics. The NAM group consisted of 21 patients with UCLP (mean age 4.7 ± 0.7 years) and 12 patients with BCLP (mean age 4.8 ± 0.7 years). Sixteen patients with UCLP (mean age 4.9 ± 0.9 years) and five patients with BCLP (mean age 5.4 ± 1.1 years) were included in the non-NAM group. The plaster models of all patients were digitized. Dental arch dimensions and malocclusion characteristics were analyzed via digital software. One-way ANOVA with Bonferroni correction was used for statistical analysis. RESULTS: Intercanine and intermolar widths showed statistically significant differences according to the cleft type (p < .01). There was no statistically significant effect of NAM therapy on maxillary arch parameters and malocclusion characteristics (p > .05). The prevalence of anterior crossbite was 12.1% in the NAM group and 23.8% in the non-NAM group. CONCLUSION: NAM therapy did not affect the maxillary arch dimensions and malocclusion characteristics in patients with UCLP and BCLP. The cleft type was the main factor, leading to a significant difference in maxillary widths.

Cleft Palate Repair Using Single Flap Palatoplasty in Patient With Associated Palatal Hemangioma.

Hemangiomas are the most common tumors of childhood with an average incidence of 10%. It is unusual for hemangiomas, which are already rarely seen isolated on the palate, to coexist with cleft palate as in the authors' patient. Four months old baby was admitted with isolated Veau 2 cleft palate and a red-purple colored raised lesion involving almost the whole right side of the hard palate. Magnetic resonance imaging revealed intensive contrasting solid nodule with a lobulated contour that was covering the right half of the hard palate, measuring 2.2×1.3 cm. To reduce the size of the vascular lesion 7 mg/d oral propranolol treatment was initiated. Following reduction in the size of hemangioma, the cleft palate was repaired at 11 months of age. Single mucoperiosteal flap from the left side of the palate preserving the major palatine artery was elevated whereas right mucoperisteal flap was minimally dissected not to interfere with the hemangioma. No intraoperative and postoperative complications in both the early and late term were experienced. As a result, since early palatal repair is important to obtain ideal speech outcomes in cleft patients, repair should be performed in similar patients with hemangiomas without delaying the timing.

Comparison of the Speech Results After Correction of Submucous Cleft Palate With Furlow Palatoplasty and Pharyngeal Flap Combined With Intravelar Veloplasty.

Submucous cleft palate (SMCP) is a relatively rare variant of the common pathology of cleft palate with specific anatomic and clinical features. Even though there are many surgical options defined previously to correct the SMCP, correction of the velopharyngeal insufficiency and obtaining ideal speech results remains as a challenge. The aim of this article was to compare the speech benefits of Furlow double opposing Z plasty and posterior pharyngeal flap operation combined with intravelar veloplasty for the correction of SMCP using objective assessment tools. This study reviewed 29 patients who underwent either superiorly based posterior pharyngeal flap combined with intravelar veloplasty or Furlow palatoplasty for submucous cleft palate repair between years 2005 and 2011. The mean standard deviation age at palate repair was 123.6 ±â€Š65.8 months and the mean follow-up period was 31.2 ±â€Š15.9 months. The postoperative results demonstrated that in both groups significantly correction has been achieved in means of velopharygeal closure (P values for Furlow and pharyngeal flap groups are 0.012 and 0.001 respectively). The correction of the nasalance scores obtained depending on the surgical procedure for /sa/ and /ka/ syllables demonstrated significantly more benefit with pharyngeal flap combined with intravelar veloplasty than Furlow palatoplasty (P = 0.026 for each). In the treatment of submucous clefts, both Furlow palatoplasty and pharyngeal flap procedure combined with intravelar veloplasty appear to be effective whereas for the patients having significant signs of hypernasality, contribution of pharyngeal flap may be taken into consideration.

Influence of nasoalveolar molding on skeletal development in patients with unilateral cleft lip and palate at 5 years of age.

INTRODUCTION: The aim of this retrospective study was to assess the influence of presurgical nasoalveolar molding (NAM) on skeletal development in patients with operated unilateral cleft lip and palate at 5 years of age. MATERIALS: Lateral cephalometric radiographs of 26 unilateral cleft lip and palate patients who had undergone presurgical NAM (NAM group) and 20 unilateral cleft lip and palate patients who did not have any presurgical NAM (non-NAM group) were analyzed. The radiographs were digitally traced using Quick Ceph Studio software (version 3.5.1.r (1151); Quick Ceph Systems, San Diego, Calif). Independent samples t tests were performed for statistical analysis. RESULTS: No significant differences were observed in sagittal and vertical skeletal measurements between the NAM and non-NAM groups. CONCLUSIONS: NAM resulted in no significant difference in skeletal development in unilateral cleft lip and palate patients compared with those without NAM in early childhood.

A Biomimetic Alternative to Synthetic Hydroxyapatite: "Boron-Containing Bone-Like Hydroxyapatite" Precipitated From Simulated Body Fluid.

BACKGROUND: Biological hydroxyapatite (HA), has several mechanical and physical advantages over the commercially available synthetic apatite (CAP-HA). The aim of this in vivo study was to investigate the effect of osteoinductive "bone-like hydroxyapatite" obtained from simulated body fluid (SBF) combined with osteoinductive "boron" (B) on bone healing. MATERIALS: Bone like nanohydroxyapatite (SBF-HA) was precipitated from 10× simulated body fluid (10×SBF). Thirty Sprague-Dawley rats were randomly divided into 5 experimental groups (n = 6 each). The groups were involving blank defect, chitosan, SBF-HA, SBF-HA/B, and CAP-HA. Two biparietal round critical sized bone defect was created using a dental burr. The rats were sacrificed respectively at the end of second and fourth months after surgery and their calvarium were harvested for further macroscopic, microtomographic, and histologic evaluation. RESULTS: The SBF-HA/B group demonstrated the highest mineralized matrix formation rates (30.69 ± 3.73 for the second month, 62.68 ± 7.03 for the fourth month) and was significantly higher than SBF-HA and the CAP-HA groups. The SBF-HA/B group demonstrated the highest mineralized matrix formation rates (30.69 ± 3.73 for the second month, 62.68 ± 7.03 for the fourth month) and was significantly higher than SBF-HA and the CAP-HA groups. In means of bone defect repair histologically, the highest result was observed in the SBF-HA/B group (P < 0.001). CONCLUSIONS: The "bone-like hydroxapatite" obtained from simulated body fluid is worth attention when both its beneficial effects on bone healing and its biological behavior is taken in consideration for further bone tissue engineering studies. It appears to be a potential alternative to the commercially available hydroxyapatite samples.

Modified Superior-Based Pharyngeal Flap Is Effective in Treatment of Velopharyngeal Insufficiency Regardless of the Preoperative Closure Pattern.

Velopharyngeal insufficiency (VPI) is certainly one of the most important problems confronted after cleft palate repairs. In this study, it was aimed to evaluate the preoperative and postoperative speaking results of patients who underwent modified superior-based pharyngeal flap. Sixty-six children who underwent modified superiorly based pharyngeal flap for treatment of VPI between 2005 and 2013 were retrospectively reviewed. The study population was evaluated in 2 distinctive groups depending on their preoperative velopharyngeal closure pattern as: coronal closure pattern or noncoronal closure patterns (ie, circular, sagittal with or without the presence of a Passavant ridge). The speech outcome of the patients was evaluated using the objective assessment tools of nasopharyngoscopy and nasometer. Coronal closure pattern was determined in 24 patients (36.4%) and noncoronal closure pattern in 42 patients (63.6%). The mean follow-up period was 14.67 ±â€Š3.90 and 13.74 ±â€Š3.53 months in the coronal and noncoronal groups, respectively. The results demonstrated that the postoperative nasalance scores of all syllables except (m) and (n) were found to be significantly lower compared to those of the preoperative period (P < 0.001). However, no significant difference between the preoperative and postoperative results was observed in means of closure pattern. The surgical approach of modified superior-based pharyngeal flap for treatment of VPI appears to be effective regardless of the preoperatively determined closure pattern.

Humanitarian Activities of Interplast Turkiye: 6 Years of Experience in Uzbekistan for Surgical Treatment of Cleft Patients and Related Secondary Deformities.

Cleft lip and palate (CL/P) is one of the leading congenital deformities among the world. Children born with CL/P experience problems with feeding, speech, hearing, and dentition. In developed countries, CL/P patients are receiving optimal health care involving multidisciplinary team approach and staged surgical operations, whereas in developing countries, there is severe shortage of both medical and financial sources. To overcome these limitations, humanitarian surgical missions are essential. The aim of this article is to share our experience of humanitarian surgical mission in Uzbekistan consisting of 6 consecutive visits between 2009 and 2014. The series of these humanitarian activities consisting of 6 consecutive visits was organized by the cooperation of Interplast Turkiye and governmental Turkish Coordination and Cooperation Agency. After initial evaluation, triage at the initial setting and prompt anesthesia evaluation among many more of them, 529 patients mostly with cleft, craniofacial, or congenital deformities were operated. The success of this type of mission is not solely based on the expertise of the team members, but also meticulous planning, patient selection, good coordination with the local colleagues and communication. At this point, caregivers attending from a culturally close and similar language-spoken countries will certainly have more advantages in achieving a mission. Volunteer surgical missions for congenital deformities can be an important relief for this burden in developing countries. Nevertheless, training the native surgeons and supporting the plastic surgery foundations in these countries are as important as providing the necessary health care by such humanitarian missions.

Poly(L-Lactide)/Poly(ε-Caprolactone) and Collagen/ß-Tricalcium Phosphate Scaffolds for the Treatment of Critical-Sized Rat Alveolar Defects: A Microtomographic, Molecular-Biological, and Histological Study.

OBJECTIVE: To determine the efficacy of a newly developed scaffold (col/ß-TCP) in a preclinical rat model as compared with the gold standard treatment (autograft) and control scaffolds (PLLA/PCL). DESIGN: Fifty-six Sprague-Dawley rats were randomized into four experimental groups, and critical-sized alveolar defects (7 × 4 × 3 mm) were created in each animal. Group A was the blank defect group, group B received autograft, group C received col/ß-TCP scaffolds, and group D received PLLA/PCL blend scaffolds to fill the bone defects. New bone formation was assessed radiomorphometrically, histomorphometrically, and molecular-biologically at 1 and 4 months following surgery. RESULTS: Radiomorphometrically, the best new bone volume rate at 1 month (43.7%) and 4 months (45.4%) was observed in the autograft group, and the difference was significantly higher than in the other three groups (P < .005, P < .001, P < .001 for 1 month and P = .004, P < .001, P < .001 for 4 months). Even though the new bone volume rate in the col/ß-TCP group (21.5%) was higher than that of the PLLA/PCL group (18.2%), the difference was not significant (P = .08). Molecular-genetic analysis revealed significantly higher BSP and ALP gene expression levels in the autograft and col/ß-TCP groups than in the blank defect group (P = .002 and P = .004). CONCLUSION: The engineered tissue scaffolds described herein have great potential as an alternative treatment option when cost, donor region morbidity, and duration of hospitalization are considered.

Growth-related changes of skeletal and upper-airway features in bilateral cleft lip and palate patients.

INTRODUCTION: The craniofacial morphology of subjects with cleft lip and palate differs from that of subjects without clefts. Subjects with bilateral cleft lip and palate tend to have maxillary retrognathism, a smaller mandible with an obtuse gonial angle, greater anterior upper and lower facial heights, and retroclined maxillary incisors. The purposes of this research were to compare the skeletal and upper-airway features of subjects with bilateral cleft lip and palate with the same features in control subjects without clefts and to determine the growth-related changes at different growth stages. METHODS: The sample comprised 212 subjects divided into 2 groups: 68 with bilateral cleft lip and palate, and 144 controls without clefts; each group was further divided into 4 subgroups according to growth stage using the cervical vertebral maturation stage method. The subgroups were defined as early childhood (stage 1), prepubertal (stage 2), pubertal (stage 3), and postpubertal (stage 4). The cephalometric variables were evaluated with 2-way analysis of variance and the Bonferroni test. RESULTS: Maxillary position showed no significant differences between the male groups. The maxilla was more prognathic at stage 2 and became more retrognathic at stages 3 and 4 in the females. The mandible was more retrusive in the bilateral cleft lip and palate subjects at stage 1 in males and at stages 3 and 4 in females. ANB was larger at stages 1 and 2, and it became similar to the controls at stages 3 and 4 in male and female bilateral cleft lip and palate subjects. Vertical growth was seen in the bilateral cleft lip and palate subjects regardless of sex, and no change was observed with age. Posterior airway space was narrower in all stages (except for stage 1 in females). Middle airway space was wider after stage 1 in the male and female bilateral cleft lip and palate subjects. Inferior airway space was narrower in the male bilateral cleft lip and palate patients at the early childhood and pubertal stages. CONCLUSIONS: Age- and sex-dependent differences in skeletal morphology and upper-airway widths of the bilateral cleft lip and palate subjects were identified when compared with the control subjects without clefts.

Evaluation of keyhole-pattern reduction glossoplasty for macroglossia in beckwith-wiedemann syndrome: A multidimensional analysis of postoperative course and outcomes.

The aim of this study was to evaluate the postoperative course and long-term functional and aesthetic outcomes in patients with Beckwith-Wiedemann syndrome (BWS) following surgical reduction of macroglossia, using multiple questionnaires. Patients with BWS who underwent keyhole reduction for macroglossia were included in this study. The postoperative course for each patient was recorded, and multiple questionnaires were administered to evaluate aesthetic concerns, oral incompetence or feeding difficulties, sleep-disordered breathing symptoms, and speech. Nine patients underwent ten reduction glossoplasty surgeries. The mean age at surgery was 22 months. The postoperative course for each case was uneventful, except for one patient who had wound dehiscence. The questionnaires revealed significant improvements in tongue appearance, feeding, drooling, facial appearance, and psychosocial outcomes. There was also a significant reduction in sleep-disordered breathing symptoms after surgery. Keyhole reduction glossoplasty is a safe and effective procedure for the treatment of macroglossia in BWS patients, with excellent functional and aesthetic outcomes and a low complication rate.

A very rare cause of asymmetric velopharyngeal incompetence: unilateral palate hypoplasia.

Asymmetric velopharyngeal incompetence (VPI) may be caused by neuromuscular disorders, trauma, tumor resection, cleft palate, or unilateral hypoplasia of the velum and pharynx. However, VPI due to isolated unilateral hypoplasia is extremely rare. In this case report, a 4-year-old girl with unilateral palate hypoplasia and her two-staged management is presented. The speech quality of the patient improved noticeably after these procedures. The first stage allowed us to make the second stage pharyngeal flap more conservatively than possible in a one-stage procedure. We think that this two-step procedure could be an alternative to other methods in the treatment of asymmetric VPI.

Congenital bony syngnathia with unilateral palatal shelf and soft palate agenesis.

Congenital fusion of upper and lower jaw is rare. Only 35 bony syngnathia have been reported up to date, and 9 of them revealed posterior topography. A 10-day-old female infant with facial asymmetry, limited mouth opening, and cardiac murmurs is presented. The radiological findings revealed congenital bony fusion of right coronoid process of the mandible to posterior maxillary region and right palatal shelf agenesis of palatal bone, which seems to be the first case in the literature. Classification systems of bony syngnathia and applied treatment procedures for palatal closure and release of the bony fusion are discussed.

Upper airway features of unilateral cleft lip and palate patients in different growth stages.

OBJECTIVES: To compare growth-related changes of skeletal and upper airway features of unilateral cleft lip and palate subjects (UCLP) with non-cleft control (NCC) subjects by using lateral cephalograms. MATERIALS AND METHODS: The sample comprised 238 subjects, collected cross-sectionally, divided into 2 groups: 94 with UCLP, and 144 NCC, subdivided into 4 groups according to their growth stages by using cervical vertebral maturation stage (CVMS). The subgroups were defined as early childhood (stage 1), prepubertal (stage 2: CVMS I and II), pubertal (stage 3: CVMS III and IV), and postpubertal (stage 4: CVMS V and VI). RESULTS: The maxilla was more retrognathic at stages 2, 3, and 4 in females with UCLP. The mandible was more retrognathic in UCLP at stage 1 in males, and stages 2 and 3 in females. ANB (angle between NA plane and NB plane) was significantly smaller in UCLP subjects at stage 4 for both sexes. A vertical growth pattern was seen in UCLP subjects except males at stages 2 and 3, and females at stage 2. Posterior airway space was significantly narrower at all stages in males and after stage 1 in females. Middle airway space was significantly wider at all stages in females and after stage 1 in males. Epiglottic airway space was significantly narrower in males at stage 3. CONCLUSIONS: Age- and sex-dependent differences in skeletal morphology and upper-airway widths of the UCLP subjects were identified when compared with controls.

Long-term impaction of a foreign body in the hard palate.

Foreign bodies in the hard palate have only rarely been documented. This article describes and illustrates a case of foreign material in the hard palate. In the literature, no such 18-month-long period of impaction in the hard palate has been reported. Surprisingly, despite this long period of impaction, the foreign material did not lead to any tissue necrosis or perforation.

A salvage procedure in cleft palate repair: suturing nasal mucosa directly to palatine process.

OBJECTIVE: Palatal fistulas are among the complications of cleft palate repair requiring additional surgery. Suturing the nasal mucosa and mucoperiosteal flaps together in a tension-free manner to create a double-layered closure in the hard palate is one of the most important points in prevention of dehiscence and fistula formation. In this report, we describe a salvage procedure to repair nasal mucosa that might be lacerated while being freed from the upper surface of the palatal process. METHOD: To restore the nasal lining, an ipsilateral vomer mucoperiosteal flap or the opposite nasal mucosa flap is advanced to the palatine bone and sutured directly to the palatal process in order to guarantee an intact cleft palate repair. RESULTS: This method is an easy, simple, and time-saving procedure. It should be a useful addition to the armamentarium of every plastic surgeon, especially those working as consultants in training units.