Dynamic Nasolabial Growth After Primary Surgery for Patients With Bilateral Cleft Lip: A Five-Year Follow-Up Study.

PURPOSE: Bilateral complete cleft lip (BCCL) causes severe tissue deficit and usually requires multiple revisions after primary repair. In the present study, we aimed to illustrate the nasolabial changes after primary BCCL correction. PATIENTS AND METHODS: The present retrospective cohort study compared patients who had undergone BCCL and palate (BCCLP) and cleft palate only (CPO). All included patients had undergone surgery at the same treatment center (West China Hospital of Stomatology) from 2007 to 2012. The patients returned for follow-up surgery at 6 months and 5 years after their primary repair surgery. We retrieved the facial plaster casts of the enrolled patients and recorded the key nasolabial measurements. The outcome variables included the prolabial length (PL), peak distance, nasal width, and columellar length (CL). The data were analyzed using a general linear model for repeated measures, and the linear association was tested using SPSS. The level of testing efficiency (P value) was set at .05. RESULTS: A total of 160 patients, 80 who had undergone BCCLP and 80 CPO controls, were included. All nasolabial measurements in the BCCLP group had increased during the 5-year follow-up period. The PL of the BCCLP group had increased more quickly than the PL of the CPO group (P = .000 < .05), but the CL had increased nearly as much (P = .270). CONCLUSIONS: For the primary correction of bilateral cleft lip nose deformity, dissection and repositioning of the cleft lip and nose did not significantly inhibit the growth of the nasolabial region in the first 5 years after surgery. Nose deformities should not remain uncorrected after primary surgical repair. In contrast, cleft surgeons should focus on the finer adjustment of columella with less doubt regarding adverse effects.

Incidence of postoperative velopharyngeal insufficiency in late palate repair.

BACKGROUND: This was a study of patients with cleft palate who for various reasons have their first hospital visit for palatal repair at an older age in developing countries. The aims of this study were to investigate the incidence of postoperative velopharyngeal insufficiency in Chinese patients with late palatal repair and to determine the relative importance of age at palatoplasty, cleft type, surgical technique, and experience for clinical outcomes. METHODS: A cohort of 224 patients who underwent primary palate repair were studied retrospectively. Speech outcomes were evaluated based on the severity of hypernasality and nasal emission. The percentage of cases that required a second operation was recorded. The related factors were analyzed, and a logistic regression model was applied. RESULTS: The mean age at palatoplasty was 5.6 (SD, 4.6) years (age range, 2-24 years of age); 29.9% of the cases required a second operation. Age at palatoplasty was the only significant contributing factor for the percentage of patients who needed a second surgery. Each additional year in age at palatoplasty was associated with a 10.8% increase in odds of requiring a second surgery (P = 0.002; odds ratio, 1.108; confidence interval, 1.038-1.182). However, cleft type, surgical technique, and surgeon's experience did not influence clinical outcomes. CONCLUSIONS: Primary palate repair at older than 2 years resulted in acceptable clinical speech outcomes in our patient population, there was an increase in the incidence of postoperative velopharyngeal insufficiency with increasing age at the time of palatoplasty. There was no correlation with cleft type, surgical technique, or surgeon's experience.

Clinical Analysis of Approach Selection of Extraction of Maxillary Embedded Mesiodens in Children.

Objective: To analyze the relationship between the position of embedded mesiodens in maxilla and surgical approach in children and thus provide reference materials for surgical design. Methods: According to the preoperative cone-beam computed tomography (CBCT) examination, the location and surgical approach characteristics of 625 children aged 4-16 years old who presented with embedded mesiodens in maxilla and were diagnosed in our department from January 2016 to December 2021 were statistically analyzed. Results: There were 877 embedded mesiodens in 625 children. The selected cases were classified according to the axial angle relationship between mesiodens and adjacent normal teeth or tooth germs, including 84 cases of acute angle type (including the same direction) (13.4%), 66 cases of vertical type (10.6%), 114 cases of obtuse angle type (18.2%), 271 cases of inverted type (43.4%), and 90 cases of mixed type (14.4%). The palatal gingival margin approach was the most selected surgical approach for the cases of acute angle (including synclastic), obtuse angle, and inverted type, and the palatal gingival margin approach and the combined labial-palatal approach were the most selected surgical approach for the cases of vertical and mixed type. Conclusion: Palatal gingival margin approach was the most common surgical approach for various types of embedded mesiodens in maxilla in children. Surgeons should classify the case of mesiodens according to the preoperative imaging examination and design the surgical approach reasonably.