An Innovative Technique of Presurgical Lip, Alveolus, and Nose Approximation (PLANA) for Infants with Clefts.

The innovative technique of "presurgical lip, alveolus, and nose approximation" (PLANA) offers a new approach within the domain of presurgical infant orthopedics for infants born with cleft lip and palate. Presurgical lip, alveolus, and nose approximation introduces the utilization of the NoseAlign device in conjunction with medical adhesive tapes, designed to approximate and support displaced soft tissue nasolabial structures in patients with cleft, without an intraoral plate. The NoseAlign device, constructed from medical-grade silicone, consists of 2 tubular portions that fit into the nostrils, connected by a columella band. Notably, it also features a wave-shaped and curved horizontal lip band, resting on the upper lip, with elastic clasps for secure attachment to the face with medical adhesive tapes. Presurgical lip, alveolus, and nose approximation therapy employs the NoseAlign device to support the collapsed nasal alar rim and cartilage, the displaced columella, the deviated nasal septum, and the displaced nasal alar base. This innovative approach minimizes the need for frequent office visits, making it particularly suitable for patients residing at a distance from specialized cleft centers. The prefabricated NoseAlign device offers effective support to nasal structures, making it suitable for unilateral and bilateral clefts. Importantly, the absence of an intraoral plate ensures it does not interfere with feeding. Presurgical lip, alveolus, and nose approximation therapy, initiated as early as 1 to 2 weeks, leverages the plasticity of nasal soft tissue and cartilage to achieve the desired nasal form before primary surgery. Although presurgical lip, alveolus, and nose approximation therapy does have some limitations, particularly in cases of medially collapsed alveolar segments, its simplicity, universal applicability, and patient-friendliness make it a promising technique in the presurgical infant orthopedics field.

Does Early Referral Lead to Early Repair? Quality Improvement in Cleft Care.

BACKGROUND: Cleft lip and palate is the most common congenital defect of the head and neck, occurring in 1 of 700 live births. Diagnosis often occurs in utero by conventional or 3-dimensional ultrasound. Early cleft lip repair (ECLR) (<3 months of life) for unilateral cleft lip (UCL), regardless of cleft width, has been the mainstay of lip reconstruction at Children's Hospital Los Angeles since 2015. Historically, traditional lip repair (TLR) was performed at 3 to 6 months of life ± preoperative nasoalveolar molding (NAM). Previous publications highlight the benefits of ECLR, such as enhanced aesthetic outcomes, decreased revision rate, better weight gain, increased alveolar cleft approximation, cost savings of NAM, and improved parent satisfaction. Occasionally, parents are referred for prenatal consultations to discuss ECLR. This study evaluates timing of cleft diagnosis, preoperative surgical consultation, and referral patterns to validate whether prenatal diagnosis and prenatal consultation lead to ECLR. METHODS: Retrospective review evaluated patients who underwent ECLR versus TLR ± NAM from 2009 to 2020. Timing of repair, cleft diagnosis, and surgical consultation, as well as referral patterns, were abstracted. Inclusion criteria dictated: age < 3 months for ECLR or 3 to 6 months for TLR, no major comorbidities, and diagnosis of UCL without palatal involvement. Patients with bilateral cleft lip or craniofacial syndromes were excluded. RESULTS: Of 107 patients, 51 (47.7%) underwent ECLR whereas 56 underwent TLR (52.3%). Average age at surgery was 31.8 days of life for the ECLR cohort and 112 days of life for the TLR cohort. Furthermore, 70.1% of patients were diagnosed prenatally, yet only 5.6% of families had prenatal consults for lip repair, 100% of which underwent ECLR. Most patients were referred by pediatricians (72.9%). Significance was identified between incidence of prenatal consults and ECLR (P = 0.008). In addition, prenatal diagnosis was significantly correlated with incidence of ECLR (P = 0.027). CONCLUSIONS: Our data demonstrate significance between prenatal diagnosis of UCL and prenatal surgical consultation with incidence of ECLR. Accordingly, we advocate for education to referring providers about ECLR and the potential for prenatal surgical consultation in the hopes that families may enjoy the myriad benefits of ECLR.

ORAL HYGIENE STATE IN CHILDREN WITH CONGENITAL DEFECTS OF THE ALVEOLAR PROCESS ON THE MAXILLA.

Bone plasty of congenital and residual defects of the alveolar process of the upper jaw is a technically difficult surgical intervention which is necessary for full rehabilitation of a patient with congenital lip and palate clefts. This operation creates conditions for stabilization of maxilla fragments and normalization of the upper jaw development and also for successful teeth eruption. The aim of the study - to assess the state of oral hygiene before surgery in children with congenital residual defect of the alveolar process we used Fedorov-Volodkina Hygiene Index and index of the intensity of gingivitis (РМА) according to Masser-Parma. The study was performed on three clinical subgroups of patients (n=54) aged 8 to 18 years who had congenital residual defects of the alveolar process of the maxilla. Subgroup 1 (n=13) - boneless bone plasty, subgroup 2 (n=11) - bone plasty using autologous mandibular graft, and subgroup 3 (n=30) - bone plasty with tibial bone graft. The state of oral hygiene of the subgroups was assessed using the Fedorov-Volodkina Hygiene Index (1971) and the level of inflammation of the marginal periodontium was assessed according to the PMA index (Masser-Parma, 1960). The level of oral hygiene in patients of all subgroups before treatment ranged from 2,6 to 3,0 («poor level¼ of oral hygiene). The using of standard prophylactic dental therapy allowed to achieve a «satisfactory¼ level of hygiene in all three clinical subgroups of patients. The condition of the marginal periodontium according to the PMA index in all subgroups corresponded to 35,0% (gingivitis of moderate severity). Preventive treatment reduced the level of inflammation to 15,0-20,0% in all subgroups. The subgroup 3 was the most compliant to treatment. The unsatisfactory oral hygiene level and the condition of periodontal tissues among patients with congenital and residual defects of the maxilla alveolar process increases the risk of postoperative complications. Preventive dental treatment improves oral hygiene and reduces the intensity of the inflammatory process in the marginal periodontium. That is an important and necessary component of the successful comprehensive rehabilitation of the patient with congenital maxillofacial area malformations.

Active bone material containing modified recombinant human bone morphogenetic protein 2 induces bone regeneration in the alveolar process cleft in rabbits.

The clinical application of most materials used to fill severe bone defects is limited owing to the insufficient ability of such materials to induce bone regeneration over a long repair period. The purpose of this study was to establish a model for the alveolar process cleft in rabbits to evaluate the effect of active bone material in bone defect repair. The active bone material used in this study is a new bone repair material composed of a heterogeneous collagen membrane implanted with modified recombinant human bone morphogenetic protein 2. This proposed active bone material can specifically bind to collagen. Twenty-four young Japanese white rabbits (JWRs) were selected and randomly divided into four groups (normal, control, material, and bone morphogenetic protein groups). The alveolar process cleft model was established by removing an equal volume bone at the left maxillary position. Blood samples were collected from the JWRs 3 and 6 months after the surgery to evaluate the biocompatibility of the active bone materials. Subsequently, the skull model was established, and the appearance was observed. Imaging methods (including X-ray examination and micro-computerized tomography scanning), tissue staining, and immunohistochemistry were employed for the evaluation. The bone collagen material and active bone material exhibited high biocompatibility. In addition, the ability of the active bone material to induce bone repair and regeneration was higher than that of the bone collagen material. The active bone material exhibited satisfactory bone regeneration performance in rabbits, indicating its potential as an active material for repairing congenital alveolar process clefts in humans.

Quantitative Evaluation of Nasolabial Alterations following Nasoalveolar Molding (NAM) Therapy in Patients with Unilateral Cleft Lip.

The clinical benefit of nasoalveolar molding (NAM) is actively debated between cleft centers without clear consensus. Nasolabial measurements were performed on pediatric patients with unilateral clefts of the lip, with or without cleft palate, at an academic cleft/craniofacial center prior to and following NAM therapy between June 2015 and August 2016. The parameters of interest were: columella height and width, cleft nostril height and width, and lip width. Measurements were performed using photographs taken alongside a reference object. The image output was then scaled to the size of the reference object and the capture angle. Intraclass correlation coefficient was calculated to assess reliability of the photographic measurements. Descriptive statistics (mean, standard deviation [SD]) were calculated to characterize the pre- and post-NAM measurements. Student's t-tests were performed to compare the pre-NAM versus post-NAM measurements. The primary objective was to measure the effect of NAM on the nasal aesthetic units that are known to be anatomically aberrant in the cleft lip patient. Nine patients were included in this study. Average pre-NAM age was 2.5 weeks, and average post-NAM age was 13 weeks. Average columellar height increased from 3.70 mm (SD = 0.14) pre-NAM to 5.85 mm (SD = 1.96) post-NAM (p < 0.01); average columellar width increased from 4.71 mm (SD = 0.49) to 5.93 mm (SD = 0.71) (p < 0.01); average cleft nostril height increased from 3.54 mm (SD = 2.97) to 6.81 mm (SD = 2.98) (p = 0.01); and average cleft nostril width decreased from 15.46 mm (SD = 2.91) to 11.05 mm (SD = 1.01) (p = 0.01). Average lip width decreased from 34.61 mm (SD = 1.73) to 33.87 mm (SD = 3.67); however, this change was not statistically significant (p = 0.16). This study objectively quantifies positive changes in nasal aesthetics associated with NAM therapy, providing further evidence for its utility as a presurgical treatment modality for optimal aesthetic nasal results in the unilateral cleft lip patient. The major limitation of this study was a lack of control group, as our center universally treats complete unilateral cleft lip patients with NAM therapy. However, the authors strongly believe that the positive aesthetic nasal findings would persist if compared with a non-NAM control group.

Cleft Alveolus Reconstruction Using a Three-Dimensional Printed Bioresorbable Scaffold With Human Bone Marrow Cells.

Bone tissue engineering technology based on scaffold has been applied for cleft lip and palate treatment. However, clinical applications of patient-specific three-dimensional (3D) scaffolds have rarely been performed. In this study, a clinical case using patient-specific 3D-printed bioresorbable scaffold with bone marrow stromal cells collected from iliac crest in the operating room has been introduced. At 6-month after transplantation, the bone volume of the newly regenerated bone was approximately 45% of the total defect volume. Bone mineral density of the newly regenerated bone was about 75% compared to the surrounding bone. The Hounsfield unit value was higher than that of cancellous maxillary alveolar bone and lower than that of the cortical maxillary alveolar bone. Bone-marrow-derived mesenchymal stem cells-seeded 3D-printed patient-specific polycaprolactone scaffolds offer a promising alternative for alveolar cleft reconstruction and other bony defects.

Evaluating of Platelet-Rich Fibrin in the Treatment of Alveolar Cleft With Iliac Bone Graft By Means of Volumetric Analysis.

The purpose of this study was to evaluate the efficiency of platelet-rich fibrin usage in the treatment of alveolar cleft with iliac bone graft by means of volumetric analysis. In this study, 22 patients with alveolar clefts-including 13 unilateral and 9 bilateral-were treated with anterior iliac crest bone grafts. Patients were divided into 2 groups as control (group A) and platelet-rich fibrin (group B) groups. Cone beam computed tomography (CBCT) scans were obtained preoperatively and 6 months postoperatively. Three-dimensional reconstructions of CBCT images were created by using Mimics software. Preoperative alveolar cleft volume and postoperative newly formed bone volume were assessed volumetrically. The percentages of preoperative alveolar cleft volume ranged from 0.51 to 2.04 cm, with a mean volume of 0.98 ±â€Š0.33 cm. The percentages of newly formed bone in group B ranged from 50.70% to 80.09%, with a mean percentage of 68.21 ±â€Š10.80%. In Group A, the percentages of bone formation ranged from 47.02% to 79.23%, with a mean percentage of 64.62 ±â€Š9.49%. Platelet-rich fibrin can be used in the treatment of alveolar cleft with corticocancellous bone graft harvested from the anterior iliac crest, but in this study, there was no statistically significant difference between the groups for postoperative newly formed bone volume (P > 0.05).

Effects of Nasoalveolar Molding Therapy on Alveolar and Palatal Cleft Deformities in Unilateral and Bilateral Cleft Lip and Palate.

OBJECTIVE: The purpose of this study was to evaluate and compare the efficacy of nasoalveolar molding (NAM) therapy in the improvement of alveolar and palatal cleft deformity on unilateral (UCLP) versus bilateral (BCLP) cleft lip and palate. MATERIALS AND METHODS: A total of 19 UCLP (14 boys and 5 girls) and 8 BCLP (7 boys and 1 girl) infants completed NAM therapy were included in this study. Standardized parameters of cleft width of alveol and palate were measured on photocopies taken from the pre- and post-treatment plaster casts. To assess the intragroup differences, paired-samples test in UCLP and Wilcoxon test in BCLP groups were used. Mann-Whitney U test was used to evaluate the differences between the groups. RESULTS: Significant decreases in alveolar and palatal cleft gaps were achieved in an average period of 3.3 ±â€Š1.9 and 3.7 ±â€Š1.6 months in UCLP and BCLP patients, respectively. The alveolar cleft decreased 7.85 ±â€Š4.59 mm in UCLP and 4.25 ±â€Š3.13 and 3.81 ±â€Š3.50 mm in right and left alveolar cleft sides in BCLP, respectively. The palatal clefts were decreased 4.63 ±â€Š2.44 mm in medial and 3.72 ±â€Š2.62 mm in posterior parts in UCLP. The decrements in BCLP were 3.00 ±â€Š2.75 mm in medial and 2.88 ±â€Š2.75 mm in posterior palatal cleft distances. No significant differences were determined in the amount of alveolar or palatal cleft closure between UCLP and BCLP groups. The only decrease in arch width was 1.39 mm in medial part of palate in UCLP. CONCLUSION: The NAM device provides significant decreases in both alveolar and palatal cleft deformities in UCLP and BCLP infants, as compared with their birth status.

Alternatives to Autologous Bone Graft in Alveolar Cleft Reconstruction: The State of Alveolar Tissue Engineering.

Alveolar cleft reconstruction has historically relied on autologous iliac crest bone grafting (ICBG), but donor site morbidity, pain, and prolonged hospitalization have prompted the search for bone graft substitutes. The authors evaluated bone graft substitutes with the highest levels of evidence, and highlight the products that show promise in alveolar cleft repair and in maxillary augmentation. This comprehensive review guides the craniofacial surgeon toward safe and informed utilization of biomaterials in the alveolar cleft.A literature search was performed to identify in vitro human studies that fulfilled the following criteria: Level I or Level II of evidence, ≥30 subjects, and a direct comparison between a autologous bone graft and a bone graft substitute. A second literature search was performed that captured all studies, regardless of level of evidence, which evaluated bone graft substitutes for alveolar cleft repair or alveolar augmentation for dental implants. Adverse events for each of these products were tabulated as well.Sixteen studies featuring 6 bone graft substitutes: hydroxyapatite, demineralized bone matrix (DBM), ß-tricalcium phosphate (TCP), calcium phosphate, recombinant human bone morphogenic protein-2 (rhBMP-2), and rhBMP7 fit the inclusion criteria for the first search. Through our second search, the authors found that DBM, TCP, rhBMP-2, and rhBMP7 have been studied most extensively in the alveolar cleft literature, though frequently in studies using less rigorous methodology (Level III evidence or below). rhBMP-2 was the best studied and showed comparable efficacy to ICBG in terms of volume of bone regeneration, bone density, and capacity to accommodate tooth eruption within the graft site. Pricing for products ranged from $290 to $3110 per 5 mL.The balance between innovation and safety is a complex process requiring constant vigilance and evaluation. Here, the authors profile several bone graft substitutes that demonstrate the most promise in alveolar cleft reconstruction.

Subphenotyping and Classification of Cleft Lip and Alveolus in Adult Unoperated Patients: A New Embryological Approach.

OBJECTIVE: Previously, a new embryological classification was introduced subdividing oral clefts into fusion and/or differentiation defects. This subdivision was used to classify all subphenotypes of cleft lip with or without alveolus (CL±A). Subsequently, it was investigated whether further morphological grading of incomplete CLs is clinically relevant, and which alveolar part is deficient in fusion/differentiation defects. DESIGN: Observational cohort study. SETTING: Three hundred fifty adult unoperated Indonesian cleft patients presented themselves for operation. Cephalograms, dental casts, and intraoral and extraoral photographs-eligible for the present study-were used to determine morphological severity of CL±A. PATIENTS: Patients with unilateral or bilateral clefts of the primary palate only were included. MAIN OUTCOME MEASURES: Clefts were classified-according to developmental mechanisms and timing in embryogenesis-as fusion and/or differentiation defects. Grades of incomplete CLs were related to the severity of alveolar clefts (CAs) and hypoplasia, and permanent dentition was used to investigate which alveolar part is deficient in fusion/differentiation defects. RESULTS: One hundred eight adult patients were included. All subphenotypes-96 unilateral and 12 bilateral clefts-could be classified into differentiation (79%), fusion (17%), fusion-differentiation (2%), or fusion and differentiation (2%) defects. The various grades of incomplete CLs were related to associated CAs and hypoplasia, and all alveolar deformities were located in the premaxillae. CONCLUSIONS: This study showed that all CL±A including the Simonart bands can be classified, that further morphological grading of incomplete CLs is clinically relevant, and that the premaxilla forms the deficient part in alveolar deformities.

Factors Associated With Adherence to Nasoalveolar Molding (NAM) by Caregivers of Infants Born With Cleft Lip and Palate.

OBJECTIVE: Identify factors associated with adherence to nasoalveolar molding (NAM) therapy. DESIGN: Retrospective case-control study. SETTING: Tertiary referral center. PATIENTS, PARTICIPANTS: Infants with cleft lip, with or without cleft palate, referred for NAM. One hundred thirty-five patients met criteria. MAIN OUTCOME MEASURE(S): Adherence to NAM therapy, defined as continuous use of the appliance and attendance of NAM adjustment visits. RESULTS: Female sex (OR = 2.85, 95% CI 1.21-6.74), bilateral cleft (OR = 2.88, 95% CI 1.29-6.46), and travel distance (OR = 1.01, 95% CI 1.00-1.01) were independent predictors of nonadherence. Bilateral clefts (OR = 8.35, 95% CI 2.72-25.64) and public-payer insurance (OR = 3.67, 95% CI 1.13-11.91) for male patients were significantly associated with nonadherence, in our sex-stratified multivariate model. The majority of the families (58%) had public health insurance. Males comprised 77.0% of the cohort. CONCLUSIONS: NAM treatment adherence is impaired by bilateral clefts, female sex, increased travel distance, and public insurance. Further studies are warranted to investigate how these factors affect adherence, and to develop interventions to improve adherence in families at risk due to economic or psychosocial barriers.

Effect of Presurgical Nasoalveolar Molding on Nasal Symmetry in Unilateral Complete Cleft Lip/Palate Patients after Primary Cheiloplasty without Concomitant Nasal Cartilage Dissection: Early Childhood Evaluation.

OBJECTIVE: The objective of this study was to assess the efficacy of presurgical nasoalveolar molding (PNAM) on long-term nasal symmetry and shaping after primary cheiloplasty in patients with unilateral complete cleft lip/palate (UCL/P). DESIGN: This was a two-group, parallel, retrospective, randomized clinical trial. SETTING: The setting for this study was the Chang Gung Craniofacial Center in Taoyuan, Taiwan. PATIENTS: Patients were divided into one of the following two groups: infants with UCL/P who underwent PNAM (PNAM group, n = 42) and infants with UCL/P who did not undergo PNAM (non-PNAM group, n = 42). INTERVENTIONS: Interventions included PNAM and primary cheiloplasty without nasal cartilage dissection. MAIN OUTCOME MEASURES: In this study, 4- to 5-year postoperative full-face and submental oblique photographs were taken of all patients and scored from 1 to 5 points by 10 medical evaluators. The scores were statistically analyzed using repeated-measures analysis of variance, and P < .05 was considered to represent statistical significance. RESULTS: After 1 to 3 months of PNAM but before primary cheiloplasty, the displaced nasal and alveolar cartilage showed obvious improvement. However, the scores in the PNAM and non-PNAM groups at 4 to 5 years postoperatively were 66.62 ± 14.25 and 66.31 ± 15.08, respectively. There was no significant difference between the two groups ( F = 0.009, P = .923). CONCLUSION: PNAM as an early-stage adjunctive therapy for nasal deformity correction is beneficial before primary cheiloplasty, but it is insufficient to maintain long-term nostril symmetry after primary cheiloplasty without nasal cartilage dissection.

A Novel Minimally Invasive Technique of Using Tooth-Borne Hyrax Expansion Screw for Distraction Osteogenesis of Large Alveolar Cleft Defects (HYDIS-TB).

Because of the high failure rates, large alveolar cleft defects cannot be successfully closed with bone grafting. Vega introduced the use of the hyrax screw for the closure of such defects by distraction osteogenesis. However, his technique was more invasive with a difficult adaptation of the appliance at the surgical table. To overcome these limitations, a completely tooth-borne trifocal distraction appliance was devised and placed after osteotomy in a 22-year-old repaired group 3 cleft patient who had a 15-mm alveolar defect on the right side. The tooth-borne trifocal distraction appliance was successful in the controlled closure of a large alveolar cleft with minimal invasiveness and low costs making this procedure feasible for a greater number of patients.

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.

Modified Activation Technique for Nasal Stent of Nasoalveolar Molding Appliance for Columellar Lengthening in Bilateral Cleft Lip/Palate.

Bilateral cleft lip/cleft palate is associated with nasal deformities typified by a short columella. The presurgical nasoalveolar molding (NAM) therapy approach includes reduction of the size of the intraoral alveolar cleft as well as positioning of the surrounding deformed soft tissues and cartilages. In a bilateral cleft patient, NAM, along with columellar elongation, eliminates the need for columellar lengthening surgery. Thus the frequent surgical intervention to achieve the desired esthetic results can be avoided. This article proposes a modified activation technique of the nasal stent for a NAM appliance for columellar lengthening in bilateral cleft lip/palate patients. The design highlights relining of the columellar portion of the nasal stent and the wire-bending of the nasal stent to achieve desirable results within the limited span of plasticity of the nasal cartilages. With this technique the vertical taping of the premaxilla to the oral plate can be avoided.

[Adherence to the treatment of pre surgical nasoalveolar molding in cleft lip and palate]. / Adherencia al tratamiento de moldeado nasoalveolar en pacientes con fisura labiopalatina.

OBJECTIVES: The nasoalveolar molding device (NAM) designed to decrease the size of the defect and improve nasal asymmetry, facilitates surgical intervention improving the results. However, family involvement is highly necessary due to the fact that the treatment herein referred is long and tedious. The aim of this study is to determine adherence to treatment and possible variables that can determine their rejection. MATERIALS AND METHODS: Patients treated with NAM over the last 6 years (64 patients). Retrospective data collection and telephone surveys. 5 groups established depending on its respective adherence to the treatment (from rejection of the treatment to good adherence to it). Several aspects are herein analyzed related to the caregiver, the patient and the social background (degree of education, number of caregivers, distance to the hospital, etc.). Through the SPSS program, a descriptive study was carried out, analyzing the variables using chi2 with Fisher's exact correction. RESULTS: 46 surveys were completed (32 boys and 14 girls), 63% were unilateral, 91% had a cleft palate. Adherence to the treatment was good by 80%, and only 6% rejected the treatment. The adherence was significantly higher, if they had contacted with other families of patients (P < 0.01) and a higher tendency of abandonment of treatment in other nationalities than the Spanish one, although without significant differences. CONCLUSIONS: Adherence to treatment is very good in general, and we can not significantly determine the variables that can condition the rejection of treatment, but contacting with family members of patients or associations of patients makes the adherence greater.

OBJETIVOS: El dispositivo de moldeamiento nasoalveolar (NAM), diseñado para aproximar los segmentos fisurados y mejorar la asimetría nasal, facilita la intervención quirúrgica mejorando los resultados. Sin embargo, necesita gran colaboración por parte de la familia por ser largo, y a veces, tedioso. El objetivo de este trabajo es determinar la adherencia al tratamiento y las posibles variables que puedan determinar su rechazo. MATERIAL Y METODOS: Pacientes tratados con NAM en los últimos 6 años (64 pacientes). Recogida de datos retrospectiva (historias) y encuesta telefónica. Clasificación en 5 grupos según el seguimiento del tratamiento (rechazo del tratamiento hasta un cumplimiento correcto del tratamiento). Analizamos factores relacionados con el cuidador, el paciente y el contexto social (nivel de estudios, número de cuidadores, distancia al hospital, etc.). Mediante el programa SPSS se realizó un estudio descriptivo, analizando las variables mediante chi2 con corrección exacta de Fisher. RESULTADOS: Se completaron las 46 encuestas (32 niños y 14 niñas), el 63% fueron unilaterales, el 91% con fisura palatina. El cumplimiento terapéutico fue bueno en el 80%, y solo el 7% rechazaron el tratamiento. La adherencia fue mayor, de forma significativa, si habían contactado con otras familias de pacientes (P< 0,01) y tendencia a mayor abandono en otras nacionalidades distinta a la española, aunque sin significación estadística. CONCLUSIONES: El cumplimiento terapéutico de estos pacientes es bueno de forma general, y no podemos determinar de forma significativa las variables que pueden condicionar el rechazo al tratamiento, pero si, que el contacto con familiares de afectados o asociaciones de pacientes hacen que la adherencia sea mayor.

Volumetric assessment of alveolar clefts: a literature review.

OBJECTIVE: To conduct a review of the literature on methods for volumetric assessment of alveolar clefts and ascertain which methods are most precise to guide future research. METHODS: The PubMed and MEDLINE databases were searched for English-language reports of clinical and in vitro studies with detailed descriptions of imaging modality, sample characteristics, and method for measurement of alveolar cleft volume. RESULTS: The search strategy yielded 34 articles, of which 14 were selected for in-depth analysis. According to the findings of computed tomography (CT)-based studies, the CT modalities and software employed for assessment were deemed reliable and satisfactory. CONCLUSIONS: Measurement of alveolar cleft volume by the proposed methods and using the equipment and software employed in the analyzed studies has high efficacy and efficiency and can be safely used for cleft lip and palate treatment planning.

Chin Symphysis Bone, Allograft, and Platelet-Rich Fibrin: Is the Combination Effective in Repair of Alveolar Cleft?

PURPOSE: Secondary grafting of alveolar defects with iliac crest bone is a common treatment method in cleft patients. The aim of this study was to evaluate the effectiveness of the combination of symphysis bone, allograft, and platelet-rich fibrin in regeneration of alveolar defects compared with iliac bone graft. MATERIALS AND METHODS: In this randomized clinical trial, patients with unilateral alveolar defects were divided randomly into two categories. Group A comprised patients in whom the combination of chin symphysis bone plus allogeneic bone material plus leukocyte- and platelet-rich fibrin was considered for treatment. Group B comprised patients in whom iliac bone graft was considered. Cone beam computed tomography before treatment and 1 year postoperatively was used for measurement of bone formation (bone volume in cubic centimeters). The data were analyzed by paired t and χ2 tests via SPSS software (version 23; IBM, Armonk, NY). P < .05 was considered significant. RESULTS: Each group included 10 patients (with 6 male patients in group A and 5 male patients in group B). The mean age of patients in groups A and B was 9.5 ± 1.5 years and 9.9 ± 1.9 years, respectively. The mean volume of alveolar defects was 0.89 ± 0.29 cm3 in group A and 0.95 ± 0.27 cm3 in group B. The percentage of bone regeneration in groups A and B was 69.5% and 73.8%, respectively. CONCLUSIONS: It seems that chin symphysis bone plus allogeneic bone material plus platelet-rich fibrin is a proper combination for bone regeneration in alveolar defects with a small to moderate volume range.

Evaluation of the skeletal and dental effects in orthodontic patients with maxillary lateral incisor agenesis.

OBJECTIVE: The purpose of this study was to evaluate the transverse dimension of the dentoalveolar and skeletal widths in both unilateral (UMLIA) and bilateral (BMLIA) maxillary lateral incisor agenesis groups. MATERIALS AND METHODS: The study sample consisted of 59 patients (34 females and 25 males) divided into three groups as UMLIA group (16 patients; 14.94 ± 1.37 years), BMLIA group (21 patients; 14.46 ± 1.53 years) and control group (22 patients; 15.28 ± 1.70 years) without tooth agenesis. Transversal measurements (maxillary and mandibular intercanine, interpremolar, intermolar, intercanine alveolar, interpremolar alveolar, intermolar alveolar widths) were done on dental casts. Craniofacial skeletal measurements were done with posteroanterior cephalometric radiographs. Statistical testing was performed with the one-way variance analysis, Kruskal-Wallis and post hoc tests. RESULTS: UMLIA and BMLIA groups had statistically significantly narrower skeletal apical base of the maxilla, maxillary intercanine and intercanine alveolar widths compared with the control group (P < .05). Moreover, UMLIA and BMLIA groups had statistically significantly similar dental, alveolar and skeletal features (P > .05). CONCLUSIONS: The UMLIA and BMLIA groups showed statistically significantly smaller values for maxillary intercanine, maxillary intercanine alveolar and skeletal maxillary widths compared with the control group. CLINICAL SIGNIFICANCE: This study provides information the transverse dimension of the dental, alveolar and skeletal widths with maxillary lateral incisor agenesis patients. Knowledge of transverse dimension of the dental, alveolar and skeletal widths with maxillary lateral incisor agenesis patients is important for diagnosis and treatment planning.

Clefting of the Alveolus: Emphasizing the Distinction from Cleft Palate.

Oral clefting is one of the most common significant fetal abnormalities. Cleft lip and cleft palate have drastically different clinical ramifications and management from one another. A cleft of the alveolus (with or without cleft lip) can confuse the diagnostic picture and lead to a false assumption of cleft palate. The cleft alveolus should be viewed on the spectrum of cleft lip rather than be associated with cleft palate. This is made evident by understanding the embryological development of the midface and relevant terminology. Cleft alveolus carries significantly different clinical implications and treatment options than that of cleft palate. Accurately distinguishing cleft alveolus from cleft palate is crucial for appropriate discussions regarding the patient's care.