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1.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 54(8): 540-545, 2019 Aug 09.
Artículo en Chino | MEDLINE | ID: mdl-31378033

RESUMEN

Objective: To establish the functional models based on various shapes of bone defects in isolated cleft palate patients and to classify the bone defects of the cleft palate cases using different functional curves. Methods: Tracking back from January 2018 to December 2018, 143 patients with cleft palate (Veau Ⅰ & Ⅱ) treated in Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, were included (age of 7 months to 25 years, average age 1.6 years, median age 1.0 year, the male to female ratio was 0.57∶1).The pre-operative (CT) data sets were reconstructed into a three dimensional model to produce a direct image of the cleft palate. According to the shapes of the bone defect, cleft palate cases were divided into three types, i.e."" shape, inverted "V" shape and inverted "U" shape, and then the cases were assessed and reviewed by five examiners independently. Using Microsoft Excel software, the curves of the bone defect were placed in the coordinate system for mathematical modeling, including exponential function (y=ae(bx)), linear function (y=ax+b) and logarithm function (y=alnx+b). The function of the maximum fit R(2) value was used as the final fit curve. Statistical analysis was performed in four aspects: ① The reliability and feasibility of the curve fitting of the functions; ② The calculation of the composition ratio of the types of bone defect; ③Analyzing the correspondence between the subjective judgment results and fitting function curves; ④ The R(2) values of three types of functional curves homologous to different morphological types, and the data were tested by variance analysis and P values were shown. Results: Among the 143 patients with cleft palate, the "" shaped defect accounted for 18% (26/143), the inverted "V" shaped defect accounted for 31% (44/143), and the inverted "U" shaped defect accounted for 51% (73/143). The coincidence rate of the "" shaped defect with the exponential function (y=ae(bx)) was 96%, the coincidence rate of the inverted "V" shaped defect with the linear function (y=ax+b) was 82%, and the coincidence rate of the inverted "U" shaped defect with the logarithmic function (y=alnx+b) was 93%. The differences in R(2) values amongst the three groups were statistically significant (P<0.05). Conclusions: The shapes of bone defects of the incomplete cleft palate can be described by functional curve models which include exponential, linear and logarithmic functions and can be used to classify and lay the foundation for digital classification of cleft lip and palate cases.


Asunto(s)
Labio Leporino , Fisura del Paladar , Labio Leporino/clasificación , Labio Leporino/diagnóstico , Fisura del Paladar/clasificación , Fisura del Paladar/diagnóstico , Femenino , Humanos , Lactante , Masculino , Reproducibilidad de los Resultados
2.
Genet Epidemiol ; 43(6): 704-716, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31172578

RESUMEN

Phenotypic heterogeneity is a hallmark of complex traits, and genetic studies of such traits may focus on them as a single diagnostic entity or by analyzing specific components. For example, in orofacial clefting (OFC), three subtypes-cleft lip (CL), cleft lip and palate (CLP), and cleft palate (CP) have been studied separately and in combination. To further dissect the genetic architecture of OFCs and how a given associated locus may be contributing to distinct subtypes of a trait we developed a framework for quantifying and interpreting evidence of subtype-specific or shared genetic effects in complex traits. We applied this technique to create a "cleft map" of the association of 30 genetic loci with three OFC subtypes. In addition to new associations, we found loci with subtype-specific effects (e.g., GRHL3 [CP], WNT5A [CLP]), as well as loci associated with two or all three subtypes. We cross-referenced these results with mouse craniofacial gene expression datasets, which identified additional promising candidate genes. However, we found no strong correlation between OFC subtypes and expression patterns. In aggregate, the cleft map revealed that neither subtype-specific nor shared genetic effects operate in isolation in OFC architecture. Our approach can be easily applied to any complex trait with distinct phenotypic subgroups.


Asunto(s)
Encéfalo/anomalías , Labio Leporino/clasificación , Labio Leporino/genética , Fisura del Paladar/clasificación , Fisura del Paladar/genética , Sitios Genéticos , Marcadores Genéticos , Pruebas Genéticas/métodos , Estudio de Asociación del Genoma Completo/métodos , Fenotipo , Encéfalo/patología , Labio Leporino/patología , Fisura del Paladar/patología , Humanos , Transcriptoma
3.
Eur Radiol ; 29(10): 5600-5606, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30887208

RESUMEN

OBJECTIVE: The aim of this study was to evaluate the value of MRI in the prenatal diagnosis and classification of cleft palate (CP). METHODS: We collected 94 fetal cases that were suspected of cleft palate with or without cleft lip by prenatal ultrasound (US) and then carried out further MRI to examine the entire body of each fetus within 1 week. The diagnoses resulting from MRI and US examination were compared separately with the final diagnoses obtained from postnatal physical examination or fetal autopsy. The diagnostic accuracy between MRI and US was then determined. RESULTS: During the follow-up period, the results for 6 fetuses (6.38%) were lost. Of the remaining 88 cases, the final diagnoses identified 23 cases of cleft lip (CL), 45 cases of unilateral cleft lip with cleft palate (UCLP), 4 cases of median cleft lip with cleft palate (MCLP), 12 cases of bilateral cleft lip with cleft palate (BCLP), 3 cases of unilateral cleft lip and cleft alveolus (CLA), and 1 case of isolated cleft palate (CPO). The total accuracy rate of US was 59.09%, while that of MRI was 92.05%. More importantly, 81 cases were accurately identified by MRI; the accuracy rate for CL, UCLP, MCLP, BCLP, CLA, and CPO was 86.96%, 95.56%, 100%, 91.67%, 66.67%, and 100%, respectively. CONCLUSION: Our results suggest that MRI could be a useful adjunct to US examination in the prenatal diagnosis of fetuses with cleft palate, and further demonstrates the classification and degree of involvement of the cleft palate. KEY POINTS: • MRI is a useful adjunct to prenatal ultrasound. • MRI has a higher accuracy rate for CP. • The accurate classification of CP diagnosed by MRI can guide clinical management.


Asunto(s)
Fisura del Paladar/clasificación , Fisura del Paladar/diagnóstico , Imagen por Resonancia Magnética/métodos , Diagnóstico Prenatal/métodos , Adolescente , Adulto , Fisura del Paladar/embriología , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Reproducibilidad de los Resultados , Adulto Joven
4.
Plast Reconstr Surg ; 143(1): 140e-151e, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30431540

RESUMEN

BACKGROUND: It is not easy to find a management-based classification of palatal fistula in the literature. A few attempts have been made to classify the wide variety of fistulae that do not describe the fistula details comprehensively and guide toward its management. The authors have come across a wide variety of fistulae that could not be classified according to any of the prevailing classification systems. The presented classification gives a clear and exact understanding of location and size of fistula/dehiscence. Palatal function has been included as one of the important determinants for devising a management plan. Based on this classification, the authors have proposed an algorithm that encompasses clear guidelines for surgical treatment of these fistulae. METHODS: Over the past 15 years, the authors' team operated on 2537 palatal fistula patients. The medical records of these patients were reviewed to determine the location, size, and velopharyngeal competence. A new classification and algorithm were developed. RESULTS: Of 2537 patients, 2258 had midline fistulae, 208 had lateral fistulae, and 53 had subtotal fistulae. There were 18 patients with dehiscence. Recurrence developed in 181 patients. CONCLUSION: The authors believe that this classification and algorithm can help follow a practical approach to manage palatal fistulae and dehiscence.


Asunto(s)
Fisura del Paladar/clasificación , Fisura del Paladar/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Colgajos Quirúrgicos/trasplante , Insuficiencia Velofaríngea/cirugía , Adolescente , Adulto , Factores de Edad , Algoritmos , Niño , Preescolar , Fisura del Paladar/diagnóstico , Fisura del Paladar/epidemiología , Estudios de Cohortes , Países en Desarrollo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pakistán , Calidad de Vida , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Resultado del Tratamiento , Insuficiencia Velofaríngea/diagnóstico , Insuficiencia Velofaríngea/epidemiología , Adulto Joven
5.
Oral Radiol ; 34(2): 127-135, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-30484129

RESUMEN

OBJECTIVE: The aim of this study was to evaluate and compare the craniofacial cephalometric morphologies among different cleft types in a Spanish population. METHODS: A retrospective cross-sectional study was carried out on 212 patients. The patients were subdivided into four groups according to their cleft types: unilateral cleft lip and palate; bilateral cleft lip and palate; cleft lip; and cleft palate. Angular and linear cephalometric measurements were taken on lateral radiographs. RESULTS: Unilateral cleft lip and palate was associated with a dolichofacial growth pattern, skeletal Class III with correct maxillary position, and lingual incisor inclination. Bilateral cleft lip and palate was associated with a mesofacial growth pattern, skeletal Class I with protruded maxillary position, and lingual incisor inclination. Cleft palate was associated with a mesofacial growth pattern, skeletal Class III with correct maxillary position, and lingual incisor inclination. Cleft lip was associated with a brachyfacial growth pattern, skeletal Class I with protruded maxillary position, lingual upper incisor inclination, and corrects lower incisor inclination. Significant correlations were observed between cleft types and their craniofacial cephalometric measurements. CONCLUSIONS: The present information can be used for the determination of orthodontic treatment and even future orthognathic surgery planning, a requirement in most cleft patients.


Asunto(s)
Cefalometría/métodos , Labio Leporino/diagnóstico por imagen , Fisura del Paladar/diagnóstico por imagen , Adolescente , Puntos Anatómicos de Referencia , Niño , Preescolar , Labio Leporino/clasificación , Fisura del Paladar/clasificación , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Desarrollo Maxilofacial , Estudios Retrospectivos
6.
J Am Acad Child Adolesc Psychiatry ; 57(11): 876-883, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30392629

RESUMEN

OBJECTIVE: Children with orofacial clefts (OFC) may have an increased risk of poor mental health. This study aimed to investigate the risk of psychiatric diagnoses in individuals with OFC, stratified by cleft type. METHOD: A nationwide register-based cohort of all individuals born with nonsyndromic OFC in Sweden between 1973 and 2012 (n = 7,842) was compared to a matched cohort (n = 78,409) as well as to their unaffected siblings (n = 9,637). The risk of psychiatric diagnoses, suicide attempts, and suicides was examined by crude and adjusted Cox regression models. Effect modification by sex was investigated with interaction terms in the models. RESULTS: Children with cleft lip (CL) had a significantly higher risk of any psychiatric disorder, intellectual disability, and language disorders; children with cleft lip and palate (CLP) had, in addition, an increased risk of autism spectrum disorder (ASD). Children with cleft palate only (CPO) had risk increases for the same diagnoses as children with CL and CLP, but with higher hazard ratios, and also for psychotic disorders, attention-deficit/hyperactivity disorder (ADHD), and other behavioral or emotional disorders in childhood. Sex stratification indicated higher risk increases among females in CL and CLP but not in CPO. Siblings without OFC were less likely to be diagnosed with any psychiatric disorder, intellectual disability, language disorder, ASD, or ADHD compared to their siblings with OFC. CONCLUSION: Children with nonsyndromic clefts had a significantly higher risk of neurodevelopmental disorders. This risk is unlikely to be explained by familial influences such as inherited genetic or shared environmental factors.


Asunto(s)
Encéfalo/anomalías , Labio Leporino/epidemiología , Fisura del Paladar/epidemiología , Trastornos del Neurodesarrollo/epidemiología , Adolescente , Niño , Labio Leporino/clasificación , Labio Leporino/genética , Fisura del Paladar/clasificación , Fisura del Paladar/genética , Estudios de Cohortes , Femenino , Humanos , Masculino , Sistema de Registros , Factores de Riesgo , Factores Sexuales , Suecia/epidemiología
7.
Arch Pediatr ; 25(7): 439-441, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30249490

RESUMEN

Spina's classification uses the incisive foramen as an anatomic reference to define groups I, II, and III. In some cases, the morphological manifestation of the cleft arises simultaneously pre- and postforamen, but without communicating. Considering that group I refers to isolated clefts of the primary palate and group III includes isolated clefts of the secondary palate, the authors suggest the classification group IIa for the association of these two occurrences in the same patient, thus associating two classifications. The original structure proposed by Spina is maintained and simply complemented and updated to Spina-A classification.


Asunto(s)
Labio Leporino/clasificación , Fisura del Paladar/clasificación , Humanos , Paladar (Hueso)/embriología
8.
Medicine (Baltimore) ; 97(25): e11224, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29924053

RESUMEN

BACKGROUND: Orofacial clefts include cleft lip only (CLO), cleft palate only (CPO), and cleft lip with palate (CLP). Previously, we reported the expression profile of plasma microRNAs in CLO, CPO, and CLP, respectively. However, the interaction of each subtype remains poorly investigated. METHODS: In this study, we integrated the expression profiles of plasma miRNAs in these 3 subtypes, and assessed the distinct and overlapping dysregulated miRNAs using Venn diagrams. Their respective target genes reported in the literature were further analyzed using pathway analysis. RESULTS AND CONCLUSION: The results showed that distinct or overlapping signaling pathways were involved in CLO, CPO, and CLP. The common key gene targets reflected functional relationships to the Wnt, Notch, TGF-beta, and Hedgehog signaling pathways. Further studies should examine the mechanism of the potential target genes, which may provide new avenues for future clinical prevention and therapy.


Asunto(s)
Encéfalo/anomalías , Labio Leporino/genética , Fisura del Paladar/genética , MicroARNs/sangre , MicroARNs/genética , Labio Leporino/sangre , Labio Leporino/clasificación , Fisura del Paladar/sangre , Fisura del Paladar/clasificación , Epigénesis Genética/genética , Humanos , Análisis por Micromatrices/métodos , Transducción de Señal/genética
9.
Am J Orthod Dentofacial Orthop ; 153(4): 542-549, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29602346

RESUMEN

INTRODUCTION: The association between maxillary protraction and bone graft in patients with cleft lip and palate remains unclear. The purpose of this study was to investigate whether a secondary alveolar bone graft influences dentoskeletal effects of facemask therapy in unilateral cleft lip and palate patients with a skeletal Class III relationship. METHODS: In this prospective nonrandomized clinical trial, 61 consecutive boys with unilateral cleft lip and palate and skeletal Class III malocclusion were divided into 3 groups: grafted facemask group (n = 21), ungrafted facemask group (n = 20), and untreated control group (n = 20). Sixteen dentoskeletal measurements on lateral cephalometric radiographs were compared before and after therapy or observation with 1-way analysis of variance or the Mann-Whitney U test. RESULTS: After facemask therapy, the grafted group showed a statistically significantly greater advancement of Point A (S-Vert-A, 4.18 ± 1.94 mm; SNA, 3.51° ± 2.21°) than did the ungrafted group (S-Vert-A, 2.64 ± 1.58 mm; SNA, 1.92° ± 1.05°). Furthermore, significant SNB changes were found in the grafted group when compared with those in the ungrafted group (-0.38° ± 1.77° vs -1.69° ± 1.34°; P <0.05). The changes in the mandibular plane angle (MP-SN, MP-FH) in the grafted group were less pronounced than in the ungrafted group by approximately 2° (P <0.05). Flaring of the maxillary incisors was more pronounced in treated subjects than in untreated subjects. The mandibular incisors proclined in both grafted (1.54° ± 4.21°) and control (0.97° ± 3.71°) patients, and were retroclined in the ungrafted group (-2.13° ± 3.68°). CONCLUSIONS: Facemask therapy performed after an alveolar bone graft produced more anterior maxillary migration (90%) and less pronounced mandibular clockwise rotation (10%) than those in the ungrafted group (50%, 50%, respectively).


Asunto(s)
Aumento de la Cresta Alveolar , Trasplante Óseo , Labio Leporino/terapia , Fisura del Paladar/terapia , Aparatos de Tracción Extraoral , Maloclusión de Angle Clase III/cirugía , Maloclusión de Angle Clase III/terapia , Injerto de Hueso Alveolar , Análisis de Varianza , Puntos Anatómicos de Referencia , Cefalometría , Niño , China , Labio Leporino/clasificación , Labio Leporino/diagnóstico por imagen , Labio Leporino/cirugía , Fisura del Paladar/clasificación , Fisura del Paladar/diagnóstico por imagen , Fisura del Paladar/cirugía , Humanos , Incisivo , Masculino , Maloclusión de Angle Clase III/diagnóstico por imagen , Mandíbula/anatomía & histología , Mandíbula/diagnóstico por imagen , Maxilar/anatomía & histología , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Ensayos Clínicos Controlados no Aleatorios como Asunto , Técnica de Expansión Palatina , Estudios Prospectivos , Rotación , Estadísticas no Paramétricas , Resultado del Tratamiento
10.
Cleft Palate Craniofac J ; 55(9): 1267-1276, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29652537

RESUMEN

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.


Asunto(s)
Proceso Alveolar/anomalías , Labio Leporino/clasificación , Labio Leporino/embriología , Fisura del Paladar/clasificación , Fisura del Paladar/embriología , Adolescente , Adulto , Proceso Alveolar/embriología , Cefalometría , Femenino , Humanos , Indonesia , Masculino , Persona de Mediana Edad , Fenotipo
11.
Cleft Palate Craniofac J ; 55(3): 348-355, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29437505

RESUMEN

OBJECTIVE: To quantitatively measure the extent of 3D asymmetry of the facial skeleton in patients with unilateral cleft lip and palate (UCLP) using an asymmetry index (AI) approach, and to illustrate the applicability of the index in guiding and measuring treatment outcome. METHOD: Two groups of subjects between the ages of 15 and 20 who had archived CBCT scan were included in this study. Twenty-five patients with complete UCLP were compared with 50 age-matched noncleft subjects. The CBCT scans were segmented and landmarked for 3D anthropometric analysis. An AI was calculated as a quantitative measure of the extent of facial skeletal asymmetry. RESULTS: For the control group, the AI ranged from 0.72 ± 0.47 at A point to 4.77 ± 1.59 at Gonion. The degree of asymmetry increased with the increasing laterality of the landmark from the midsagittal plane. In the UCLP group, the values of AI significantly increased compared to the control group at nearly all measured landmarks. The extent of the asymmetry to involve the upper, middle, and lower facial skeleton varied widely with the individual patient with UCLP. CONCLUSION: The asymmetry index is capable of capturing the 3D facial asymmetry of subjects with UCLP and as a basis for classification of the extent of the asymmetry. We found the index to be applicable in surgical planning and in measuring the outcome in improving the symmetry in patients who have undergone orthognathic surgery.


Asunto(s)
Labio Leporino/clasificación , Fisura del Paladar/clasificación , Asimetría Facial/clasificación , Cráneo/anomalías , Adolescente , Puntos Anatómicos de Referencia , Labio Leporino/diagnóstico por imagen , Labio Leporino/terapia , Fisura del Paladar/diagnóstico por imagen , Fisura del Paladar/terapia , Tomografía Computarizada de Haz Cónico , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/terapia , Femenino , Humanos , Imagenología Tridimensional , Masculino , Ortodoncia Correctiva , Procedimientos Quirúrgicos Ortognáticos , Cráneo/diagnóstico por imagen , Adulto Joven
12.
Cleft Palate Craniofac J ; 55(3): 396-404, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29437506

RESUMEN

OBJECTIVE: This study compares speech and surgical outcomes in internationally adopted and nonadopted patients undergoing cleft palate repair, and examines the influence of age at initial palatoplasty. DESIGN: Retrospective cohort study setting: Tertiary Care Children's Hospital. PATIENTS: 70 international adoptees and 211 nonadoptees with Veau type III and IV clefts (without associated syndrome) repaired at our institution. OUTCOME MEASURES: Outcomes included VPI, compensatory misarticulations, intelligibility, nasal air emission, oronasal fistula, and secondary speech surgery. Speech evaluations completed near 5 years of age were gathered from a prospectively collected database. RESULTS: Adoptees underwent palatoplasty 5.2 months after arrival, a mean of 10.4 months later than nonadoptees. Adoptees were significantly more likely to develop moderate/severe VPI and trended toward more frequent need for secondary speech surgery. Oronasal fistula occurred at similar rates. Increased age at initial palatoplasty was a significant predictor of moderate to severe VPI, and need for secondary speech surgery. CONCLUSIONS: International adoptees undergo palatoplasty 10.4 months later than nonadoptees and are significantly more likely to develop moderate/severe VPI, with a trend toward increased secondary speech surgery. An association between treatment delay and moderate/severe VPI and secondary speech surgery has been demonstrated. While a causal relationship between delayed repair and inferior outcomes in international adoptees has not been proven, this data suggests that surgical intervention upon unrepaired cleft palates soon after adoption may be beneficial. The opportunity for a change in practice exists, as half of the 10.4-month relative delay in palate repair occurs postadoption.


Asunto(s)
Niño Adoptado , Fisura del Paladar/cirugía , Trastornos del Habla/diagnóstico , Fisura del Paladar/clasificación , Femenino , Humanos , Lactante , Masculino , Fístula Oral/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Reoperación , Estudios Retrospectivos , Resultado del Tratamiento , Insuficiencia Velofaríngea/diagnóstico
13.
Ann Plast Surg ; 80(4): 406-411, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29166310

RESUMEN

BACKGROUND: Questions persist regarding the general applicability of the Furlow palatoplasty technique, and thus, widespread adoption of its use has been uneven. This study describes a consecutive, nonselective series of primary Furlow palatoplasties. Highlighted is the unique fact that plastic surgical residents functioned as the primary surgeon for all steps of all procedures throughout the series. METHODS: A retrospective review was undertaken of all primary palatoplasties performed under the direction of the senior surgeon between December 2005 and April 2012. A stringent requirement for speech outcome reporting was patient age at the latest assessment of older than 4.5 years. Other measured parameters included fistula rate, incidence of secondary surgery, and procedure duration. RESULTS: Seventy-five patients were included in this study. Nasal resonance was rated as "normal" in 56.1% of the patients and "mildly hypernasal or better" in 95.1% of the patients. Articulation errors were detected in 14.6% of the patients, and symptoms related to nasal air emission were detected in 4.9% of the patients. Overall fistula rate was 5.3%. The following associations were detected: (1) Veau cleft type and procedure duration, P = 0.001; (2) resident year of training and procedure duration, P = 0.009; (3) developmental delay and resonance score, P = 0.002; (4) patient age at surgery and resonance score, P = 0.025; and (5) presence of syndrome and resonance score, P = 0.036. CONCLUSIONS: This nonselective series of consecutive Furlow palatoplasty procedures demonstrates that plastic surgical residents are able to match best published clinical results performing the entire procedure under the close supervision and guidance of an assisting surgical mentor.


Asunto(s)
Fisura del Paladar/cirugía , Procedimientos Quirúrgicos Orales/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Preescolar , Fisura del Paladar/clasificación , Competencia Clínica , Femenino , Humanos , Lactante , Internado y Residencia , Masculino , Estudios Retrospectivos , Inteligibilidad del Habla , Resultado del Tratamiento
14.
Rev. bras. cir. plást ; 32(4): 486-490, out.-dez. 2017. ilus, tab
Artículo en Inglés, Portugués | LILACS | ID: biblio-878748

RESUMEN

Introdução: As fissuras labiopalatinas são malformações congênitas e, no Brasil, estima-se a ocorrência de 1:650 nascimentos. A classificação adotada é a de Spina. A queiloplastia e a palatoplastia são as principais cirurgias executadas. Métodos: Estudo retrospectivo descritivo com obtenção de dados a partir do sistema Smile Train Express referente a pacientes com fissura labiopalatina atendidos por equipe cirúrgica de referência entre 1 de março de 2014 e 1 de dezembro de 2016. Resultados: Foram identificados 477 pacientes, predominando o sexo masculino e os dois primeiros anos de vida na admissão. A fissura mais prevalente foi transforame e unilateral esquerda. O tratamento cirúrgico mais frequente foi a queiloplastia. Conclusões: O padrão epidemiológico está em consonância com a literatura nacional.


Introduction: Orofacial clefts are congenital malformations with an estimated occurrence of 1:650 births in Brazil. The most widely adopted classification system in that country is the method developed by Spina, and cheiloplasty and palatoplasty are the main surgeries performed. Methods: This was a retrospective descriptive study using data collected from the Smile Train Express organization regarding patients with orofacial clefts treated by a reference surgical team between March 1, 2014 and December 1, 2016. Results: A total of 477 patients were identified, predominantly male and in the first two years of life at admission. The most prevalent type of malformation was left unilateral transforamen cleft. The most frequent surgical treatment was cheiloplasty. Conclusions: The epidemiological pattern is consistent with the findings described in the national literature.


Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Historia del Siglo XXI , Estudios Retrospectivos , Labio Leporino , Fisura del Paladar , Anomalías Maxilofaciales , Labio , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Fisura del Paladar/clasificación , Fisura del Paladar/terapia , Fisura del Paladar/epidemiología , Anomalías Maxilofaciales/cirugía , Anomalías Maxilofaciales/patología , Labio/anomalías , Labio/cirugía
15.
J Small Anim Pract ; 58(11): 610-614, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28887848

RESUMEN

An easy-to-use classification that enables an accurate record of canine cleft lip and palate is fundamental for effective communication between professionals and researchers and optimal use of published information. Here we present how a classification system for human cleft lip and palate can be used to register spontaneous cases in dogs, highlighting its advantages. This system is based on four topographic areas with a numerical representation of the severity of the cleft in each area. The use of spontaneous cases has the advantage of providing clefts that are naturally similar to their human counterparts for surgical, genetic and genomic studies and, furthermore, will reduce the need for experimental models of this condition.


Asunto(s)
Labio Leporino/veterinaria , Fisura del Paladar/veterinaria , Enfermedades de los Perros/clasificación , Animales , Labio Leporino/clasificación , Labio Leporino/diagnóstico , Fisura del Paladar/clasificación , Fisura del Paladar/diagnóstico , Perros
16.
J Craniofac Surg ; 28(5): 1369-1374, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28582287

RESUMEN

PURPOSE: Wider cleft palates are thought to be associated with increased complications and poorer outcomes following cleft palate repair. Objective cleft palate photographic measurement and assessment of complications have not been previously performed. The purpose of this study is to quantitatively characterize a series of cleft palate dimensions and to investigate possible correlations with Veau classification and intra-, peri-, and postoperative outcomes. METHODS: The analytic sample included primary cleft palate repairs performed by the senior author over a 2-year period. Standard photographs of clefts taken at the time of repair were analyzed using Image-J software. Demographic, intraoperative, perioperative, and postoperative information were collected. Width measurements were correlated with Veau classification, intraoperative variables, perioperative variables, and adverse outcomes. Statistical tests performed included simple regression analyses and multiple regression analysis. RESULTS: Out of 70 patients, 50 had adequate photographic documentation for inclusion in the study; 44% of patients were classified as Veau I with an average cleft width of 5.4 mm, 28% Veau II with an average of 8.9 mm, 16% Veau III with an average of 11.3 mm, and 12% Veau IV with an average of 10.0 mm. No patients exhibited postoperative bleeding, dehiscence, airway problems, infection, fistula formation, or return to the operating room. The authors found that increasing cleft width significantly predicts increasing Veau classification (P < 0.01), increasing operating time (P < 0.05), increased hypernasality (P < 0.05), and speech delay (P < 0.001). Additionally, the presence of an intentional alveolar fistula (Veau III or Veau IV clefts) significantly predicts fluid emission (P < 0.001) but cleft width did not predict fluid emission. Increased cleft width did not significantly predict length of stay. CONCLUSION: Our data demonstrate that wider preoperative cleft palates correlate with Veau classification, increased operating time, and slightly worsened postoperative sequela. There were no perioperative instances of bleeding, dehiscence, respiratory complications, infection, fistula formation, and return to operating room. Hypernasality and speech delay were associated with increased cleft palate width. Length of stay did not correlate with cleft palate width.


Asunto(s)
Fisura del Paladar/patología , Fisura del Paladar/cirugía , Fisura del Paladar/clasificación , Femenino , Humanos , Lactante , Masculino , Análisis Multivariante , Tempo Operativo , Complicaciones Posoperatorias , Estudios Retrospectivos , Habla , Resultado del Tratamiento
17.
Cleft Palate Craniofac J ; 54(3): 338-342, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-28471735

RESUMEN

Objective To study the phenotype and overview the clinical management on Cleft Lip and/or Palate (CL/P) with Nevoid Basal Cell Carcinoma Syndrome (NBCCS) patients in Peking University School and Hospital of Stomatology. Design Case series study. Main Outcome Measures To describe the clinical phenotype of 12 CL/P with NBCCS patients who fulfilled the diagnostic criteria as well as to explore clinical management. Results Seven cases (7/12, 58.33%) were classified as bilateral complete cleft lip and palate (BCCLP). Two cases (2/12, 16.67%) were classified as unilateral complete cleft lip and palate (UCCLP). Three cases (1/12, 8.33%) were classified as unilateral complete cleft lip (UCCL), submucosa cleft uvula (SCU), and bifid uvula (BU), respectively. The ratio of male/female was 9/:3. Keratocystic odontogenic tumors (KCOTs) were presented in all 12 cases. The most common site was the mandible region (12/12, 100%) followed by the maxilla region (7/12, 58.33%). The diagnostic age of 12 NBCCS with CL/P ranged from 11 to 42 years old (usually postponed to the occurring of KCOTs). The delayed diagnosis of NBCCS can be attributed to its complicated clinical manifestations. In some cases, the mutual effect between the surgical therapy of removing KCOTs and alveolar bone grafting made the team approach (TA) of CL/P more complicated. Conclusion CL/P may become important clinical phenotype in NBCCS. The type of cleft varied, with bilateral cleft lip and palate comprising above 50%. Larger sample sizes are needed to study and confirm this result. KCOTs, as one of the most common clinical feature of NBCCS, make the diagnosis delayed and the TA more difficult because of the occurring time and site. This compels us to improve the diagnostic criteria to make an early diagnosis and explore a better therapeutic protocol for CL/P.


Asunto(s)
Síndrome del Nevo Basocelular/terapia , Labio Leporino/terapia , Fisura del Paladar/terapia , Adolescente , Adulto , Síndrome del Nevo Basocelular/diagnóstico , Síndrome del Nevo Basocelular/epidemiología , Niño , China/epidemiología , Labio Leporino/clasificación , Labio Leporino/diagnóstico , Labio Leporino/epidemiología , Fisura del Paladar/clasificación , Fisura del Paladar/diagnóstico , Fisura del Paladar/epidemiología , Femenino , Humanos , Masculino , Fenotipo
18.
J Craniomaxillofac Surg ; 45(6): 1010-1017, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28434827

RESUMEN

OBJECTIVE: Due to the lack of a universally accepted classification system, we are aiming to introduce a modified comprehensive, precise and relatively simple classification system for primary diagnosis of cleft lip and palate. METHODS: The proposed classification is based on the Kernahan's striped Y diagram with more details in cleft extent and with the addition of severity scores to each cleft component. Clear definitions of cleft extents and severity degrees were described based on 400 consecutive primary cases. Two medical students were taught the classification then diagnosed photographs of 100 cases twice to test its reliability. RESULTS: The students' results were 11% and 13% wrong diagnoses for student 1 and 2 in the first time, 8% and 10% in the second time, respectively. The inter-rater reliability for the two students in the first and second time was 0.716 and 0.878, respectively. The intra-rater reliability for student 1 and 2 were 0.826 and 0.755 respectively. The average duration to diagnose a case was less than a minute. CONCLUSION: This classification is comprehensive and records many diagnostic variables with high reliability and precision.


Asunto(s)
Labio Leporino/clasificación , Fisura del Paladar/clasificación , Humanos , Recién Nacido , Fotograbar , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad
19.
Indian J Dent Res ; 28(1): 105-108, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28393824

RESUMEN

Tessier facial clefts are among the rarest facial clefts reported in literature and many contradicting issues have always been rising over the management and surgical approaches involved during the craniofacial cleft repair. Among the craniofacial clefts Tessier no. 4 is an extremely rare facial anomaly, and there are very few evidence which clearly describe the surgical approaches and techniques. Often these type of craniofacial clefts yield very poor surgical results, and they require multidisciplinary sequential corrective surgeries. This article presents a rare case of an 18-month-old baby with bilateral Tessier no. 4 clefts and its successful rehabilitation.


Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Anomalías del Sistema Estomatognático/cirugía , Mejilla/anomalías , Mejilla/cirugía , Labio Leporino/clasificación , Labio Leporino/diagnóstico por imagen , Fisura del Paladar/clasificación , Fisura del Paladar/diagnóstico por imagen , Anomalías del Ojo/clasificación , Anomalías del Ojo/diagnóstico por imagen , Anomalías del Ojo/cirugía , Ojo Artificial , Párpados/anomalías , Párpados/cirugía , Humanos , Imagenología Tridimensional , Lactante , Comunicación Interdisciplinaria , Colaboración Intersectorial , Masculino , Conducto Nasolagrimal/anomalías , Conducto Nasolagrimal/diagnóstico por imagen , Conducto Nasolagrimal/cirugía , Anomalías del Sistema Estomatognático/clasificación , Anomalías del Sistema Estomatognático/diagnóstico por imagen , Colgajos Quirúrgicos/cirugía , Técnicas de Sutura , Tomografía Computarizada por Rayos X
20.
Clin Oral Investig ; 21(1): 267-273, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26976284

RESUMEN

OBJECTIVES: Evaluate the results of secondary alveolar bone grafting (SABG) in patients with complete unilateral cleft lip and palate (UCLP), operated after permanent canine eruption (CE). MATERIALS AND METHODS: Seventy-four periapical radiographs from patients with complete UCLP (mean age 14 years) submitted to SABG were retrospectively analyzed for the amount of bone in the cleft site through the Bergland and Chelsea scales. RESULTS: Of the cases, 47.3 % was classified as Bergland type I and Chelsea type A, 35.2 % as type II/C, 6.7 % as type III/D, and 10.8 % as type IV/failure. When the canine was moved into the grafted area, the success rate (type I/A) was 56.8 %; for cases in which the space was maintained for an implant or prosthetic finishing, the index was 45.8 %; however, this difference was not statistically significant. CONCLUSION: Even in advanced ages, after permanent canine eruption, SABG can be considered a highly successful procedure. CLINICAL RELEVANCE: This research shows good results of secondary alveolar bone grafting performed in patients with unilateral complete cleft lip and palate, even when it was performed after eruption of the permanent canine in the cleft area.


Asunto(s)
Injerto de Hueso Alveolar , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Diente Canino/diagnóstico por imagen , Erupción Dental , Adolescente , Adulto , Niño , Labio Leporino/clasificación , Labio Leporino/diagnóstico por imagen , Fisura del Paladar/clasificación , Fisura del Paladar/diagnóstico por imagen , Dentición Permanente , Femenino , Humanos , Masculino , Estudios Retrospectivos , Resultado del Tratamiento
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