Craniofacial Morphology in Midline Cervical Cleft: Case Report and Review of Literature.

Congenital midline cervical cleft is a rare anomaly of the neck. This paper presents the case of a boy diagnosed with this disorder in which a preliminary orthodontic treatment was implemented. The craniofacial anomalies associated with this malformation produced a defect that could only be successfully treated through the implementation of orthodontic and surgical treatments. In this case, congenital midline cervical cleft was accompanied by certain disorders within the facial structures of the skull, primarily mandibular retrusion, flattening of the contour of the mandibular base, and a steep angle between the cranial base and the mandibular plane.

The presence of the maxillary lateral incisor in the cleft gap in patients with unilateral cleft lip and palate. Preliminary report.

OBJECTIVE: Evaluation of the presence of the maxillary lateral incisor in the cleft in patients with complete unilateral cleft lip and palate treated with the use of various surgical protocols. MATERIAL AND METHODS: A retrospective analysis was conducted as regards diagnostic models, panoramic radiographs and tooth images of the cleft of 75 patients with complete unilateral cleft lip and palate treated with the use of various surgical protocols (group I: patients who underwent one-stage surgery with early alveolar bone grafting; group II: one-stage operation with secondary alveolar bone grafting; group III: two-stage operation with secondary bone graft or no graft). RESULTS: The analysis of the relation between the applied surgical protocol and the absence of the maxillary lateral incisor indicated the lack of the lateral incisor in the cleft in 4 patients from group I(16%), 8 patients from group II (32%) and 13 patients from group III (52%). The difference between groups I and III was statistically significant (p=0.007). The analysis also revealed that as regards the lack of the incisor on the side of the cleft (in all three groups), the hypodontia of the maxillary lateral incisor on the left side was twice as rare as on the right side, in 14 patients (25%) on the left side and in 11 patients (58%) on the right side respectively (p=0.009). The analysis of the relation between the absence of the lateral incisor and the side of the cleft in particular groups of patients indicated that the relation was statistically significant only in group III. CONCLUSIONS: The studies reveal that the type of surgical procedure may affect the presence or lack of the lateral incisor in the maxilla on the cleft side. However, it is necessary to conduct studies on larger material.

[Moebius syndrome with facial-dental impairments - rare or rather seldom diagnosed syndrome?]. / Zespól Moebiusa Z Zaburzeniamitwarzowo"zebowymi. Zespól Rzadkowystepujacy, Czy Rzadko Rozpoznawany?

As publications on craniofacial anomalies, malocclusions and dental complications recognised in patients suffering from Moebius syndrome are scarce, the authors of this paper decided to discuss the above aspects in broader terms along with the possibilities offered by orthodontic treatment. The etiology of Moebius syndrome has not hitherto been discovered, however the opinion prevails that it is brought on by multiple factors and conditions. In the analysed case, Moebius syndrome was diagnosed only when the patient was 6 years old. Based on the clinical examination, typical characteristics of the syndrome were observed: craniofacial dysmorphism as well as foot development disorder in the form of talipes equinovarus (club foot). Moreover, Type II Angle's classification of malocclusion was detected - crowded teeth in the mandible and maxilla and hypoplastic enamel. Cephalometric analysis identified retruded position of the mandible against the cranial base, protruded position of the maxilla, shortening of posterior face height, protrusion of incisors in the maxilla. The orthopantomogram showed the presence of all permanent teeth. At the beginning of the orthodontic treatment removable appliances were used, but despite good cooperation on the part of the patient, only a slight improvement was observed. Further orthodontic treatment envisaged extraction of permanent teeth and use of fixed appliances while waiting for the improvement of occlusion.

Treatment outcome after one-stage repair in children with complete unilateral cleft lip and palate assessed with the Goslon Yardstick.

OBJECTIVE: To compare results of Golson Yardstick measurement of dental arch relationships in a sample of 10-year-old Polish children with results of the Golson measurement in published reports. MATERIALS AND METHODS: Plaster models of 28 consecutively treated subjects with unilateral cleft lip and palate (UCLP) that was repaired with a one-stage simultaneous closure performed in the first year of life. All individuals were born between 1994 and 1995. The Goslon score (categories 1 to 5) was allocated. Intra- and interrater agreement was assessed with kappa statistics and Pearson correlation coefficient. Independent t tests were employed to detect difference between the score in the present and other published samples. RESULTS: Mean Goslon score equaled 2.44; 57% of the patients were allocated Goslon category 1 or 2, 32% were rated Goslon 3, and 11% of the patients were assigned category 4 or 5. Intrarater agreement was between 0.75 and 0.77. Interrater agreement was 0.79. CONCLUSIONS: Dental arch relationship following one-stage repair was comparable with the results of the centers with the best outcome.

Midfacial growth in a consecutive series of preadolescent children with complete unilateral cleft lip and palate following a one-stage simultaneous repair.

OBJECTIVE: To evaluate midfacial growth in prepubertal children with complete unilateral cleft lip and palate following one-stage simultaneous repair. SUBJECTS: A series of 28 consecutively treated subjects with complete unilateral cleft lip and palate were compared with age- and gender-matched controls with normal midfacial structure. METHODS: On the lateral cephalograms taken at the age of approximately 10 years, size and position of the maxilla and upper dental arch were evaluated in vertical and horizontal planes. Statistical analysis included independent t tests and nonparametric Mann-Whitney tests. RESULTS: The maxilla was found to be retruded (sella-nasion-point A angle decreased by 4.5 degrees and nasion to point A distance increased by 4.2 mm) and rotated posteriorly (sella-nasion/palatal plane angle decreased by 4.5 degrees) in the cleft group. Maxillary length (pterygomaxillare-point A distance) was diminished by approximately 2 mm. Upper incisors were found retroclined in comparison to controls (both upper incisor axis/sella-nasion and upper incisor axis/palatal plane angles were decreased by 10.7 degrees and 6.1 degrees, respectively). CONCLUSION: Maxillary prominence, as measured with the sella-nasion-point A angle and the condylion-point A and articulare-point A distances, was decreased. Shortened length and posterior position of the maxillary body were responsible at a ratio of 60% to 40% for a decreased prominence of the maxillary complex. The palatal plane demonstrated a larger inclination to the sella-nasion plane by 4.5 degrees due to a decreased sella-posterior nasal spine distance.

Mandibular morphology and spatial position following one-stage simultaneous repair of complete unilateral cleft lip and palate.

OBJECTIVE: To assess mandibular structure and spatial position following one-stage simultaneous repair of the unilateral cleft lip and palate. DESIGN: Forty boys and 17 girls with complete unilateral cleft lip and palate who underwent one-stage simultaneous repair of the cleft by the same surgeon at the age of 9.23 months (standard deviation = 1.74) were selected. Lateral cephalograms taken at the age of approximately 10 years were analyzed and were compared with a sex- and age-matched control group that consisted of individuals with Angle Class I, no crossbite, positive overbite <5 mm, mild crowding (Incisor Irregularity Index <3.5 mm), and harmonious facial build. RESULTS: No intergroup differences were demonstrated regarding structure of the cranial base. The mandible was found to be retruded and at a larger inclination to the cranial base as compared with controls. Both total mandibular length (ArGn) and length of the mandibular body were larger in the control group, at <2 mm. Height of the ramus and gonial angle were similar in both groups. Intergender comparison showed few significant differences in control subjects only (SN, SGo, and NMe variables). CONCLUSIONS: The mandible, following a one-stage simultaneous repair of cleft, was found to be retrusive, and the length of mandibular body was <2 mm shorter than that of the controls.

Cephalometric standards for Polish 10-year-olds with normal occlusion.

OBJECTIVE: To establish gender-specific normative data for Polish children at the age of 10 years. MATERIALS AND METHODS: Thirty-nine boys and 34 girls (mean age 10.37, SD = 0.52) of Polish ethnicity were selected based on the following criteria: Class I molar relationship, lack of crossbite or scissor-bite, positive overjet and overbite less than 5 mm, adequate amount of space in both dental arches, no visible asymmetry, and good facial proportions. Lateral cephalograms of each subject were scanned and analyzed with the use of NemoCeph NX2005 software. Descriptive statistics (mean and standard deviation) were calculated for all measured variables. Independent t-tests were performed to assess the intergender differences. The results were compared to the published norms of other white populations. Normative data were presented in the tables. RESULTS: Intergender differences included anterior cranial base length (sella-nasion), total and lower anterior facial height (nasion-menton and ANS-menton, respectively), posterior facial height (sella-gonion), SNA angle, point A to nasion perpendicular distance, pogonion to nasion perpendicular distance, and facial axis. CONCLUSIONS: Polish 10-year-old boys had a larger anterior cranial base, and larger total anterior, lower anterior and posterior facial heights than girls. The maxillae and chin protrusion were more pronounced in girls.

[Craniofacial structure of 10-year-old children with complete unilateral cleft lip and palate following a one-stage simultaneous repair]. / Budowa twarzoczaszki 10-latków z jednostronnym calkowitym rozszczepem wargi i podniebienia leczonych metoda jednoczasowa.

AIM: To determine the effects of a one-stage simultaneous repair of lip and palate upon the growth of craniofacial structures inpatients with complete unilateral cleft lip and palate (UCLP). MATERIAL AND METHODS: This retrospective study involved 21 children who presented with non-syndromic complete unilateral cleft lip and palate and underwent a one-stage simultaneous closure performed by the same surgeon. 6 females and 15 males ranged in age from 6 to 12 months at the time of surgery (mean = 9.2 months). During the observation period only limited orthodontic treatment with removable appliances was carried out. Morphology of craniofacial structures was evaluated through cephalometric analysis of lateral headfilms taken at the age of approximately 10 years. Measurements obtained were compared to age-matched controls. RESULTS: Maxillo-mandibular relationship in the cleft group did not differ relative to the controls--point A-Nasion-point B angle and WITS index showed no statistically significant difference. However, both maxilla and mandible were retrognathic relative to the norm. Sella-Nasion-point A angle was on average 5 degrees less than in controls and the maxilla rotated anteriorly in comparison to the control group. Sella-Nasion-point B angle was decreased by 4 degrees and the mandible rotated posteriorly. CONCLUSIONS: Our findings suggest that a simultaneous one-stage closure of the unilateral complete cleft lip and palate results in good maxillo-mandibular relationship, with 81% of subjects having adequate overjet. However, both maxilla and mandible were retrognathic.

[Cephalometric evaluation of craniofacial morphology in preadolescent children with a repaired unilateral cleft of the primary palate]. / Cefalometryczna ocena budowy twarzoczaszki przed okresem pokwitania u dzieci z jednostronnym rozszczepem podniebienia pierwotnego leczonych operacyjnie.

PURPOSE: evaluation of craniofacial morphology in preadolescent subjects with a repaired cleft of primary palate. METHODS: 21 girls and 10 boys aged 11 years, with unilateral cleft of primary palate (14 with cleft lip and 17 with cleft lip and alveolus) were matched according to age and gender with subjects without cleft. Craniofacial morphology was evaluated based on performed cephalograms. RESULTS: upper incisors were retroclined (1/PP angle decreased by 6.3 degree), and maxilla and mandible were positioned posteriorly (SNA and SNB angle decreased by 1.9 degree and 2.1 degree, respectively). Mandibular morphology did not show any difference between groups. CONCLUSIONS: craniofacial growth in preadolescent individuals with surgically repaired cleft of primary palate is insignificantly disturbed.

[Morphology and spatial position of the mandible in complete unilateral cleft lip and palate individuals after one-stage repair of the cleft]. / Budowa i polozenie zuchwy u osób z calkowitym jednostronnym rozszczepem wargi i podniebienia leczonych metoda jednoetapowa.

AIM: To compare the size and spatial position of the mandible in unilateral cleft lip and palate (UCLP) individuals treated with one-stage repair of the lip and palate, with normal individuals. MATERIAL AND METHODS: 25 UCLP children aged 9-11 years, treated during the first year of life (average--9 months) compared with 25 subjects with normal morphology craniofacial skeleton. The measurements included: anterior and posterior facial height, mandibular plane angle, mandibular ramus, corpus and total length, Sella-Nasion-point B and Sella-Nasion-Pogonion angles. The difference between the groups was assessed by the T test for independent samples. RESULTS: The mandibular anterior surface was retruded (SNB and SNPog angles were approximately 3 degrees less than in controls). The other variables measured in the cleft group showed no difference in comparison to the controls. In the cleft group, standard deviation was higher for most measurements. CONCLUSIONS: Growth of the mandible in the UCLP subjects treated with a one-stage repair is close to normal. However, final verification of the mandibular growth will be possible after attainment of maturity.

[Long-term evaluation of width and length of the maxillary dental arch in unilateral cleft lip and palate children]. / Odlegla analiza szerokosci i dlugosci górnego luku zebowego u osób z jednostronnym rozszczepem wargi i podniebienia.

AIM: To compare the width and length of a maxillary dental arch in unilateral cleft lip and palate (UCLP) children treated during the first year of life with a one-stage repair of the lip and palate and a control group. MATERIAL AND METHODS: 25 UCLP 10-12 years old subjects treated in the first year of life compared to 26 subjects with normal morphology of the dental arches. Intermolar and interpremolar widths and the length of the dental arch were measured. The difference between the groups was assessed by the T test for independent samples. RESULTS: The intermolar width was similar in both groups. The interpremolar width and the length of the dental arch were smaller in the treated group. However the difference in the interpremolar width between the groups was small -- approximately 2 mm. CONCLUSIONS: One-stage surgical repair of the cleft lip and palate performed in the first year of life prevents a serious constriction of the maxillary dental arch. However a final verification of the treatment protocol employed in our Centre for Craniofacial Disorders will only be possible after the completion of maxillary growth.

[Distraction osteogenesis in the treatment of hemifacial microsomia]. / Zastosowanie osteogenezy dystrakcyjnej w leczeniu polowiczego niedorozwoju twarzy na podstawie badan wlasnych.

PURPOSE: This report presents the results of distraction osteogenesis using an extra oral device in 28 patients with different grade of vertical mandibular ramus hypoplasia. MATERIAL AND METHOD: 28 patients (aged 2 to 15 years) with hemifacial microsomia underwent unilateral lengthening of the ascending ramus using unidirectional extraoral devices (Molina distractor). 3D-CT and cephalometric radiographs were analysed to determine the placement of the mandibular osteotomy and select the appropriate placement of the distraction device. RESULT: On the basis of one-year follow-up we can conclude that excellent, stable and functional mandibular lengthening was achieved with external distraction osteogenesis with minimal complications in all our patients. Coordinated growth between maxillary and mandibular arches with stable occlusion is observed. CONCLUSION: Mandibular distraction osteogenesis has proved to be an excellent technique for the treatment of mandibular deficiency. Careful and comprehensive planning of treatment, coupled with control of the distraction vector can bring about predictable results with minimal morbidity. Nevertheless. It is our conclusion that good and effective orthodontics within the period of consolidation is the key to achieve satisfactory stability results.