A retrospective cohort study on dental implant survival in patients with grafted alveolar clefts.

OBJECTIVES: The aim of this study was to assess the survival rate of dental implants inserted in an alveolar cleft area where one or more bone graft procedures were performed and to identify possible factors that affect the survival rate. MATERIALS AND METHODS: The available data from 78 implants placed in 64 patients with grafted alveolar clefts were retrospectively analysed. Statistical analyses were performed using Kaplan-Meier survival analysis, log-rank tests and univariable Cox proportional hazard models. RESULTS: The median follow-up period from insertion to the last follow-up appointment was 46 months (IQR: 29-79.3). In five patients, a single implant failed. This resulted in a cumulative survival rate of 95.0% at median follow-up. The factors investigated in this study did not have a significant effect on implant survival. CONCLUSIONS: Dental implants placed in patients with alveolar clefts are a reliable treatment option for dental rehabilitation.

Customized Tray for Impression Taking in Children With Cleft Lip and Palate.

The assessment of rehabilitation outcomes requires a patient documentation protocol, including records obtained at standardized ages, to compare different types of surgeries, their effects, as well as between different rehabilitation centers. The aim of this paper was to present proper trays for babies with different types of cleft lip and palate, which are used in the outpatient routine at Hospital of Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP). The customized trays are made with self-curing acrylic resin. The tray must have suitable depth to copy the buccal sulcus, and wax is usually applied to contour the tray edge, and the adjustment of the tray to the fornix, making the tray specific for each child. The impression precludes the utilization of dental casts for diagnosis, treatment plan, and research measurements. In the clinical practice at HRAC-USP, it was observed that customized trays increased the quality of impression, accurately reproducing anatomical features of dental arches of babies with oral clefts.

Prosthetic treatment of cleft lip and palate patient - a case report.

It is assumed that most cleft lip and palate are due to a combination of genetic and environmental factors (maternal diseases, smoking, alcohol intake, infections, and ionizing treatment) that alter morphogenesis. Treatment of these cases begins from birth to adulthood and requires a number of interventions depending on the period of development of the maxillofacial area and teeth.We present the case of a patient with unilateral cleft lip and palate. Surgery and orthodontic treatment were carried out subsequently, and then a metal-ceramic bridge was made to correct the defect. In the course of the treatment, we made decisions that were determined by the available space.The construction restored the dentition, the aesthetics, speech, and masticatory functions of the patient. The treatment of such defects requires good collaboration between individual specialists in order to achieve optimally good results. We believe that in such cases of crucial importance is the contribution of a prosthetic dentistry expert since surgical and orthodontic treatments alone are insufficient to achieve complete recovery and rehabilitation of patients.

Oral rehabilitation of a cleft palate patient with tooth-supported, telescopic magnetic overdenture.

A 49-year-old male patient with residual cleft palate and missing pre-maxilla presented with an ill-fitting and unaesthetic maxillary denture. The posterior teeth were periodontally sound but crowded and had defective restorations and secondary caries. We restored the bilateral maxillary canines and first premolars with conical telescopic crowns having magnetic keepers. A metal-reinforced acrylic overdenture with magnetic attachments corresponding to the keepers of the telescopic crowns was fabricated. The telescopic crowns provided a single path of insertion, retention and stability to the prosthesis. The magnetic attachments provided additional retention and self-centring properties. The prosthesis effectively sealed the oronasal communication and enhanced the function, aesthetics and oral hygiene. The 6-month and 1-year follow-ups revealed that the patient was delighted, and the prosthesis provided excellent obturation and function. Periodic follow-up, maintenance, patient education and meticulous oral hygiene are vital for long-term success of such prostheses.

Estudos de casos múltiplos: escolares com fissura labiopalatina no contexto da avaliação foniátrica / Multiple case studies: schoolchildren with cleft lip and palate in context of phoniatric evaluation / Múltiplesestudios de caso: escolares conlábio leporino y paladar hendido en el contexto de la evaluación foniátrica

Introdução: A foniatria tem interesse em fissura labiopalatina (FLP) devido à complexidade em aspectos de fala, linguagem e audição. Objetivo: No contexto da avaliação foniátrica em crianças escolares com fissura labiopalatina, o objetivo do estudo de múltiplos casos foi descrever a interferência de fatores clínicos no desempenho em testes da função perceptiva auditiva de linguagem, assim como a associação entre eles. Método: Trinta crianças, entre 6 anos e 2 meses e 9 anos e 11 meses, foram avaliadas pelo médico foniatra, em serviço interdisciplinar de tratamento da FLP: 13 (43%) fissura pós-forame incisivo e 17 (57%) fissura transforame incisivo. Foram descritos os fatores clínicos (incluindo tipo de fissura, idade na avaliação, sexo, condição socioeconômica, desempenho escolar, realização de fototerapia, exame audiológico e outros) e o desempenho em testes de discriminação auditiva, memória auditiva e consciência fonológica, incluindo a associação entre eles. Resultados: Não houve diferença significativa entre os grupos de fissura e médias de idade (p=0,618), sexo (p=0,431), nível socioeconômico (p=0,580) e desempenho escolar (p=0,785).A porcentagem de crianças que fez terapia é maior no grupo de fissura transforame (94,1%). Alterações nos testes: 4 crianças (13,3%) discriminação auditiva, 6 (20%) memória auditiva e 8 (26,7%) consciência fonológica. Os casos com desempenho escolar insatisfatório, mais tempo de fonoterapia e piores médias do limiar de reconhecimento de fala tiveram desempenho pior em memória auditiva e consciência fonológica. Conclusão: A avaliação foniátrica possibilitou o apontamento de fatores clínicos da fissura, que parecem, de alguma forma, interferir no desenvolvimento da linguagem destas crianças.

Introduction: Phoniatrics is interested in cleft lip and palate (CLP) due to the complexity in aspects of speech, language and hearing. Objective: In context of phoniatric evaluation in schoolchildren with CLP, the objective of multiple cases study was to describe the interference of clinical factors in the performance in tests of auditory perceptual function of language, as well as the association between them. Method: Thirty children, between 6 years and 2 months and 9 years and 11 months, were evaluated by Phoniatric doctor, in interdisciplinary treatment service for CLP: 13 (43%) cleft palate and 17 (57%) cleft lip and palate. Clinical factors (including type of cleft, age at evaluation, sex, socioeconomic status, school performance, speech therapy, audiological examination and others) and performance in tests of auditory discrimination, auditory memory and phonological awareness were described, including the association between them. Results: There was no significant difference between the cleft groups and the mean age (p = 0.618), sex (p = 0.431), socioeconomic level (p = 0.580) and school performance (p = 0.785). The percentage of children who had attended therapy is higher in cleft lip and palate group (94.1%). Changes in tests: 4 (13.3%) auditory discrimination, 6 (20%) auditory memory and 8 (26.7%) phonological awareness. The cases with unsatisfactory school performance, more speech therapy time and worse speech recognition thresholds had a worse performance in auditory memory and phonological awareness. Conclusion: The phoniatric evaluation made it possible to identify clinical factors of the cleft, which seems, in some way, to interfere in the language development of these children.

Introducción: Foniátrica está interesado en el labio leporino y paladar hendido debido a la complejidad en los aspectos del habla, el lenguaje y la audición. Objetivo: El contexto de la evaluación foniatría en escolares con labio leporino y paladar hendido, el objetivo del estudio de múltiples casos fue describir la interferencia de factores clínicos en el desempeño en las pruebas de la función auditiva perceptiva del lenguaje, así como la asociación entre ellos. Método: Treinta niños, entre 6 años y 2 meses y 9 años y 11 meses de edad, fueron evaluados por un médico foniátrico, en un centro de tratamiento interdisciplinario para labio leporino y paladar hendido: 13 (43%) paladar hendido y 17 (57%) labio leporino y paladar hendido. Se describieron y verificaron los factores clínicos (incluido el tipo de hendidura, la edad en la evaluación, el sexo, el estado socioeconómico, el rendimiento escolar, la fototerapia, el examen audiológico y otros) y el rendimiento en las pruebas de discriminación auditiva, memoria auditiva y conciencia fonológica, incluida la asociación entre ellos. Resultados: No hubo diferencias significativas entre los grupos de hendidura y la edad media (p = 0.618), sexo (p = 0.431), nivel socioeconómico (p = 0.580) y rendimiento escolar (p = 0.785). El porcentaje de niños que se sometieron a terapia es mayor en el grupo de paladar hendido y labio leporino (94.1%). Cambios en las pruebas: 4 niños (13.3%) discriminación auditiva, 6 (20%) memoria auditiva y 8 (26.7%) conciencia fonológica. Los casos con un rendimiento escolar insatisfactorio, más tiempo de terapia del habla y peores umbrales de reconocimiento del habla tuvieron un peor rendimiento en la memoria auditiva y la conciencia fonológica. Conclusión: La evaluación foniátrica permitió identificar factores clínicos de la hendidura, que de alguna manera, parece interferir en el desarrollo del lenguaje de estos niños.

Articulation rehabilitation induces cortical plasticity in adults with non-syndromic cleft lip and palate.

In this study, we investigated brain morphological changes in adults with non-syndromic cleft lip and palate (NSCLP) after articulation rehabilitation (AR). High-resolution T1 weighted brain magnetic resonance imaging data were analyzed from 45 adults with NSCLP after palatoplasty: 24 subjects were assessed before AR (bNSCLP) and 21 subjects were assessed after AR (aNSCLP). In addition, there were 24 age and sex matched controls. Intergroup differences of grey matter volume were evaluated as a comprehensive measure of the cortex; cortical thickness and cortical complexity (gyrification and fractal dimensions) were also analyzed. As compared to controls, the bNSCLP subjects exhibited altered indexes in frontal, temporal, and parietal lobes; these morphological changes are characteristic for adults with NSCLP. Importantly, as compared to the bNSCLP and control subjects, the aNSCLP subjects exhibited cortical plasticity in the regions involved in language, auditory, pronunciation planning, and execution functions. The AR-mediated cortical plasticity in aNSCLP subjects may be caused by AR-induced cortical neurogenesis, which might reflect the underlying neural mechanism during AR.

Optimizing speech outcomes for cleft palate.

PURPOSE OF REVIEW: Cleft lip with or without palate is one of the most common pediatric birth anomalies. Patients with cleft palate often have speech difficulties from underlying anatomical defects that can persist after surgery. This significantly impacts child development. There is a lack of evidence exploring, which surgical techniques optimize speech outcomes. The purpose of this update is to report on recent literature investigating how to optimize speech outcomes for cleft palate. RECENT FINDINGS: The two-flap palatoplasty with intravelar veloplasty (IVVP) and Furlow double-opposing Z-plasty has the strongest evidence for optimizing speech. One-stage palatal repair is favored at 10-14 months of age, while delays are associated with significant speech deficits. For postoperative speech deficits, there is no significant difference between the pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation. Surgical management should be guided by closure pattern and velopharyngeal gap but few studies stratify by these characteristics. SUMMARY: According to recent evidence, the two-flap palatoplasty with IVVP and Furlow palatoplasty result in the best speech. The pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation are all viable techniques to correct residual velopharyngeal insufficiency. Future research should focus on incorporating standardized measures and more robust study designs.

A cleft care workshop for speech and language pathologists in resource-limited countries: The participants' experiences about cleft care in Uganda and satisfaction with the training effect.

OBJECTIVES: workshops and specialized training programs are often inaccessible for speech and language pathologists (SLPs) based in resource-limited countries given the lack of supply, the long travel distances and the excessive participation fees. To stimulate life-long learning opportunities for all, this study described and measured the effect of a free, two-day cleft care workshop for SLPs in Uganda. The workshop included different topics related to the assessment and treatment of children with a cleft of the palate with or without a cleft of the lip (CP ± L). METHODS: The participants who presented during the two-day course were asked to complete a pre- and post-workshop questionnaire to evaluate their satisfaction. The pre-workshop form also included some questions concerning cleft care in Uganda. Both the pre- and post-workshop forms included three visual analogue scales to investigate the evolution of the participants' estimation of their knowledge regarding speech in patients with a CP ± L and to assess the changes in their self-confidence in the diagnosis and treatment of this population. RESULTS: seventeen SLPs completed the pre- and post-workshop questionnaires. In general, the participants were highly satisfied with the different themes covered in the program. After the training course, the participants rated their general knowledge about CP ± L and their self-confidence in the diagnosis and treatment of children with a CP ± L significantly higher than before the workshop. CONCLUSION: the vast majority of the SLPs reported that cleft care was not easily accessible in Uganda. The most commonly reported obstacle for cleft care was a lack of knowledge about this matter in the SLPs themselves highlighting the importance of the organization of additional education opportunities. The participants reported a significantly higher level of self-confidence in diagnosing and treating children with a CP ± L after the workshop. The content of this workshop can form the basis for future learning opportunities for SLPs based in resource-limited countries.

Correção de fenda palatina secundária traumática em cão - relato de caso / Correction cleft palate secondary traumatic in dog - case report

A fenda palatina é a comunicação entre a cavidade oral e a nasal através de um orifício no palato. Tem diversas etiologias, podendo ser congênita, traumática, por deficiência mineral ou por fatores hormonais. O diagnóstico é realizado por meio de exame físico da cavidade oral, e a correção cirúrgica é o tratamento de escolha. Em animais adultos, pode ser corrigida com o auxílio de retalho mucoperiosteal, apresentando bons resultados. Já em filhotes, a correção cirúrgica é mais complicada, com prognóstico menos favorável. Este trabalho relata o caso de um canino, fêmea, sem raça definida, adulta, com histórico de fenda palatina secundária, de origem traumática, no palato mole por ingestão de osso. Para a correção cirúrgica, primeiramente foi utilizada membrana biológica de pericárdio bovino, mas não se obteve êxito. O segundo procedimento foi realizado com retalho mucoperiosteal simples autólogo e, dois meses após o procedimento, já havia cicatrização completa. A técnica de retalho mucoperiosteal simples autólogo se mostrou eficaz no tratamento da fenda palatina, aliada aos cuidados adequados no pós-operatório.(AU)

The cleft palate is the communication between the oral and nasal cavity through an aperture in the palate, it's causes include an infinitude of factors: congenital, traumatic, mineral deficiency or hormonal. Examination of the oral cavity determines if the diagnosis and treatment is surgical. Correction in adult animals is performed with mucoperiosteal flap showing good results. However, surgical correction in puppies is more complicated with less favorable prognosis. This current work reports a case of an adult, female dog of undefined breed, with a history of secondary clef palate of traumatic origin in the soft palate due to bone ingestion. For correction, a biological membrane of bovine pericardium was used, but it was not successful, requiring a second surgical procedure performed with autologous simple mucoperiosteal flap. The last technique combined with adequate postoperative care was effective.(AU)

Craniofacial Interventions in Children.

Craniofacial interventions are common and the surgical options continue to grow. The issues encountered include micrognathia, macroglossia, midface hypoplasia, hearing loss, facial nerve palsy, hemifacial microsomia, and microtia. In addition, a unifying theme is complex upper airway obstruction. Throughout a child's life the focus of interventions may change from airway management to speech, hearing, and language optimization, and finally to decannulation and procedures aimed at social integration and self-esteem. Otolaryngologists play an important role is this arena and provide high-quality care while continuing to expand what can be done for our patients.

3D comparison of dental arch stability in patients with and without cleft lip and palate after orthodontic/rehabilitative treatment.

This study aimed to compare the linear dimensions of the dental arches of adult patients with complete unilateral cleft lip and palate (UCLP) after orthodontic and prosthetic treatment with fixed partial dentures (FPD) to patients without clefts, using 3D technology. This retrospective longitudinal study sample consisted of 35 subjects divided into two groups. Included in this sample were 15 complete UCLP individuals who had received orthodontic treatment before rehabilitation with a fixed partial denture (FG), as well as 20 patients without cleft as control group (CG). All patients were aged between 18 and 30 years. Digital dental casts were obtained in two stages: (T1) end of orthodontic treatment and (T2) one year after prosthetic rehabilitation (FG); and (T1) end of orthodontic treatment and (T2) one year after removal of the orthodontic appliance (CG). Intercanine, interfirst premolar and intermolar distances, and incisor-molar length were obtained. A precalibrated and trained examiner performed the assessments. Intergroup differences between T2 and T1 were compared between the groups using the t test or Mann-Whitney test with a significance level of 5% (p<0.05). The intercanine distance variation (T2-T1) showed statistical difference (p=0.005) increasing in the FG group and decreasing in the CG group. In the interfirst premolar distance variation, FG decreased, while CG increased with statistically significant difference (p=0.008). The intercanine distance of individuals with cleft showed stability, while that of the CG had no stability. The CG showed stability in the interfirst premolar distance, while FG had no stability. These findings showed that the FPD is capable of restricting orthodontic results, leading to a stabilization of the dental arches.

Intensive speech therapy in Ugandan patients with cleft (lip and) palate: a pilot-study assessing long-term effectiveness.

BACKGROUND/AIMS: In resource-limited countries, traditional models for speech therapy delivery are not adequate to reach all patients in need. In those countries, intensive speech therapy might be a solution. Preliminary results of previous research demonstrated that intensive speech therapy can be effective in the short term for patients living in countries with limited access to speech therapy. Questions might arise whether or not intensive treatment results in long-term benefits for these patients. Hence, the present study investigated long-term effectiveness of intensive speech therapy provided to Ugandan patients born with a cleft palate with or without cleft lip (CP ±â€¯L) in terms of different speech characteristics. METHODS: Five Ugandan patients with CP ±â€¯L, who received intensive speech therapy in the past, were contacted to participate in this follow-up study. All patients agreed to participate. Perceptual and instrumental speech evaluations were performed identically to the assessments immediately before and after speech therapy, to allow for comparison. Additionally, the Cleft Evaluation Profile, investigating self-perceived satisfaction with cleft-related features was included to compare satisfaction before and after speech therapy. RESULTS: Long-term improvement in percentage correct consonants was seen in four patients. Furthermore, after speech therapy, decreased presence of resonance disorders was observed in two of the included patients. Before speech therapy, all participants were dissatisfied with speech. Interestingly, after intensive speech therapy, satisfaction with speech was seen in every patient and this satisfaction remained in the long term. CONCLUSION: In summary, speech improvements after speech therapy varied among the five patients. Nevertheless, present study provided encouraging results to further investigate effectiveness of intensive speech therapy in patients with CP ±â€¯L.

Implant placement for patients with cleft lip and palate: A clinical report and guidelines for treatment.

The multidisciplinary teams involved in the treatment of individuals with cleft lip and palate are challenged when implants are indicated in the cleft area. Difficulties include obtaining a healthy peri-implant area and, especially, obtaining the natural-looking papilla essential for esthetic success. The area affected by the cleft has a bone deficiency, which is typically augmented with an alveolar bone graft at adolescence. Guidelines for the 3-dimensional placement of implants at the cleft area are presented based on clinical reports. The patients were followed up for at least 1 year. Adoption of the proposed guidelines enables satisfactory esthetic and functional outcomes in patients with cleft lip and palate.

3D comparison of dental arch stability in patients with and without cleft lip and palate after orthodontic/rehabilitative treatment

Abstract This study aimed to compare the linear dimensions of the dental arches of adult patients with complete unilateral cleft lip and palate (UCLP) after orthodontic and prosthetic treatment with fixed partial dentures (FPD) to patients without clefts, using 3D technology. This retrospective longitudinal study sample consisted of 35 subjects divided into two groups. Included in this sample were 15 complete UCLP individuals who had received orthodontic treatment before rehabilitation with a fixed partial denture (FG), as well as 20 patients without cleft as control group (CG). All patients were aged between 18 and 30 years. Digital dental casts were obtained in two stages: (T1) end of orthodontic treatment and (T2) one year after prosthetic rehabilitation (FG); and (T1) end of orthodontic treatment and (T2) one year after removal of the orthodontic appliance (CG). Intercanine, interfirst premolar and intermolar distances, and incisor-molar length were obtained. A precalibrated and trained examiner performed the assessments. Intergroup differences between T2 and T1 were compared between the groups using the t test or Mann-Whitney test with a significance level of 5% (p<0.05). The intercanine distance variation (T2-T1) showed statistical difference (p=0.005) increasing in the FG group and decreasing in the CG group. In the interfirst premolar distance variation, FG decreased, while CG increased with statistically significant difference (p=0.008). The intercanine distance of individuals with cleft showed stability, while that of the CG had no stability. The CG showed stability in the interfirst premolar distance, while FG had no stability. These findings showed that the FPD is capable of restricting orthodontic results, leading to a stabilization of the dental arches.

Importancia del manejo interdisciplinario de pacientes con Fisuras Labiopalatinas y Anemia de Blackfan Diamond. Reporte de caso: seguimiento a 2 años / Importância da abordagem interdisciplinar de paciente com Fissura Labiopalatina e Anemia de Blackfan Diamond: acompanhamento de dois anos / Importance interdisciplinary management of Diamond-Blackfan anemia and Cleft lip and palate sequel: Accompaniment of two years

Las fisuras labiopalatinas (FLP) son las malformaciones craneofaciales congénitas más comunes. La anemia de Diamond-Blackfan o anemia aneritroblástica es una hipoplasia congénita selectiva de la serie roja, asociada a alteraciones cardiacas, renales, malformaciones en manos, hipertelorismo y retraso en el crecimiento. La presentación de las FLP y pacientes con Anemia de Diamond-Blackfan es del 10.3%. Objetivo: Presentar un reporte de caso de un paciente de 12 años con anemia de Diamond-Blackfan y secuela de FLP de la Clínica Interdisciplinaria de LPH de la Pontificia Universidad Javeriana (Bogotá-Colombia) donde el abordaje interdisciplinario, el casomanejo del comportamiento y el apoyo psicológico brindado a la familia fueron fundamentales para lograr la adherencia, clarificar el diagnóstico y obtener los resultados terapéuticos esperados. Resultados: se logró la adherencia al tratamiento y el éxito de éste en apoyo con otras especialidades, permitiendo un seguimiento de 2 años. Conclusiones: El manejo multidisciplinario e interdisciplinario con especialidades odontológicas, médicas, y de la salud en general para el manejo de pacientes con FLP y síndromes asociados, resulta importante para el éxito en el tratamiento.

As fissura labiopalatina são as malformações craniofaciais congênitas mais comuns. A anemia do Diamante-Blackfan ou anemia aneritroblástica seletiva é uma hipoplasia congênita da série vermelha, associada com o coração, rim, malformações mãos, hipertelorismo e distúrbios retardo de crescimento. A apresentação de Fissura labiopalatina e pacientes com anemia do Diamante-Blackfan é de 10,3% dos casos. Objetivo: Apresentar um caso clínico de um paciente de 12 anos com anemia do Diamante-Blackfan e Fissura labiopalatina sequela do Interdisciplinar Clinic LPH da Pontificia Universidad Javeriana (Bogotá Colômbia), onde a abordagem interdisciplinar, gestão de comportamento e apoio psicológico prestado aos família foram fundamentais para alcançar a adesão a esclarecer o diagnóstico e obter os resultados terapêuticos esperados. Resultado: a adesão ao tratamento e seu sucesso no apoio de outras especialidades de saúde alcançados. Conclusões: O tratamento multidisciplinar e interdisciplinar com especialidades odontológicas, médicas e de saúde em geral para o tratamento de pacientes com FLP e síndromes associadas, é importante para o sucesso do tratamento

Cleft lip and palate (CLP) are the most common congenital craniofacial malformations. The Diamond-Blackfan anemia or congenital erythroblastic anemia is a selective red cell hypoplasia associated with heart, kidney, malformed hands, hypertelorism and stunted alterations. The presentation of Cleft lip and palate in patients with Diamond-Blackfan anemia is 10.3% of cases. Aim: To present a case report of a patient of 12 years with Diamond-Blackfan anemia and Cleft lip and palate sequel from the Interdisciplinary Clinic LPH of the Pontificia Universidad Javeriana (Bogota Colombia) where the interdisciplinary approach, behavior management and psychological support provided to the family were instrumental in achieving the expected therapeutic results. Results: Adherence to treatment and its success in supporting other health specialties during two years is slown. Conclusions: The multidisciplinary and interdisciplinary management with dental specialties, medical, and health in general for the management of patients with FLP and associated syndromes, it is important for successful treatment

Quality of life and mastication in denture wearers and cleft lip and palate adults.

The impact of oral rehabilitation on masticatory function and oral health-related quality of life (OHRQoL) may vary with the experience of the individual with tissue loss. Our hypothesis is that patient-centered outcomes vary among adults who have experienced large defects in the maxilla due to congenital or acquired conditions even after oral rehabilitation to restore aesthetics and function. This study compared OHRQoL, perceived masticatory ability, maximum bite force (MBF), and symptoms of pain and depression among subjects with acquired (edentulous maxilla) and congenital (cleft lip and palate) loss of oral tissues in the maxilla after dental treatment. A gender-matched sample (n = 60) of cleft lip and palate (CLP), maxillary denture wearers (DENT) and controls (CONT) was recruited. OHRQoL was assessed using OHIP-14. Chewing was evaluated through a masticatory ability questionnaire and by MBF. The RDC/TMD Axis II questionnaire was used to assess symptoms of pain and depression. Data were analyzed by Fisher's test, Kruskal Wallis test, and Spearman correlation coefficients. CLP showed higher OHIP-14 and depression scores than DENT and CONT (p < 0.05). Sub-analysis by OHIP-14 items (%FOVO) showed higher prevalence of psychological impact for CLP and of functional impacts for DENT. The number of foods difficult to chew, of food textures difficult to chew, and avoided foods were similar between CLP and DENT. OHIP-14, MBF, and depression scores showed significant correlation (p < 0.05). The results suggest that adults with treated CLP or maxillary DENT have chewing impairment and lower MBF than healthy subjects, with different psychological and functional impacts.

Assessment of Orthodontic Burden of Care in Patients With Unilateral Complete Cleft Lip and Palate.

OBJECTIVE: To assess the orthodontic burden of care of patients from a Brazilian rehabilitation center (Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo [HRAC-USP]). DESIGN: Retrospective. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo. INTERVENTIONS: One hundred files of unilateral complete cleft lip and palate patients who had consecutively finished orthodontic rehabilitation at HRAC-USP were evaluated from January 2011 to January 2013. The duration of orthodontic treatment, number of visits, kilometers traveled, number of appliances and surgical procedures performed were recorded. The sample was divided into 2 subgroups according to severity the interarch relation (Goslon Yardstick score) at the beginning of orthodontic treatment. Mann-Whitney test was applied for intergroup comparison ( P < .05). RESULTS: For the total sample (n = 100), the mean time of orthodontic treatment was 140.2 months, the mean number of orthodontic appointments was 61.8, the mean number of appliances was 10, the mean number of surgical procedures was 6.2, and the mean distance traveled to attend the center for orthodontic appointments was 38,978.5 km. The subgroup with the most severe malocclusion (Goslon yardsticks scores 4 and 5) showed a longer orthodontic treatment length, greater number of surgical procedures, and longer distance traveled than those presenting Goslon yardstick scores 1, 2, and 3. CONCLUSION: Patients with greater severity of the initial malocclusion experienced a higher burden of care than patients with less severity of the initial malocclusion. To reduce the burden of care, research and efforts should focus on minimizing maxillary growth deficiency related to primary surgery.

[Complex rehabilitation of children with congenital cleft lip and palate at stomatological treatment stages]. / Kompleksnaia reabilitatsiia detei s vrozhdennymi rasshchelinami guby i neba na étapakh stomatologicheskogo lecheniia.

Congenital malformations of the maxillofacial area - congenital cleft lip and palate (CCLP) due to their frequency, the severity of anatomical and functional disorders, the difficulty of social adaptation of patients, economic aspects are one of the most important problems of medicine. It is established that for timely stage surgical treatment of children with IAPC the emphasis is on the somatic status of the child, anti-infective resistance, the ability to safely tolerate surgery, which is important for the restoration of anatomical defects, communication functions and psychosomatic health. Children with CCLP are at risk for increased occurrence of postoperative complications, since upper respiratory tract infection and exacerbation of chronic respiratory tract diseases and ENT organs is a contraindication to surgical intervention. The study of immune status revealed deep violations of antiviral and antibacterial immunity in children with CCPC aged from 6 to 12 years. A program of combine interferon- and immunotherapy has been created. Positive clinical and immunological efficacy of combine interferon-(gel Viferon - recombinant IFNα2b in combination with antioxidant) and immunotherapy in the rehabilitation of children with CCPC aged 6 to 12 years was demonstrated.

The maxillary lateral incisor in the rehabilitation of cleft lip and palate.

Objective This study analyzed the maintenance of lateral incisors in the dental rehabilitation of individuals with cleft lip and palate. Material and Methods The study was conducted on a tertiary craniofacial center and comprised retrospective analysis of panoramic and periapical radiographs of Caucasoid individuals with non-syndromic complete unilateral cleft lip and palate, analyzing all radiographs available on the records of each individual, from the first to the last up to 12 years of age. Overall, 2,826 records were reviewed to achieve a sample of 1,000 individuals. Among these, 487 individuals presented the permanent lateral incisors on both cleft and non-cleft sides, which were included in this study. Results The results were evaluated in percentages and by descriptive statistics. The association between maintenance of the lateral incisor and timing of alveolar bone graft were analyzed by the t test. Among the 487 individuals, 265 had not completed treatment, 62 presented insufficient information, and 44 concluded the treatment elsewhere. Among the remaining 116 individuals, the lateral incisor was extracted from 88 (75.86%) of them on the cleft side (CS) and from 23 (19.83%) people on the non-cleft side (NCS). The age at accomplishment of alveolar bone graft was significantly associated with maintenance of the lateral incisor on the cleft side (p<0.01). Most extractions were indicated because of the inadequate positioning on the CS and for midline correction on the NCS. Rehabilitation was primarily completed by orthodontic movement (53 individuals on the CS and 13 individuals on the NCS). Conclusion In conclusion, the lateral incisor on the cleft side was not maintained in most individuals. Positive relationship was observed between extraction of the lateral incisor and age at accomplishment of the alveolar bone graft, suggesting the need to anticipate the initial radiographic evaluation to enhance its maintenance and reduce the procedures required for rehabilitation.

[Outcome and influential factors of speech therapy delivered to cleft patients with post-operative velopharyngeal competence].

OBJECTIVE: To analyze the training technique, intervention timing, and other related factors involved in the speech therapy delivered to cleft patients with velopharyngeal competence after surgery. METHODS: A retrospective study was conducted on 32 patients who received phonology-articulation speech therapies during 2012 to 2013 in Dept. of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University. All patients achieved normal speech one year after therapy. Information collected included the types and number of consonant articulation error, the overall period of training, the interval between surgery and speech training, and the age during speech training. Statistical analyses were performed in SPSS 16.0. RESULTS: Ten patients received less than five sessions of training, seventeen received six to ten sessions, and five received eleven to twenty sessions. The number of sessions was positively correlated with the number of errors (r(s)=0.394, P=0.026). On the average, each additional error cost another 0.570 session for correction (confidence interval: 0.137-1.004). Moreover, the number of sessions was negatively correlated with age (P=0.055). Patients between 5 to 10 years old took significantly lesser sessions than those above 10 years. No correlation was found between the number of sessions and the interval between surgeries and trainings. CONCLUSIONS: Appropriate speech therapy efficiently rehabilitate the speech condition of cleft patients with velopharyngeal sufficiency after surgery. The number of errors is directly proportional to the number of sessions needed. Patients above 10 years require more sessions than those less than 10 years.