Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.046
Filtrar
1.
Shanghai Kou Qiang Yi Xue ; 29(1): 51-54, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-32524121

RESUMO

PURPOSE: To evaluate the symmetry and stability of nasolabial area of unilateral complete cleft lip (UCCL) after primary repair with the method of rotation descent step by step. METHODS: Thirty patients with UCCL who were operated on were photographed before, 1 week after and 1 year after surgery, the distances from alare point (al), sub alare point (sba), christa phlitri point (cph) and chelion point (ch) to the facial vertical midline (VML) were measured and compared with the opposite side by paired t test. Statistical analysis was performed with SPSS 19.0 software package. RESULTS: There were significant differences in al, sba and cph between the cleft side and non-cleft side before(P<0.05) and 1 week after surgery; significant differences were found in al, sba and ch between the affected and unaffected side (P<0.05); but 1 year after surgery, there was no significant difference between the two sides except sba. After surgery, all the distances from VML were less than those before surgery. There was no significant difference in symmetry rate between 1 week and 1 year after surgery for all the points except sba. CONCLUSIONS: The results indicated that the method of rotation descent step by step is very helpful in reconstruction of lip symmetry, but primary repair can not achieve full recovery of nasal symmetry.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Face , Humanos , Nariz , Rotação , Resultado do Tratamento
2.
Codas ; 32(4): e20190152, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32401996

RESUMO

Purpose This study investigated the influence of the cleft type on the appearance of hypernasality after surgical maxillary advancement (MA). Methods Nasality was determined by measurement of nasalance (acoustic correlate of nasality) by nasometry. The study involved analysis of the nasalance scores of 17 individuals with isolated cleft palate (CP), 118 with unilateral cleft lip and palate (UCLP) and 69 with bilateral cleft lip and palate (BCLP), of both sexes, aged 18 to 28 years, after MA. Only individuals with normal nasalance scores indicating balanced resonance before MA were included in this study. Nasometry was performed 3 days before and 15 months after MA, on average. The proportion of patients who presented nasalance scores indicating hypernasality after surgery was calculated by the ANOVA test, and comparison among the different cleft types was evaluated by the chi-square test (p < 0.05). Results No significant difference was found in the proportions of individuals with hypernasality among the cleft types. Conclusion Nasometry showed that the appearance of hypernasality after MA in individuals with cleft palate with or without cleft lip occurred in similar proportions, regardless of the cleft type.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Distúrbios da Fala/etiologia , Fala/fisiologia , Insuficiência Velofaríngea/etiologia , Adolescente , Adulto , Fenda Labial/fisiopatologia , Fissura Palatina/fisiopatologia , Feminino , Humanos , Masculino , Maxila/cirurgia , Osteotomia de Le Fort/efeitos adversos , Estudos Retrospectivos , Distúrbios da Fala/fisiopatologia , Medida da Produção da Fala , Insuficiência Velofaríngea/fisiopatologia , Adulto Jovem
3.
Khirurgiia (Mosk) ; (4): 88-94, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352676

RESUMO

OBJECTIVE: Is to evaluate the advantage of Contractubex gel with regards to influence on vascularisation, pigmentation, thickness, surface size, configuration, and elisticity of postsurgical scars of children (after cheilorinoplasty) in comparison to absence of systematized topical treatment. MATERIAL AND METHODS: Into the prospective, non-interventional, observational, multi-centered, in parallel groups, open, controlled study were included 60 patients aged 2,5 months and older with postsurgical scars after first cheilorinoplasty after 7-14 day after operation. Patients were randomized into 2 groups of 30 patients in each. I group - patients get applications of Contractubex gel 3 times a day (in the morning, in the afternoon, in the evening) in accordance with patient information leaflet. II group - control group with no regular therapy of of postsurgical scars (without treatment or without application of oils and gels with anticsarring action). The period of medicine usage - 9 months and more for each patient, the each patient observation duration is 18 months. RESULTS: After analysis of the primary as well as secondary efficacy criteria (total grade based on POSAS scale, reported by investigator/parent) after 3, 6, 12, 18 months of observation in both groups a positive statistically significant dynamics was registered. At the same time in the Contractubex group results were statistically significantly better than in the control group. Positive dynamics was achieved quickier in the main group than in the contol group and was to observe already after 3 months of therapy, during the whole treatment and observation phase, and after 18 months of therapy. Additionally conducted photodocumentation of postsurgical scar development dynamics in terms of the study confirms positive effect of surgery and absence of visual data regarding keloids or hyperthrophic scars formation in patients in both groups. Adverse events, i. a. pain, itch, burning, long-run hyperemia were not registered during the whole period os study. CONCLUSION: The conducted study has shown high efficacy and safety of Contractubex usage for the treatment of postsurgical scars of children with with congenital cleft lip and palate (from 2,5 months old). The statistically significant advantage of the therapy with Contractubex was demonstrated in comparison with the control group (with no regular topical treatment). The obtained results allow to recommend Contractubex gel as an effective and safe medicine for the treatment of scarring after surgeries for kids directly after sutures removal.


Assuntos
Alantoína/administração & dosagem , Cicatriz/tratamento farmacológico , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Fármacos Dermatológicos/administração & dosagem , Heparina/administração & dosagem , Extratos Vegetais/administração & dosagem , Cicatriz/etiologia , Fenda Labial/complicações , Fissura Palatina/complicações , Combinação de Medicamentos , Géis/administração & dosagem , Humanos , Lactente , Complicações Pós-Operatórias/tratamento farmacológico , Estudos Prospectivos , Resultado do Tratamento
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 200-205, 2020 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-32030952

RESUMO

Objective: To discuss the clinical application and effectiveness of autologous costal cartilage transplantation in the repair of upper lip depression in the secondary repair of cleft lip. Methods: The clinical data of 10 patients of secondary repair of upper lip depression with cleft lip by autologous costal cartilage transplantation between January 2017 and January 2019 were retrospectively analysed. There were 7 males and 3 females with an average age of 24 years (range, 18-33 years). There were 8 cases of bilateral lip fissure and 2 cases of unilateral lip fissure. All of them underwent early lip repair at the age of 2-3 years old. The change of the profile of the soft tissue profile of the upper lip of the patient was quantitatively analyzed before operation and at immediate after operation, including the soft tissue facial angle (G-Sn-Pg'), the nasolabial angle (Cm-Sn-UL), the mentolabial angle (UL-LL-Pg'), the distance between the most salient point of the upper lip to the aesthetic plane (UL-E), the highest point of the frontal part, the projection distance of the most salient point of the upper lip on the plane of the orbital ear (G-UL), and the upper lip protrusion (ULP). Results: One case had incision infection and healed after dressing change, and in the other 9 patients, the incisions healed by first intention, and no acute infection and other complications occurred. The appearance of the lateral morphology of the upper lip at immediate after operation was significantly improved when compared with that before operation. The value of UL-LL-Pg', UL-E, G-UL, and ULP were significantly increased and G-Sn-Pg' was significantly decreased when compared with preoperative ones ( P<0.05). There was no significant difference in Cm-Sn-UL between pre- and post-operation ( t=0.821, P=0.433). All the 10 patients were followed up 6-24 months, with an average of 15 months. During the follow-up, the soft tissue morphology of the upper lip was good. No long-term complications such as cartilage absorption and cartilage displacement were found. Conclusion: Autologous costal cartilage transplantation is a safe and effective treatment for upper lip depression in the secondary repair of cleft lip.


Assuntos
Fenda Labial , Cartilagem Costal , Adolescente , Adulto , Pré-Escolar , Fenda Labial/cirurgia , Depressão , Feminino , Humanos , Masculino , Nariz , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
Plast Reconstr Surg ; 145(3): 591e-603e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097323

RESUMO

The surgical techniques and execution of primary cleft lip and palate repair are no longer the greatest challenge to achieving successful rehabilitation for those born with facial clefting (i.e., bilateral and unilateral cleft lip and palate). Despite a surgeon's best efforts, when cleft palate repair is carried out during infancy, by the mixed dentition, a majority will demonstrate nasomaxillary deficiency. The cleft team's commitment to a family under their care is to ensure that the newborn reaches adulthood reconstructed without need for special regard to their original birth malformation. Guiding principles are provided for the accurate diagnosis and reliable reconstruction of the bilateral and unilateral cleft lip and palate adolescent/adult who presents with nasomaxillary deficiency and any residual oronasal fistula, bony defects, cleft dental gap(s), nasal obstructions, and associated facial dysmorphology. Successful orthognathic surgery provides a stable foundation on which any remaining soft-tissue cleft lip or cleft nasal deformities can be accurately assessed and then reconstructed.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Doenças Maxilares/cirurgia , Doenças Nasais/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Fenda Labial/complicações , Fissura Palatina/complicações , Feminino , Humanos , Lactente , Masculino , Doenças Maxilares/etiologia , Doenças Nasais/etiologia
8.
Rev Med Suisse ; 16(679): 237-240, 2020 Jan 29.
Artigo em Francês | MEDLINE | ID: mdl-31995322

RESUMO

The labio-maxillofacial cleft (LMFC) penalizes the child from birth by its aesthetic, functional, psychological and social repercussions. The prognosis is conditioned by a multidisciplinary care that starts from the antenatal period to continue until the end of growth. The treatment is long and complex. This explains the multiplicity of techniques and the variability of schedules according to the teams. The purpose of this article is to describe the protocol of management of the LMFC within the multi-disciplinary team in Lausanne and to emphasize the novelties in both surgical and organizational plan.


Assuntos
Fenda Labial/terapia , Fissura Palatina/terapia , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Recém-Nascido
9.
Plast Reconstr Surg ; 145(2): 507-516, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985649

RESUMO

BACKGROUND: Cleft repair requires multiple operations from infancy through adolescence, with repeated exposure to opioids and their associated risks. The authors implemented a quality improvement project to reduce perioperative opioid exposure in their cleft lip/palate population. METHODS: After identifying key drivers of perioperative opioid administration, quality improvement interventions were developed to address these key drivers and reduce postoperative opioid administration from 0.30 mg/kg of morphine equivalents to 0.20 mg/kg of morphine equivalents. Data were retrospectively collected from January 1, 2015, until initiation of the quality improvement project (May 1, 2017), tracked over the 6-month quality improvement study period, and the subsequent 14 months. Metrics included morphine equivalents of opioids received during admission, administration of intraoperative nerve blocks, adherence to revised electronic medical record order sets, length of stay, and pain scores. RESULTS: The final sample included 624 patients. Before implementation (n =354), children received an average of 0.30 mg/kg of morphine equivalents postoperatively. After implementation (n = 270), children received an average of 0.14 mg/kg of morphine equivalents postoperatively (p < 0.001) without increased length of stay (28.3 versus 28.7 hours; p = 0.719) or pain at less than 6 hours (1.78 versus 1.74; p = 0.626) or more than 6 hours postoperatively (1.50 versus 1.49; p = 0.924). CONCLUSIONS: Perioperative opioid administration after cleft repair can be reduced in a relatively short period by identifying key drivers and addressing perioperative education, standardization of intraoperative pain control, and postoperative prioritization of nonopioid medications and nonpharmacologic pain control. The authors' quality improvement framework has promise for adaptation in future efforts to reduce opioid use in other surgical patient populations. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Analgésicos Opioides/administração & dosagem , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Derivados da Morfina/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Dor Processual/prevenção & controle , Adolescente , Anestesia por Condução/estatística & dados numéricos , Criança , Pré-Escolar , Protocolos Clínicos , Esquema de Medicação , Humanos , Lactente , Cuidados Intraoperatórios , Tempo de Internação/estatística & dados numéricos , Medição da Dor , Satisfação do Paciente , Melhoria de Qualidade , Estudos Retrospectivos , Adulto Jovem
10.
Plast Reconstr Surg ; 145(2): 518-521, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985651

RESUMO

The mature bilateral cleft nasolabial deformity exhibits prolabial and vermilion deficiency, a broad depressed nasal tip, and short columella. Many strategies attempt to correct these stigmata, with varying degrees of success. The purpose of this communication is to describe a novel sequenced approach, staging an Abbe flap and rhinoplasty, with morphometric analysis of results. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Fenda Labial/cirurgia , Rinoplastia/métodos , Retalhos Cirúrgicos , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Satisfação do Paciente , Resultado do Tratamento , Adulto Jovem
13.
J Craniofac Surg ; 31(1): 72-76, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31469727

RESUMO

BACKGROUND: Smile Train, an international children's charity committed to improving cleft care around the world, empowers local medical professionals in developing countries to provide quality comprehensive cleft care in their own communities. As part of their sustainable model, Smile Train developed a web-based, interactive virtual simulator to improve surgical training of cleft procedures for surgeons around the world, replicating the anatomical and technical steps involved in cleft surgery. This study evaluated the simulator as a tool for enhancing surgical training. METHODS: A pre-test and questionnaire addressing cleft care, surgical knowledge, and confidence level was administered to surgeons-in-training at an academic institution. Participants completed 3 simulator modules followed by a post-test and questionnaire to measure changes in knowledge and confidence levels. RESULTS: Sixteen surgeons-in-training participated in this study. The mean score on the knowledge examination increased after reviewing the modules for both junior residents (33.1%-64.4%) and senior residents (46.9%-70.8%). Reviewing the modules increased participants' confidence in the knowledge of cleft anatomy, understanding of surgical procedures, and ability to follow along meaningfully while assisting in operations. CONCLUSIONS: The Smile Train Virtual Surgery Simulator increased knowledge and reported surgeon confidence in understanding and assisting in cleft lip surgery, signifying its usefulness as a training tool for surgeons-in-training. Virtual simulation is a valuable resource for improving understanding and competence of the craniofacial surgeon while serving as an educational resource to other members of the comprehensive cleft care team, patients, and families.


Assuntos
Cirurgiões/educação , Fenda Labial/cirurgia , Humanos , Organizações , Qualidade da Assistência à Saúde
14.
J Craniofac Surg ; 31(1): 62-63, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31469729

RESUMO

BACKGROUND: An anterior palatal fistula in a bilateral cleft lip and palate is a challenging clinical dilemma. The authors evaluate the feasibility and outcomes of the reconstruction of large anterior palatal fistulae using anteriorly based dorsal tongue flaps. METHODS: Eight patients with anterior palatal fistulae after repair of a bilateral cleft lip and palate using anteriorly based dorsal tongue flaps. The defect size varied from 1.0 × 1.0 cm to 1.5 × 2.0 cm, and the tongue flap size varied from 1.5 × 3.5 cm to 2.0 × 3.5 cm. RESULTS: All patients underwent successful reconstruction of palatal defects using anteriorly based tongue flaps, and no case of spontaneous detachment of the tongue flap occurred. The patients with palatal fistulae were followed up for 10 to 30 months, and no recurrence was encountered. CONCLUSION: An anteriorly based dorsal tongue flap is a safe and feasible surgical technique for the closure of anterior palatal fistulae.


Assuntos
Fístula/cirurgia , Retalhos Cirúrgicos/cirurgia , Língua/cirurgia , Adolescente , Fenda Labial/cirurgia , Feminino , Humanos , Masculino , Recidiva , Adulto Jovem
15.
Int J Pediatr Otorhinolaryngol ; 128: 109692, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568953

RESUMO

INTRODUCTION: Lipofilling of the upper lip as secondary treatment in patients with a cleft lip (and palate) (CL ±â€¯P) has been proposed to improve projection and volume especially in profile view. The purpose of the present study was to document differences in functional (i.e. logopaedic) and self-reported aesthetic outcomes by comparing pre- and postoperative results after lipofilling of the upper lip in patients with CL ±â€¯P. METHODS: Eight Dutch-speaking youngsters and young adults (three women, five men) with CL ±â€¯P were included. The median age was 19 years (range: 14-24 years). Logopaedic outcomes (i.e. assessment of orofacial myofunctional behavior, articulation and lip strength) and self-reported aesthetic outcome (i.e. patients' satisfaction using the Cleft Evaluation Profile) were determined. RESULTS: Neither for lip strength and orofacial myofunctional behavior nor for articulation statistically significant differences were found when comparing measurements before and after lipofilling. Regarding patients' satisfaction, a statistically significant increased self-evaluation of appearance in profile was found after lipofilling. CONCLUSION: Regarding functionality, the present study did not find any differences when comparing outcomes before and after lipofilling. Nevertheless, patients were more satisfied with appearance in profile after performance of this technique. As this is a small sample study, further research and long-term follow-up studies are necessary.


Assuntos
Fenda Labial/fisiopatologia , Fenda Labial/terapia , Preenchedores Dérmicos/uso terapêutico , Lábio/fisiopatologia , Satisfação do Paciente , Adolescente , Fenda Labial/complicações , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estética , Músculos Faciais/fisiopatologia , Feminino , Humanos , Masculino , Força Muscular , Projetos Piloto , Fala , Testes de Articulação da Fala , Distúrbios da Fala/etiologia , Adulto Jovem
16.
Eur J Orthod ; 42(1): 15-23, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-31586176

RESUMO

BACKGROUND: The Scandcleft international multicenter study is a prospective clinical trial of the long-term outcome after four different surgical protocols for palatal closure in patients born with unilateral cleft lip and palate (UCLP). This paper is one of a series of follow-up studies in 8-year olds. OBJECTIVES: To evaluate the dental occlusion of 8-year-old patients after four different protocols of primary surgery for UCLP. TRIAL DESIGN: Ten cleft centres in five countries tested three different surgical procedures for primary palatal repair in three parallel trials (Arms B, C, and D) against a common procedure (Arm A). METHODS: Initially 448 children born with non-syndromic UCLP were included in the project. At 8 years of age, 428 children remained in the study. Dental casts of 411 patients (270 boys, 141 girls), mean age 8.1 years (range 7.0-10.0) were taken. The casts were blindly assessed with the Modified Huddart and Bodenham (MHB) index by four orthodontists. The main outcome measures were anterior (+2 to -6) and posterior (0 to -8) mean scores. Comparisons were made with previous data in 5-year-olds. RESULTS: The inter- and intra-examiner reliability was good to excellent (0.75-0.90; 0.73-0.97), respectively. The mean total scores varied from -7.09 (Trial 2C) to -10.13 (Trial 3D). The mean anterior scores varied from -1.75 (Trial 2C) to -3.18 (Trial 1A). The mean posterior cleft-side scores varied from -4.32 (Trial 1B) to -5.21 (Trial 3D) and the mean non-cleft-side scores varied from -0.88 (Trial 2C) to -2.40 (Trial 3A). No significant differences were found within the trials. A significant difference was found between Trials 2 and 3 (Arm C/D) for the total score (P = 0.004). CONCLUSIONS: There was no evidence of clinically significant differences in occlusion between the two surgical methods in each trial or between the trials. All mean scores showed more negative values in 8-year-olds compared with previously reported values in 5-year-olds. TRIAL REGISTRATION: ISRCTN29932826.


Assuntos
Fenda Labial , Fissura Palatina , Oclusão Dentária , Procedimentos Cirúrgicos Reconstrutivos , Criança , Fenda Labial/complicações , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Arco Dental , Modelos Dentários , Feminino , Humanos , Masculino , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Resultado do Tratamento
17.
Eur J Orthod ; 42(1): 30-35, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-31586178

RESUMO

OBJECTIVES: The present study validated data that had been reported to the Swedish Quality Registry for Cleft Lip and Palate (CLP) under new requirements from 2016, when use of the 5-year-old (5YO) and the Modified Huddart and Bodenham (MHB) indices for rating occlusion in children born with unilateral CLP (UCLP) was introduced. MATERIALS AND METHODS: The sample included blinded study casts (n = 97) and photos (n = 4) of 5-year-old children who had been born with UCLP in 2009-2011 and were enrolled at one of six cleft centres in Sweden. Fourteen orthodontists from the centres assessed the patients (n = 101) using the 5YO and the MHB indices. Median 5YO and MHB scores of the 14 assessments were compared with original registry data (n = 61). Each centre devised code keys to protect the identities of their patients in the registry. RESULTS: Interrater agreement among the 14 orthodontists was good for the 5YO index (quadratic-weighted kappa: 0.72-0.92) and the MHB index (intraclass correlation coefficient: 0.991-0.994). Comparisons of median 5YOs for each identifiable child with their registry data (n = 61) found total agreement for 70.5 per cent. Comparisons between median MHBs and registry data showed very good or good agreement in 93.4 per cent of the cases. LIMITATIONS: Two teams lost their code keys, which reduced the sample to 61 patients. CONCLUSIONS: The dentoalveolar outcome data in the CLP registry was trustworthy. There was good agreement among the Swedish cleft teams assessing the 5YO and MHB indices in children born with UCLP at age 5 years.


Assuntos
Fenda Labial , Fissura Palatina , Arco Dental , Sistema de Registros , Pré-Escolar , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Arco Dental/anatomia & histologia , Arco Dental/cirurgia , Humanos , Reprodutibilidade dos Testes , Suécia , Resultado do Tratamento
18.
Eur J Orthod ; 42(1): 24-29, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-31586198

RESUMO

OBJECTIVES: To assess differences in craniofacial growth at 8 years of age according to the different protocols for primary cleft surgery in the Scandcleft project. DESIGN AND SETTING: Prospective, randomized, controlled clinical trial (RCT) involving 10 centres, including non-syndromic Caucasians with unilateral cleft lip and palate (UCLP). In Trial 1, a common surgical method (1a) with soft palate closure at 3-4 months of age and hard palate closure at 12 months of age was tested against similar surgery but with hard palate repair at 36 months (delayed hard palate closure) (1b). In Trial 2, the common method (2a) was tested against simultaneous closure of both hard and soft palate at 1 year (2c). In Trial 3, the common method (3a) was tested against hard palate closure together with lip closure at 3 months of age and soft palate closure at 1 year of age (3d). Participants were randomly allocated by use of a dice. Operator blinding was not possible but all raters of all outcomes were blinded. SUBJECTS AND METHODS: The total number of participating patients at 8 years of age was 429. Lateral cephalograms (n = 408) were analysed. The cephalometric angles SNA and ANB were chosen for assessing maxillary growth for this part of the presentation. RESULTS: Within each trial (Trial 1a/1b, Trial 2a/2c, and Trial 3a/3d), there was no difference in cephalometric values between the common and the local arm. There were no statistically significant differences in the SNA and ANB angles between the common arm in Trial 1a (mean SNA 77.8, mean ANB 2.6) and Trial 2a (mean SNA 79.8, mean ANB 3.6) and no difference between Trial 1a and Trial 3a, but a statistical difference could be seen between Trial 2a and Trial 3a (mean SNA 76.9, mean ANB 1.7). However, the confidence interval was rather large. Intra- and inter-rater reliability were within acceptable range. CONCLUSIONS: The timing and the surgical method is not of major importance as far as growth outcomes (SNA and ANB) in UCLP are concerned. REGISTRATION: ISRCTN29932826. PROTOCOL: The protocol was not published before trial commencement.


Assuntos
Fenda Labial , Fissura Palatina , Maxila , Desenvolvimento Maxilofacial , Criança , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Seguimentos , Humanos , Maxila/crescimento & desenvolvimento , Maxila/cirurgia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Fatores de Tempo
19.
Oral Dis ; 26(2): 381-390, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31808229

RESUMO

OBJECTIVES: Cleft lip and palate (CL/P) are common congenital orofacial anomalies. Autogenous iliac bone grafting closes alveolar cleft defects but requires surgical intervention. Mesenchymal stem cell culture supernatant can regenerate tissues via paracrine activity. However, little is known about the bone-regenerative effects of stem cells from human exfoliated deciduous teeth (SHED) and conditioned media (CM). Our aim was to address this. MATERIALS AND METHODS: Stem cells were isolated from primary tooth pulp and cultured. Defects were made in calvariae of immunodeficient mice and implanted with stem cell- or CM-containing atelocollagen. Regenerated bone was analysed by microcomputed tomography, haematoxylin-eosin and Masson's trichrome staining. Vascular endothelial growth factor, CD31 and CD34 expression were confirmed by immunohistochemistry, and the presence of several proteins and growth factors was verified in SHED-CM. RESULTS: Bone regeneration was enhanced in defects treated with stem cells and CM compared to that in controls 8 weeks after transplantation. Mature bone formation and angiogenesis were confirmed with CM but not with stem cells or in controls. Secretome analysis using multiple cytokine assays revealed that SHED-CM contained tissue-regenerating factors with roles in angiogenesis and osteogenesis. CONCLUSION: CM non-invasively regenerate bone and might be effective to reconstruct alveolar clefts in CL/P patients.


Assuntos
Regeneração Óssea/efeitos dos fármacos , Meios de Cultivo Condicionados/farmacologia , Polpa Dentária/fisiologia , Células-Tronco/fisiologia , Esfoliação de Dente , Dente Decíduo/citologia , Animais , Criança , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Osteogênese/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/metabolismo , Microtomografia por Raio-X
20.
J Plast Surg Hand Surg ; 54(1): 6-13, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31393744

RESUMO

Internationally adopted children (IAC) with a cleft lip and/or palate (CL/P) tend to arrive with un-operated palates at an age at which their Swedish-born peers have completed their primary palate surgery. Our aim of the present study was to analyze surgical, speech and hearing outcomes of IAC at age 5 and compare with those of a matched group of Swedish-born children. Fifty children with CL/P born in 1994-2005 participated in the study. Twenty-five IAC were matched according to age, sex and cleft type with 25 Swedish-born children. Audio recordings were perceptually analyzed by two experienced, blinded speech-language pathologists. Hearing and speech statuses were evaluated on the same day for all children. Surgical timing and complications as in fistulas and requirement for secondary velopharyngeal (VP) surgery, speech evaluation results, and present hearing status were analyzed for all children of age 5 years. Results showed that primary palatal surgery was delayed by a mean of 21 months in IAC. IAC had a higher prevalence of velopharyngeal impairment that was statistically significant, a higher fistula rate, and experienced more secondary surgery than Swedish-born peers. Hearing loss due to middle ear disease was slightly more common among IAC, whereas the rate of treatment with tympanostomy tubes was similar between the two groups. In conclusion, IAC with CL/P represent a challenge for CL/P teams because of the heterogeneous nature of the patient group and difficulties associated with delayed treatment, and the results show the importance of close follow-up over time.


Assuntos
Criança Adotada , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Pré-Escolar , Fenda Labial/complicações , Fissura Palatina/complicações , Feminino , Perda Auditiva/complicações , Humanos , Internacionalidade , Masculino , Ventilação da Orelha Média/estatística & dados numéricos , Fístula Bucal/complicações , Reoperação/estatística & dados numéricos , Suécia , Tempo para o Tratamento , Insuficiência Velofaríngea/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA