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1.
J Clin Pediatr Dent ; 45(2): 123-128, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33951163

RESUMO

Currently, the treatment protocol for cleft palate at several centers around the world involves primary lip repair around 3-4 months of age, using presurgical nasoalveolar molding, which is done soon after birth. Unfortunately, in cases where treatment is delayed, the potential for repositioning the nasoalveolar apparatus is severely limited. The purpose of this paper is to illustrate a novel use of an expansion screw appliance to aid in the faster and more efficient active molding of the premaxillary and lateral maxillary segments in infants for whom the start of PNAM therapy is delayed, without the side effects commonly seen with pin-retained active molding appliances.


Assuntos
Fenda Labial , Fissura Palatina , Parafusos Ósseos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Lactente , Nariz , Cuidados Pré-Operatórios
2.
Cleft Palate Craniofac J ; 58(5): 603-611, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33840261

RESUMO

OBJECTIVE: This study assesses the association between risk of secondary surgery for oronasal fistula following primary cleft palate repair and 2 hospital characteristics-cost-to-charge ratio (RCC) and case volume of cleft palate repair. DESIGN: Retrospective cohort study. SETTING: This study utilized the Pediatric Health Information System (PHIS) database, which consists of clinical and resource-utilization data from >49 hospitals in the United States. PATIENTS AND PARTICIPANTS: Patients undergoing primary cleft palate repair from 2004 to 2009 were abstracted from the PHIS database and followed up for oronasal fistula repair between 2004 and 2015. MAIN OUTCOME MEASURE(S): The primary outcome measure was whether patients underwent oronasal fistula repair after primary cleft palate repair. RESULTS: Among 5745 patients from 45 institutions whom met inclusion criteria, 166 (3%) underwent oronasal fistula repair within 6 to 11 years of primary cleft palate repair. Primary palatoplasty at high-RCC facilities was associated with a higher rate of subsequent oronasal fistula repair (odds ratio [OR] = 1.84 [1.32-2.56], adjusted odds ratio [AOR] = 1.81 [1.28-2.59]; P ≤ .001). Likelihood of surgery for oronasal fistula was independent of hospital case volume (OR = 0.83 [0.61-1.13], P = .233; AOR = 0.86 [0.62-1.20], P = .386). Patients with complete unilateral or bilateral cleft palate were more likely to receive oronasal fistula closure compared to those with unilateral-incomplete cleft palate (AOR = 2.09 [1.27-3.56], P = .005; AOR = 3.14 [1.80-5.58], P < .001). CONCLUSIONS: Subsequent need for oronasal fistula repair, while independent of hospital case volume for cleft palate repair, increased with increasing hospital RCC. Our study also corroborates complete cleft palate and cleft lip as risk factors for oronasal fistula.


Assuntos
Fenda Labial , Fissura Palatina , Fístula , Criança , Fissura Palatina/cirurgia , Hospitais , Humanos , Lactente , Fístula Bucal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
3.
Anesth Prog ; 68(1): 45-46, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33827117

RESUMO

Preformed cuffed oral endotracheal tubes are widely used to intubate children undergoing oral surgery. To evaluate the efficacy and safety of oral Ring-Adair-Elwyn (RAE) Microcuff® pediatric endotracheal tubes, we retrospectively investigated the endotracheal tube exchange rate and associated complications in Japanese children younger than 2 years of age undergoing cheiloplasty or palatoplasty. The exchange rate was 3.5%, and although unplanned extubations occurred in 2 patients, no severe complications were observed. Our results suggest that oral RAE Microcuff® tubes are effective and safe for intubating Japanese children younger than 2 years of age, with a low tube exchange rate and minor complications.


Assuntos
Fissura Palatina , Procedimentos Cirúrgicos Bucais , Criança , Fissura Palatina/cirurgia , Humanos , Intubação Intratraqueal/efeitos adversos , Japão , Estudos Retrospectivos
4.
Prog Orthod ; 22(1): 10, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33791877

RESUMO

BACKGROUND: The quality of life (QoL) of children and adolescents with cleft lip/palate (CL/P) has been shown to be a predictor of good psychosocial functioning in this population group. This study aimed to measure QoL, from the patient´s perception of change produced by the different surgical and orthodontic treatments carried out since early childhood, and if gender and age are modulating the outcome variables results. MATERIALS AND METHODS: A cross-sectional research study was carried out. The study included 60 patients with cleft lip, cleft palate, or cleft lip/palate, aged between 8 and 18, who were in orthodontic treatment and had undergone at least one surgery. They were asked to complete the Quality-of-Life Adolescent Cleft Questionnaire (QoLAdoCleft), which allows the assessment of the QoL through self-perception of improvement after surgical and orthodontic interventions. In particular, this questionnaire (administered only once), allows the evaluation of self-perception of QoL at the present time and before orthodontic and surgical treatment. This double assessment was carried out for the domains of physical, psychological, and social health. The results were analysed by looking at the interaction of gender and age. RESULTS: Statistically significant differences were found in the perception of the current QoL in comparison to the retrospective perception in all the dimensions considered. The perception of QoL improved in all cases. The results also showed a moderation of gender in the relation between perception of previous behaviour and social function and actual behaviour and social function. CONCLUSION: The results indicated that patients perceived their quality of life had improved as a result of the treatments received, with the highest effect sizes found in the physical health domain. Specifically, the improvement in QoL in behaviour and social function tended to be influenced to a greater extent by perception of previous QoL. In this sense, personalized preventative measures from holistic and biopsychosocial approaches are necessary.


Assuntos
Fenda Labial , Fissura Palatina , Adolescente , Criança , Pré-Escolar , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estudos Transversais , Humanos , Percepção , Qualidade de Vida , Estudos Retrospectivos
5.
Oral Maxillofac Surg Clin North Am ; 33(2): 231-238, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33663951

RESUMO

The goals of alveolar cleft repair include (1) stabilization of the maxilla, (2) permitting tooth eruption, (3) eliminating the oronasal fistula, (4) improving aesthetics, and (5) improving speech. Alveolar cleft repair should be considered one of the steps of a larger comprehensive orthodontic management plan. In conjunction with closure of the oronasal fistula, a variety of grafting materials can be used in the alveolar cleft. Autogenous grafts have been found to have greater efficacy compared with allogenic or xenogeneic bone, substitute bone, and alloplasts but with more donor site morbidity.


Assuntos
Fenda Labial , Fissura Palatina , Processo Alveolar/cirurgia , Transplante Ósseo , Fissura Palatina/cirurgia , Estética Dentária , Humanos , Maxila
6.
Value Health ; 24(3): 404-412, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33641775

RESUMO

OBJECTIVES: The aim of this study was to evaluate the psychometric performance of the patient- and parent-reported measures in the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set for Cleft Care, and to identify ways of improving concept coverage. METHODS: Data from 714 patients with cleft lip and/or palate, aged 8 to 9, 10 to 12.5, and 22 years were collected between November 2015 and April 2019 at Erasmus University Medical Center, Boston Children's Hospital, Duke Children's Hospital, and from participating sites in the CLEFT-Q Phase 3 study. The Standard Set includes 9 CLEFT-Q scales, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, the Child Oral Health Impact Profile-Oral Symptoms Scale (COHIP-OSS), and the Intelligibility in Context Scale (ICS). Targeting, item-fit statistics, thresholds for item responses, and measurement precision (PSI) were analyzed using Rasch measurement theory. RESULTS: The proportion of the sample to score within each instruments range of measurement varied from 69% (ICS) to 92% (CLEFT-Q teeth and COHIP-OSS). Specific problems with individual items within the NOSE and COHIP-OSS questionnaires were noted, such as poor item fit to the Rasch model and disordered thresholds (6 of 10). Reliability measured with PSI was above 0.82 for the ICS and all but one CLEFT-Q scale (speech distress). PSIs were lowest for the COHIP-OSS (0.43) and NOSE questionnaire (0.35). CONCLUSION: The patient- and parent-reported components within the facial appearance, psychosocial function, and speech domains are valid measures; however, the facial function and oral health domains are not sufficiently covered by the CLEFT-Q eating and drinking, NOSE, and COHIP-OSS, and these questionnaires may not be accurate enough to stratify cleft-related outcomes.


Assuntos
Fenda Labial/psicologia , Fissura Palatina/psicologia , Medidas de Resultados Relatados pelo Paciente , Inquéritos e Questionários/normas , Adolescente , Criança , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Relações Interpessoais , Pais/psicologia , Satisfação do Paciente , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Adulto Jovem
7.
J Craniomaxillofac Surg ; 49(4): 304-311, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33663962

RESUMO

OBJECTIVE: The present study was designed to investigate the usefulness of combining two different ordinal scaling indices, infant index (I-I) and 5-point aesthetic index (5-PAI), for the assessment and prediction of esthetic outcome of primary lip repair for patients with unilateral cleft lip. MATERIALS AND METHODS: The nasolabial appearance of the patients was evaluated before primary lip repair and at 5 years of age using cropped facial photographs with frontal and oblique views. The I-I and 5-PAI employ expanded reference photographs and objective esthetic variables for judgment. RESULTS: The inter- and intrarater Kappa values of both I-I and 5-PAI demonstrated good to very good agreement (range: 0.74-0.84 for I-I and 0.62-0.77 for 5-PAI). Furthermore, both the declination of the columella and the deformity of the alar cartilage in I-I showed a correlation with nasal rating score of 5-PAI and were identified as predictable independent parameters (declination of the columella: Rs = 0.37, P = 0.04; deformity of the alar cartilage: Rs = 0.35, P = 0.02). CONCLUSION: The combined use of I-I and 5-PAI with expanded reference photographs and objective variables could be useful for obtaining greater accuracy of the esthetic assessment and predicting postsurgical nasolabial esthetics at infancy.


Assuntos
Fenda Labial , Fissura Palatina , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estética , Estética Dentária , Face , Humanos , Lactente , Cartilagens Nasais , Nariz/cirurgia
8.
Medicine (Baltimore) ; 100(6): e24012, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578517

RESUMO

INTRODUCTION: Distraction osteogenesis (DO) is a widely used for cleft and palate related maxillary hypoplasia. There has been little research on temporomandibular joint (TMJ) dislocation after maxillary DO. We present these 3 cases and analyze the possible causes for reference by other clinicians. PATIENT CONCERNS: In the late stages of maxillary DO, the patients gradually felt a decrease in mandibular mobility and suffered from limited mouth opening. Case 2 and 3 could open their mouth up to 1 and 2 fingers and Case 1 barely able to open her mouth at the completion of distraction. DIAGNOSIS: Case 1 and Case 3 were diagnosed as right TMJ dislocation and Case 2 had a TMJ dislocation on her left side. INTERVENTIONS: Patients with TMJ dislocation were repositioned with manipulation as soon as detected. OUTCOMES: There was no recurrence in all three cases during the postoperative follow-up period. CONCLUSIONS: Maxillary DO can sufficiently advance the maxilla in cleft lip and palate patients. Clinicians should be mindful of the TMJ dislocations that maxillary DO can exert on patients.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Luxações Articulares/etiologia , Maxila/cirurgia , Osteogênese por Distração/efeitos adversos , Adolescente , Criança , Fenda Labial/complicações , Fissura Palatina/complicações , Feminino , Seguimentos , Humanos , Fixadores Internos/normas , Luxações Articulares/cirurgia , Masculino , Maxila/anormalidades , Osteogênese por Distração/instrumentação , Transtornos da Articulação Temporomandibular/fisiopatologia , Resultado do Tratamento , Adulto Jovem
9.
J Orofac Orthop ; 82(3): 198-208, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33544175

RESUMO

PURPOSE: The aims of this retrospective cross-sectional study were to measure and compare labial and palatal alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients, following STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. PATIENTS AND METHODS: The study group consisted of 21 patients with a mean age of 16 years. High-resolution cone-beam computed tomography was performed at least one year after secondary alveolar bone grafting. The experimental side was the cleft side and the contralateral side without congenital cleft was the control. Measurements were performed on incisors' midsagittal cross-sections. The Wilcoxon signed-rank test was used for intergroup comparisons. RESULTS: The labial and palatal distances between alveolar bone crests and cementoenamel junctions were significantly greater on the cleft side than on the noncleft side. Mean differences were 0.75 and 1.41 mm, respectively. The prevalence of dehiscences at the cleft side maxillary central incisors was 52% on the labial surface and 43% on the palatal surface. In the controls, it was 19% and 14%, respectively. CONCLUSION: The cleft-adjacent maxillary central incisors had more apically displaced alveolar bone crests on the labial and palatal sides of the roots than the controls. Higher prevalence of dehiscences was found on the cleft side. Bone margin differences predispose to gingival height differences of the central incisors. These differences could increase the demands of patients to obtain more esthetic treatment results with orthodontic extrusion and periodontal intervention on the cleft side.


Assuntos
Fenda Labial , Fissura Palatina , Adolescente , Fenda Labial/diagnóstico por imagem , Fenda Labial/epidemiologia , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/epidemiologia , Fissura Palatina/cirurgia , Tomografia Computadorizada de Feixe Cônico , Estudos Transversais , Estética Dentária , Humanos , Incisivo/diagnóstico por imagem , Maxila/diagnóstico por imagem , Estudos Retrospectivos
10.
J Craniomaxillofac Surg ; 49(4): 298-303, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33612407

RESUMO

Our study aimed to evaluate perioperative complications following our institutional pre- and intraoperative management in cleft palate repair with Robin sequence (RS). RS patients who underwent cleft palate repair between 2000 and 2020 were retrospectively analysed. RS children with complete documentation and whose initial treatment involved the Tuebingen palatal plate (TPP) were included. Clinical records and operative charts were reviewed with regard to clinical characteristics as well as the neonatal and perioperative course. Results before and after adjustment of the anesthesiology protocol in 2014 were compared. 143 RS patients (41% male, 59% female) were included. Median pretherapeutic mixed-obstructive apnea index (MOAI) after birth was 9.4/hour (IQR 20.0). TPP treatment was associated with normalisation of the MOAI and adequate weight gain until surgery. At surgery, median age was 10 months (IQR 3), MOAI 0.1/h (IQR 0.5), and weight 8.7 kg (IQR 1.7). In 93% of cases (n = 133), the postoperative course was uneventful. Refinement of the anesthesiology protocol showed positive effects on the perioperative course and led to a reduction in perioperative events (10.7% vs. 2.9%). No severe perioperative complications occurred. We recommend the adoption of TPP treatment in the therapy of RS children. Our favourable results show that early TPP treatment minimizes perioperative complications in cleft palate repair by effectively and sustainably correcting upper airway obstruction.


Assuntos
Fissura Palatina , Síndrome de Pierre Robin , Procedimentos Cirúrgicos Reconstrutivos , Criança , Fissura Palatina/cirurgia , Feminino , Humanos , Lactente , Masculino , Síndrome de Pierre Robin/cirurgia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos
13.
J Craniomaxillofac Surg ; 49(3): 215-222, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33485752

RESUMO

BACKGROUND: The aim of this study is to compare speech outcomes, fistula rates, and rates of secondary speech surgeries after palatoplasty using Furlow palatoplasty or type 2b intravelar veloplasty for soft palate repair. PATIENTS AND METHODS: Patients with unilateral cleft lip and palate who had either Furlow palatoplasty or intravelar veloplasty for soft palate repair were retrospectively evaluated for demographic and perioperative variables and speech outcomes. Fistula rate, secondary surgical intervention for improved speech results, and findings of speech assessment were further reviewed for the patients who met the inclusion criteria. RESULTS: A total of 76 patients, 36 in the Furlow palatoplasty group and 40 in the intravelar veloplasty group, were included in the study. In the speech assessment, nasalance values were statistically similar between the two groups. Also, there was no statistically significant difference between the groups in velopharyngeal motility (p = 0.103). The total rates of secondary surgeries and fistula were statistically similar between the groups (p = 0.347 and 0.105, respectively). CONCLUSION: The similar outcomes of speech and surgical evaluation between the two groups make the surgeon's preference determinant in the selection of the surgical technique for soft palate repair.


Assuntos
Fenda Labial , Fissura Palatina , Procedimentos Cirúrgicos Reconstrutivos , Insuficiência Velofaríngea , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Palato Mole/cirurgia , Estudos Retrospectivos , Fala , Resultado do Tratamento , Insuficiência Velofaríngea/cirurgia
14.
World J Pediatr Congenit Heart Surg ; 12(1): 35-42, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33407037

RESUMO

BACKGROUND: Congenital heart disease (CHD) frequently occurs in conjunction with extracardiac developmental anomalies, including cleft malformations. The clinical impact of concomitant cleft disease on the surgical management of CHD has not been studied. We evaluated cardiac surgical outcomes in patients with concomitant CHD and cleft lip and/or palate (CL/P). METHODS: Patients with CHD + CL/P managed at our institution between January 2004 and December 2018 were included. Demographic, operative, and follow-up data were retrospectively collected and analyzed using SAS 9.4. Chi-square tests were used for categorical variables and t test or Wilcoxon rank sum tests for continuous variables. Significance of P < .05 was used. RESULTS: There were 127 patients with CHD + CL/P; 63 (50%) were boys. Compared to the general CHD population, patients with CHD + CL/P demonstrated an enrichment of atrial septal defects (10.5% vs 34%), tetralogy of Fallot/double outlet right ventricle (6.4% vs 15.7%), arch defects (4.5% vs 10.2%), truncus arteriosus (1.2% vs 3.1%), and total anomalous pulmonary venous return (1.0% vs 2.4%). Of 63 patients who underwent CHD repair, 58 (92%) did so prior to CL/P repair at 21.5 (6-114) days of age. Compared to CHD lesion-matched patients undergoing cardiac surgical repair at our institution, patients with CL/P had a 2- to 3.7-fold longer intensive care stay, 1.8- to 2.6-fold longer hospital stay, and 6- to 13.5-fold increase in major morbidity, without a significant difference in mortality. CONCLUSIONS: Cardiac outflow tract defects are particularly overrepresented in CL/P patients. The presence of CL/P increases the complexity of postoperative care after CHD surgery, without a significant impact on mortality.


Assuntos
Anormalidades Múltiplas , Procedimentos Cirúrgicos Cardíacos/métodos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Cardiopatias Congênitas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fenda Labial/diagnóstico , Fissura Palatina/diagnóstico , Feminino , Cardiopatias Congênitas/diagnóstico , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento
15.
J Craniomaxillofac Surg ; 49(2): 110-117, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33357967

RESUMO

Evaluation of relevant clinical outcomes in patients with bilateral cleft lip and palate (BCLP) after secondary aveolar bone grafting (SABG) and premaxilla osteotomy (PMO), through the use of a new scoring system. Data were collected retrospectively from all patients with BCLP who were operated on between 2004 and 2014, at the end of follow-up. The treatment protocol consisted of SABG + PMO in patients aged between 9 and 13 years. At the end of follow-up, the following parameters were scored: (un)interrupted dental arch, skeletal sagittal relationship, bone height using the Bergland/Abyholm criteria, and the presence of postoperative fistula. These parameters were combined to produce a dento-maxillary scoring system, giving a final score between 1 and 10. For statistical analysis, the independent t-test was used. Of 55 children, 45 were suitable for analysis. The mean age at time of surgery was 12.0 years (8.9-16.4 yrs), and the mean follow-up time was 11.7 years (5.8-15.8 yrs). The average number of surgeries executed under general anesthesia was 6 (range: 3-11). The average dento-maxillary score in this patient cohort was 7.6 (1-10; median: 8). Among these patients, 31 had an uninterrupted dental arch; the average Bergland/Abyholm score was 2.07; 30 patients exhibited an Angle class I incisor relationship; and, in 38 cases, the oronasal communication was closed after SABG + PMO treatment. A significant effect of fistulas was seen on dento-maxillary score (p = 0.001). Specifically, a significant effect of fistulas was seen on interrupted dental arch (p = 0.002) and on Bergland/Abyholm score (p = 0.037). The proposed dento-maxillary scoring system is a straightforward tool that can be used to describe and analyze the amount of dento-maxillary rehabilitation at the end of the treatment. Persistence of oronasal fistulas in patients with BCLP has a significant impact on interruption of the dental arch, and can influence dental results at the end of the second decade.


Assuntos
Enxerto de Osso Alveolar , Fenda Labial , Fissura Palatina , Adolescente , Criança , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Maxila/cirurgia , Osteotomia , Estudos Retrospectivos
16.
Br J Oral Maxillofac Surg ; 59(3): 375-379, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33349494

RESUMO

Most scoring systems used to assess facial aesthetics in cleft patients tend to lack consistency, and the absence of an internationally agreed system makes comparison challenging. The most widely used and validated tool is the five-point Asher-McDade index. We note that there are currently no reports (to our knowledge) of its use for scoring outcomes after bilateral cleft lip repair. To validate it for this use, the aim was to describe the outcomes of 22 consecutive bilateral cleft lip repairs assessed using this scale. A retrospective review was undertaken of 22 consecutive patients with bilateral cleft lip repairs performed at our centre. Each patient underwent bilateral advancement rotation repair with a vomer flap on one side at three months followed by repair of the remaining hard palate and an intravelar veloplasty three months later. Standardised photographs were taken five years after repair and were cropped to isolate the nasolabial component. Eleven members of the cleft multidisciplinary team were asked to rate each image on a five-point Likert scale. Statistical analysis was performed using a two-way ANOVA test and intraclass correlation coefficient to interrogate intraobserver and interobserver variance. A total of 22 consecutive patients with complete bilateral cleft lips were photographed. The overall mean (range) score for the repairs was 3.2 (4.3 - 1.8). Two-way ANOVA demonstrated that inter-rater variability accounted for just over 10% (11.23% of the total variance, p < 0.0001). As predicted, the single biggest factor affecting score variability was the patient's appearance, which accounted for 44.51% of the total variance between scores (p < 0.0001). Intraobserver variance was not found to be significant, accounting for 0.33% of the total variance (p = 0.0006). We demonstrate that the Asher-McDade scoring system is a valid tool to use when assessing bilateral cleft lip repairs. Variance in the patient's score was significantly related to a true difference in appearance, with only a small percentage of differences being due to intraobserver and interobserver variation.


Assuntos
Fenda Labial , Fissura Palatina , Procedimentos Cirúrgicos Reconstrutivos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estética , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
17.
Angle Orthod ; 91(2): 243-247, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33351889

RESUMO

OBJECTIVES: To determine if the skeletal form of individuals born with oral clefts was associated with maxillary position. MATERIALS AND METHODS: Lateral cephalometric radiographs of 90 individuals 8 to 12 years old born with or without cleft lip and palate paired by age and sex were used. Skull base length, cranial base angle, cranial deflection angle, and maxillary skeletal length and position were studied. Also, mandibular skeletal length and position, lower anterior facial height, and dental position were defined. Individuals were divided into three groups: 30 individuals born with cleft lip and palate with Class III malocclusion (UCLP Class III), 30 individuals born with cleft lip and palate with Class I malocclusion (UCLP Class I), and 30 individuals born without cleft lip and palate with Class III malocclusion (non-cleft Class III). RESULTS: When comparing the UCLP Class III group with the UCLP Class I group, there were differences in maxillary position (P < .001) and mandibular position (P = .004) found. No differences were found when comparing the UCLP Class III group with the non-cleft Class III group. CONCLUSIONS: There are intrinsic factors that affect craniofacial morphology of individuals born with cleft lip and palate.


Assuntos
Fenda Labial , Fissura Palatina , Cefalometria , Criança , Fenda Labial/diagnóstico por imagem , Fenda Labial/cirurgia , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Humanos , Mandíbula , Maxila/diagnóstico por imagem , Maxila/cirurgia
18.
Plast Reconstr Surg ; 147(1): 94e-97e, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370062

RESUMO

SUMMARY: Large oronasal palatal fistulas can be challenging to reconstruct. The authors present a modified buccal myomucosal flap repair technique and review intermediate-term outcomes. In this technique, large anterior palatal fistulas are closed in two layers. First, apposing nasal turnover flaps of vomer mucosa medially and nasal wall mucosa laterally are approximated. Second, a posteriorly based buccal flap incorporating full-thickness buccinator muscle and overlying mucosa is transposed with interposition of the flap in the retromolar trigone and lateral palate to preserve dental occlusion. Consecutive patient cases performed in low-resource settings were reviewed and outcomes reported. Among eight subjects aged 3 to 22 years, with average defect size of 2.5 cm2 (range, 0.8 to 3.5 cm2), the flap was viable in all cases and required revision or pedicle division in only two patients (25 percent); all patients showed symptom improvement. The modified buccal myomucosal flap shows promising intermediate-term results as a single-stage reconstruction suitable to a wide patient age range, low airway/anesthetic risk, reliable functional outcomes, and low comorbidity.


Assuntos
Fissura Palatina/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Fístula Bucal/cirurgia , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Retalhos Cirúrgicos/transplante , Adolescente , Criança , Pré-Escolar , Estética , Músculos Faciais/transplante , Feminino , Humanos , Masculino , Mucosa Bucal/transplante , Deformidades Adquiridas Nasais/etiologia , Fístula Bucal/etiologia , Palato/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Oral Maxillofac Surg Clin North Am ; 33(1): 143-159, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33246546

RESUMO

Cleft lip and palate patients represent one of the most challenging groups of patients for septorhinoplasty, presenting as a complex surgical obstacle for even the most seasoned surgeons. These individuals have undergone several surgeries throughout their lives, resulting in a considerable amount of scar tissue, significant asymmetries and structural deficits. Key factors in successfully treating cleft lip and palate patients are the reconstruction of the absent/asymmetric cartilages and the replacement of bony structures. The use of autogenous rib cartilage allows the surgeon to create various grafts as well as fortify the soft tissue to resist persistent soft tissue deformities.


Assuntos
Fenda Labial , Fissura Palatina , Rinoplastia , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Nariz/cirurgia
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