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1.
Plast Reconstr Surg ; 151(2): 274e-281e, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36696325

RESUMO

BACKGROUND: To ensure the feasibility of implementing PROMs in clinical practice, they must be continually appraised for undue burden placed on patients and clinicians and their usefulness for decision-making. This study assesses correlations between the CLEFT-Q psychosocial scales in the International Consortium for Health Outcomes Measurement Standard Set for cleft and explores their associations with patient characteristics and psychosocial care referral. METHODS: Spearman correlation coefficients were calculated for CLEFT-Q psychological function, social function, school function, face, speech function, and speech-related distress scales. Logistic regressions were used to assess the association of cleft phenotype, syndrome, sex, and adoption status on scale scores and clinical referral to psychosocial care for further evaluation and management. RESULTS: Data were obtained from 3067 patients with cleft lip and/or palate at three centers. Strong correlations were observed between social function and psychological function (r > 0.69) and school function (r > 0.78) scales. Correlation between school function and psychological function scales was lower (r = 0.59 to 0.68). Genetic syndrome (OR, 2.37; 95% CI, 1.04 to 5.41), psychological function (OR, 0.92; 95% CI, 0.88 to 0.97), school function (OR, 0.94; 95% CI, 0.90 to 0.98), and face (OR, 0.96; 95% CI, 0.94 to 0.98) were significant predictors for referral to psychosocial care. CONCLUSIONS: Because social function as measured by the CLEFT-Q showed strong correlations with both school and psychological function, its additional value for measuring psychosocial function within the Standard Set is limited, and it is reasonable to consider removing this scale from the International Consortium for Health Outcomes Measurement Standard Set for cleft.


Assuntos
Fenda Labial , Fissura Palatina , Humanos , Fenda Labial/cirurgia , Fenda Labial/psicologia , Fissura Palatina/cirurgia , Fissura Palatina/psicologia , Fala , Avaliação de Resultados em Cuidados de Saúde
2.
Plast Reconstr Surg ; 151(2): 385-394, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36696324

RESUMO

BACKGROUND: Nasal airway obstruction is an increasingly recognized phenomenon in patients with cleft lip and/or palate and has the potential to significantly affect quality of life in this patient population. To date, the effect of secondary cleft rhinoplasty on cleft-related nasal airway obstruction has not been studied. METHODS: Patients undergoing secondary cleft rhinoplasty at the Children's Hospital of Philadelphia from 2015 to 2021 were identified. Preoperative and postoperative Nasal Obstruction Symptom Evaluation scores were recorded. Alterations in scores were evaluated for variation depending on patient characteristics, operative maneuvers, and postoperative nasal stenting. RESULTS: Nasal airway obstruction was present in mild to moderate severity in patients before secondary cleft rhinoplasty. Postoperatively, obstruction improved or resolved in the domains of nasal blockage/obstruction, trouble breathing through the nose, and ability to get enough air through the nose during exertion (P < 0.05). Overall composite Nasal Obstruction Symptom Evaluation scores improved (P < 0.05). Lateral crural strut grafting was associated with improvement in nasal blockage, whereas alar revision and tip sutures were associated with worsening in specific nasal symptoms. Patients who underwent nasal stenting were found to report less trouble breathing after surgery than patients who did not (P < 0.05). CONCLUSIONS: Nasal airway obstruction is present in mild to moderate severity in patients with cleft lip and/or palate, and the subjective severity of obstruction is decreased by secondary cleft rhinoplasty. Specific operative maneuvers are associated with alterations in nasal airway obstructive symptoms, and nasal stenting is associated with an improvement in trouble breathing after secondary cleft rhinoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Fenda Labial , Fissura Palatina , Obstrução Nasal , Rinoplastia , Criança , Humanos , Obstrução Nasal/cirurgia , Obstrução Nasal/complicações , Fenda Labial/complicações , Fenda Labial/cirurgia , Fenda Labial/diagnóstico , Estudos Longitudinais , Qualidade de Vida , Fissura Palatina/complicações , Fissura Palatina/cirurgia , Nariz/cirurgia , Resultado do Tratamento
3.
BMC Oral Health ; 23(1): 16, 2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36631872

RESUMO

BACKGROUND: Machine learning based auto-segmentation of 3D images has been developed rapidly in recent years. However, the application of this new method in the research of patients with unilateral cleft lip and palate (UCLP) is very limited. In this study, a machine learning algorithm utilizing 3D U-net was used to automatically segment the maxilla, fill the cleft and evaluate the alveolar bone graft in UCLP patients. Cleft related factors and the surgery impact on the development of maxilla were analyzed. METHODS: Preoperative and postoperative computed tomography images of 32 patients (64 images) were obtained. The deep-learning-based protocol was used to segment the maxilla and defect, followed by manual refinement. Paired t-tests and Mann-Whitney tests were performed to reveal the changes of the maxilla after surgery. Two-factor, two-level analysis for repeated measurement was used to examine the different trends of growth on the cleft and non-cleft sides of the maxilla. Pearson and Spearman correlations were used to explore the relationship between the defect and the changes of the maxillary cleft side. RESULTS: One-year after the alveolar bone grafting surgery, different growth amount was found on the cleft and non-cleft sides of maxilla. The maxillary length (from 34.64 ± 2.48 to 35.67 ± 2.45 mm) and the alveolar length (from 36.58 ± 3.21 to 37.63 ± 2.94 mm) increased significantly only on the cleft side while the maxillary anterior width (from 11.61 ± 1.61 to 12.01 ± 1.41 mm) and posterior width (from 29.63 ± 2.25 to 30.74 ± 2.63 mm) increased significantly only on the non-cleft side after surgery. Morphology of the cleft was found to be related to the pre-surgical maxillary dimension on the cleft side, while its correlation with the change of the maxilla after surgery was low or not statistically significant. CONCLUSION: The auto-segmentation of the maxilla and the cleft could be performed very efficiently and accurately with the machine learning method. Asymmetric growth was found on the cleft and non-cleft sides of the maxilla after alveolar bone graft in UCLP patients. The morphology of the cleft mainly contributed to the pre-operation variance of the maxilla but had little impact on the maxilla growth after surgery.


Assuntos
Enxerto de Osso Alveolar , Fenda Labial , Fissura Palatina , Humanos , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Maxila/diagnóstico por imagem , Maxila/cirurgia , Fenda Labial/diagnóstico por imagem , Fenda Labial/cirurgia , Enxerto de Osso Alveolar/métodos , Tomografia Computadorizada por Raios X
4.
PLoS One ; 18(1): e0274657, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36595514

RESUMO

BACKGROUND: Cleft of the lip and palate is the most common craniofacial birth defect with a worldwide incidence of one in 700 live births. Early surgical repairs are aimed at improving appearance, speech, hearing, psychosocial development and avoiding impediments to social integration. Many interventions including the Smile Train partner model have been introduced to identify and perform prompt surgical procedures for the affected babies. However, little is known about the trends of the incidence and surgical procedures performed at our hospital. Nothing is also known about the relationship between the clinical characteristics of the patients and the timing of primary repairs. OBJECTIVE: To determine the trends in cleft surgeries, patterns of cleft surgeries and identify factors related to late primary repair at the University College Hospital, UCH, Ibadan, Nigeria. METHODS: A retrospective cohort study and trends analysis of babies managed for cleft lip and palate from January 2007 to January 2019 at the UCH, Ibadan was conducted. The demographic and clinical characteristics were extracted from the Smile Train enabled cleft database of the hospital. The annual trends in rate of cleft surgeries (number of cleft surgeries per 100,000 live births) was represented graphically. Chi square test, Student's t-test and Mann Whitney U were utilised to assess the association between categorical and continuous variables and delay in cleft surgery (≥12 months for lip repair, ≥18months for palatal repair). Kaplan-Meier graphs with log-rank test was used to examine the association between sociodemographic variables and the outcome (late surgery). Univariable and multivariable Cox proportional hazard regression was conducted to obtain the hazard or predictors of delayed cleft lip surgery. Stata version 17 (Statacorp, USA) statistical software was utilised for analysis. RESULTS: There were 314 cleft surgeries performed over the thirteen-year period of study. The male to female ratio was 1.2:1. The mean age of the patients was 58.08 ± 99.65 months. The median age and weight of the patients were 11 (IQR:5-65) months and 8 (IQR: 5.5-16) kg respectively. Over half (n = 184, 58.6%) of the cleft surgeries were for primary repairs of the lip and a third (n = 94, 29.9%) were surgeries for primary repairs of the palate. Millard's rotation advancement flap was the commonest lip repair technique with Fishers repair introduced within two years into the end of the study. Bardachs two flap palatoplasty has replaced Von Langenbeck palatoplasty as the commonest method of palatal repair. The prevalence of late primary cleft lip repair was about a third of the patients having primary cleft lip surgery while the prevalence of late palatal repair was more than two thirds of those who received primary palatoplasty. Compared with children who had bilateral cleft lip, children with unilateral cleft lip had a significantly increased risk of late primary repair (Adj HR: 22.4, 955 CI: 2.59-193.70, P-value = 0.005). CONCLUSION: There has been a change from Von Langenbeck palatoplasty to Bardachs two-flap palatoplasty. Intra-velar veloplasty and Fisher's method of lip repair were introduced in later years. There was a higher risk of late primary repair in children with unilateral cleft lip.


Assuntos
Fenda Labial , Fissura Palatina , Lactente , Humanos , Criança , Masculino , Feminino , Fenda Labial/epidemiologia , Fenda Labial/cirurgia , Fissura Palatina/epidemiologia , Fissura Palatina/cirurgia , Nigéria/epidemiologia , Estudos Retrospectivos , Universidades , Hospitais , Resultado do Tratamento
5.
J Craniofac Surg ; 34(1): e96-e98, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36608091

RESUMO

Infantile cranial development typically occurs in a predictable sequence of events; however, less is known about how the development occurs in isolated, nonsyndromic congenital craniofacial anomalies. Furthermore, the timing of pediatric cranioplasty has been extrapolated from adult studies. Thus, the management of nonsyndromic congenital craniofacial anomalies presents with unique challenges to the craniofacial surgeon. The authors describe the case of a baby girl who was born with right Tessier 3 cleft, cleft palate, anophthalmos, and severe left craniofacial microsomia with Pruzansky grade III left mandibular anomaly. By analyzing 3-dimensional chronological models of the patient, the authors found that her abnormal fontanelle initially increased in size until 22 weeks of age, with subsequent spontaneous closure at a rate of 60.53 mm2/y. Although similar cranial anomalies are typically surgically corrected early in life, delaying treatment until after 2 years of age may be appropriate in some patients, obviating surgical morbidity in the newborn period.


Assuntos
Anoftalmia , Fissura Palatina , Síndrome de Goldenhar , Feminino , Humanos , Lactente , Fissura Palatina/cirurgia , Ossos Faciais/anormalidades , Crânio
7.
Plast Reconstr Surg ; 151(1): 149-157, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36576825

RESUMO

BACKGROUND: The aim of this study was to compare midchildhood speech outcomes in patients with nonsyndromic Robin sequence with cleft palate (RSCP) treated with mandibular distraction osteogenesis (MDO) to patients with nonsyndromic Veau class I and Veau class II cleft palate (CP). METHODS: The authors performed a retrospective review of patients with nonsyndromic Robin sequence from 2000 to 2017, comparing those who underwent MDO to patients with nonsyndromic CP. Demographics, operative details, length of hospital stay, complications, and Pittsburgh Weighted Speech Scale scores were collected. RESULTS: Thirty-three patients met inclusion criteria in the MDO group with 127 patients as controls. Despite similar median age (RSCP, 4.5 years; CP only, 4.6 years) and Veau cleft type at early evaluation, there was a significant increase in composite Pittsburgh Weighted Speech Scale score within the MDO cohort ( P ≤ 0.002); specifically, with worse visible nasal emission ( P ≤ 0.007), hypernasality ( P ≤ 0.001), and compensatory articulation ( P ≤ 0.015). However, these differences were not present at age-matched midchildhood evaluation (median, RSCP, 6.5; CP only, 7.1; P ≥ 0.092). Median age-matched follow-up was 6.4 years in the MDO group and 7.1 years in the control group ( P ≥ 0.136). There was also no difference in the rate of secondary speech surgery at midchildhood evaluation ( P ≥ 0.688). CONCLUSIONS: The authors' retrospective comparison of speech outcomes in RSCP versus CP only demonstrates no difference in midchildhood speech, conflicting with recent reports. Although patients with Robin sequence treated with MDO had worse visible nasal emission, hypernasality, and compensatory articulation in early childhood, this appears to have resolved in the interim without additional intervention. Longitudinal follow-up is needed to fully understand the speech ramifications of RSCP. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Fissura Palatina , Doenças Nasais , Osteogênese por Distração , Síndrome de Pierre Robin , Humanos , Pré-Escolar , Lactente , Criança , Estudos Retrospectivos , Síndrome de Pierre Robin/complicações , Síndrome de Pierre Robin/cirurgia , Fissura Palatina/cirurgia , Fissura Palatina/complicações , Resultado do Tratamento , Fala , Osteogênese por Distração/métodos , Mandíbula/cirurgia
8.
Cleft Palate Craniofac J ; 60(1): 82-92, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34841909

RESUMO

OBJECTIVES: Previous literature finds that having a child with a cleft lip and/or palate (CL/P) may pose social and emotional challenges for parents. For parents of children born during the Covid-19 pandemic, such challenges may be heightened. Further, novel demands brought about by the pandemic could have caused additional hardships. The aim of this study was to describe the impact of the pandemic on new parents through qualitative exploration of their experiences. DESIGN: Semi-structured interviews were conducted with 14 parents of children born in the United Kingdom with CL/P between January and June 2020, around the start of the pandemic. Data were analysed using inductive thematic analysis. RESULTS: Three themes, with sub-themes, were identified. The first theme, "Changes to Healthcare: The Impact of Restrictions and Reduced Contact", discussed the impact of the pandemic on perinatal care, the care received from the specialist CL/P teams, and parents' experiences of virtual consultations. The second theme, "Family Functioning During the Pandemic", covered parental anxiety, fathers' experiences, and social support. The third theme, "Surgical Prioritisation: Delays and Uncertainty", addressed changes to surgical protocols, coping with uncertainty, complications associated with delayed surgery, and how parents created positive meaning from this period. CONCLUSIONS: A range of increased and additional psychosocial impacts for parents were identified, along with several coping strategies, utilization of social support, and the positive aspects of their experiences. As the pandemic continues, close monitoring of families affected by CL/P remains imperative, particularly for those at risk of emotional distress.


Assuntos
COVID-19 , Fenda Labial , Fissura Palatina , Acesso aos Serviços de Saúde , Criança , Humanos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Pandemias , Tempo para o Tratamento , Distanciamento Físico , Incerteza , Atenção à Saúde , Angústia Psicológica
9.
Cleft Palate Craniofac J ; 60(1): 5-12, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34786981

RESUMO

OBJECTIVE: To determine differences in burden of care between nonsyndromic patients with unilateral cleft lip and palate undergoing treatment at American Cleft Palate-Craniofacial Association (ACPA)-accredited centers and nonaccredited centers in New York State. DESIGN: A retrospective review of the New York Statewide Planning and Research Cooperative System database from January 2001 to December 2014 was performed using ICD-9 and CPT coding. PATIENTS, PARTICIPANTS: This study included patients with unilateral cleft lip and palate who underwent both lip and palate repairs during their first 6 years of life. Exclusion criteria included orofacial cleft syndromes, follow-up under 6 years, and one-stage combined cleft lip and palate repairs. RESULTS: Eighty-eight patients were treated at cleft centers, and 29 patients at nonaccredited centers ( n = 117). Age at primary palatoplasty (13.0 months vs 18.1 months; p = .019), total number of cleft operations (2.3 vs 2.7; p = .012), and total number of primary cleft-specific procedures (2.2 vs 2.5; p = .0049) were significantly lower for patients treated in cleft centers. Age at primary cheiloplasty (4.8 months vs 4.6 months; p = .865), post-cheiloplasty length of stay (1.2 days vs 1.2 days; p = .673), post-palatoplasty length of stay (1.5 days vs 1.9 days; p = .211), average hospital admissions (2.2 vs 2.3; p = 0.161), and total complication rates (34.1% vs 21.1%; p = 0.517) did not differ significantly between cleft centers and noncenters. CONCLUSIONS: This data demonstrates some significant differences in overall 6 year burden of care for nonsyndromic patients with unilateral cleft lip and palate treated at ACPA-accredited cleft centers versus nonaccredited centers.


Assuntos
Fenda Labial , Fissura Palatina , Humanos , Lactente , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , New York , Efeitos Psicossociais da Doença
10.
Cleft Palate Craniofac J ; 60(1): 75-81, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34730019

RESUMO

OBJECTIVE: Treatment of severe maxillary hypoplasia is commonly addressed via distraction osteogenesis with a rigid external device (RED). While effective, this method can be socially stigmatizing in an already vulnerable patient population. To prepare children and their caregivers for life with a RED and decrease peri-operative anxiety, we instituted a multidisciplinary pre-surgical education session (MPES). This educational team involves our cleft care coordinator, child life specialist, orthodontist and plastic surgeon 2 weeks prior to surgery. We reviewed the impact of this intervention by examining clinical outcomes before and after its implementation. DESIGN: From February 2017 to February 2020, a retrospective chart review was performed to include patients with orofacial clefts and maxillary hypoplasia who underwent maxillary distraction osteogenesis with RED at our center before (28 patients) and after (29 patients) the implementation of MPES. RESULTS: MPES was associated with a significantly shorter length of stay compared to controls who did not receive MPES (3.6 vs 3.1 days, p < 0.03) and significantly decreased usage of inpatient narcotic pain medication compared to controls (16.8 morphine equivalents vs 31.8 morphine equivalents, p < 0.02). Our intervention also demonstrated a trend towards decrease in minor complications but did not achieve statistical significance p = 0.32). CONCLUSIONS: Multidisciplinary presurgical education is a beneficial adjunct in the care of patients with orofacial clefts and maxillary hypoplasia undergoing maxillary advancement with a RED.


Assuntos
Fenda Labial , Fissura Palatina , Criança , Humanos , Fenda Labial/cirurgia , Estudos Retrospectivos , Fissura Palatina/cirurgia
11.
Cleft Palate Craniofac J ; 60(1): 115-121, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34841928

RESUMO

OBJECTIVE: To compare the use of a computer simulation by Mimics software and the water displacement method as means for measurement of alveolar cleft volume on cone beam computed tomography (CBCT) data. DESIGN: Prospective study. SETTLING: Institutional research. PATIENTS: Patients with unilateral complete cleft lip and palate (UCCLP) who would undergo alveolar bone grafting. INTERVENTIONS: CBCT images of twenty patients with UCCLP were included in the study. In the first method, the water displacement method was adopted to measure volume of plasticine filled in the alveolar cleft imprinted on 3D printed model of maxilla. In the second method a volumetric assessment function in Mimics software was adopted to measure volume of 3D virtual model of alveolar cleft constructed from CBCT images. A comparison on the alveolar cleft volumes derived from the two methods was assessed using the statistical paired t-test. MAIN OUTCOME MEASURE: The paired-t test showed no statistically significant difference between alveolar cleft volumes measured by the two methods (P = 0.075). RESULTS: Mean volume of the alveolar cleft measured by the water displacement method was 1.03 ± 0.31 ml whereas by the computer simulation using Mimics software the value was 1.00 ± 0.31 ml. The mean difference between the two methods was 0.03 ± 0.08 ml. CONCLUSION: The computer simulation by Mimics software as a means for measurement of alveolar cleft volume on CBCT data is as accurate as the measurement by the water displacement method.


Assuntos
Fenda Labial , Fissura Palatina , Humanos , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Simulação por Computador , Fenda Labial/diagnóstico por imagem , Fenda Labial/cirurgia , Água , Estudos Prospectivos , Tomografia Computadorizada de Feixe Cônico
12.
Dent Med Probl ; 59(4): 509-515, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36534430

RESUMO

BACKGROUND: Simonart's band is a soft tissue band that connects the cleft gap of the base of the nostril or the margin of the alveolus. While research on the prevalence of Simonart's band in cleft lip and palate cases has been carried out in various countries, research on Simonart's band in Indonesia has yet to be conducted. OBJECTIVES: This study aimed to determine the prevalence of different types of Simonart's band at a cleft center in Indonesia. MATERIAL AND METHODS: The data of cleft patients were reviewed retrospectively over a 9-year period at the Cleft Lip and Palate Center Center, Harapan Kita Women and Children Hospital, Jakarta, Indonesia. The patients were divided based on the type of cleft and the type of Simonart's band. The results were analyzed by means of descriptive statistics. RESULTS: Out of 638 cleft patients from the period 2008-2016, 77 patients had Simonart's band. The liptolip band was most commonly found (52 cases, 67.5%). The lip-to-alveolus band was found in 20 cases (26.0%) and the alveolus-to-alveolus band had the lowest prevalence of 5 cases (6.5%). Associations between the cleft type (unilateral cleft lip and palate (UCLP), unilateral cleft lip and alveolus (UCLA), and bilateral cleft lip and palate (BCLP)) and Simonart's band type were all significant (p = 0.001, according to Fisher's exact test), which indicates significant differences in the distribution of the bands with regard to different cleft types. There was a significant difference in the distribution of the bands between the UCLP and UCLA groups (p = 0.000). On the other hand, the distribution of the bands in the UCLP group did not differ much from that in the BCLP group (p = 0.065). CONCLUSIONS: The prevalence of Simonart's band was significantly higher in the patients with the unilateral complete cleft of the primary and secondary palate than in the subjects with the cleft of the primary palate. In the UCLP group, most patients had the lip-to-lip band type. In the BCLP group, the majority also had the lip-to-lip band type. In contrast, in the UCLA group, the majority showed the lip-to-alveolus band type.


Assuntos
Fenda Labial , Fissura Palatina , Humanos , Criança , Feminino , Fenda Labial/epidemiologia , Fenda Labial/cirurgia , Fissura Palatina/epidemiologia , Fissura Palatina/cirurgia , Estudos Retrospectivos , Prevalência , Indonésia/epidemiologia
13.
BMJ Open ; 12(9): e061831, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-36581967

RESUMO

INTRODUCTION: Bone-anchored maxillary protraction (BAMP) was devised recently as a method of direct maxillary protraction using anchor plates implanted in the maxilla and mandible without involving the teeth. Although several reports have described orthognathic effects of BAMP on patients with cleft lip and palate (CLP) with skeletal crossbite, none has described a study of Japanese patients with CLP or of BAMP treatment effects on speech in patients with CLP. This study, by performing BAMP treatment, and by evaluating speech function and skeletal and soft tissues, is intended to clarify BAMP efficacy and safety for patients with unilateral CLP (UCLP) who have skeletal crossbite. METHODS AND ANALYSIS: This single-arm, open-label, non-randomised prospective study examines 20 patients with UCLP with skeletal crossbite (Wits appraisal ≤-5.0 mm). These 10-15 year-old participants had already undergone cheiloplasty, palatoplasty and bone grafting. The anchor plates are implanted in the zygomatic process in the maxilla and in the anterior part of the mandible. Two weeks after anchor plate implantation, maxillary protraction is started using elastics. Protraction is performed at 150 g per side at the start of protraction, 200 g per side from 1 month after the start of protraction and 250 g per side from 3 months after the start of protraction. The treatment period will be approximately 1½ years. Pretreatment and post-treatment, cephalometric analysis, speech evaluation, nasopharyngeal closure function evaluation and facial soft tissue evaluation will be performed to ascertain the effects of BAMP on patients with UCLP. ETHICS AND DISSEMINATION: Ethical approval for this study has been received from Tohoku Certificated Review Board of Tohoku University, Japan, CRB2200003. The approval number is 2021-34-2. The results of this research shall be presented at domestic and international academic conferences, and be published to peer-reviewed journals. TRIAL REGISTRATION NUMBER: jRCTs022210007.


Assuntos
Fenda Labial , Fissura Palatina , Má Oclusão , Humanos , Criança , Adolescente , Maxila/cirurgia , Fissura Palatina/cirurgia , Fenda Labial/cirurgia , Estudos Prospectivos , Cefalometria/métodos
14.
BMC Oral Health ; 22(1): 600, 2022 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-36514035

RESUMO

BACKGROUND: Patients with unilateral cleft lip and palate were associated with different nasomaxillary complex from the normal population. Although the biomechanical effects of conventional rapid palatal expansion (Hyrax expansion) and bone-borne rapid palatal expansion (micro-implant-assisted expansion) in non-cleft patients have been identified by multiple studies, little is known in patients with unilateral cleft lip and palate. The purpose of this study was to investigate and compare the biomechanical effects of the conventional and bone-borne palatal expanders in a late adolescence with unilateral cleft lip and palate. METHODS: A cone beam CT scan of a late adolescence with unilateral cleft lip and palate was selected to construct the three-dimensional finite element models of teeth and craniofacial structures. The models of conventional and born-borne palatal expanders were established to simulate the clinical maxillary expansion. The geometric nonlinear theory was applied to evaluate the Von Mises stress distribution and displacements in craniofacial structures and teeth. RESULTS: Bone-borne palatal expander achieved more transverse movement than conventional palatal expander in the whole mount of craniofacial regions, and the maximum amount of expansion was occurred anteriorly along the alveolar ridge on cleft-side. The expanding force from born-borne palatal expander resulted in more advancement in nasomaxillary complex than it in conventional palatal expander, especially in the anterior area of the minor segment of maxilla. Stresses from the both expanders distributed in similar patterns, but larger magnitudes and ranges were generated using the bone-borne expander around the maxillary buttresses and pterygoid plates of sphenoid bone. The maximum expanding stresses from born-borne palatal expander were concentrated on palatal slope supporting minscrews, whereas those from conventional palatal expander were concentrated on the anchoring molars. In addition, the buccal tipping effect of teeth generated using the bone-borne expander was less than it using the conventional palatal expander. CONCLUSION: Bone-borne expander generated enhanced skeletal expansion at the levels of alveolar and palate in transversal direction, where the miniscrews contributed increased expanding forces to maxillary buttresses and decreased forces to buccal alveolar. Bone-borne expanders presented a superiority in correcting the asymmetric maxilla without surgical assistant in late adolescence with unilateral cleft lip and palate.


Assuntos
Fenda Labial , Fissura Palatina , Maxila , Adolescente , Humanos , Fenda Labial/diagnóstico por imagem , Fenda Labial/cirurgia , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Análise de Elementos Finitos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Técnica de Expansão Palatina , Tomografia Computadorizada de Feixe Cônico
15.
Pan Afr Med J ; 43: 57, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36578810

RESUMO

Cleft palate-lateral synechiae syndrome (CPLSS) is an extremely rare congenital malformation syndrome with undetermined etiology, characterized by a cleft palate and lateral intraoral synechiae linking the free borders of the palate to the mouth floor. We report a case of a female neonate, admitted for suckling difficulties with a cleft lip and palate associated to multiple lateral intraoral synechiae. Resection of the synechiae allowed oral feeding. Cleft palate-lateral synechiae syndrome is an exceptional syndrome as only seventeen cases have been reported in the literature. Synechiae can be isolated or more frequently in association with other congenital anomalies such as cleft lip and/or palate. These synechiae can cause functional deficits, especially in the respiratory and feeding tracts, language disorders or recurrent otitis. Although it is exceptional, this malformative entity must be known by medical practitioners in order to set up a well-adapted therapeutic protocol.


Assuntos
Fenda Labial , Fissura Palatina , Doenças da Íris , Anormalidades Maxilomandibulares , Anormalidades da Boca , Recém-Nascido , Feminino , Humanos , Fissura Palatina/diagnóstico , Fissura Palatina/cirurgia , Fissura Palatina/complicações , Fenda Labial/diagnóstico , Fenda Labial/cirurgia , Anormalidades da Boca/complicações , Anormalidades da Boca/cirurgia , Anormalidades Maxilomandibulares/complicações , Aderências Teciduais/complicações
16.
J Craniofac Surg ; 33(8): e831-e834, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36409858

RESUMO

Orofaciodigital syndrome type 1 (OFDS1) is a genetic disorder characterized by specific oral, facial, and limb malformations. A 14-month-old girl with congenital cleft palate, lower lip midline cleft, and digital anomalies admitted to our hospital was preliminarily diagnosed with OFDS1. Genetic analysis revealed that she carried a heterozygous variant of OFD1 at locus Xp22.2 on the X chromosome. Herein, we present the specific phenotype and genotype and the treatment modalities for this patient and references for diagnosing and treating OFDS.


Assuntos
Fissura Palatina , Deformidades Congênitas dos Membros , Síndromes Orofaciodigitais , Feminino , Humanos , Síndromes Orofaciodigitais/diagnóstico , Síndromes Orofaciodigitais/genética , Éxons , Face , Fissura Palatina/diagnóstico , Fissura Palatina/genética , Fissura Palatina/cirurgia
17.
J Craniofac Surg ; 33(8): 2411-2416, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36409866

RESUMO

Since almost all patients with an alveolar cleft have a deviated and thickened vomer bone, the purpose of this study was to investigate the relationship between the vomer shape and the size of the alveolar cleft in patients with unilateral cleft lip and alveolus (CLA). A total of 40 adult patients with unilateral CLA were enrolled, and 40 normal adults without CLA were enrolled as controls. All patients underwent preoperative computed tomography scans and analysis by computer-aided engineering software to obtain the vomer volume (VV), deviated septal angle (DSA), and alveolar cleft volume (ACV). An independent-sample t test or nonparametric test was used to compare the VV and DSA between the unilateral CLA and control groups. The correlation between ACV, VV, and DSA in the unilateral CLA group was assessed using Pearson correlation analysis or Spearman correlation analysis. Vomer volume was significantly higher in patients with CLA (1595.35±48.45 mm3) than in the control group (1043.2±164.976 mm3) (P<0.001), as was DSA (13.099±7.0 versus 3.4398±1.74 degrees) (P<0.001). In the CLA group, VV and DSA were significantly associated with ACV (VV and ACV: r=0.886, P<0.001; DSA and ACV: r=0.543, P<0.001), and VV was significantly correlated with DSA (VV and DSA: r=0.582, P<0.001). In conclusion, the vomer is thicker and more convex in patients with unilateral CLA than in people without, and the vomer angle and degree of volume deviation correlate with alveolar cleft severity.


Assuntos
Fenda Labial , Fissura Palatina , Adulto , Humanos , Fenda Labial/diagnóstico por imagem , Fenda Labial/cirurgia , Vômer , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Alvéolo Dental , Tomografia Computadorizada por Raios X
18.
J Craniofac Surg ; 33(8): 2522-2528, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36409871

RESUMO

Presurgical infant orthopedic (PSIO) therapy has evolved in both its popularity and focus of treatment since its advent. Nasoalveolar molding, nasal elevators, the Latham appliance, lip taping, and passive plates are the modern treatment options offered by cleft teams. Many cleft surgeons also employ postsurgical nasal stenting (PSNS) after the primary lip repair procedure. The purpose of this study is to examine trends in current PSIO care as well as PSNS for the management of patients with cleft lip and palate. An electronic survey was distributed to cleft team coordinators listed by the American Cleft Palate Association. The survey reported on team setting, provider availability, PSIO offerings, contraindications, and use of PSNS. Descriptive statistics and analyses were performed using MS Excel and SPSS. A total of 102 survey responses were received. The majority of settings were children's specialty hospitals (66%) or university hospitals (27%). Presurgical infant orthopedics was offered by 86% of cleft teams, and the majority of those (68%) provided nasoalveolar molding. Nasal elevators and lip taping are offered at 44% and 53% of centers, respectively. Latham and passive plates are both offered at 5.5% of centers. Most centers had an orthodontist providing treatment. The majority of centers use PSNS (86%). Nasoalveolar molding is the most popular PSIO technique in North American cleft centers followed by the nasal elevator, suggesting that the nasal molding component of PSIO is of critical influence on current treatment practices.


Assuntos
Fenda Labial , Fissura Palatina , Procedimentos Ortopédicos , Ortopedia , Lactente , Criança , Humanos , Estados Unidos , Fissura Palatina/cirurgia , Fenda Labial/cirurgia , Procedimentos Ortopédicos/métodos , América do Norte
19.
J Craniofac Surg ; 33(8): 2567-2572, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36409874

RESUMO

BACKGROUND: Intermediate rhinoplasties are performed during preschool to reduce the patients' psychosocial burden. At our institution, limited dissection of the cartilages followed by suspension and interdomal sutures was performed through an alar rim incision on the cleft side to minimize the risk of iatrogenic nasal growth restriction. However, the long-term outcomes of "limited intermediate rhinoplasty" through skeletal growth are uncertain. MATERIALS AND METHODS: A retrospective review of all unilateral complete cleft lip and/or palate patients who underwent definitive rhinoplasty was performed. To avoid the confounding effect of primary rhinoplasty, only the patients who did not receive primary rhinoplasty were included in the analysis. The maneuvers performed during definitive rhinoplasty were analyzed and compared between patients who underwent intermediate rhinoplasty and those who did not. RESULTS: A total of 60 Korean patients (27 female and 33 male) underwent definitive rhinoplasty at the average age of 20.6 years old (17.1-25.5). Forty-three (71.6%) patients previously underwent intermediate rhinoplasty. A combination of 6 maneuvers was performed based on the deformity of each subunit (alar medialization, interdomal with suspension sutures, nostril sill depression correction, septoplasty, osteotomy, and hump rasping). The average number of maneuvers performed during definitive rhinoplasty was significantly higher in the intermediate group (3.31 versus 2.1, P=0.012). Alar medialization and nostril sill depression correction were more frequently performed in the intermediate group, while the frequencies of other maneuvers were not statistically different. CONCLUSION: While intermediate rhinoplasty improves the patients' psychosocial well-being, the effects of "limited intermediate rhinoplasty" manipulating only the cartilages do not seem to last until skeletal maturity. A more comprehensive dissection allowing the release of the lower lateral cartilage in the hinge area along with septoplasty may be more effective in providing longer-lasting effects.


Assuntos
Fenda Labial , Fissura Palatina , Doenças Nasais , Rinoplastia , Humanos , Masculino , Feminino , Pré-Escolar , Adulto Jovem , Adulto , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Resultado do Tratamento , Doenças Nasais/cirurgia
20.
Sci Rep ; 12(1): 18837, 2022 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-36336749

RESUMO

Growth alterations have been described in patients operated on for oral clefts. The purpose of this work was to analyze the craniofacial and palate morphology and dimensions of young adults operated on for oral clefts in early childhood in Spain. Eighty-three patients from eight different hospitals were divided into four groups based on their type of cleft: cleft lip (CL, n = 6), unilateral cleft lip and palate (UCLP, n = 37), bilateral cleft lip and palate (BCLP, n = 16), and cleft palate only (CPO, n = 24). A control group was formed of 71 individuals. Three-dimensional (3D) digital models were obtained from all groups with an intraoral scanner, together with cephalometries and frontal, lateral, and submental facial photographs. Measurements were obtained and analyzed statistically. Our results showed craniofacial alterations in the BCLP, UCLP, and CPO groups with an influence on the palate, maxilla, and mandible and a direct impact on facial appearance. This effect was more severe in the BCLP group. Measurements in the CL group were similar to those in the control group. Cleft characteristics and cleft type seem to be the main determining factors of long-term craniofacial growth alterations in these patients. Prospective research is needed to clearly delineate the effects of different treatments on the craniofacial appearance of adult cleft patients.


Assuntos
Fenda Labial , Fissura Palatina , Adulto Jovem , Humanos , Pré-Escolar , Fenda Labial/epidemiologia , Fenda Labial/cirurgia , Fissura Palatina/epidemiologia , Fissura Palatina/cirurgia , Espanha/epidemiologia , Estudos Prospectivos , Cefalometria , Maxila
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