Adult Cleft Palate Patients Research Articles

Alignment for alveolar bone graft and improvement of transverse discrepancy in adult patients with unilateral/bilateral cleft lip and palate

Since 2019, orthodontic treatments of cleft lip and/or palate have been supported by the Korean National In­surance System. Based on the national claim data, more than 30% of fixed orthodontic treatments were provided to adult cleft palate patients. Their maxillary arches frequently were deformed and collapsed, and sometimes needed arch coordination for alveolar bone graft. Therefore, the treatment progress for two patients with uni­lateral/bilateral cleft palate was introduced, presenting improvement of inter-arch horizontal disharmony and dental alignment with fixed orthodontic appliances to enable iliac bone graft and implant prosthesis.

Subjective and Objective Evaluation of Speech in Adult Patients With Repaired Cleft Palate.

To explore the speech outcomes of adult patients with repaired cleft palate through subjective perception evaluation and objective acoustic analysis, and to compare the differences in pronunciation characteristics between speakers with complete velopharyngeal closure (VPC) and velopharyngeal insufficiency (VPI) patients. Subjective evaluation indicators included speech intelligibility, nasality and consonant missing rate, for objective acoustic analysis, we used speech sample normalization and objective acoustic parameters included normalized vowel formants, voice onset time and the analysis of 3-dimensional spectrogram and spectrum, were carried out on speech samples produced by 3 groups of speakers: (a) speakers with velopharyngeal competence after palatorrhaphy (n=38); (b) speakers with velopharyngeal incompetence after palatorrhaphy (n=70), (c) adult patients with cleft palate (n=65) and (d) typical speakers (n=30). There was a highly negative correlation between VPC grade and speech intelligibility (ρ=-0.933), and a highly positive correlation between VPC and nasality (ρ=0.813). In subjective evaluation, the speech level of VPI patients was significantly lower than that of VPC patients and normal adults. Although the nasality and consonant loss rate of VPC patients were significantly higher than that of normal adults, the speech intelligibility of VPC patients was not significantly different from that of normal adults. In acoustic analysis, patients with VPI still performed poorly compared with patients with VPC. The speech function of adult cleft palate patients is affected by abnormal palatal structure and bad pronunciation habits. In subjective evaluation, there was no significant difference in speech level between VPC patients and normal adults, whereas there was significant difference between VPI patients and normal adults. The acoustic parameters were different between the 2 groups after cleft palate repair. The condition of palatopharyngeal closure after cleft palate can affect the patient's speech.

Oral Rehabilitation of an Adult Cleft Palate Patient with Zygomatic Implant-supported Obturator Prosthesis: A Case Report

IntroductionWith advancement in medical services and their accessibility across the country, as well as growing awareness among the patient population, it is rare to find an adult with an untreated cleft lip and/or palate nowadays. Treatment of these patients to restore form and function can be challenging, often yielding less-than-satisfactory outcomes. In current literature, there have been case reports of patients with atrophic maxilla or severe maxillary defects after oncologic resections, where zygomatic implants have been utilized for fabrication of a fixed maxillary prosthesis.Here, the authors present a case of an adult cleft palate patient treated with a zygomatic implant-supported removable obturator prosthesis, which has not yet been reported in literature. BackgroundThe patient is a 66-year-old female who presented to the University of Maryland Oral & Maxillofacial Surgery Associates in 2016 for management of an untreated bilateral cleft palate. She had been wearing an obturator for several years prior that had slowly lost retention over time due to ridge resorption. Patient had undergone multiple procedures for placement of endosseous implants to support a fixed prosthesis as well as sinus lift surgeries, all of which had failed. She had 1 clinically osseointegrated implant in the right maxilla that was restorable. The patient did not wish to pursue any extensive surgical interventions, so after consultation with a maxillofacial prosthodontist at the authors' unit, the decision was made to pursue a zygomatic implant-supported obturator prosthesis fabrication to restore the patient's form and function. Surgical techniqueThe patient underwent general anesthesia induction and nasotracheal intubation. Mucoperiosteal flaps were reflected bilaterally in the oral cavity along the maxillary alveolar ridge, extending up to orbital rims and laterally over the zygomatic eminence. Sinus windows were created for visualization of twist drills. Osteotomies were created in the zygomatic bone using NobelBiocare protocol, and 2 35mm implants were inserted in the left zygoma, and a 45mm implant was placed on the right-side mesial to the existing endosseous implant. Left maxillary palatal side was grafted with particulate bone, and cover screws were placed. Soft-tissue closure was with 3-0 chromic gut sutures. Implants were buried for 6 months, then uncovered and restored using locator bars to connect implants in each alveolar segments, which would, in turn, support the maxillary obturator. ResultsThe patient has been compliant with follow-ups and last seen in August 2020. She reported good function without any nasal regurgitation and was satisfied with retention and stability of her prosthesis. On examination of her oral cavity after obturator removal, the tissues were healthy-appearing, and the locator housings were evaluated and found to be in good shape and retentive. Radiographically, the implants were stable without signs of bone loss. ConclusionThe authors have found that zygomatic implants can be utilized as an alternative to support an obturator prosthesis. However, given lack of long-term follow-up in literature, some reservations must be expressed in its use, especially when other predictable alternatives are available.

Prosthetic management of an adult cleft patient with velopharyngeal appliance and airway evaluation by acoustic pharyngometry

Cleft lip and palate is the most common congenital malformation in oro-facial region. In adult cases where defect is large and paucity of tissue is there, prosthetic management of the defect with palatal obutrator and velopharyngeal appliance is the treatment of choice. It requires scrupulous clinical skills and detailed knowledge of anatomy to prevent airway obstruction and discomfort during function. Acoustic pharyngometry (AP) is an advanced tool to evaluate the airway in 3D during function without radiation exposure. In this case report palatal obturator with speech aid prosthesis was fabricated to rehabilitate an adult cleft palate patient. AP test was done to ensure adequate airway space with prosthesis.

A Comparison of Transverse Palatal Width in Adult Untreated Cleft Palate Patients with Normal Adult Palates: A Pilot Study

Objective: The purpose of this pilot study is to compare the transverse palatal widths in untreated adult cleft palate patients with normal adult patients. Methods and Materials: The study was conducted in Bangladesh recruiting 10 patients with adult sized untreated cleft palate and 15 patients with normal adult sized palates. The control group was comprised of 7 males and 8 females with a mean age of 30.5 ± 4.4 years. The affected group comprised of 7 males and 3 females with a mean age 17 ± 3.3 years. Alginate impressions of the maxillary arch were taken and poured into plaster dental casts. The inter-canine, inter-premolar and intermolar widths were measured to evaluate the maxillary growth pattern in patients with unoperated cleft palate. Due to the small sample size, both independent T-test and Mann Whitney non-parametric tests were performed to analyze the statistical significance of the data. Results: According to both the T-test and Mann Whitney non-parametric tests, the inter-premolar width including both the first and second premolars was statistically significantly smaller in the affected group with p values of 0.003 and 0.00 respectively. There was no significant difference in the inter-canine width between the affected and control group due to the variable canine position in cleft palate patients. Due to small sample size, no significant difference in the intermolar width between the affected and control group could be established. Conclusion: The interpremolar width is significantly smaller in patients with adult sized cleft palates than individuals with normal adult sized palates.

Speech Outcomes Comparison Between Adult Velopharyngeal Insufficiency and Patients With Unrepaired Cleft Palate.

This study compared the speech outcomes of adult velopharyngeal insufficiency patients and adult cleft palate (ACP) patients, and explored whether there was any difference in the phonological level of these 2 types of patients. Perceptual evaluation was used to assess speech intelligibility, hypernasality and compensatory articulation in 89 adult patients with velopharyngeal insufficiency and 35 adult patients with unrepaired cleft palate. Each group was divided into complete cleft palate and incomplete cleft palate (including submucous cleft palate). The phonological differences were compared between the 2 groups of patients and 2 types of cleft palate. The mean speech intelligibility was 43.04% in velopharyngeal insufficiency group and 32.87% in ACP group. There was a significant difference in speech intelligibility between the 2 groups by T test, t = 2.916 (P < 0.01), speech intelligibility between 2 types of cleft palate was no significant difference. Also, there was a significant difference between the 2 groups in the constitution of hypernasality degree by Chi-Square test, x2 = 31.650 (P < 0.01), compensatory articulation were present in 74.3% ACP patients (26/35) and 47.2% velopharyngeal insufficiency patients (42/89), x2 = 7.446 (P < 0.01), there was a significant difference in incidence of compensatory articulation between the 2 groups. Adult patients with unpaired cleft palate present an even worse speech intelligibility and hypernasality degree than velopharyngeal insufficiency patients after cleft palate repair, regardless of the cleft type. Additionally, patients in ACP group have a higher incidence of compensatory articulation than that in incomplete cleft palate group. In sequenced treatments of cleft lip and palate, evaluation and treatment of speech disorders cannot be ignored.

A case of adult cleft palate patient treatment with differential maxillary lateral expand distraction osteogenesis using combined expansion appliances

A 34-year-old female patient who had undergone surgical treatment for a cleft in the soft palate during childhood received orthodontic treatment for crowding. She had a straight type facial profile and facial asymmetry with a concave area on the left side of the philtrum and mandibular deviation to the left. The surgical scar was observed on the center of the palate. She also had a severely constricted maxillary arch and unilateral cross bite on the left side. In this report, we suggest a novel method for uneven maxillary lateral expansion using a dento-osseous-supported expansion appliance in the frontal side of the maxilla and a modified dental-supported expansion appliance in the mid-palatal area. With this method, we achieved the optimal maxillary expansion in the maxillary frontal and molar areas. As a result of the surgically-assisted orthodontic treatment, facial asymmetry, the facial midline, and severe malocclusion were corrected. Furthermore, the resulting occlusion and facial symmetry were maintained over a 2-year retention period. Although attention must be paid regarding the retention of the expanded maxillary bone, our findings in the present study suggest that differential maxillary lateral expand distraction osteogenesis, which is performed using combined expansion appliances, can be successfully performed in patients with cleft palate.

What Operative or Anatomic Factors Affect Dental Arch Development in the Cleft Patient?

There has been dispute about the exact factors influencing dental arch development in adult cleft palate patients, so we designed this study to investigate the effects of operative and anatomic factors on the development of dental arch morphology. A retrospective cohort study was conducted among 3 groups of patients (operated, unoperated, and normal) from West China College of Stomatology, Sichuan University, Chengdu, China. The differences in dental arch morphology, including length and width of the upper and lower dental arches, inclination of the palatal shelf, and palatal height, were analyzed by variance analysis with SPSS software, version 13.0 (IBM, Armonk, NY). We enrolled 90 individuals: 30 unoperated adults with bilateral cleft lip and palate, 30 adults with operated bilateral cleft lip and palate, and 30 normal adults. The widths of all upper and posterior lower arches, lengths of the anterior upper arch, palatal height, and palatal shelf inclination in the operated group were smaller than those in the unoperated group; the lengths and widths of the anterior upper arch were smaller whereas the widths of the posterior upper and lower arches, palatal height, and palatal shelf inclination were greater in the unoperated group compared with the normal group. Operated cleft patients show the most severe deformation of the maxillary arch, especially in the anterior part. There is an intrinsic palatal tissue deficiency in cleft patients, whereas the maxillary arch deformation in unoperated cleft patients is limited to the anterior region only.

Nonsurgical Management of Adult Cleft Palate Patient

Successful cleft lip and palate rehabilitation requires an interdisciplinary approach. When the patient is reluctant to interdisciplinary approach then the problem becomes even more challenging. This case report describes management of 18-year-old postpubertal male cleft patient who was referred by a plastic surgeon for the orthodontic correction of irregular upper teeth. Patient had maxillary deficiency. Initially maxillary advancement was planned to address the problem. In the mid course of treatment, patient was reluctant to orthognathic surgery. Therefore, an alternate nonsurgical orthodontic camouflage treatment plan was designed with extractions of lower first premolars and proclination of upper anteriors. Though the presented case showed improved esthetics with nonsurgical orthodontic camouflage treatment, which is not possible in all cases. Interdisciplinary approach is must to get optimal facial and dental esthetics.

Masticatory system rehabilitation of adult cleft palate patients without prior prosthodontic treatment. A case report

Masticatory system rehabilitation of adult cleft palate patients without prior prosthodontic treatment. A case report

Surgical and Prosthetic Rehabilitation of Edentulous Adult Cleft Palate Patients by Dental Implants

Adult patients who did not receive proper treatment for cleft palate are challenging for clinicians in terms of prosthetic rehabilitation. Moreover, during the late stages of adulthood when patients become edentulous, prosthetic reconstruction becomes even more challenging. This clinical report describes the prosthetic rehabilitation of 2 edentulous geriatric patients with unrepaired cleft palate by placement of dental implants after closure of the oronasal communications.

Outcome of Treatment regarding Articulation, Resonance and Voice in Flemish Adults with Unilateral and Bilateral Cleft Palate

The purpose of this study was to evaluate the outcome regarding speech intelligibility, articulation, nasalance, nasality and voice in adult cleft palate patients. An additional objective of this study was to delineate the impact of a unilateral versus bilateral cleft lip and palate on speech outcome and to compare the nasalance and nasality patterns of cleft palate adults with data from non-cleft subjects. Objective (nasalance values obtained by the Nasometer, mirror-fogging test according to Glatzel and the determination of the dysphonia severity index, DSI) and subjective assessment techniques (perceptual evaluation of speech, nasality and voice, the Bzoch tests and the Gutzmann test) were used. All 14 subjects with a complete unilateral or bilateral cleft lip and palate consulted the same craniofacial team, followed an identical surgical protocol, completed the surgical cleft palate treatments and followed speech therapy. Most of the patients had a fairly satisfactory outcome with normal speech intelligibility, but three types of articulation errors seemed to predominate. More than one half of the subjects demonstrated hypernasality. In comparison with the non-cleft normative data, statistically higher nasalance values were obtained in the cleft group. The subjects had a DSI score that corresponds with a normal or slightly impaired voice quality. No significant differences regarding speech outcome were found between subjects with a unilateral or bilateral cleft lip and palate. The results provide important information for speech-language pathologists to evaluate and improve speech outcome in cleft palate patients.

Three-Dimensional Analysis Techniques—Part 1: Three-Dimensional Soft-Tissue Analysis of 24 Adult Cleft Palate Patients Following Le Fort I Maxillary Advancement: A Preliminary Report

Three-Dimensional Analysis Techniques—Part 1: Three-Dimensional Soft-Tissue Analysis of 24 Adult Cleft Palate Patients Following Le Fort I Maxillary Advancement: A Preliminary Report

Survey on surgical correction of mandibular deformities in Japan. Part 2: Positioning of the proximal segment, and preoperative and postoperative orthodontic treatment

Eleven patients (9 UCLP, 2 BCLP) were treated with segmental osteotomies with or without osteotomies at the Le Fort I level and simultaneous bone grafting of the alveolo-palatal clefts at adult age. These patients were clinically and radiographically evaluated after a mean follow-up period of 59 months (range 39–110 months).One patient showed complete dentoalveolar relapse, whereas the skeletal stability after miniplate fixation proved to be adequate in all cases. Only one patient presented with a persisting oro-nasal fistula. In six cases, the alar base asymmetry had improved to such an extent that further nasal corrections were not necessary. The procedure described is a reliable technique to graft the alveolo-palatal cleft and reposition the dentoalveolar segments simultaneously in those adult cleft palate patients who had had no previous alveolar bone grafting.

Long-term results of segmental repositioning of the maxilla in cleft palate patients without previously grafted alveolo-palatal clefts

Eleven patients (9 UCLP, 2 BCLP) were treated with segmental osteotomies with or without osteotomies at the Le Fort I level and simultaneous bone grafting of the alveolo-palatal clefts at adult age. These patients were clinically and radiographically evaluated after a mean follow-up period of 59 months (range 39-110 months). One patient showed complete dentoalveolar relapse, whereas the skeletal stability after miniplate fixation proved to be adequate in all cases. Only one patient presented with a persisting oro-nasal fistula. In six cases, the alar base asymmetry had improved to such an extent that further nasal corrections were not necessary. The procedure described is a reliable technique to graft the alveolo-palatal cleft and reposition the dentoalveolar segments simultaneously in those adult cleft palate patients who had no previous alveolar bone grafting.

Primary palatorraphy in the adult cleft palate patient: Surgical, prosthetic and logopaedic aspects

The treatment of 8 adults with untreated cleft palates is retrospectively discussed. A palatorraphy, consisting of a palatoplasty with pedicled palatal mucoperiosteal flaps and an intravelar veloplasty, is performed. A rib graft between the nasal and oral layer and a partial vestibuloplasty are used in a few patients to create a more favourable anatomical situation for the prosthetic appliance. The palatorraphy contributes to improved speech intelligibility however, combined with a pharyngeal flap as performed in 5 patients, an even better result can be achieved. According to the results, a surgical procedure in the adult still seems to be worthwhile.

Transmaxillary temporalis transfer for reconstruction of a large palatal defect: Report of a case

The infratemporal transmaxillary transfer of a temporalis myofascial flap for reconstruction of an extensive palatal defect in an adult cleft palate patient is described. A modified temporal approach is discussed.

唇顎口蓋裂患者で口蓋裂のみ成人まで未処置であった２症例の顎・顔面の所見

Underdevelopment of the maxilla is frequently seen in post-operative cleft lip and palate patients. This is considered mainly due to cleft lip and palate repair, or the retarded growth potential of the disease itself, but the cause still remains unexplained. Accordingly, cephalometric roentgenograms and oral casts of two unoperated adult cleft palate patients were analyzed.Case 1. A male, aged 41, with unilateral (left side) cleft lip and palate, had a lip closure operation just after birth. Unfortunately, he had no further palate operation.Oral findings; The right upper first incisor, left upper first incisor, left upper second incisor, and left upper canine were missing. Bridge work was found from the right upper second incisor to the left upper first premolar. Reversed relation of the jaws was not observed, but the right upper second incisor was significantly displaced towards the palate. A slightly narrow upper dental arch was found.Cephalometric findings; A slightly concave type of skeletal pattern because of the undergrowth of the anterior part of maxilla was observed. The mandibule was located anteriorly and a slightly prognatia type of skeletal pattern was observed.Oral cast findings; The maxillary dental arch width was a little less than average.Case 2. A female, aged 22, with unilateral (right side) cleft lip and palate, had a lip closure operation at the age of 12.Oral findings; The left and right upper second incisors were congenitally missing. The left and right upper first incisors were slightly inclined towards the palate, but the fore teeth relationship was normal.Both the results of the cephalometric analysis and oral casts analysis were almost within normal limits.This is the presentation of two cases. However, these findings suggest that early lip closure seems to be a factor restricting the development of the maxilla. But, the development of maxilla and especially the maxillary dental arch width were not affected in our cases compared with the case which had palatoplasty during infancy.

Role of Passavant's ridge in cleft palate speech.

In order to reevaluate the role of Passavant's ridge, 10 adult cleft palate patients with a marked ridge were examined by a radiographic and cineradiographic method. Following results were obtained: 1. Height of the ridge varies with the vowels. 2. Height of the ridge in consonant syllable phonation is not related to velopharyngeal closure required for each consonat but to the succeeding vowels. 3. Tongue position for vowel phonation has a great effect on the appearance of the ridge. In conclusion, formation of Passavant's ridge is not associated with the degree of velopharyngeal closure necessary for the specific speech sound, but it closely related to the tongue position for vowel production. Thus the significance of Passavant's ridge in cleft palate speech remains quite doubtful.

A study of untreated adult cleft palate patients.

A study of untreated adult cleft palate patients.