Bilateral Cleft Lip And Palate Research Articles

Speech Assessments in Hypoplastic Cleft Maxilla Treated by Anterior Segmental Distraction Osteogenesis

Introduction: Cleft lip and palate (CLP) affect the craniofacial region, with significant implications for speech, hearing, feeding, and facial aesthetics. This study aimed to evaluate the impact of anterior maxillary segmental distraction osteogenesis (AMSDO) using an internal distractor on speech outcomes in CLP patients, assessed using the Pittsburgh Weighted Speech Scale (PWSS).Methodology: A single-center prospective study was conducted between March 2022 and April 2024. Twelve CLP patients with maxillary hypoplasia, aged 17.8 to 32.6 years, were included. Purposive sampling was done to include patients with complete unilateral or bilateral CLP who exhibited Class III skeletal relationships with reverse overjet greater than 7 mm. Speech assessments were conducted preoperatively (1-3 months before surgery) and postoperatively (5-7 months after distraction). Speech samples were recorded and evaluated by a licensed speech-language pathologist using the PWSS. Statistical analysis was performed using paired t-tests and Chi-square tests.Results: Significant improvements were observed in the total PWSS score (p = 0.03), nasality (p < 0.001), phonation (p < 0.001), and articulation errors (p = 0.004) postoperatively. No significant changes were seen in nasal emission and facial grimace. No correlation was found between the amount of distraction and speech outcomes. Unilateral cleft patients showed better outcomes than bilateral cleft patients, though not statistically significant.Conclusion: AMSDO significantly improves speech outcomes in CLP patients with maxillary hypoplasia. The PWSS is a reliable tool for assessing these changes. Further research with larger samples and longer follow-ups is warranted to confirm these findings.

Patient-Reported Esthetic Outcomes Following Secondary Rhinoplasty in Adult Patients with a Cleft lip and Palate.

Secondary rhinoplasty is a frequently requested revision procedure in patients with a history of cleft lip and palate (CLP). The satisfaction of patients with the esthetic outcome of the procedure has been infrequently studied. Adult patients with CLP who had undergone a secondary rhinoplasty between 2009 and 2019 were identified in a cross-sectional cohort that had filled the FACE-Q rhinoplasty module. The effect of the cleft type and the number and timing of the nasal revision surgeries were evaluated. Forty participants were included, median age of 26 years (range 18-59 years). Nine (23%) participants had a history of bilateral CLP. The median time form the last nasal operation to the study was 4.5 years (range 16 days to 10 years). The participants reported being satisfied with the appearance of the nose (median score 52, interquartile range [IQR] 44-60) but the satisfaction with the appearance of the nostrils (median score 44, IQR 30-64) was below the normative value for the scale. Patients with a history of bilateral CLP reported worse satisfaction across all the aspects of health-related quality of life assessed (P < .05 for all). No association was observed between the age at the first open rhinoplasty and satisfaction with the appearance of the nose or the nostrils. Following secondary rhinoplasty, adults with CLP are, in general, satisfied with their nose but less so with nostrils. Compared to unilateral CLP, bilateral CLP is associated with a worse health-related quality of life.

Effectiveness of 2 Lip Taping Techniques in Infants With Bilateral Cleft Lip and Palate: A Randomized Clinical Trial.

This trial was designed to test the efficacy of 2 lip taping methods in modifying the maxillary arch dimensions (MADs) of infants with bilateral cleft lip and palate (BCLP) before lip repair surgery. Parallel-group randomized clinical trial. The trial was conducted at 3 centers in Baghdad city. Thirty-six nonsyndromic infants with BCLP. The eligible infants were randomly assigned to either the first experimental group that received a conventional horizontal tape (3 M Steri strip-1/4 inch) or the second experimental group that received a custom-made tape made of Steri strips and orthodontic extra oral elastics. All of the included infants in both groups had rubber base impressions taken for them at the start of treatment (T1) and right before surgical lip repair (T2). A desktop scanner was used to scan each of the generated models, creating digital models that could be used for outcome evaluation. Virtual MAD measurements were performed by a blinded assessor on the generated digital models both before (T1) and after (T2) treatment. At T2, both groups showed statistically significant changes in all measured MADs, with a mean difference ranging from 1.36 to 2.95 mm for the conventional taping group and from 1.46 to 7.96 mm for the custom-made one. The comparison of the 2 groups revealed both statistically and clinically significant differences with a P value <.05. The custom-made taping demonstrated more constriction in maxillary arch in terms of changes, which could provide easier surgical manipulation for the cleft parts. Lip taping appears to be an efficient technique for modifying the MADs in infants with BCLP.

Hospital-based Costs to the National Health Service (UK) for Children and Adolescents Born with Cleft from Birth to 20 Years.

The primary aim was to assess the cost (£) to the National Health Service (NHS) of hospital treatment for individuals born with bilateral cleft lip and palate (BCLP), unilateral cleft lip and palate (UCLP), and cleft palate (CP), from birth to 20 years. The secondary aim was to assess the number of scheduled clinical outpatient and inpatient/outpatient surgical visits for this cohort. Retrospective micro-costing analysis. Patients treated within the South West of England Cleft Service (UK). Twenty-three case-notes of children born with cleft (5 BCLP; 10 UCLP; 8 CP) were identified from birth up to and including secondary alveolar bone graft (ABG), and a second group of 23 hospital case-notes (3 BCLP; 10 UCLP; 10 CP) were identified, post-ABG to 20 years. Mean costs from birth to ABG were £17,004 (BCLP), £11,620 (UCLP), and £6137 (CP), and post-ABG to 20 years were £9,463, £7,945, and £3,816, respectively. The largest costs were for staff. Repeat surgery had a significant impact on costs. The mean number of clinical outpatient visits for BCLP, UCLP, and CP were 140, 110 and 83 respectively and 8, 6 and 2 for inpatient/outpatient surgical visits, respectively. Costs for provision of cleft care by the NHS are significant. The greatest costs were incurred with care for patients with BCLP. Patients were expected to attend many appointments, with BCLP experiencing the most visits. Engagement with quality improvement programmes to minimise repeat surgery, and remote consultation for certain appointments, to reduce the patient burden are recommended.

The Efficacy of Naso-Alveolar Molding on Premaxilla Pushback and Dentoalveolar Changes in Patients With Bilateral Cleft Lip and Palate.

To evaluate the extent of naso-alveolar molding (NAM) in pushing the premaxilla posteriorly in patients with bilateral cleft lip and palate (BCLP). Naso-alveolar molding application in cleft lip and palate cases bridges the cleft gap and increases nasal tip projection. In BCLP, NAM potentially mobilizes the premaxilla posteriorly to allow tension-free primary lip closure. However, some patients with BCLP with NAM history still necessitate osteotomy during labioplasty, questioning the efficacy of NAM for BCLP management. This single-center retrospective study was conducted using medical records of nonsyndromic patients with BCLP. Twenty-six patients with BCLP were enrolled over a 5-year period with a history of NAM application before primary labioplasty. The changes in premaxilla width (P), anterior arch width (A), posterior arch width (R), and anteroposterior projection of the premaxilla (P'-A') were statistically analyzed at 2 time points: (1) at the start of NAM application (T1) and (2) after completion of NAM before surgery (T2). The average age at NAM initiation was 46.2 ± 40.4 days, and the average duration of NAM usage was 125.14 ± 62.94 days. A and P-A showed significant differences between T1 and T2 (P < 0.0001), whereas the rest did not show significant differences in value following NAM application (P > 0.05). Naso-alveolar molding successfully pushed back the premaxilla portion about 4.68 ± 2.83mm on average. Naso-alveolar molding can push back the premaxillary protrusion up to 5mm, which can serve as a cutoff point for the consideration of combined modalities. Prenatal diagnosis, counseling, and cleft education should be the benchmark in cleft centers to improve overall patient outcomes.

Reliability of Variables of Consonant Production and Velopharyngeal Competence in 10-year-olds with Cleft Palate Using Multiple Raters.

To assess the reliability of speech data and speech-related quality indicators in the Swedish quality registry for cleft lip and palate (CLP) at 10 years of age. Retrospective study. University hospitals. One hundred twenty-one 10-year-olds with unilateral or bilateral CLP. Six independent raters reassessed audio recordings for comparison with registry data. For calculation of agreement, the single measures intraclass correlation coefficient (ICC) was used for percentage of consonants correct (PCC) and non-oral speech errors, quadratic weighted kappa for velopharyngeal competence (VPC), and percentage agreement and kappa for quality indicators. The results of the three to four raters with the highest intra-rater and inter-rater reliability were used for comparison with registry data. There was excellent agreement between registry data and reassessments for PCC (ICC, 0.93) and percentage of non-oral errors (ICC, 0.80). For VPC, one rater and registry data had good agreement (k, 0.704); the remaining cases had fair agreement (k, 0.476-0.554). The percentage agreement between registry data and reassessments for quality indicators ranged from fair to excellent. When calculated with kappa, agreement was good to excellent (mean of all k values, 0.67-0.70). The CLP registry variables PCC and percentage of non-oral errors and the quality indicators without non-oral speech errors and competent/marginally incompetent velopharyngeal function are reliable for use in clinical audits and research of 10-year-olds. The three-tier ratings of VPC have weaker reliability but can still be useful in more detailed analyses if interpreted with caution.

Smartphone‐based scans of palate models of newborns with cleft lip and palate: Outlooks for three‐dimensional image capturing and machine learning plate tool

AbstractObjectivesTo evaluate the performance of smartphone scanning applications (apps) in acquiring 3D meshes of cleft palate models. Secondarily, to validate a machine learning (ML) tool for computing automated presurgical plate (PSP).Materials and MethodsWe conducted a comparative analysis of two apps on 15 cleft palate models: five unilateral cleft lip and palate (UCLP), five bilateral cleft lip and palate (BCLP) and five isolated cleft palate (ICP). The scans were performed with and without a mirror to simulate intraoral acquisition. The 3D reconstructions were compared to control reconstructions acquired using a professional intraoral scanner using open‐source software.ResultsThirty 3D scans were acquired by each app, totalling 60 scans. The main findings were in the UCLP sample, where the KIRI scans without a mirror (0.22 ± 0.03 mm) had a good performance with a deviation from the ground truth comparable to the control group (0.14 ± 0.13 mm) (p = .653). Scaniverse scans with a mirror showed the lowest accuracy of all the samples. The ML tool was able to predict the landmarks and automatically generate the plates, except in ICP models. KIRI scans' plates showed better performance with (0.22 ± 0.06 mm) and without mirror (0.18 ± 0.05 mm), being comparable with controls (0.16 ± 0.08 mm) (p = .954 and p = .439, respectively).ConclusionsKIRI Engine performed better in scanning UCLP models without a mirror. The ML tool showed a high capability for morphology recognition and automated PSP generation.

Evaluation of Sphenoid Sinus Variations in Cleft Lip and Palate Patients: A Comprehensive Cone Beam Computed Tomography Analysis.

This study aims to compare sphenoid sinus variations between unilateral and bilateral cleft lip and palate (CLP) patients and healthy controls using CBCT images. It is notable for its large sample size and comparison of unilateral and bilateral cleft patients, cleft and noncleft sides, and different age groups. Retrospective cohort study. University Hospital. CBCT images of 97 CLP patients (76 unilateral, 21 bilateral) and 97 healthy controls were evaluated.Main Outcome Measures: Sphenoid sinus main types, sellar subtypes, clival, and lateral extensions were assessed for all groups. A significant increase in the anterior type was observed in both unilateral and bilateral CLP groups. The bilateral CLP group had a higher prevalence of the lesser wing type. In CLP and control groups, lesser wing, combined type, and lateral type were statistically significantly lower under 13 years of age. The study highlights an elevated prevalence of anterior pneumatization in unilateral and bilateral CLP individuals, emphasizing its significance in surgery planning due to proximity to critical structures like the optic nerve and sphenopalatine artery. The increased prevalence of the lesser wing type in bilateral CLP patients requires extra caution during anterior clinoidectomy. Lower pneumatization rates in CLP patients under 13 suggest their sphenoid sinus development is similar to that of healthy individuals. Understanding these variations is crucial for appropriate surgical planning and avoiding complications during transsphenoidal surgery.

Characterization of Tissue Immunity Defense Factors of the Lip in Primary Dentition Children with Bilateral Cleft Lip Palate.

Bilateral cleft lip palate is a severe congenital birth defect of the mouth and face. Immunity factors modulate immune response, inflammation, and healing; therefore, they are vital in the assessment of the immunological status of the patient. The aim of this study is to assess the distribution of Gal-10, CD-163, IL-4, IL-6, IL-10, HBD-2, HBD-3, and HBD-4 in tissue of the bilateral cleft lip palate in primary dentition children. Five patients underwent cheiloplasty surgery, where five tissue samples of lip were obtained. Immunohistochemical staining, semi-quantitative evaluation, and non-parametric statistical analysis were used. A statistically significant increase in HBD-2, HBD-3, and HBD-4 was found in skin and mucosal epithelium, hair follicles, and blood vessels. A notable increase was also noted in IL-4, IL-6, and IL-10 in the mucosal epithelium and CD163 in blood vessels. The connective tissue of patients presented with a statistically significant decrease in Gal-10, IL-10, and HBD-3. Spearman's rank correlation revealed multiple significant positive and negative correlations between the factors. Upregulation of CD163 points to increased angiogenesis but the increase in IL-4 and IL-10 as well as the decrease in Gal-10 points to suppression of excessive inflammatory damage. Decreased connective tissue healing and excessive scarring are suggested by the decrease in HBD-3 and IL-10 and the increase in IL-6.

Prevalence of tooth agenesis and supernumerary teeth related to different Thai cleft lip and cleft palate populations

BackgroundPattern of dental anomalies encountered in cleft patients shows subtle signs of genetic involvement. This study aimed to evaluate the prevalence and pattern of tooth agenesis and supernumerary teeth in Thai cleft population according to the cleft type.MethodsData collected from patients with cleft lip and palate, who had been treated at Tawanchai Cleft Center, Khon Kaen University, Thailand, available during year 2012–2022, were investigated. Records from 194 patients with non-syndromic clefts met the inclusion criteria. Standard dental records, and at least either orthopantomogram (OPG) or cone beam computed tomography (CBCT), were examined. Statistical analysis was performed using chi-square and binominal test (p ≤ 0.05).ResultsPrevalence of tooth agenesis was higher (77.3%) than that of supernumerary teeth (5.7%) and was more common in bilateral cleft lip and palate (BCLP) (88.1%) than in unilateral cleft lip and palate (UCLP) (72.6%) (p = 0.017). The upper lateral incisor was more frequently affected (46.4%), followed by the upper second premolar. The number of missing teeth observed on the left side was significantly higher. Patients with left UCLP (ULCLP) had the highest prevalence of tooth agenesis. A total of 41 tooth agenesis code (TAC) patterns was found. The prevalence of supernumerary teeth was comparable with 6.6% of ULCLP, 5.1% of BCLP, and 4.5% of URCLP. Tooth-number anomalies were observed more often in the BCLP and were most likely to occur on the left side of the maxilla. Both types of anomalies could be featured in a small proportion of cleft patients.ConclusionsMore than half of the patients with non-syndromic cleft lip and palate in this study, presented with tooth-number anomalies. Tooth agenesis was approximately 10-time more prevalent than supernumerary teeth. Tooth agenesis was likely to appear on the left-side of the maxilla regardless of the laterality of the cleft.

Comparative Evaluation of Temporomandibular Joint Parameters in Unilateral and Bilateral Cleft Lip and Palate Patients Using Cone-Beam CT: Focus on Growing vs. Non-Growing Subjects.

Morphological differences in the temporomandibular joint (TMJ) are crucial for the treatment of patients with cleft lip and palate (CLP). This study aims to evaluate and compare the TMJ parameters in patients with unilateral and bilateral CLP across growing and non-growing age groups using cone-beam computed tomography (CBCT). CBCT records from 57 patients (23 males and 34 females) aged 6-50 years with a diagnosed unilateral or bilateral CLP were analyzed. Patients were categorized into four groups: growing unilateral (UGCLP), growing bilateral (BGCLP), non-growing unilateral (UNGCLP), and non-growing bilateral (BNGCLP). Measurements of TMJ parameters, including the mandibular fossa, articular eminence inclination, joint spaces, and roof thickness of the glenoid fossa, were conducted using CBCT images. Significant differences were observed in the anterior joint space (AJS) and the roof of the glenoid fossa (RGF) between growing and non-growing unilateral cleft patients. Additionally, significant discrepancies were found in the articular eminence angle when comparing the cleft and non-cleft sides within the unilateral growing group. No significant differences were observed in TMJ parameters between the right and left sides among bilateral cleft patients. The study highlights distinct TMJ morphological differences between growing and non-growing patients with CLP, emphasizing the importance of age-specific considerations in the treatment planning and growth monitoring of these patients.

Autogenous Bilateral Cleft Alveolar Bone Grafting with rhBMP-2 and Cellular Bone Matrix.

Alveolar bone grafting (ABG) in bilateral cleft lip and palate (BCLP) patients provides a reconstructive challenge. We present a novel technique of combining autologous iliac crest bone graft (ICBG) with recombinant human bone morphogenic protein 2 (rhBMP-2) and cellular bone matrix (CBM) for ABG in BCLP patients. Complete bone fill occurred in 90% of patients, with 100% having bilateral canine eruption. No patients required repeat ABG, and no significant complications were reported. The alveolar cleft gap volume significantly decreased with an improvement of 75.87%. ABG with autologous ICBG with rhBMP-2 and CBM is an effective technique for patients with BCLP.

Multidisciplinary Treatment in a Patient with Cleft Lip and Palate: A Case Report

Background: Cleft lip and palate (CLP) are among children’s most common congenital craniofacial abnormalities. CLP results from the failure of the fusion of facial processes during embryogenesis. The etiology of CLP is complex and thought to involve genetic influences along with variable interactions from environmental factors. The treatment process involves a multidisciplinary approach while focusing on achieving functional and aesthetic well-being for the patient. Case Report: In this paper, we report using a multidisciplinary approach to treat a complex case of bilateral transforaminal CLP in a 7-year-old female patient. The treatment significantly changed the patient’s facial profile, in addition to improving her occlusion, aesthetics, and function. Conclusion: The treatment of CLP should follow a multidisciplinary approach while considering several factors, such as age, developmental stage, and psychosocial factors. This approach has been shown to improve patients’ well-being and quality of life.

Surgical Premaxilla Reposition and Secondary Bone Grafting in a Children with Complete Bilateral Trans-Foramen Cleft Lip and Palate: a Case Report

The objective of this study is to report the clinical case of a child with complete bilateral trans-foramen CLP who underwent surgical repositioning of the premaxilla with internal rigid fixation and a secondary bone grafting. The boy was following by different specialists since five days of life, being subjected to the entire surgical protocol to close the lip and palate. At 9 years old it was proposed surgical premaxilla reposition and, in a second surgery, a bone grafting in the alveolar process. After a virtual planning, surgery was performed under general anesthesia. The access was performed maintaining the vestibular pedicle of premaxilla, and after remove the interferences at the vomer and maxilla, premaxilla was fixed with titanium plates and screws. Six months after, fixation material was removed and the remaining gaps were grafted with iliac bone. After 21 months of the first surgery, the patient presents a good anteroposterior positioning of the maxilla and lip seal and, those responsible for the patient, reported an improvement in the patient's quality of life, with improvements mainly in speech, chewing and the patient's social life.

Maxillary arch dimensions in bilateral cleft lip and palate in the age 0-5 months.

The complete bilateral cleft lip and palate (BCLP) divides the maxillary arch into three segments, separated from each other, resulting in abnormal growth of the alveolar arch. This study evaluated the maxillary arch dimensions in BCLP and compared them with neonates without craniofacial anomalies. This retrospective study was conducted in a tertiary cleft centre. Sixty-six neonates aged 0-5 months were divided into two groups: cleft group-children with BCLP (23 boys and 18 girls) and control group-children without craniofacial deformities (15 boys and 10 girls). The dental models were processed by a 3D scanner. Landmarks were marked to achieve inter-canine distance, inter-tuberosity distance and arch length measurements. t-Tests were used for intergroup comparisons (p < .05). The maxillary cleft arch was demonstrated to be wider and longer in the posterior region compared to the control group. The inter-canine distance did not present differences between the cleft and controls. The inter-canine distance of the control group was the only measurement influenced by the variable sex. The cleft significantly interfered with the arch posterior width and arch sagittal length, making them larger. There was no statistical difference in the measurements between sex in the cleft group.

Comparison of temporomandibular joint osseous components in unilateral and bilateral cleft lip and palate patients and normal controls: A CBCT study

ObjectiveThe objective of this study was to conduct a comparative analysis of the components of the temporomandibular joint in individuals with unilateral, bilateral cleft lip and palate (CLP), and in healthy individuals, utilizing cone beam computed tomography (CBCT) images. Method and materialThe present study employed a cross-sectional design and recruited participants aged 18 to 30 years. The participants were categorized into three groups: a control group consisting of 36 individuals without any cleft, a group of 35 patients with unilateral cleft lip and palate (UCLP), and a group of 15 patients with bilateral cleft lip and palate (BCLP). The analysis of CBCT images encompassed the examination of condylar height and angulation, glenoid fossa height and width, articular eminence inclination, as well as joint spaces across all three groups. The Kruskal-Wallis and Mann-Whitney tests were employed to ascertain the significant differences among the three groups. ResultsThe UCLP and BCLP groups demonstrated a statistically significant reduction in condylar height and articular eminence inclination in comparison to the control group. Furthermore, a significant difference in the width of the glenoid fossa was seen between the group with clefts and the control group. ConclusionThe CBCT images showed significant differences in several aspects of the temporomandibular joint, including condylar height, articular eminence inclination, and glenoid fossa width, in individuals with cleft palate. These abnormalities can contribute to the development of temporomandibular joint diseases. Therefore, recognizing these distinctions can help prevent further deterioration and progression of temporomandibular disorders (TMD) in CLP patients.

Alteration in maxillary arch dimensions following preoperative nasoalveolar moulding therapy in bilateral cleft lip and palate patients

ABSTRACT Purpose Bilateral cleft lip and palate (BCLP) are severe congenital anomalies. The cleft interferes with the normal growth of the maxilla, leading to deficient midfacial development. The aim of the present study was to evaluate the short-term influence of preoperative nasoalveolar moulding (NAM) therapy on maxillary arch dimensions in patients with BLCP. Materials and methods 18 newborns (male: 12; female: 6) were recruited who underwent NAM therapy before cheiloplasty. The pre- (T0) and post-NAM (T1) plaster casts of the maxilla were scanned using a laboratory scanner. The measured parameters on the digital casts included premaxilla width, right and left alveolar cleft width, right and left molar region length, anterior interalveolar-, intercanine-, intermolar-, intertuberosity width, palatal length and anterior basal angle. Results Both left (p = 0.047) and right (p = 0.019) alveolar clefts significantly reduced in size at T1. A significant expansion in premaxilla width was detected (p = 0.037). Anterior basal angle showed a significant increase too. Except for the intermolar width (p = 0.045), no significant changes were identified in the transversal dimensions. Conclusion NAM therapy could potentially serve as an effective tool in mitigating the severity of bilateral cleft deformities at a short-term interval without interfering with maxillary growth. However, long-term studies are required to confirm the effectiveness of the therapy.

Cleft lip Sidedness and the Association with Additional Congenital Malformations.

To investigate the association between the sidedness of orofacial clefts and additional congenital malformations. Linkage of a national registry of cleft births to national administrative data of hospital admissions. National Health Service, England. 2007 children born with cleft lip ± alveolus (CL ± A) and 2724 with cleft lip and palate (CLP) born between 2000 and 2012. The proportion of children with ICD-10 codes for additional congenital malformations by the sidedness (left, right or bilateral) of orofacial clefts. For CL ± A phenotypes, there was no evidence for a difference in the prevalence of additional anomalies between left (22%, reference), right (22%, aOR 1.02, 95% CI 0.80 to 1.28; P = .90) and bilateral clefts (23%, aOR 1.09, 95% CI 0.75 to 1.57; P = .66). For CLP phenotypes, there was evidence of a lower prevalence of additional malformations in left (23%, reference) compared to right (32%, aOR 1.54, 95% CI 1.25 to 1.91; P < .001) and bilateral clefts (33%, aOR 1.64, 95% CI 1.35 to 1.99; P < .001). The prevalence of additional congenital malformations was similar across sidedness subtypes with CL ± A phenotypes but was different for sidedness subtypes within CLP cases. These data support the hypothesis that CL ± A has a different underlying aetiology from CLP and that within the CLP phenotype, right sided CLP may lie closer in aetiology to bilateral CLP than it does to left sided CLP.

Management of Constricted Upper Arch and Protruded Premaxilla in a 2-Year-Old Patient With Unrepaired BCLP

The paper presented the treatment procedure of a 2-year-old patient with unrepaired bilateral cleft lip and palate (BCLP). Complicated situation included severely protruded premaxilla and constricted upper dental arch, possibly related to delayed treatment of cleft lip and palate. Orthodontic expansion lasted for 8 months, including using fan-type expander for 3 months. After that, premaxillary osteotomy was performed to reset the premaxilla, and 4 months later, simultaneous repair of cleft lip and palate was taken. Follow-up evaluation in 5.5 years revealed acceptable language development and craniofacial profile, and maxillary growth was satisfactory. The treatment procedure of this patient provided an exploratory protocol for those patients with unrepaired BCLP who suffered from deteriorated preaxillary protrusion and constricted upper arch.

Determination of safety margin of nasal septum osteotomy for sphenoid sinus in cleft lip and palate patients

BackgroundNasal septum osteotomy is used for separating the nasal septum and maxilla during a Le Fort I osteotomy. If this osteotomy is applied too high or is tilted into the nasal cavity, the sphenoid sinus and various adjacent vital structures may be damaged, and serious bleeding, neurological complications, blindness or even death may occur. The aim of this study is to determine the safety margin of the nasal septum osteotomy for sphenoid sinus during the Le Fort I surgery in cleft lip and palate (CLP) patients.MethodsTwenty cleft lip and palate (the CLP group) and 20 healthy individuals (the control group) were included in this study. Three values (two lines and an angle) were measured by cone beam computed tomography (CBCT). The first line is the line passing through the junction of the spina nasalis anterior point and the lower point of the perpendicular lamina of the palatine bone. The undersired line is the line passing through the junction of the spina nasalis anterior point and the lower anterior border of the base of the sphenoid sinus. The osteotomy angle is the angle between these two lines.ResultsIn the control group; a surgical line of 44.11–61.14 mm (mean 51.91 ± 4.32), an undesired line of 52.48–69.58 mm (mean 59.14 ± 5.08) and an angle of 18.22–27.270 (mean 22.66 ± 2.55) were found, while in the CLP group, a surgical line of 34.53–51.16 mm (mean 43.38 ± 4.79), an undesired line of 46.86–61.35 mm (mean 55.02 ± 3.24) and an angle of 17.60–28.810 (mean 22.60 ± 2.81) were found.ConclusionsAlthough the angle to the sphenoid sinus was not significantly affected by CLP, careful planning and consideration of these anatomical differences are crucial to prevent complications and ensure the safety of Le Fort I surgery in CLP patients. Further research with larger sample sizes and subgroup analysis of unilateral and bilateral CLP cases is needed to improve our understanding of these anatomical variations and improve surgical approaches to individuals with CLP undergoing orthognathic procedures.