Bilateral Cleft Lip Patients Research Articles

Comparison of Nasopharyngeal Airway Volume in Cleft Lip and Palate Patients With Normal Individuals Using Cone Beam Computed Tomography.

This study aimed to compare nasopharyngeal airway volume in cleft lip and palate patients with normal individuals using Cone Beam Computed Tomography (CBCT). In this cross-sectional study, 40 CBCT scans of 9 to 12-years-old patients were enrolled and divided into 3 groups: normal individuals (n=16), unilateral cleft lip and palate (UCLP, n=14) and bilateral cleft lip and palate patients (BCLP, n=10). Superior and middle pharyngeal airway volumes and nasal width were measured and compared between 3 groups. ANOVA and χ 2 tests were used for statistical comparison. P <0.05 was considered significant. Superior airway volume was not significantly different between the 3 groups ( P =0.36). However, there was a significant difference between the 3 groups regarding middle pharyngeal volume ( P =0.49) and nasal width ( P =0.021). There was not a significant difference in the upper and middle pharyngeal volume and also nasal width between the 2 sexes. Considering different dimensions of evaluation of the pharyngeal airway volume of cleft lip and palate patients, the evaluation of airway volume is essential during orthodontic or orthognathic surgical treatments that expand or protect the maxilla.

Alterations in Facial Soft Tissue Thickness Post-Facemask Treatment in Noncleft Skeletal Class III and Bilateral Cleft Lip Palate Class III Patients.

The purpose of this retrospective study was to assess the alteration in the facial soft tissue thickness after rapid maxillary expansion with facemask treatment in bilateral cleft lip and palate (BCLP) Class III patients and noncleft Class III patients. Case records including lateral cephalograms of 30 patients (19 females, 11 males) treated using a rapid maxillary expansion with facemask treatment were analyzed. Group I (age: 11.4 ± 1.02 years) (10 females, 5 males) consisted of noncleft skeletal Class III patients, and group II (age: 10.8 ± 0.84 years) (9 females, 6 males) comprised skeletal Class III patients with bilateral cleft lip and palate. Fifteen hard tissue and 10 soft tissue measurements were made at the beginning and at the end of the treatment to evaluate the change with rapid maxillary expansion combined facemask treatment. The bilateral cleft lip and palate group displayed a statistically significant increase in the thickness of the subnasale, labrale superius, labrale inferius, labiomentale, and pogonion, whereas the thickness of the stomion was found to be significantly decreased. The noncleft group demonstrated a statistically significant decrease in the thickness of the stomion and gnathion. There was a statistically significant difference between the bilateral cleft lip and palate and noncleft groups in the facial soft tissue thickness measurements at labrale superius, gnathion, and subnasale points and in Y axis, U1-SN, U1-NA in the hard tissue measurements. The results of the study indicated that the rapid maxillary expansion with facemask treatment produced diverse alterations in the facial soft tissue thickness of bilateral cleft lip and palate patients and noncleft Class III patients.

Long-Term Evaluation of the Lip and Nose in Bilateral Complete Cleft Lip Patients following Lip Adhesion and Secondary Nose Correction.

Background Surgical correction of bilateral cleft lip deformities remains one of the most challenging areas in facial plastic surgery. Many surgical techniques and conservative devices have been offered for the early management of bilateral cleft lip in infants. The purpose of this study was to evaluate the effect of lip adhesion on the lip and nose of patients with bilateral cleft lip. Methods A retrospective review of 13 patients with bilateral cleft lip was performed and compared with age-matched noncleft children. Patients underwent lip adhesion at a mean age of 2.8 months, and cheiloplasty at 6.6 months of age using a modification the Mulliken method. Secondary rhinoplasty was performed at the age of 6 in 13 patients. The surgical results were analyzed using photographic records obtained at the age of 1 and 7 years. Twelve length measurements and one angle measurement were obtained. Results All measurements were not statistically different from those of the noncleft age-matched control group at the age of 1. At 7 years of age, upper lip height and vermilion mucosal height were shorter ( p < 0.05) than in the control group. Nasal tip protrusion and the nasolabial angle were greater ( p < 0.05) than in the control group. Conclusion Lip adhesion followed by secondary rhinoplasty resulted in an acceptable lip and nasal appearance. Although nasoalveolar molding is now widely used, lip adhesion can be an appropriate alternative if an orthodontist is not available due to geographical or economic constraints.

Zygomaticomaxillary suture maturation evaluation in patients with and without cleft lip and palate

The zygomaticomaxillary suture (ZMS) maturation evaluation is a reliable method for predicting the optimal timing of maxillary protraction. The objective of this study was to compare age distribution patterns of ZMS maturation stages between cleft lip and palate (CLP) patients and non-cleft lip and palate (non-CLP) patients to aid our comprehension in choosing the optimal timing of maxillary protraction. Samples of 216 non-CLP and 220 CLP Asian patients without orthodontic and orthognathic treatment aged 5-25 years were scanned to evaluate the ZMS maturation stage by 2 evaluators blindly. Evaluators' agreements and bilateral ZMS maturation consistency were assessed by weighted kappa tests. Age distribution patterns of each ZMS maturation stage were described. Gender effect and age distribution differences between groups were analyzed using an independent t-test. Evaluators'agreements and bilateral ZMS maturation consistency were satisfying (weighted kappa coefficient>0.90). At stages A and B, patients with CLP were 1.3 and 0.4 years older than patients in the non-CLP group (P<0.001 and P= 0.01). In contrast, at stage C, patients with CLP were approximately 1.2 years younger (P= 0.004). Gender barely played a role in the divergence of ZMS maturation (P>0.05). No statistically significant difference was observed between ZMS maturation of patients with unilateral or bilateral cleft lip and palate (UBCLP) and patients with unilateral or bilateral cleft lip (UBCL) (P>0.05). The ZMS development of patients with CLP was premature at stage C, whereas delayed at stages A and B.

Gingivectomy as a Supportive Therapy in Orthodontic Treatment of Bilateral Cleft Lip and Palate Patient: A Case Report

Background: One of the congenital malformation in the early phase of embryogenesis is cleft lip and/or palate that need multidisciplinary treatment in dentistry. Although surgery is performed in the first few months of life, advanced treatment is needed sometimes in the growth age, such as orthodontic, periodontic and esthetic treatment.&#x0D; Objective: To describe a gingivectomy procedure to support orthodontic treatment in bilateral cleft lip and palate patient.&#x0D; Case Report: A 13-year-old boy was referred from the orthodontic department with complaints of enlargement in maxillary anterior gingiva teeth, blocking the placement of the orthodontic device. Patient’s examination showed bilateral cleft lip and palate, plaque score 35%, bleeding on probing 73%, dental agenesis on teeth 12 and 22, and gingival enlargement on regions 13–23. The aim of gingivectomy, in this case, was to eliminate pockets, restore physiologic gingival contour and facilitate the placement of the orthodontic device.&#x0D; Results: Clinical evaluation after gingivectomy showed satisfying results in reducing the pocket depth.&#x0D; Conclusion: Gingivectomy is effective in supporting the orthodontic treatment for cleft lip and/or palate patient.&#x0D; Keywords: cleft lip, cleft palate, gingival enlargement, gingivectomy, orthodontic treatment

Bite Force Changes in Bilateral Cleft Lip and Palate Patients Before and After ALT-RAMEC Protocol.

To evaluate the bite force (BF) changes in bilateral cleft lip and palate (BCLP) in contrast to the non BCLP children after ALT-RAMEC Facemask therapy. The prospective study was carried out on a total of 60 subjects of age 6 to 13 years in a tertiary care hospital; treatment group, 30 children with BCLP and control group, 30 children without cleft lip and palate. Each cleft patient was received ALT-RAMEC Facemask treatment and their BF assessed at 4 different stages. Bite force taken before treatment, immediately, 3 months and 6 months after treatment. Bite force of the control group was taken at baseline to compare with the treatment group to demonstrate the difference in BF values. Independent t test and analysis of variance were used to perform statistical analysis. There was a significant difference in BF between the treatment group (BCLP) 122.53 ± 8.64 N and the control group (non BCLP) 181.38 ± 18.84 N at baseline. After the Alt RAMEC protocol, changes in BF recorded over 3 and 6 months of therapy showed significant improvement. The mean values of BF at 3months and 6 months were 106.7 ± 9.3 N and 137.4 ± 9.5 N, respectively. Bite force was significantly improved after ALT-RAMEC protocol followed by facemask therapy in BCLP patients.

A predictor of a postoperative fistula after double-opposing Z-plasty in bilateral cleft lip and palate patients

Furlow double-opposing Z-plasty (FDOZ) as primary palatoplasty for the bilateral cleft lip and palate (BCLP) closure often leads to a palatal fistula formation in cases with wide clefts. We examined the utility of the calculated maximum closable cleft width to determine the feasibility of a direct palatal closure without lateral incisions. In this retrospective study, we analyzed consecutive patients with a BCLP who were treated for 5 years from 2009. In sixty-three BCLP patients, the following dimensions were measured preoperatively: an actual distance between maxillary tuberosities (Actual X); actual cleft height, calculated from the line joining the maxillary tuberosities to the cleft edge (Actual Y); and actual cleft width at the hard-soft palate junction (Actual Z) and calculated maximum cleft width requiring a direct closure (CMZ). Six months postoperatively, the relationships between the fistula occurrence and actual Z/CMZ were examined. Median values (interquartile range) of Actual X, Y, and Z and CMZ were 35.0 (33.0-39.0) mm, 7.0 (6.0-8.0) mm, 10.0 (8.0-11.0) mm, and 4.6 (2.7-5.7) mm, respectively. The median age at operation was 8.0 (7.0-17.0) months. Fistulae at the hard-soft palate junction developed postoperatively in three cases with more than a 10-mm cleft width (4.76%). A receiver operating characteristic (ROC) curve analysis indicated that actual Z was a better predictor of a postoperative fistula formation than CMZ. An actual cleft width was a better predictor of the fistula occurrence than a calculated maximum cleft width after FDOZ for a BCLP repair. The low fistula rate of FDOZ suggested that FDOZ could be used to close the palate with less than a 10-mm cleft width.

A case of camouflage orthodontic treatment in a bilateral cleft lip and palate patient with skeletal class III and anterior open bite malocclusion

A case of camouflage orthodontic treatment in a bilateral cleft lip and palate patient with skeletal class III and anterior open bite malocclusion

Effect of the prophylactic use of antibiotics on wound infection after cleft lip surgery.

To study the effect of preoperative prophylactic use of antibiotics on wound infection in patients with cleft lip. Aretrospective study was conducted on the clinical data of 1 361 patients who underwent one-stage cleft lip repair in the Department of Cleft Lip and Palate in West China Hospital of Stomatology, Sichuan University, from January 2015 to November 2018. The patients were divided into two groups according to whether prophylactic antibiotics were used or not. There were 594 patients in the prevention group, including 373 unilateral incomplete cleft lip (UICL) patients, 157 unilateral complete cleft lip (UCCL) patients, 25 bilateral incomplete cleft lip (BICL) patients, 39 bilateral complete cleft lip (BCCL) patients. There were 767 patients in the non-prophylactic group, including 482 UICL patients, 211 UCCL patients, 31 BICL patients, 43 BCCL patients. The relationship between preoperative and postoperative leukocyte count, preoperative and postoperative body temperature, and postoperative wound infection were compared between the two groups. No significant difference was observed in the leukocyte count and body temperature between both groups (P>0.05). The preoperative prophylactic use of antibiotics has no significant effect on the incidence of postoperative infection in patients undergoing cleft lip repair.

Gingivosupraperiosteoplasty following Presurgical Maxillary Orthopedics Is Associated with Normal Midface Growth in Complete Unilateral and Bilateral Cleft Patients at Mixed Dentition.

Passive orthodontic appliances and gingivosupraperiosteoplasty are adjuncts that can be used by surgeons at the time of primary cleft lip repair. These treatments, along with the surgical technique of cleft lip and palate repair, may impact midface growth. The objective of this study was to describe the authors' protocol for unilateral and bilateral cleft lip repair and to evaluate midfacial growth in a cohort of patients at mixed dentition who had undergone presurgical passive orthodontic appliance therapy and gingivosupraperiosteoplasty at the time of unilateral and bilateral cleft lip repair. Fifteen complete unilateral and 15 complete bilateral cleft lip and palate patients underwent passive orthodontic appliance treatment and primary lip repair with gingivosupraperiosteoplasty. Lateral cephalograms were analyzed by three blinded reviewers. Mean cephalometric measurements at mixed dentition were compared to cephalometric values for noncleft patients, unilateral cleft lip and palate patients who did not undergo gingivoperiosteoplasty or presurgical treatment, and unilateral cleft lip and palate patients who underwent gingivoperiosteoplasty/nasoalveolar molding with independent samples t tests. Mean cephalometric values were within age-specific normal values for sella-nasion-A point, sella-nasion-B point, A point-nasion-B point, and facial axis. Eighty-seven (13/15) percent of unilateral cleft lip and palate patients and 93 percent (14/15) of bilateral cleft lip and palate patients did not exhibit skeletal class III malocclusion. There was no significant difference between cephalometric values for our patients and patients who did not receive gingivosupraperiosteoplasty or presurgical treatment or who underwent the gingivoperiosteoplasty/nasoalveolar molding protocol. Presurgical passive orthodontic appliances, combined with gingivosupraperiosteoplasty at the time of lip repair, leads to normal maxillary development in most patients at mixed dentition. Assessment of midface growth at skeletal maturity is required. Therapeutic, IV.

Treatment Outcome in Bilateral Cleft lip and Palate Patients Evaluated With the Huddart-Bodenham Scoring System and the Bilateral Cleft lip and Palate Yardstick: A Systematic Review.

ObjectivesTo assess treatment outcome (transversal and sagittal dental arch relationships) and its determinants in complete bilateral cleft lip and palate (BCLP) evaluated with the modified Huddart-Bodenham scoring system and the BCLP Yardstick.Materials and methodsMultiple electronic databases were searched without time limitation. Randomized clinical trials, cohort and case control studies using BCLP Yardstick and/or modified Huddart-Bodenham system to judge treatment outcome of patients with BCLP were included. The Risk of Bias in Nonrandomized Studies of Interventions tool and Grading of Recommendations, Assessment, Development, and Evaluation was used.ResultsOf the 528 studies identified by the electronic search, only eight retrospective studies met the inclusion criteria and were included. A total of 12 cleft centers were represented. All treatment protocols differed and background information was underreported. The results for the BCLP yardstick showed that all except the centers in New Zealand had a mean score lower than 3, indicating good treatment results. However, these studies had a moderate to high risk of bias. The modified Huddart-Bodenham scores were negative in all studies. No further meta-analysis was done due to heterogeneity and high risk of bias. The quality of evidence was graded as very low.ConclusionResults for the dental arch relationship of studies in complete BCLP and possible determinants were not synthesized due to very low quality of evidence. Clinical research for patients with BCLP should focus on sound methodological designs to enable evidence-based decision making to improve treatment for patients with BCLP and thereby hopefully their quality of life.

Changes to the Cleft Nose Esthetic After Le Fort I Advancement: A 3-Dimensional Analysis

Background and Purpose: The study of nasal changes in cleft lip and palate (CLP) orthognathics is limited. This study aimed to determine differences in 3-dimensional (3D) nasal changes for unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients after Le Fort I advancement. Methods: This study was a retrospective cohort evaluation of 18 subjects (9 male, 9 female) treated at a single institution over a 5-year period who had class III skeletal and dentoalveolar malocclusion related to non-syndromic cleft lip and/or palate and underwent surgical correction via Le Fort I osteotomy. Patients underwent pre- and postoperative cephalometric measurements and 3D volumetric assessment for comparison to analyze nasal changes. Statistical analysis was performed to determine changes in nasal parameters using student’s t-test and multivariate analysis. Differences were considered significant for P-values ≤.05. Results: All nasal parameters except for nasolabial angle and nasal length changed significantly postoperatively in the entire cohort. Alar base and flare width both increased significantly (2.1 mm, P = .0002, 1.4 mm, P = .0005), while both relative and total tip projection decreased (−3.4 mm, P = .000004, −2.2 mm, P = .0008). An advancement of the entire nasal complex was seen postoperatively (1.0 mm, P = .0005). UCLP patients had a significantly larger decrease in total nasal tip projection following surgery relative to BCLP patients (−3.5 ± 1.2 mm, −0.8 ± 2.1 mm, P = .008). BCLP morphology increases the degree of 3D nasal surface area advancement relative to UCLP (1.2 mm ± 0.3, 0.8 mm ± 0.6, P = .028). Alar cinch stitch decreases nasolabial angle ( P = .024) but increases nasal length ( P = .004). Conclusion: Discrepancies exist in nasal changes after Le Fort I advancement between UCLP and BCLP patients. Increased understanding of outcomes for cleft patients undergoing Le Fort I can help improve the predictability of nasal esthetic changes in this patient population.

Early Postoperative Complications in Primary Cleft Lip and Palate Repair: A Retrospective Analysis of 328 Cases

Aim&#x0D; Primary cleft lip and palate (CLP) repair is the most critical stage throughout lifetime. CLP surgery involves risks of surgery and anaesthesia related complications. In this study, it was aimed to evaluate complications occurred in early period after primary CLP surgery and to determine early factors that trigger these conditions.&#x0D; Materials and Methods&#x0D; In this study 328 surgeries of 271 CLP patients were included. Complications were classified as minor complications such as fever occurring within first 3 days. Complications that cannot be treated with palliative care or required transfer to intensive care were considered as major complications. Epidemiology and causal link of early complications were statistically evaluated.&#x0D; Results&#x0D; Early complications were seen in 19% (n: 63) of all cases that operated for cleft lip and palate. Among them rate of minor complications were 9% (n: 25). It was determined that prolongation of anaesthesia lead to rising of minor complications such as deficiency in oral feeding. Major complications were observed in 11% (n: 38). These major complications were more common in bilateral cleft lip, syndromic, palate and male patients. Mean hospitalisation of complicated cases were 3.35 days. When compairing to noncomplicated cases there was increasing in hospitalisation time (p

Tek ve Çift Taraflı Dudak ve Damak Yarıklı Hastalarda Maksiller Genişletme ve İlerletme Uygulamasının Değerlendirilmesi

Dudak ve damak yarıkları; genetik ve çevresel nedenlerden dolayı ortaya çıkan en yaygın kraniyofasiyal anomalilerdir. Dudak ve damak yarıklı bireylerde solunum, işitme ve konuşma gibi fonksiyonel ve psikososyal sorunlar meydana gelmekte ve bu nedenle de bu bireyler multidisipliner tedavilere gereksinim duymaktadır. Dudak ve damak yarıklarının onarımı sonrası iyi bir fonksiyon, estetik ve yumuşak doku rekonstrüksiyonu elde etmek için erken yaşta alveolar yarıkların onarılması gerekmektedir. Alveolar kemik grefti uygulanan cerrahi işlemler, kemik formasyonunu oluşturur; oronasal fistülü ortadan kaldırır, ortodontik problemin nüksetmesini önler ve protetik tedavileri kolaylaştırır. Bu cerrahi işlemler, avantajlarına rağmen dudak damak yarıklı bireylerde skar oluşumuna sebep olur. Bu skar dokusu maksillanın sagital, vertikal ve transversal gelişimini ve pozisyonunu olumsuz yönde etkiler. Dolayısıyla maksiller diş kavsi daralır ve bu durum posterior çapraz kapanışa neden olur. Maksillanın genişletilmesi (maksiller genişletme apareyleri ile) ve ilerletilmesi (yüz maskesi ile) oluşan pozisyonel ve gelişimsel yetersizliklerin giderilmesinde kullanılır. Bu derlemenin amacı; tek veya çift taraflı dudak ve damak yarıklı bireylerin genişletme ve ilerletme uygulamaları sonucunda fasiyal morfolojilerinde meydana gelen iskeletsel, dentoalveolar ve yumuşak doku değişikliklerinin değerlendirilmesidir.

Alveolar bone grafting and gingivoperiosteoplasty in bilateral cleft lip and palate.

Gingivoperiosteoplasty (GPP) and alveolar bone grafting (ABG) procedures have a vast history. There have been many publications regarding ABG and secondary ABG, with and without presurgical infant orthopedics (PSIO), in bilateral cleft lip and palate patients. There is little long-term data available describing results of both techniques. The interdisciplinary approach to primary and secondary surgical procedures has proven to be beneficial for patients with bilateral cleft lip and palate. In the neonates, naso-alveolar molding (NAM) has been found to optimize the aesthetic outcome as well as re-approximating the arches to facilitate GPP. During the mixed dentition stage, arch preparation/expansion before the secondary ABG procedure improves arch morphology, restores the functional interarch relationship, and facilitates surgery. This review aims to highlight the key points of both the procedures and why combining both procedures along with PSIO procedures such as NAM might be helpful for the patients in the long term.

Comparative Three-Dimensional Evaluation of Spheno-Occipital Synchondrosis and Zygomatico-Maxillary Suture in Cleft Lip and Palate Children versus the Normal Population

Background: The purpose of the present study was a three-dimensional evaluation of the spheno-occipital synchondrosis (SOS) and zygomatico-maxillary suture (ZMS) in cleft lip and palate patients versus the normal population. Materials and Methods: In the case-control study, cone beam computed tomography scans of 153 unilateral or bilateral cleft lip and palate patients and 153 scans of healthy non-cleft individuals with skeletal Class I occlusion from 6 to 18 years were selected. Then the ZMS and SOS maturation stages were determined. Mann-whitney test, spearman correlation, repeated measurement, and bayesian transition analysis were used for statistical analysis. P-value 0.05). Conclusion Maturation of zygomatico-maxillary suture in cleft lip and palate was earlier than non-cleft children, however sphenooccipital synchondrosis did not show any significant differences in maturational stages between cleft lip and palate patients and healthy controls.

CBCT evaluation of cephalometric variables among samples of Egyptian non-operated cleft lip and palate patients

Objectives: to evaluate the cephalometric and craniofacial measurements in unilateral and bilateral cleft lip and palate (CLP) patients and to investigate the effect of these measurements in growing and non-growing cleft patients using cone beam computed tomography (CBCT) 3D software, and to compare them to healthy individual. Setting and Sample population: Retrospective study was performed in Department of pedodontics and Orthodontics, October 6 University. The study sample comprised unilateral and bilateral 36 growing CLP (aged 6-17years), and 24 non-growing CLP (aged 18- 40 years). The control group included 60 Non-CLP subjects. Methods: Cephalometric measurements were obtained using CBCT software, all measurements were assessed by Mann-test to clarify differences between study samples. Results: There was a significant difference between (Growing Bilateral) and (Control Growing) for (MP-SN, B, A, ANB, SNB & ANS-ME) and There was a significant difference between (Growing Unilateral) and (Control Growing) for (MP-SN, B, SNA, SNB, GO-GN, GO-GN, N-ANS & ANS-ME). While there was a significant difference between (Non-Growing Bilateral) and (Control Non-Growing) for (MP-SN, B, A, SNA, SNB, GO-GN, & ANS-ME) and there was a significant difference between (Non-Growing Unilateral) and (Control Non-Growing) for (MP-SN, B, A, SNA, SNB & ANS-ME) where (Z) values were significant at (0.05). Conclusion: Our study shows that there was significant increase in mandibular length in both growing and non- growing BCLP than of UCL, in growing UCLP there was reduced upper face height and in growing BCLP there was increased lower face height

Non-surgical treatment of vertical excess of the premaxilla in growing bilateral cleft lip and palate patients

Patients with bilateral complete cleft lip and palate (BCLP) may present a vertical excess of the premaxilla in childhood. This is a severe functional and aesthetic problem, where bone grafting is more challenging. The aim of this study was to describe a simple and reproducible non-surgical orthopaedic treatment for vertical excess of the premaxilla in the deciduous/early mixed dentition phase in BCLP patients. Six growing patients with complete BCLP with a severe vertical excess of the premaxilla were included. An intrusion device associated with a bonded rapid palatal expander was applied to intrude the premaxilla. Radiographic and photographic records obtained before and at the end of the orthodontic intrusion, at short- and long-term follow-up, were available. A flattening of the occlusal plane was achieved in all patients. Normalization of the position of the maxillary incisors and gingival display in relation to the upper lip was obtained, and an improvement in anterior nasal spine position was also observed in all cases. The novel technique described might be of assistance in treating BCLP children with vertical excess of the premaxilla during the deciduous/early mixed dentition phase. This simplified, easily reproducible method may allow the burden of care of this rare but complex problem affecting BCLP patients to be reduced significantly.

Retrospective analysis of clinical outcomes in bilateral cleft lip and palate patients after secondary alveolar bone grafting and premaxilla osteotomy, using a new dento-maxillary scoring system

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

Orofacial clefts: treatment based on a multidisciplinary approach

Orofacial clefts: treatment based on a multidisciplinary approach