Bilateral Cleft Patients Research Articles

Results of Multidisciplinary Management of Bilateral Cleft Lip and Palate at the Iowa Cleft Palate Center

Bilateral cleft of the lip and palate is by many standards the most complex and severe form of the defect. The complexity and severity of the defect require an unusual degree of cooperation among all specialists and especially between the surgeon and the orthodontist. There are no published findings that we know about in which comprehensive data from a number of disciplines are reported for the same group of bilateral cleft patients. Fifty randomly selected patients with bilateral complete clefts were examined by the Iowa team and two orthodontists from other institutions. The evaluations revealed that a large number of patients over the age of 10 have multiple residual problems requiring further treatment. Only 23 percent of the older patients studied were judged to have had treatment completed by the surgeon, speech pathologist, and orthodontist. It is very difficult to state whether the results obtained by our team can be considered satisfactory because there are no comparable studies that have attempted to evaluate the same parameters in multidisciplinary management.

Results of Multidisciplinary Management of Bilateral Cleft Lip and Palate at the Iowa Cleft Palate Center

Bilateral cleft of the lip and palate is by many standards the most complex and severe form of the defect. The complexity and severity of the defect require an unusual degree of cooperation among all specialists and especially between the surgeon and the orthodontist. There are no published findings that we know about in which comprehensive data from a number of disciplines are reported for the same group of bilateral cleft patients. Fifty randomly selected patients with bilateral complete clefts were examined by the Iowa team and two orthodontists from other institutions. The evaluations revealed that a large number of patients over the age of 10 have multiple residual problems requiring further treatment. Only 23 percent of the older patients studied were judged to have had treatment completed by the surgeon, speech pathologist, and orthodontist. It is very difficult to state whether the results obtained by our team can be considered satisfactory because there are no comparable studies that have attempted to evaluate the same parameters in multidisciplinary management.

Pulp test response of the maxillary anterior teeth in cleft palate patients

The relative pulpal responsiveness of the six maxillary incisors to electrical and cold thermal stimuli was tested in patients with complete unilateral and bilateral clefts. The six maxillary anterior teeth were tested at random to electrical stimuli. After a 5-minute interval, the same teeth were tested at random to cold stimuli with an ice pencil. Unilateral and bilateral cleft palate patients had statistically significant higher mean electrical pulp test thresholds for the maxillary anterior teeth than the noncleft palate patients. No statistically significant difference between unilateral and bilateral cleft palate patients was found in electric pulp test responses of the maxillary anterior teeth. No statistically significant differences in electric pulp test responses and cold test responses of the maxillary anterior teeth in both cleft palate and noncleft palate individuals based on differences in sex were observed. No statistically significant difference in cold test responses were observed between cleft palate and noncleft palate patients. Cleft palate patients who completed orthodontic treatment within 1 year of testing showed elevated mean electrical pulp test thresholds as did noncleft palate patients who received orthodontic treatment within 1 year of testing.

Three-dimensional nasal morphology in adult bilateral cleft palate patients: a morphanalytic study

The residual anomalies of the soft and hard tissues of the nose were studied in a group of adult bilateral cleft palate patients. Standard morphanalytic techniques were used to produce objective and accurate pictorial representations of the mean nasal deformities in three dimensions. The spatial positions of these mean outlines were tested statistically against normal means. Mean bilateral cleft nasal outlines were shown to have symmetric lateral and superior displacement of both alae with nasal blunting and retrusion and rounding of the nasal dorsum. The analytic techniques used indicated that the reduction in the depth of the external nose was confined to its posterior part. The presence of a palatal cleft in conjunction with the bilateral labial cleft only slightly increased the degree of deformity. In the case of asymmetrically incomplete bilateral clefts the nasal deformity in adulthood retained certain asymmetric features.

Isolated naso-ocular cleft: a one-stage repair.

The naso-ocular cleft is a rare defect; however, isolated alar clefts with or without additional hamartomatous local tissue are an even rarer problem. The authors describe six unilateral and one bilateral cleft patients who were all initially repaired using the same operative procedure. The concept of this procedure is based on the principle that there is basically no soft-tissue deficiency but rather a malpositioning of the parts. The leading edge of the ala is re-created by a rotation advancement of both the medial and the lateral segments adjacent to the cleft. The created secondary defect is filled with a paranasal transposition flap. Three of our patients had hamartomatous excesses and were the most difficult to balance, and at the same time, two of these patients required subsequent bridging or augmentation using a free conchal cartilage graft. Examples of the operative procedures are outlined both schematically and clinically.