Cleft Group Research Articles

Tongue dorsum activity in children with velopharyngeal insufficiency vs. typically developing children.

To investigate whether children with velopharyngeal insufficiency (VPI) exhibit increased elevation and retraction of the tongue dorsum. Two quantitative metrics of tongue dorsum activity: Dorsum excursion Index (DEI) and Tongue Constraint Position Index (TCPI) were captured using mid-sagittal images of the tongue obtained from Ultrasound Tongue Imaging. Participants: Six children with velopharyngeal insufficiency (VPI), six children with palate (w/wo cleft lip) without velopharyngeal insufficiency (wo VPI) and ten typically developing children aged 6-15 repeated six different consonants in aCa and iCi contexts five times. A linear mixed-effect model was used to examine the response variables across three groups. Overall, DEI was not significantly higher in the VPI group than in the other two groups. Also, TCPI was not significantly lower in the cleft palate group (VPI and wo VPI). However, significant differences were detected between certain phonetic contexts in the VPI group. In addition, a significant interaction between group and consonant was found in the context of /i/. These findings suggest that the presence of VPI may not lead to a uniform increase in tongue dorsum elevation or retracted position across all speech sounds. Rather, the articulatory behaviours of children with VPI may be influenced by the specific phonetic context and individual variability.

Distribution of Immunomodulation, Protection and Regeneration Factors in Cleft-Affected Bone and Cartilage.

Craniofacial clefts can form a significant defect within bone and cartilage, which can negatively affect tissue homeostasis and the remodeling process. Multiple proteins can affect supportive tissue growth, while also regulating local immune response and tissue protection. Some of these factors, like galectin-10 (Gal-10), nuclear factor kappa-light-chain-enhancer of activated B cells protein 65 (NF-κB p65), heat shock protein 60 (HSP60) and 70 (HSP70) and cathelicidin (LL-37), have not been well studied in cleft-affected supportive tissue, while more known tissue regeneration regulators like type I collagen (Col-I) and bone morphogenetic proteins 2 and 4 (BMP-2/4) have not been assessed jointly with immunomodulation and protective proteins. Information about the presence and interaction of these proteins in cleft-affected supportive tissue could be helpful in developing biomaterials and improving cleft treatment. Two control groups and two cleft patient groups for bone tissue and cartilage, respectively, were organized with five patients in each group. Immunohistochemistry with the semiquantitative counting method was implemented to determine Gal-10-, NF-κB p65-, HSP60-, HSP70-, LL-37-, Col-I- and BMP-2/4-positive cells within the tissue. Factor-positive cells were identified in each study group. Multiple statistically significant correlations were identified. A significant increase in HSP70-positive chondrocytes in cleft patients could indicate that HSP70 might be reacting to stressors caused by the local tissue defect. A significant increase in Col-I-positive osteocytes in cleft patients might indicate increased bone remodeling and osteocyte activity due to the presence of a cleft. Correlations between factors indicate notable differences in molecular interactions within each group.

Some oral microbiota in complete cleft infants in comparison with normal infants.

To compare caries-related microorganisms and candida in complete cleft infants with normal palate infants. The case-control study was conducted from April 2021 to January 2022 at the College of Dentistry, University of Baghdad, Baghdad, Iraq, and comprised infants with age ranging from 1 day to 4 months. They were divided into complete cleft group A and control group B. Group A was subdivided into those with class III Veau's palatal classification, and the rest with class IV Veau's palatal classification. Samples were taken using oral swab which were subjected to colony morphology, gram staining and biochemical testing. Data was analysed using SPSS 21. Of the 52 subjects, 26(50%) were in each of the 2 groups. The subgroups of group A had 13(50%) patients each. The counting and colonisation of streptococcus mutans, lactobacilli and candida albicans were significantly higher in group A than in group B (p<0.05). The difference between the subgroups of group A was not significant (p>0.05). Infants with cleft palate were more susceptible to dental caries and oral infection than those with normal palate.

Maximum mouth opening in patients with cleft lip and palate or craniofacial anomalies compared with non-affected controls: A cross-sectional study.

There are limited published data on maximum mouth opening (MMO) for children with cleft lip or palate (CLP) or craniofacial anomalies (CFA). To report MMO of patients with CLP or CFA compared with non-affected controls. Retrospective cross-sectional review of electronic medical and dental records. Patients with CLP or CFA with recorded MMO, height, and weight were included and compared with a non-affected control individuals seen during orthodontic screening. Outcome measures included MMO, recorded in millimeters of inter-incisal distance, age, height, weight, and sex. Patients with CLP or CFA (n = 376) were matched by age and body mass standardized index (BMIz) to the non-affected pool (n = 376). The affected group had a MMO of 43.14 mm (±7.1 mm) compared with the control group MMO of 48.01 mm (±7.6 mm) with a statistically significant difference of -4.86 mm (p < .0001). Specifically, MMO of the unilateral cleft group is 4.26 mm smaller than that of non-affected controls (p < .0001). MMO of the bilateral cleft group is 3.65 mm smaller than that of non-affected controls (p = 0.0063). MMO for patients with CLP was significantly smaller as compared to non-affected controls. This study helps establish MMO values for children with CLP and CFA.

Long-term Results and Efficacy of Intermediate Rhinoplasty in Patients With Unilateral Cleft Lip: A Single Surgeon's Experience.

Intermediate rhinoplasty, the correction of cleft lip nose deformities, is performed between the time of primary and secondary rhinoplasties, which is at ~6 years of age. Although intermediate rhinoplasty reduces psychological stress in school-aged children through improvements in appearance, studies on intermediate rhinoplasty are scarce. Hence, in this study, we aimed to evaluate the long-term outcomes of intermediate rhinoplasty in patients with unilateral cleft lip. Twenty-three patients with unilateral cleft lip who underwent intermediate rhinoplasty without primary rhinoplasty from 1997 to 2004 were enrolled in this retrospective study. They were categorized into total, male, and female groups. Photogrammetric analysis of 9 proportional, 5 angular, and 6 nostril-related parameters was performed using photographs that were taken after skeletal maturity had been reached; these parameters were compared with those of normal controls. The cleft group had significantly lower dome-to-columellar ratio, nasal sill ratio, labial-columellar angle, nostril width ratio, nostril height (base) ratio, nostril one-fourth medial part ratio, and nostril area ratio measurement and significantly higher alar width/mouth width ratio, columella height/alar width ratio, nasal tip protrusion/alar base width ratio, nasal dorsum angle, and nostril dimension in the cleft side values than the control group. After intermediate rhinoplasty, significant nasal improvement was achieved, including sufficient nasal tip projection, nasal height, nasal protrusion, and a relatively symmetric nasal tip without tip deviation. Intermediate rhinoplasty may contribute to reducing the psychosocial stress of school-aged children with unilateral cleft lip.

Evaluation of Sella Turcica and Maxilla Morphometry of Individuals With Cleft Lip and Palate on Lateral Cephalometric Radiographs

Objective: The objective of this study was to evaluate the dimensions and the morphology of the sella turcica, as well as maxillary cephalometric landmarks, in patients with and without clefts. Methods: Lateral cephalometric radiographs of 55 cleft patients and 55 non-cleft (control) patients were included in the study. The morphology of the sella turcica, including its shape, height, width, and diameter was evaluated. Additionally, maxillary cephalometric measurements, comprising four lengths and two angles, were assessed on the radiographs. The chi-squared test was employed to compare sella turcica shapes between the cleft and non-cleft groups. Independent samples t-tests were conducted to analyze dimensional parameters between groups and genders. Results: Significant relationship was found between groups with cleft and non-cleft for sella shapes (p=0.032). There was no statistical association for sella dimensions according to the cleft presence (p&gt;0.05). All maxillary cephalometric measurements were significantly greater in individuals of the non-cleft group compared to those in the cleft group (ANS-PNS, A-PNS, S-N-ANS , S-N-A, N-A) except R-PNS. Conclusion: Patients with clefts more frequently exhibited a flattened sella shape, whereas those without clefts tended to have a round sella shape. Maxillary cephalometric dimensions were lower in the individuals of cleft group.

Evaluation of the success of anterior iliac crest harvested bone graft in reconstruction of different jaw defects: a retrospective study

Aims: The aim of this study was to evaluate the success of bone grafts obtained from the anterior iliac crest, the recipient and donor site complications in the reconstruction of jaw defects caused by different etiologies in maxillofacial surgery. Methods: A retrospective cohort study was conducted at the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Erciyes University between 2012-2022. It included patients with iliac crest harvested bone grafts due to jaw defect with full records. The primary predictive variable was the type of jaw defect. The primary outcomes were the presence of complications at donor and recipient sites. Secondary outcomes were length of hospital stay and type of complications at donor and recipient sites. The obtained data were analyzed with Kruskal Wallis Test, Pearson’s chi-square test and Fisher’s exact test. Results: This study included 104 (44 female, 60 male) patients. Complication rate was 21.15%. There was no statistically significant relationship between the type of jaw defect and the success of iliac bone grafts (p=0.257). The most common recipient site complication was resorption in alveolar atrophy groups, the dehiscence in alveolar cleft groups, infection in other reason groups. There was no statistically significant relationship between type of jaw defect and complication types (p=0.524). Conclusion: The results of the study demonstrate that general success rate was 78.85% in jaw reconstruction with anterior iliac crest harvested bone grafts. The major complication rate causing total graft loss was 13.46%. There was no statistically significant relationship between the type of jaw defect and the success of iliac bone grafts.

Effect of facial and nasolabial asymmetry on perceived facial esthetics in children with non-syndromic cleft lip and palate

ObjectiveThe aim of the present study was to objectively assess the degree of residual facial asymmetry after primary treatment of non-syndromic unilateral cleft lip and palate (UCLP) in children and to correlate it with subjective ratings of facial appearance.Materials and methodsStereophotometry was used to record the faces of 89 children with UCLP for comparison of cleft and non-cleft sides up to 5 years after primary cleft closure. Root mean square values were calculated to measure the difference between the shape of cleft and non-cleft sides of the face and were compared to controls without a cleft lip. The Asher-McDade Aesthetic Index (AMAI) was used for subjective rating of the nasolabial area through 12 laypersons.ResultsChildren with a cleft lip (CL) showed no significant difference in RMS values compared to controls. Significant differences occurred when the evaluation was limited to the nasolabial area, however only in patients with cleft lip alveolus (CLA) and cleft lip palate (CLAP)(p < 0.001). In contrast, subjective ratings showed significantly higher values for all three cleft severity groups (CL, CLA, CLAP) compared to controls (p < 0.001). There was a non-linear correlation between the RMS (root mean square) values and the AMAI score.ConclusionsEven non-significant discrete objective deviations from facial symmetry in children after primary closure of UCLP are vigilantly registered in subjective ratings and implemented in the judgement of facial appearance.Clinical relevance3D stereophotometry is a usefull tool in monitoring asymmetry in patients with a cleft.

Nasal airway resistance in patients with different degrees of operated unilateral cleft lip: Evaluation of ventilation in 112 patients

ObjectiveThe aim of this study was to compare the nasal airway resistance between the cleft and non-cleft sides in operated unilateral cleft lip (UCL) patients with varying severities at birth, as well as to assess the differences in nasal airway resistance between UCL patients and healthy individuals. MethodsThis retrospective study was conducted on 112 UCL patients who have undergone primary lip reconstructions but not advanced surgeries as the study group and 20 healthy participants as the control group between February 2023 to March 2024. The study group patients were grouped based on the severity of their cleft lip at birth, divided into occult cleft lip group, incomplete cleft lip group, and complete cleft lip group. The anterior rhinomanometry was used to evaluate nasal resistance, including unilateral effective resistances during inspiration (Reffin), expiration (Reffex), and the entire breath (ReffT), as well as unilateral vertex resistance during inspiration (VRin) and expiration (VRex). The Kolmogorov-Smirnov test was used to assess normality. Paired t-tests were utilized to analyze the differences in nasal resistance between the healthy and affected sides within the same group of patients. Student's t-test was used to analyze the differences in nasal resistance among patients with different degrees of cleft lip. A p-value of <0.05 was considered statistically significant. ResultsThe nasal resistances of the occult cleft and incomplete cleft lip groups showed no significant differences between the cleft and non-cleft sides, and were similar to the control group. However, in the complete cleft lip group, the cleft side nasal resistance was significantly higher than the non-cleft side and control group. Among the groups, the complete cleft lip group had significantly higher nasal resistances on the cleft side for Reffin, VRin, and ReffT compared to the occult cleft group. ConclusionUnderstanding the nasal resistance of different degrees of operated UCL patients can benefit clinical diagnosis and treatment. Patients with complete cleft lip have more severe nasal obstruction on the cleft side, with greater impact on inhalation than exhalation. For these patients, treatment by an otolaryngologist is recommended to improve nasal airflow.

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.

Validation of an objective assessment tool for velopharyngeal insufficiency in cleft lip and palate children

The nasalance scores of 42 children aged 8 to 10 years old, born with a cleft lip and palate, were collected and compared with 50 control children. The scores were then analyzed in relation to 31 verbal stimuli from the French corpus created for this study (sentences and syllables). The most relevant threshold values were determined by receiver operating characteristic curves, which exhibited the highest sensitivity and specificity. The results demonstrated statistically significant differences (p < 0.05) in the mean nasalance scores of the control and cleft groups for all verbal stimuli containing oral phonemes. Threshold values with good diagnostic accuracy were defined, and 15 verbal stimuli were selected for use in clinical practice. The nasalance threshold values defined in this study can be utilized for the objective diagnosis of velopharyngeal insufficiency (VPI) and the subsequent monitoring of French children aged 8 to 10 years old, born with a cleft lip and palate.

Evaluation of hard palate and cleft morphology in neonates with Pierre Robin Sequence and Cleft Palate Only.

This study aimed to establish a fully digital measurement protocol for standardizing the description of hard palate and cleft morphology in neonates with an isolated cleft palate (CPO) and Pierre Robin sequence (PRS). A total of 20 digitized plaster models of neonates with CPO and 20 digitized plaster models of neonates with PRS were retrospectively investigated. For the control group, the hard palate was segmented from 21 pre-existing 1.5 T MRI datasets of neonates and exported as an STL file. The digital models were marked with predefined reference points by three raters. Distance, angular, and area measurements were performed using Blender and MeshLab. Neonates with CPO (20.20 ± 2.33 mm) and PRS (21.41 ± 1.81 mm) had a significantly shorter hard palate than the control group (23.44 ± 2.24 mm) (CPO vs. control: P < .001; PRS vs. control: P = .014). Notably, neonates with PRS (33.05 ± 1.95 mm) demonstrated a significantly wider intertuberosity distance than those with CPO (30.52 ± 2.28 mm) (P = .012). Furthermore, there were also significant differences measured between the cleft and control groups (25.22 ± 2.50 mm) (P < .001). The data from this study demonstrate the feasibility of using MRI datasets to generate digital models of the hard palate. The presence of a cleft palate leads to pronounced adaptations of the total palatal surface area, dorsal width, and length of the hard palate. Mandibular retrognathia and altered tongue position in PRS, as opposed to CPO, might further impact palatal morphology and intertuberosity distance.

Treatment outcomes of digital nasoalveolar moulding in infants with cleft lip and palate: A systematic review with meta-analysis.

The aim of this systematic review was to compare the treatment outcomes of digital nasoalveolar moulding (dNAM) technique with conventional nasoalveolar moulding (cNAM) or non-presurgical intervention protocol in infants with unilateral (UCLP) or bilateral (BCLP) cleft lip and palate. A bibliometric search by MEDLINE (via Ovid), Embase, Cochrane Library, grey literature and manual method was conducted without language restriction until November 2023. Literature screening and data extraction were undertaken in Covidence. The risk of bias was evaluated using the Newcastle-Ottawa Scale and RoB-2. Pooled effect sizes were determined through random-effects statistical model using R-Software, and the certainty of evidence was assessed using the GRADE approach. Among 775 retrieved articles, nine studies were included for qualitative synthesis (6-UCLP, 3-BCLP), with only three eligible UCLP studies for meta-analysis. In the UCLP group, very low certainty of evidence indicated no difference in alveolar cleft width (SMD, 0.13 mm; 95% CI, -0.31 to 0.57; I2, 0%), soft tissue (lip) cleft gap, nasal width, nasal height, and columellar deviation angle changes between dNAM and cNAM. In the BCLP group, qualitative synthesis suggested similar changes in alveolar, lip, and nasal dimensions with dNAM and cNAM. In both cleft groups (UCLP, BCLP), reduced alveolar cleft width was observed in the dNAM group compared to the non-presurgical intervention protocol, along with fewer clinical visits and reduced chairside time for dNAM compared to cNAM. It can be concluded that the treatment outcomes with dNAM were comparable to cNAM in reducing malformation severity and were advantageous in terms of chairside time and clinical visit frequency. However, the overall quality of evidence is very low and standardization is needed for the virtual workflow regarding the alveolar movements and growth factor algorithms. Registration: PROSPERO-database (CRD42020186452).

Need for orthognathic surgery in cleft patients from Northern Finland.

Northern Finland has a unique distribution of clefts compared to the rest of Europe and Finland. This may reflect the need for orthognathic surgery among Northern Finland's patient pool. The aim of this study was to compare previously operated patients aged 18 years or older with cleft lip, cleft lip and alveolus, cleft lip and palate, cleft palate and to evaluate the need for orthognathic surgery in order to achieve a stable and functional occlusion. Materials and methods: The study group consisted of all 18-years-old cleft patients treated in the Oulu Cleft Center. The total amount of patients was 110. The patients were compared retrospectively using patients' hospital records. The majority of patients did not have any cleft-associated syndrome. The need for maxillary or bimaxillary orthognathic or corrective-jaw surgery was evaluated by the Oulu Cleft Team. A descriptive and statistical analysis was used to determine the need for orthognathic surgery according to sex and cleft type. There were nineteen patients of the total of 110 patients who met the criteria requiring corrective-jaw surgery (17,3%). In total 12 males (25,0%) and 7 females (11,3%) were evaluated for the need of orthognathic surgery. Sixteen of the 19 patients had palatal involvement of the cleft. The need for orthognathic surgery was greater in the cleft lip palate and cleft palate patient groups compared to cleft lip alveolus or cleft lip groups. This study also found that males from Northern Finland need surgery more often than females.

Early language intervention and IQ of children with non-syndromic orofacial clefts

Introduction Children with non-syndromic orofacial clefts are at higher risk for developmental difficulties. Speech and language as commonly affected developmental domains in these children.ObjectivesThe aim of the current study was to explore the effects of early interventions for speech and language on later cognitive outcomes in this patient population.MethodsA combined retrospective/prospective-comparative study was carried out at the Department of Pediatrics of the University of Pécs in Hungary. The participants were children between 6 and 16 years of age. The study consisted of a self-designed demographic questionnaire and an IQ test (WISC-IV).ResultsA total of 41 children with non-syndromic orofacial clefts and 44 age-matched controls participated in the study. Children of the cleft group were examined by pedagogical professional services and required special education plans significantly more often than controls (p&lt;0.001 and p=0.02, respectively). Participants of the cleft group who received early speech and language therapy score higher on the Verbal Comprehension Index (p=.005). Full-Scale IQ score was also higher for cleft participants who received therapy, however not significant but borderline (p=0.08).ConclusionsEarly language and speech interventions for children with non-syndromic orofacial clefts may have a positive effect on verbal skills and overall cognitive development. Future longitudinal studies examining baseline cognitive functioning of infants are needed to provide more conclusive evidence on the effects of interventional programs on speech and language development in cleft patients.Disclosure of InterestNone Declared

Alveolar Bone Grafting in Unilateral Cleft Lip and Palate: Impact of Timing on Palatal Shape.

Alveolar bone grafting (ABG) is a critical surgical intervention in patients with a cleft of the alveolus, aimed at reconstructing the alveolar ridge to facilitate proper eruption, periodontal support, and alignment of adjacent permanent teeth. The optimal timing for ABG remains debated, with late secondary ABG between the ages of 9 and 11 being widely adopted. This study compared the palatal shapes of 28 children at a mean age of 9.5 years (SD = 0.7) who underwent early secondary ABG at a mean age of 2.1 years (SD = 0.6) or 33 children at a mean age of 10.8 years (SD = 1.5) who underwent late secondary ABG at a mean age of 8.6 years (SD = 1.3) to 60 non-cleft controls at a mean age of 8.6 years (SD = 1.2). The palatal shapes were captured with 239 landmarks digitized on the palate on a digital model. Utilizing geometric morphometric methods, i.e., generalized Procrustes superimpositions, principal component analysis, and permutation tests, we assessed the impact of ABG timing on palatal morphology. The first five principal components (PCs) explained 64.1% of the total shape variability: PC1 = 26.1%; PC2 = 12%; PC3 = 11.9%; PC4 = 7.8%; and PC5 = 6.4%. The Procrustes distance between both cleft groups and the control group was more than twice as large as the Procrustes distance between the early ABG and late ABG groups. Nonetheless, all intergroup differences were statistically significant. Our findings suggest that early ABG has a limited negative effect on palatal shape, providing comparable outcomes to late ABG. The study highlights the potential suitability of early ABG, challenging conventional practices and encouraging further exploration into its long-term effects on maxillary growth.

Analysis Study for Cleft Lip And / Or Palate Patients and Steps of Management in Al-Wasity Hospital

Cleft is defined as defect in the fusion of facial tissues alone or with palatal processes during embryonic life causes an opening in face or roof of mouth in baby which considers as most common anomalies visit our hospital. To analyses most important problems which may consider as one of the cause of cleft lip and palate patients with steps in management of this important anomaly. The sample involves 500 patient distributed between cleft lips only, cleft palate group and cleft lip and palate. The parent of patient takes important field in our study since they are who answer the questions, the study take five years from 2010 to 2015, patients came to our hospital with age extend from few hour to 28 years old .the problem is very important and this first study in our hospital . Of this st udy analyzed by chi-square test, the results were founded cleft li p group was found to be (15.6%), cleft palate group (33.6%) and cleft lip and palate group were (50.8%). We take the order of patient in family found 28% of sample first in order (highest percentage).Most patient fathers above 30 years (65%), 8.6%of them with systemic disease (40%) were smokers. Most age group of mother were younger between 16-30 years old (65.4%), previous history of cleft found in 33% of sample and (45.6 %) of mother had a history of psychological problem. Management of patient include long process therapy as early age of patient when reach hospital to age above 20 years old which include plastic surgery , orthodontic treatment and maxillofacial surgery.

Early Orthodontic Intervention in Cleft Lip-Palate and Noncleft Children with Developing Class III Malocclusion: A Clinical Study.

Orthopedic correction of skeletal class III malocclusion in a growing patient is crucial as it can circumvent future surgical procedures. The aim of the study is to evaluate the dental and skeletal effects of early orthodontic intervention of developing class III malocclusion. A final sample of 38 children in the age-group of 6-14 years having skeletal class III malocclusion was selected. Subjects were divided into two groups; group I-included 18 children (male-10, female-8) with surgically repaired cleft lip and palate and group II-20 children (male-14, female-6) without any cleft lip and palate. Cemented rapid maxillary expansion (RME) appliances with 11 mm hyrax screws were used in all patients. Elastic traction forces were applied to the reverse-pull headgear worn by the patients. Both pre- and posttreatment records along with lateral cephalograms were taken. The pre- and posttreatment mean and standard deviation measurements of the angular and linear observations were statistically analyzed with Statistical Package for the Social Sciences (SPSS) software (version 13) and were correlated through independent t-test and paired t-test. Following headgear therapy, improvement was greater in the cleft group than noncleft group with greater advancement of maxilla along with clockwise rotation of mandible in clefts. Protraction mechanics with expansion can be employed successfully in repaired cleft lip and palate and noncleft prepubertal children having developing class III malocclusion, showing concave profile, and retrusive maxilla. Accurate diagnosis and understanding of the individual growth pattern are crucial in the early interception of a class III malocclusion to achieve a more favorable facial profile. Sahoo SS, Dash JK, Sahoo PK, et al. Early Orthodontic Intervention in Cleft Lip-Palate and Noncleft Children with Developing Class III Malocclusion: A Clinical Study. Int J Clin Pediatr Dent 2023;16(5):716-723.

Oral Microbiota in Children with Cleft Lip and Palate: A Systematic Review.

Cleft in the lip and/or palate (CLP) is a congenital facial deformity that significantly impacts the oral cavity's structure and function. This malformation can affect the oral microbiota. The objective of this systematic review was to examine and consolidate the current scientific evidence on the oral microflora in children with CLP. The search strategy included the PubMed, PubMed Central, Web of Science, Scopus, and Embase databases. The inclusion criteria were studies assessing oral microbiota in children with CLP. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included studies. The search strategy identified 422 potential articles. Twelve papers met the inclusion criteria. High heterogeneity was observed in methodologies, sample sites, and patient characteristics. Eight studies assessed the levels of Streptococcus mutans and Lactobacillus in saliva, with some reporting significantly higher levels in the cleft group compared to controls, while others found no differences. One study reported a significantly higher colonization rate of Candida species in patients with cleft lip and/or palate. The results of the available studies are unclear. Further research is needed to gain a comprehensive understanding of the oral microbiota and potential implications for oral health management in this population. The review was not registered Registration Statement.

Classification of Skeletal Phenotypes of Preadolescent Patients With Isolated Cleft Palate Using Principal Component Analysis and Cluster Analysis.

This study aimed to classify the skeletal phenotypes of preadolescent patients with isolated cleft palate using principal component analysis and cluster analysis. Sixty-four preadolescent female patients with isolated cleft palate (incomplete hard palate and complete soft palate cleft group, n=51; complete cleft of the hard and soft palate group, n=13; the mean age when lateral cephalograms were taken, 7.08±0.76y) were included. Ten angular and 2 ratio cephalometric variables were measured on a lateral cephalogram. Cluster analysis was performed using 3 representative variables obtained from principal component analysis (SN-GoMe, SNA, and SNB). The differences in the variables among the clusters were characterized using the Kruskal-Wallis test. As a result of the analysis, 6 clusters were obtained from 3 groups: the retrusive maxilla and mandible group: cluster 3 (14.1%, moderately hyperdivergent pattern), cluster 5 (17.2%, severely hyperdivergent pattern); the normal maxilla and mandible group: cluster 1 (23.4%, normodivergent pattern), cluster 4 (12.5%, moderately hyperdivergent pattern), cluster 6 (20.3%, severely hyperdivergent pattern); the normal maxilla and protrusive mandible group: cluster 2 (12.5%, normodivergent pattern). The distribution of isolated cleft palate types did not differ among the 6 clusters ( P >0.05). Two thirds of the patients (68.7%, clusters 1, 2, 4, and 6) had a normal anteroposterior position of the maxilla, while one third of the patients (31.3%, clusters 3 and 5) showed a retrusive mandible. These results indicate that isolated cleft palate patients have diverse maxillo-mandibular growth patterns compared with patients with cleft lip and palate.