Cleft Patients Research Articles

Nasal Deformity Correction in Cleft Lip and Palate Patients by Secondary Rhinoplasty: Patients Satisfactions.

To evaluate the degree of patient satisfaction postsecondary rhinoplasty, specifically in cleft patients in Mosul city. A retrospective comparison questionnaire study was conducted between March and April 2024 among cleft patients who underwent surgical secondary rhinoplasty in Mosul City of Nineveh Province. All cleft patients aged 18 to 40 who underwent secondary rhinoplasty are included in the study. Forty participants respond to a specific questionnaire in 3 time periods (before surgery 3 and 6 months after). Basic demographic information (age, gender, cause of visit, diagnosis, and treatment) is recorded. Questionnaire which conflict the patient's perception presurgery and postsurgery also. The improvement rate and reduction rate of improvement are calculated according to a special equation.Thanks for such comment. The sentences changed as requested with (Six standard questions applied to evaluate the patients' satisfaction postsurgery. Responses are assessed statistically by special equation to detect the improvement rate). According to age groups, the age between 26 and 30 years have the highest incidence between the cases with 37.5%. Females are highest with (55%). Esthetics are the most common cause. Effective or improvement rate shows positive except for question 6 ( median: 4%). The reduction rate shows positive results. Despite being a complicated surgical operation, cleft rhinoplasty can yield symmetry, improved esthetics, and enhanced functioning, including improved breathing, which can be life-changing for patients and fulfilling for the surgeon. Its difficulty stems from the fact that it has required several surgical phases throughout the years, each of which calls for a comprehensive surgical team with a variety of specializations to be addressed for optimal outcomes.

Oral Health Assessment in Cleft Lip & Palate Patients During Orthodontic Treatment for Maxillary Protraction: A Periodontal & Microbiological Study.

To assess the oral health status and microbiota of subgingival plaque in patients with surgically repaired cleft lip and palate (CLP) during orthodontic treatment for maxillary protraction with two different orthodontic appliances. Randomized controlled trial. Institutional. A total of 90 patients with surgically repaired Unilateral Cleft Lip and Palate, out of initially enrolled 120 patients, were divided into 3 groups: experimental group I, experimental group II and control group, with 30 subjects each. Patients with a history of oral prophylaxis in last 6 months or antibiotic therapy within 3 months were excluded from the study. Bone Anchored Maxillary Protraction was done in experimental group I, while facemask with acrylic occlusal splint was used for maxillary protraction in experimental group II and no orthodontic intervention in control group. Plaque Index (PI), Gingival Index (GI), Gingival Bleeding Index (GBI), Probing Depth (PD), and microbiota of subgingival plaque (P. gingivalis, P. intermedia, Veillonella and Capnocytophaga) were compared at baseline (T0) and after 8 months (T1). The PI, GI, GBI and PD were observed to be significantly higher in experimental group II followed by experimental group I as compared to control group at 8 months interval (P < .001). The microbiota counts increased significantly in experimental group II and experimental group I (P < .001), as compared to control group. Maxillary protraction with facemask and bone plates was found to be a better alternative than facemask with occlusal splint, considering the overall oral health of patients with CLP.

Features Extraction on Cleft Lip Speech Signal using Discrete Wavelet Transformation

Cleft is one of the most common birth defects worldwide, including in Indonesia. In Indonesia, there are 1,596 cleft patients, with 50.53% having a cleft lip and palate (CL/P), 24.42% having a cleft lip (CL), and 25.05% having a cleft palate (CP). Individuals with clefts encounter difficulties with resonance and articulation during communication due to dysfunctions in the oral and nasal cavi-ties. This study investigates various types of mother wavelets as feature extractors for cleft speech signals. Five different mother wavelets, namely Symlet order 2, Reverse Biorthogonal order 1.1, Discrete Meyer, Coiflet order 1, and Biorthogonal order 1.1 are analyzed. This work aims to find the best type of mother wavelet. The extracted features are statistical features, such as mean, me-dian, standard deviation, kurtosis, and skewness. The dataset used in this study consists of 200 sound signals from 10 individuals with cleft conditions and 10 normal volunteers. To assess the performance of the extractor, classification is performed using K-Nearest Neighbor (KNN) and K-Fold cross-validation. The experimental results indicate that the Reverse Biorthogonal order 1.1 mother wavelet achieves the highest accuracy compared to other types of mother wavelet, where the accuracy is 93%, with sensitivity and specificity of 94% and 92%, respectively.

Optimizing examination of methylenetetrahydrofolate reductase gene promoter methylation in cleft lip with or without cleft palate non-syndromic patients using the pyrosequencing method

Optimizing examination of methylenetetrahydrofolate reductase gene promoter methylation in cleft lip with or without cleft palate non-syndromic patients using the pyrosequencing method

Single vs. Double-Opposing Z-Plasty: Evaluating Their Impact on Palatoplasty Postoperative Outcomes.

The double-opposing Z-plasty is a fundamental approach for cleft palate repair. Recently, some surgeons have begun implementing a single Z-Plasty, igniting discussions on the most effective technique for enhancing postoperative outcomes. Consequently, this study sought to evaluate the outcomes of employing single and double Z-plasties within the modified Sommerlad-Furlow technique. 116 cleft palate patients undergoing primary surgical repair were divided into two groups: those treated with the Sommerlad-Furlow method using a double-opposing Z-plasty (S.F.2.Z.P. group, n = 58) and those receiving a single nasal Z-plasty (S.F.1.Z.P. group, n = 58). Data on cleft type and width, soft palate length, palatal fistula, and velopharyngeal function were collected. Mann-Whitney test compared the mean values between groups. The S.F.2ZP group demonstrated a statistically significant increase in soft palate length compared to those in the S.F.1ZP group (p = 0.008). However, the S.F.1ZP group demonstrated adequate soft palate length (7.9 ± 2.8mm) compared to the S.F.2ZP group (9.3 ± 2.8mm). The velopharyngeal function was good in both groups, with no significant differences (P = 0.52). While the proper velopharyngeal closure was 81% in the S.F.1ZP group and 87.9% in the S.F.2ZP group, velopharyngeal insufficiency was 10.3% and 5.2%, respectively. The rates of persistent palatal fistula were 5.2% in the S.F.1ZP group and 3.4% in the S.F.2ZP group, with no significant differences found between both groups (P= 0.64). There were no significant differences in crucial outcomes such as velopharyngeal function and the incidence of persistent palatal fistulas, indicating the effectiveness of both techniques. While the double-opposing Z-plasty demonstrated a statistically significant increase in soft palate length, the a nasal Z-plasty demonstrated adequate soft palate length which sufficiently enables effective velopharyngeal closure. These outcomes suggest that a single Z-plasty is both effective and easy to perform, making it a valuable surgical approach for achieving the desired outcomes.. The current study suggests that although the soft palate may not be as elongated with nasal Z-plasty alone compared to the double Z-plasty, it sufficiently enables effective velopharyngeal closure.

Quantitative Assessment of Lip Morphology in Patients With and Without Cleft Lip and Palate Using 3-Dimensional Stereophotogrammetry.

This study aimed to assess and quantify the morphologic characteristics of the lips and the lower third of the face in cleft and noncleft patients, utilizing three-dimensional (3D) stereophotogrammetry. Sixty patients were included in the study, comprising 30 unilateral cleft lip and palate patients (G1, 24 female, 6 male; aged 20 to 60y, mean age 44.0±12.0y) and 30 noncleft patients (G2, 23 female, 7 male; aged 20 to 59y, mean age 43.5±12.0y). Anthropometric landmarks were identified on the facial surface. Three-dimensional stereophotogrammetry was employed to capture images. Statistical analysis was conducted to compare the groups, with a significance level set at 0.05. The comparative analysis revealed statistically significant differences in 5 linear and 6 angular measurements. Linear measurements such as philtrum width, upper and lower cutaneous lip height, mandibular ramus length, and midfacial depth exhibited significant differences between cleft and noncleft patients. Similarly, angular measurements, including upper lip angle, Cupid's bow angle, lower/medium face convexity, lip seal, nasolabial angle, and left gonial angle, displayed statistically significant disparities. These findings underscore the ongoing surgical challenges in the comprehensive rehabilitation of patients with clefts, highlighting the critical need for continued advancements in treatment strategies.

30 Does the Use of Antibiotics Prophylaxis Affect the Rate of Postoperative Fistula Rates in Cleft Palate Patients?

Abstract Aim Assess whether post-operative antibiotic prophylaxis affected the incidence of oronasal fistula formation in cleft palate patients. Design and setting: Institutional retrospective study using data from patients undergoing primary palatoplasty. Gold standard Fistula rate of no more than 8-10%. Method In the first cycle, there were two groups (A and B). In group A, the patients had antibiotics on induction and 24 hours after, in group B, the patients had further antibiotics for a week. Our work from the cleft collective showed no evidence of change in fistula rates in relation to the antibiotic regime. Therefore, group A surgeon changed practice had antibiotics only on induction and group B remained the same from the first cycle. Results In cycle 1, we found little evidence to suggest a difference in fistula rate between the use of an antibiotic regimen as binary variables: Grp A(P=0.171) and Grp B (P=0.69). Cycle 2 also demonstrated the following: Grp A (P=0.557) and Grp B(P=0.443). Conclusions The use of antibiotics and differing regimes, postoperatively do not influence the incidence of postoperative fistulae in cleft palate.

Non-syndromic Cleft Lip and Palate Patients of the North Indian Population and the Association of Methylenetetrahydrofolate Reductase Gene.

Cleft lip and palate (CLP) is a common congenital anomaly characterized by incomplete fusion of the lip and/or palate during embryonic development. The etiology of CLP is multifactorial, involving genetics and different environmental factors. The methylenetetrahydrofolate reductase (MTHFR) gene has been proposed as a candidate gene associated with CLP due to its involvement in folate metabolism and DNA methylation processes. However, the association between MTHFR gene variants and CLP in non-syndromic patients in the North Indian population remains unclear. This research aimed to see the association between MTHFR gene polymorphisms in non-syndromic patients withCLP in the North Indian population. A case-control observational design comprised 50 CLP patients (cases) and 50 healthy individuals without CLP (controls).Blood samples were collected from patients visiting two hospitals. Genomic DNA was extracted from collected peripheral blood samples, and the genotyping of MTHFR gene polymorphisms (specifically, C677T) was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. The allelic and genotypic frequencies of MTHFR gene variants were compared between cases and controls using appropriate statistical tests. This research revealed a significant association between MTHFR gene polymorphismand CLP in the North Indian population. The odds for the genotypes reach statistical significance, suggesting that the MTHFR gene variantmay play a major role in this population's susceptibility to non-syndromic CLP. This study provides evidence for a linkage between the MTHFR gene C677T polymorphism and an increased risk of CLP in non-syndromic patients in the North Indian population. These findings do support the involvement of MTHFR gene variants in the etiology of CLP. In the future, more research is warranted to elucidate the underlying mechanisms linking MTHFR gene variants to CLP and to explore potential gene-environment interactions in this context.

Unbiased transcriptome analysis of human cleft palate reveals evolutionally conserved molecular signatures of development: experimental study.

The development of the secondary palate, an essential process for hard palate formation, involves intricate cellular processes. Here, we examined the expression patterns of palatal fusion-associated genes in postdevelopmental human palatal tissues. Mucosal samples collected from the anterior fused (control; n=5) and posterior unfused regions (study; n=5) of cleft palate patients were subjected to RNA sequencing. Gene Set Enrichment Analysis (GSEA) was conducted to identify consistent changes in molecular signaling pathways using hallmark (h) gene set collections from the Molecular Signature Database v7.4. The results of RNA sequencing were validated by epithelial-mesenchymal transition (EMT) assays with suppression of target genes, including lrp6, shh, Tgfβ-3 (Bioneer, Daejeon, Korea), and negative control siRNA in a human fibroblast cell line (hs68). Transcriptome profiling of the cleft mucosa demonstrated that the fully fused anterior mucosa exhibited globally upregulated EMT, Wnt β-catenin, Hedgehog, and TGF-β signaling pathways in gene set enrichment. This strongly indicates the evolutionary conserved similarities in pathways implicated in palatogenesis, as previously shown in murine models. In EMT assays with suppression of Lrp6, Shh, and TGF-β3 in human fibroblast cell lines, suppression of Lrp6 exhibited consistent suppression effects on EMT markers. This indicates a closer association with EMT compared to the other two signals. Our study highlights evolutionarily conserved molecular signatures and provides insights into the importance of the EMT pathway in palatal fusion in humans. Furthermore, intraindividual comparative analysis showed the spatial regulation of gene expression within the same organism. Further research and animal models are needed to explore the complexities of EMT-related palatal fusion.

The impact of zygomatic buttress bone graft on nasal floor augmentation in unilateral alveolar cleft patients with late referral: A case series

PurposeThis preliminary study aimed to assess the efficacy of zygomatic buttress bone grafting for nasal floor augmentation in patients with a unilateral alveolar cleft who were referred after the optimal timetable for this surgery had elapsed. Case seriesFive patients, aged 12–18 years, with unilateral alveolar clefts were treated at Qaem Hospital, Mashhad, Iran. Initially, a mucous layer was established on the side of the cleft nose, followed by forming a bony bridge between the defect's sides through a bone graft derived from the zygomatic buttress and xenograft bone powder. Subsequently, the grafted region was covered with an absorbable collagen membrane, and the oral-side flap was sealed. Post-operative follow-ups occurred at 1 week, 1 month, and 3 months, and cone beam computed tomography (CBCT) was performed 6 months post-treatment. Discrepancy between the anterior edge height of the pyriform aperture on the healthy and cleft sides post-grafting was assessed. The average disparity between the height of the anterior edge of the pyriform aperture on the healthy side and the peak height achieved post-grafting on the cleft side was 1.90 ± 2.82 mm. ConclusionWithin the limitations of the study, it seems that zygomatic buttress is applicable for late unilateral alveolar bone grafting as an intraoral source, and is helpful in symmetric bony nasal floor reconstruction, with a good success rate.

Effect of selective trimming of nasoavleolar molding on maxillary arch growth in patients with unilateral cleft lip and palate.

Presurgical Nasoalveolar molding (PNAM) is a technique used for cleft lip and palate patients prior to cheiloplasty. However, concerns exist regarding its negative impact on maxillary arch growth.This study aimed to assess the effect of selective trimming in NAM on maxillary arch growth in patients with unilateral cleft lip palate. The retrospective observational study analyzed the study casts of 30 patients before and after undergoing nasoalveolar molding treatment. Study casts which were repositories of the institute were analyzed and segregated as Group A: NAM given with selective trimming of the appliance, and Group B: NAM without selective trimming of the appliance. Pre and post-treatment casts were assessed digitally at L-L' (Intercleft segment width), C-C' (Intercanine width), T-T' (Alveolar arch width), L-TT' (Alveolar arch length from major cleft segment), and L'-TT' (Alveolar arch length from minor cleft segment) RESULTS: A notable significant difference between Group A's and B's mean Alveolar arch width and Intercleft segment width was seen. Whereas parameters such as intercanine width, and alveolar arch length as functions from major and minor segments showed no significant variance. Although NAM has been known to affect the growth of the maxillary arch, this study proposes that techniques such as selective trimming can help counteract this drawback.

Dental health of cleft patients attending the 18-month-old clinic at a specialised centre

Orofacial clefts are the most common craniofacial anomaly and children with a cleft are at increased risk of dental caries and anomalies, the most common being hypodontia. This evaluation aimed to establish whether implemented changes after the first cycle led to improved oral health prevention in children attending the 18-month-year-old cleft dental appointment. A total of 44 records were analysed retrospectively over a 9-month period for the second cycle. The initial findings were presented locally and nationally to cleft teams, and an article discussing the dental health of 18-month-old cleft patients was published in the British Dental Journal. Despite the Covid-19 pandemic limiting dental care access, registration with a local dentist increased by 8% in the second cycle. There was a 24% increase in the number of patients having twice-daily toothbrushing performed and an 11% increase in the number of cleft patients who have stopped bottle-feeding by 18 months. The implemented changes following the initial cycle looking at dental health had a positive impact on the percentage of patients who brush twice daily, stopped bottle-feeding and registered with a local dentist.

The Fisher Subunit Anatomical Approach for Cleft Lip Revisions

Abstract Many techniques exist to reapproximate a cleft lip but can leave unsatisfactory results with nonanatomic scars and a short upper lip, creating a need for revision. Many revisions focus on adjacent tissue transfers and realignment of landmarks, but in the senior authors' experience, recreating the defect and utilizing the Fisher repair for revision have led to aesthetically pleasing results and less noticeable scars. A database was collected that included all cleft lip revisions performed at a large, comprehensive children's hospital from October 2018 to July 2021. Inclusion criteria included any cleft patient with a cleft lip revision performed by two craniofacial surgeons. Data collected included sex, characteristics of the cleft lip, age at initial and index repair, type of initial repair, previous revisions, type of revision with any additional tissue rearrangement, and any nose repair. Sixty-five patients were included in the study for analysis. The type of initial repair was known in sixty-four cases (98%), and fifty-four were Millard repairs (83%). Twenty-two patients (33%) had a previous revision prior to their index revision. Sixty patients (92%) underwent the Fisher repair technique for their index revision and forty-six patients (70%) underwent nasal revision. In follow-up, all patients demonstrated an improvement in lip aesthetics. This study demonstrates a large subset of patients that have undergone cleft lip revision using the Fisher technique. In the senior surgeons' experience, the Fisher repair technique in the setting of cleft lip revision is an ideal way to address the shortcomings of historical repair techniques.

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.

Comparative Three-dimensional Analysis of Philtral Ridge Projection in Unilateral Cleft Lip Repair enhanced with Muscle to sub-Dermis suture

Introduction: Recreating the philtral ridge and restoring orbicularis oris muscle continuity in cleft patients is a challenging task. Our muscle to sub-dermis technique introduces an effective method for achieving the desired philtral ridge reconstruction. Method: From August 2015 to July 2023, a retrospective study was conducted with a follow-up period of at least 6 months. This procedure involved a suture technique using muscle-to-sub-dermis sutures. Measurements of philtral projection were taken at two distinct points: one above the cupid's bow and the other at the mid-philtral level. In the comparative analysis of philtral ridges between the cleft and non-cleft sides, the root mean square (RMS) projection value was assessed. Additionally, an analysis of the restoration of the orbicularis oris muscle included the use of color mapping from the mid-sagittal plane and covered seven different points across three distinct horizontal planes: below subnasale, at the mid-philtral level, and above the cupid's bow. Results: Total 134 patients were included with a 37.8-month follow-up(SD 9.4). Philtral side projection was well-maintained, measuring -0.36(0.43)mm, -0.24(0.49)mm on the classical group vs. 0.23(0.29)mm, 0.20(0.21)mm on the muscle to sub-dermis group(p=0.001). The RMS projection value was 0.57(0.46) vs. 0.14(0.046), indicating greater symmetry in the muscle to sub-dermis group, with no difference in sagittal vector analysis of the orbicularis oris muscle between normal and cleft sides. Conclusion: A suturing technique utilizing muscle to sub-dermis sutures has shown promising results in philtral projection and dimple formation. This improvement can be attributed to the combined effect of sub-dermis and less muscle sutures.

Speech characteristics of cleft lip and palate patients after orthognathic surgery

Speech characteristics of cleft lip and palate patients after orthognathic surgery

Characterization and functional prediction of the dental plaque microbiome in patients with alveolar clefts.

Alveolar cleft (AC) is a common congenital defect in people with cleft lip and palate (CLP). Alveolar bone grafting (ABG) is typically performed during adolescence, resulting in the fissure remaining in the mouth for a longer length of time. Patients with AC have a greater rate of oral diseases such as dental caries than the normal population, and the precise characteristics of the bacterial alterations caused by AC are unknown. We recruited a total of 87 subjects and collected dental plaque samples from AC adolescents (AAP), post-operative ABG adolescents (PAP), healthy control adolescents (CAP), AC young adults (AYP), post-operative ABG young adults (PYP), and healthy control young adults (CYP). The sequencing of 16S rRNA genes was performed. The microbial composition of plaque from alveolar cleft patients differed significantly from age-matched healthy controls. Linear discriminant analysis effect size (LEfSe) analysis revealed that AAP was enriched for Neisseria, Haemophilus, Fusobacterium, Rhodococcus, Aggregatibacter, Gemella, and Porphyromonas, whereas AYP was enriched for Capnocytophaga, Rhodococcus, and Actinomyces-f0332. There were phenotypic differences in facultatively anaerobic, Gram-negative, Gram-positive, and oxidative stress tolerance between the AYP group with longer alveolar cleft and the healthy control group according to Bugbase phenotypic predictions. Alveolar bone grafting did not alter the functional phenotype of alveolar cleft patients but reduced the number of differential genera between alveolar cleft patients and healthy controls at both ages. Our study systematically characterized the supragingival plaque microbiota of alveolar cleft patients, post-alveolar bone grafting patients, and matched healthy controls in two ages to gain a better understanding of plaque ecology and microbiology associated with alveolar clefts.

Basic and Informative Photographic Standards for Cleft Lip Patients.

Standardized and reliable medical photographs are crucial for preoperative and postoperative comparisons and academic communication in the medical field. There is limited research on photographic techniques in patients with cleft lip. Deformities of the lip and nose in patients with cleft lip are not only associated with morphological abnormalities but also with abnormalities of muscle function. Considering the morphology and function of the lips and nose in cleft lip patients, the study captured the deformity of cleft lip patients in 6 positions: frontal view, 45 degrees left-right tilted side view, 90 degrees left-right tilted side view, and basal view, and in 5 facial expressions: tightly closed lips, slightly open mouth, smiling, teeth bared, and pout. In 6 different positions and 5 different expressions, we took pictures of lip and nasal deformities covering most of the common deformities in patients with cleft lip, such as white lip scarring, interruption of continuity of vermillion border, lip prolapse, asymmetric corners of the mouth, collapsed ala nasi, loss of the nasal base and deviated nasal septum. This paper suggests a set of effective, easy-to-follow, and precise photographic protocols to assist cleft lip surgeons in capturing suitable and informative, high-quality 2D digital photographs. Level-V.

Genetic Analysis of TPM1 Gene Polymorphism (rs11071720) in Patients with Non-Syndromic Cleft Lip/Palate in the South Indian Population. A Case Control Study

The aim of this study was to find out if there was an association between TPM1 gene polymorphism (rs11071720) and non-syndromic cleft lip and palate in humans. Twenty five patients with non-syndromic cleft lip and palate (NSCL/P) and twenty five healthy patients as controls were enrolled in the study. Whole blood drawn from the participants was used to obtain genomic DNA. Sequence specific primers were used to amplify the region spanning the polymorphic site of the TPM1 gene using polymerase chain reaction (PCR). The genotype of the subjects was identified employing the RFLP technique. The genotype and allele frequency distributions in the non-syndromic cleft lip and cleft palate patients and control groups were compared using Chi-square test. In the NSCL/P, the genotype in the order from highest to lowest frequency was TC (48%), followed by CC (32%) and TT (20%). Although the genotype frequency of the case and the control groups were found to be in agreement with Hardy Weinberg Equilibrium, the genotype frequencies TC, CC and TT of the polymorphism (rs11071720) among the two groups were not statistically significant which was evident from the p-value 0.8472. No significant association was found between TPM1 gene (rs11071720) polymorphism and NSCL/P.

A novel approach in orthodontics: Archwise distraction osteogenesis

Distraction osteogenesis can be described as a procedure that is based on the principles of physiologic remodeling and indirect fracture healing. In dentoalveolar level, conventional appliances may present some difficulties such as the need for multiple stages of DO to achieve a good occlusion due to distraction on a straight vector; incompetency to reduce the oronasal fistula in cleft patients; and the difficulty in achieving complete hard and soft tissue reconstruction, especially in cases with large alveolar defects.ArchWise Distraction Appliance (AWDA) have been developed to overcome these limitations and obtain a regenerated bone curvilinear in shape, similar to the original alveolar bone configuration. This article aims to introduce and explain the AWDA method in detail so that every clinician will be able to perform the treatment. The reader can observe the application of the procedure on a variety of cases including cleft lip and palate, trauma, and bone pathology. Possible complications and their solutions are also explained on actual cases.