Cleft Lip And Palate Group Research Articles

Craniofacial structure variations in patients with palatal anomalies and velopharyngeal dysfunction.

Cephalometric evaluation of craniofacial and craniopharyngeal morphology is important for understanding the factors affecting velopharyngeal dysfunction (VPD) in patients with palatal anomalies. In this study, 366 patients with VPD were retrospectively stratified into cleft lip and palate (CLP), cleft palate (CP), submucous cleft palate (SMCP), occult submucous cleft palate (OSMCP), and non-CP groups. Lateral cephalometrics were used to assess craniofacial, craniopharyngeal, and velopharyngeal anatomy. The average craniofacial morphology in patients with VPD differed significantly according to the type of palatal anomaly. The non-CP and OSMCP groups differed from the CLP, CP, and SMCP groups in nasopharyngeal size and shape as depicted by a larger ANS-Ptm-Ve angle, a smaller S-N-Ba and NBa-PP angles, and a shorter linear value of S-Ar in the non-CP group. The CLP and CP groups had shorter ANS-Ptm, shorter Ptm-P, and smaller SNA and SNB angles. VPD patients with overt clefts have different skeletal and nasopharyngeal shapes compared to non-CP and OSMCP. Velopharyngeal function assessment should include the size and shape of the nasopharyngeal space in addition to the size and the activity of the velum and posterior and lateral walls of the nasopharynx. This should enable a more precise understanding of VPD pathology, and lead to improvements in the posterior pharyngeal flap technique in order to obtain better postoperative speech outcomes after surgical management of velopharyngeal dysfunction.

Nasal Septal Anatomy in Skeletally Mature Patients With Cleft Lip and Palate

Septal deviation commonly occurs in patients with cleft lip and palate (CLP); however, the contribution of the cartilaginous and bony septum to airway obstruction in skeletally mature patients is poorly understood. To describe the internal nasal airway anatomy of skeletally mature patients with CLP and to determine the contributors to airway obstruction. This single-center retrospective review included patients undergoing cone-beam computed tomography (CBCT) from November 1, 2011, to July 6, 2015, at the cleft lip and palate division of a major academic tertiary referral center. Patients met inclusion criteria for the study if they were at least 15 years old at the time of CBCT, and images were used only if they were obtained before Le Fort I osteotomy and/or formal septorhinoplasty. Twenty-four skeletally mature patients with CLP and 16 age-matched control individuals were identified for the study. Septal deviation and airway stenosis were measured in the following 3 coronal sections: at the cartilaginous septum (anterior nasal spine), bony septum (posterior nasal spine), and midpoint between the anterior and posterior nasal spine. The perpendicular plate of the ethmoid bone and vomer displacement were measured as angles from the vertical plane at the coronal section of maximal septal deviation. The site of maximal septal deviation was identified. Among the 40 study participants, 26 were male. The mean (SD) age was 21 (5) and 23 (6) years for patients with CLP and controls, respectively. Septal deviation in patients with CLP was significantly worse than that of controls at the anterior nasal spine (2.1 [0.5] vs 0.8 [0.2] mm; P < .05) and posterior nasal spine (2.9 [0.5] vs 1.0 [0.3] mm; P < .01) and most severe at the midpoint (mean [SD], 4.4 [0.6] vs 2.1 [0.3] mm; P < .01). The point of maximal septal deviation occurred in the bony posterior half of the nasal airway in 27 of 40 patients (68%). The CLP bony angular deviation from the vertical plane was significant in the CLP group compared with the control group (perpendicular plate of the ethmoid bone, 14° [2°] vs 8° [1°]; vomer, 34° [5°] vs 13° [2°]; P < .05 for both), and vomer deviation was significantly associated with anterior nasal airway stenosis (r = -0.61; P < .01). Skeletally mature patients with CLP have significant septal deviation involving bone and cartilage. Resection of the bony and cartilaginous septum should be considered at the time of definitive cleft rhinoplasty. NA.

Evaluation of Delayed Puberty in Adolescents With Cleft Lip/Palate.

To assess the frequency of delayed puberty in adolescents with cleft lip and/or cleft palate (CL/P). This was a cross-sectional study of 203 patients with CL/P and no associated syndromes treated at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil. We evaluated boys aged 14-19 years and girls aged 13-18 years. The patients were classified according to Tanner stages of sexual development. The age of menarche was recorded. Patients were assigned to three groups according to cleft type: isolated cleft lip (CL), cleft lip and palate (CLP), and isolated cleft palate (CP). The results were expressed as frequencies and averages and compared with pubertal changes described for typically developing adolescents as reported in the literature. Subjects were 115 boys and 88 girls. All boys in the CL group and the CP group had already started puberty, and two boys in the CLP group (2.3%) had delayed puberty. All girls had started puberty. The average age at menarche was 12.3 years in the CL group, 12.1 years in the CLP group, and 12.5 years in the CP group. The frequency of delayed puberty and the average age at menarche in adolescents with CL/P and no associated genetic syndromes or anomalies were within the expected range for typically developing adolescents (i.e., those without CL/P) in the same age group.

Use of the Derriford Appearance Scale 59 to assess patient-reported outcomes in secondary cleft surgery

Background Secondary rhinoplasty, one of the final procedures in addressing the stigma of the cleft lip and palate (CLP), has both functional and aesthetic objectives. The way in which physicians evaluate outcomes in surgery concerning aesthetics is changing. Well-designed patient-reported outcome measures to assess health-related quality of life improvements attributable to surgery are increasingly being used. The Derriford Appearance Scale 59 (DAS-59) is currently the only available validated patient-reported outcome measure that assesses concern about physical appearance. Methods Twenty patients with CLP presenting between May 2009 and May 2013 for secondary rhinoplasty to Sunnybrook Health Sciences Centre (Toronto, Ontario) were recruited. DAS-59 measures were administered both preoperatively and at least six months after surgery. Pre- and postoperative measures were scored and compared. Item-by-item analysis of the measure was also performed. Results Total scores for this CLP group indicated greater concern about appearance than the general population. Across all subscales of the measure, there was a reduction in scores after secondary rhinoplasty suggesting less patient concern with appearance and a positive effect of surgery on patient quality of life. Item-by-item analysis suggested relatively few items in the measure were driving overall change in total scores. Conclusion Comparison of pre- and postoperative scores with the DAS-59 in secondary cleft rhinoplasty suggests there is less concern with appearance after surgery. However, a small number of items within this generic scale contributing to this difference may suggest the need for a more patient specific measure for assessment of surgical outcomes in the cleft population.

Use of the Derriford Appearance Scale 59 to assess patient-reported outcomes in secondary cleft surgery.

Secondary rhinoplasty, one of the final procedures in addressing the stigma of the cleft lip and palate (CLP), has both functional and aesthetic objectives. The way in which physicians evaluate outcomes in surgery concerning aesthetics is changing. Well-designed patient-reported outcome measures to assess health-related quality of life improvements attributable to surgery are increasingly being used. The Derriford Appearance Scale 59 (DAS-59) is currently the only available validated patient-reported outcome measure that assesses concern about physical appearance. Twenty patients with CLP presenting between May 2009 and May 2013 for secondary rhinoplasty to Sunnybrook Health Sciences Centre (Toronto, Ontario) were recruited. DAS-59 measures were administered both preoperatively and at least six months after surgery. Pre- and postoperative measures were scored and compared. Item-by-item analysis of the measure was also performed. Total scores for this CLP group indicated greater concern about appearance than the general population. Across all subscales of the measure, there was a reduction in scores after secondary rhinoplasty suggesting less patient concern with appearance and a positive effect of surgery on patient quality of life. Item-by-item analysis suggested relatively few items in the measure were driving overall change in total scores. Comparison of pre- and postoperative scores with the DAS-59 in secondary cleft rhinoplasty suggests there is less concern with appearance after surgery. However, a small number of items within this generic scale contributing to this difference may suggest the need for a more patient specific measure for assessment of surgical outcomes in the cleft population.

Maxillary gap at 11-13 weeks' gestation: marker of cleft lip and palate.

To describe a new sign of cleft lip and palate (CLP), the maxillary gap, which is visible in the mid-sagittal plane of the fetal face used routinely for measurement of nuchal translucency thickness. This was a retrospective study of stored images of the mid-sagittal view of the fetal face at 11-13 weeks' gestation in 86 cases of CLP and 86 normal controls. The images were examined to determine if a maxillary gap was present, in which case its size was measured. In 37 (43.0%) cases of CLP the defect was isolated and in 49 (57.0%) there were additional fetal defects. In the isolated CLP group, the diagnosis of facial cleft was made in the first trimester in nine (24.3%) cases and in the second trimester in 28 (75.7%). In the group with additional defects, the diagnosis of facial cleft was made in the first trimester in 46 (93.9%) cases and in the second trimester in three (6.1%). A maxillary gap was observed in 96% of cases of CLP with additional defects, in 65% of those with isolated CLP and in 7% of normal fetuses. There was a large gap (>1.5 mm) or complete absence of signals from the maxilla in the midline in 69% of cases of CLP with additional defects, in 35% of those with isolated CLP and in none of the normal controls. The maxillary gap is a new simple marker of possible CLP, which could increase the detection rate of CLP, especially in isolated cases.

Amelogenin gene influence on enamel defects of cleft lip and palate patients.

The aim of this study was to investigate the occurrence of mutations in the amelogenin gene (AMELX) in patients with cleft lip and palate (CLP) and enamel defects (ED). A total of 165 patients were divided into four groups: with CLP and ED (n=46), with CLP and without ED (n = 34), without CLP and with ED (n = 34), and without CLP or ED (n = 51). Genomic DNA was extracted from saliva followed by conducting a Polymerase Chain Reaction and direct DNA sequencing of exons 2 through 7 of AMELX. Mutations were found in 30% (n = 14), 35% (n = 12), 11% (n = 4) and 13% (n = 7) of the subjects from groups 1, 2, 3 and 4, respectively. Thirty seven mutations were detected and distributed throughout exons 2 (1 mutation - 2.7%), 6 (30 mutations - 81.08%) and 7 (6 mutations - 16.22%) of AMELX. No mutations were found in exons 3, 4 or 5. Of the 30 mutations found in exon 6, 43.34% (n = 13), 23.33% (n = 7), 13.33% (n = 4) and 20% (n = 6) were found in groups 1, 2, 3 and 4, respectively. c.261 C > T (rs2106416), a silent mutation, was detected in 26 subjects, and found more significantly (p = 0.003) in patients with CLP (groups 1 and 2 - 23.75%), compared with those without CLP (groups 3 and 4 - 8.23%). In the groups without ED, this silent mutation was also found more significantly (p = 0.032) among subjects with CLP (17.65% in group 2), compared with those without CLP (7.8% in group 4). In conclusion, this study suggested that AMELX may be a candidate gene for cleft lip and palate.

Impact of Early Synchronous Lip and Palatal Repair on Speech

Aims: The purpose of this study was to describe articulation and resonance characteristics of Ugandan English-speaking children with cleft lip and palate (CLP) after synchronous lip and palatal closure (Sommerlad technique) prior to the age of 6 months in comparison with an age- and gender-matched control group. Methods: Eleven Ugandan patients with CLP (mean age 4;9 years), repaired during a synchronous lip and (soft and hard) palatal closure at a mean age of 3.4 months, were included as well as a control group (n = 22) consisting of 2 Ugandan age- and gender-matched noncleft children for each patient (mean age 4;10 years). Objective and perceptual speech assessment techniques were applied. Results: Consonant inventories were significantly smaller in the CLP group. Moreover, phonetic disorders and phonological processes occurred in 91 and 100% of the CLP group, respectively. Perceptual consensus evaluation revealed absence of hyponasality and cul-de-sac resonance in all patients. Hypernasality and nasal emission/turbulence occurred in 18 and 27% of the patients, respectively. No significant group differences were observed regarding the mean nasalance values of oral speech samples. Conclusion: Various deviations from normal speech development seem to occur in patients with CLP following synchronous lip and palatal closure before 6 months of age.

Pharyngeal Airway Dimensions in Cleft Lip and Palate Patients Compared With Class I Subjects

ABSTRACT Objective: The aim of this study was to analyze and compare the pharyngeal airway dimensions of cleft lip and palate (CLP) and skeletal Class I patients. Materials and Method: The study was carried out in 91 subjects asking for orthodontic treatment in Ankara University, Turkey. The patients were selected from the archives of the Orthodontics Department. Forty-eight of the patients had CLP and 43 were skeletal Class I patients. Both control and CLP groups were divided into 3 subgroups according to the ages 7–11, 11–14, and 15 years and older. The number of subjects was matched in the same age groups. The pretreatment lateral cephalometric head films of the subjects were used in the study. Airway dimensions were evaluated with area measurements using planimeter. The airway was divided into 3 parts, and measurements were done on those areas. SNA, SNB, ANB, and GoGnSN angles were measured in all cephalograms by the same examiner. The values were compared within the same age group in both the CLP and...

Effect of maxillary osteotomy on speech in cleft lip and palate: perceptual outcomes of velopharyngeal function

Abnormal facial growth is a well-known sequelae of cleft lip and palate (CLP) resulting in maxillary retrusion and a class III malocclusion. In 10-50% of cases, surgical correction involving advancement of the maxilla typically by osteotomy methods is required and normally undertaken in adolescence when facial growth is complete. Current evidence for the impact of the surgery on velopharyngeal function is weak and mixed. The first objective of the study was to investigate the nature of the effect of maxillary osteotomy on the perceptual outcomes of velopharyngeal function in CLP. The second objective was to establish if speech changes seen early at 3 months post-operation persisted for a year after/following surgery', when it is considered that the maxilla is relatively stable. Twenty consecutive patients with CLP undergoing maxillary osteotomy by a single surgeon were seen pre-operatively (T1), 3 months (T2) and 12 months (T3) post-operation. A non-cleft control group (NonCLP) undergoing surgery was also recruited. Speech data were collected using the Cleft Audit Protocol for Speech-Augmented (CAPS-A). A velopharyngeal composite score-summary (VPC-SUM) was derived from specific CAPS-A-rated parameters. An external CAPS-A-trained therapist, blinded to the study, rated the randomized samples and inter-rater reliability was established. For the CLP group, hypernasality and nasal turbulence increased significantly post-operation. Planned comparisons were significant for T1-T2 only with a medium effect size. For hypernasality, the CLP group differed statistically from the NonCLP group at T2 and T3. For nasal turbulence, the CLP group differed statistically from the NonCLP group at T2. For VPC-SUM, there were statistically significant changes post-operatively between T1-T2 and T1-T3 only with medium effect sizes for the CLP group only. This study provides evidence that maxillary osteotomy affects patients with and without CLP differently. In patients with CLP, surgery may impact negatively on velopharyngeal function for speech and changes seen early on at 3 months post-operatively appear to persist at 12 months postoperatively. The findings in this study have implications for the speech care pathway of patients with CLP undergoing maxillary osteotomy in terms of assessment, review and management.

Caries Experience of Chinese Children with Cleft Lip and Palate

Objective : This study evaluated the caries experience in the primary teeth of children with and without cleft lip and palate (CLP). Design : Observational study. Setting : Dental hospital clinic. Patients : The sample consisted of 132 pairs of Chinese children with and without CLP matched by gender, age, ethnicity, and socioeconomic status. Their ages were between 2 and 7 years. Methods : The children were dichotomized into 2- to 4-year-old (n = 71) and 5- to 7-year-old groups (n = 61). The oral examination was performed by one trained and calibrated dentist, and the caries experience was determined using the dmft (decay missing filled teeth) index. Results : For the 2- to 4-year-old group, the dmft values were 1.5 for the cleft group and 1.6 for the non-CLP group, but the difference was not statistically significant. For the 5- to 7-year-old group, the dmft indices were 5.2 for the cleft group compared with 2.9 for the control group; this difference was statistically significant (p = .0006). The caries rate for the various tooth types in the 5- to 7-year-old group was higher in the CLP group than in the non-CLP group; the most marked difference was for the lateral incisors, mandibular molars, and maxillary left first molars (p = .0001). Conclusions : The 5- to 7-year-old children with CLP had a higher caries experience in the primary dentition than the children without CLP.

Dental anxiety in children with cleft lip and palate: a pilot study.

To investigate the level of dental fear and anxiety of children who have cleft lip and palate (CLP). The study was performed at Cukurova University, Faculty of Dentistry. A total of 32 7- to 12-yearold children, 17 of them with CLP (8 girls and 9 boys) and 15 of them without CLP (7 girls and 8 boys) participated in the study. The children were evaluated by using the Facial Image Scale (FIS) and Dental Subscale of Children's Fear Survey Schedule (CFSS-DS) methods. The anxiety state of the children was assessed twice using FIS: first in the dental hospital waiting room (FIS-WR) and after, while sitting in the dental chair (FIS-DC). CFSS-DS was administered to all participants in order to assess the dental anxiety while they were sitting in the dental chair. According to the FIS results, there was no difference between CLP and control group in the waiting room (P = 0.682). However, the CLP group showed lower scores than the control group while they were sitting in the dental chair (P = 0.030). The FIS scores of the CLP group were significantly higher in the waiting room than while sitting in the dental chair (P = 0.007). In the control group, there was no significant difference between FIS-WR and FIS-DC values (P = 0.664). The total CFSS-DS scores of children with CLP were lower than those of the control group, but these differences were not statistically significant (P > 0.05). Children with CLP showed more anxiety in the FIS-WR than in the FIS-DC, but they showed lower scores than the control group in the FIS-DC. The positive previous experience of meetings with dentists of the CLP children could explain these results. Positive previous experiences with dentists and a short time in the waiting room could be key elements in the care of CLP children.

Psychological Implications of Cleft Lip and Palate (CLP) in Children

BACKGROUND: Although quality of life (QOL) is becoming an important outcome measure in research on children with CLP in Western countries, there is very little information available on this aspect in children with CLP in India.&#x0D; OBJECTIVE: To determine the self-concept and QOL of children with cleft lip and palate (CLP) patient and to compare it with age matched non CLP patients.&#x0D; METHODS: Self-concept and QOL were assessed using the Self Concept Scale (SCS) and Pediatric Quality of Life inventory. Total of 160 subjects were divided into 4 age groups of each containing 40 subjects i.e., group 1 (7-10 years), group 2 (11- 13years), group 3 (14-16years) and group 4 (16-24years). In each age group, 20 were CLP subjects and the other 20 were non CLP subjects&#x0D; RESULTS: The CLP subjects had lower self-concept scores than the non-CLP subjects. The self-concept scores showed a decreased trend in CLP subjects across the group from age 7-10 years to subjects &gt; 16 years. The quality of life score in CLP subjects was lower than that in the non CLP subjects. A statistically significant lower quality of life score was seen in adult cleft group compared to non CLP group.&#x0D; CONCLUSION: The self-concept and quality of life scores were significantly lower in older age CLP subjects compared to non CLP subjects. JMS 2012;15(2):115-18

Health related quality of life of patients with non-syndromic orofacial clefts

ObjectiveTo evaluate the relation between health-related quality of life (QOL), in a large representative group of adolescents with non-syndromic orofacial clefts. Study design724 non-syndromic patients with an orofacial cleft who had finished their surgical treatment were included in this prospective study. Mean age of the patients was 16.8 years (SD=1.9). Patients were divided into two groups: cleft lip (CL), and cleft lip and palate (CLP). The CL and CLP group were again divided into patients with unilateral and bilateral cleft lips. Health related quality of life was measured using a modified SF-36 questionnaire to measure eight dimensions. To validate the modified SF-36 questionnaire, a control group of 744 patients who had undergone ENT surgeries were given the same questionnaire. ResultsThe answers of the ENT patients were compared with the answers of the cleft patients, using the Chi-Square test. Cleft patients showed a high score on the eight dimensions of the questionnaire. For five of the dimensions the mean score was above 4. The lowest score was found on bodily pain (mean 3.45). There was no effect of age. Having a cleft palate influenced all eight dimensions statistically more in a negative way than a cleft lip does. ConclusionOn average cleft patients have a good health related quality of life. However, there were differences in the levels of satisfaction. The major factor influencing quality of life negatively was the presence of a cleft palate.

Dental anomalies in individuals with cleft lip and/or palate

Significant heterogeneity has previously been reported but with no consensus on the prevalence of dental anomalies in subjects with a cleft lip and palate (CLP), thus, the purpose of this study was to investigate the frequency of various dental anomalies in the upper dental arch in different cleft groups. Diagnostic records, i.e., panoramic, occlusal and periapical films, dental casts, and intra-oral photographs, of 122 subjects (mean age: 14 +/- 5 years; 67 males and 55 females) were grouped as either unilateral left cleft lip and palate (ULCLP), unilateral right cleft lip and palate (URCLP), bilateral cleft lip and palate (BCLP), or cleft palate (CP). Prevalence rates of 15 different dental anomalies were calculated for each group. Wilcoxon's test was used to determine if there was a statistically significant difference in the number of missing teeth between the right and left sides, in each cleft group. Overall, 96.7 percent of patients were found to have at least one dental anomaly. The most prevalent was agenesis in the anterior region on the cleft side (70.8-97.1 percent). There was a statistically significant difference in the prevalence of agenesis by cleft and non-cleft sides but only in the ULCLP group (P < 0.001). Significantly higher rates of impaction were observed in the anterior and premolar regions in the CLP groups (2.9-29.2 percent), with the highest rates in the anterior region on the cleft sides. A very high proportion of subjects were found to have at least one dental anomaly. Thus, the management of dental anomalies should be central to the treatment planning process of individuals with a cleft.

Three-dimensional geometric morphometrics applied to the study of children with cleft lip and/or palate from the North East of England

This prospective cross-sectional, case-controlled morphometric study investigated three-dimensional facial morphological variation among and between 8- and 12-year-old children [40 with a unilateral cleft lip and palate (UCLP), 23 with a unilateral cleft lip and alveolus (UCLA), 19 with a bilateral cleft lip and palate (BCLP), and 21 with an isolated cleft palate (ICP)]. Eighty gender- and age-matched individuals comprised the control group. The mean shape of each group was computed using generalized Procrustes analysis (GPA). Differences in shape between group means were assessed using multivariate analysis of variance and permutation tests, and shape differences were visualized for interpretation using warpings of the grand mean shape and transformation grids computed using thin plate splines (TPA). Statistically significant differences between the mean facial shapes and forms (shape plus size) of all groups were found. The greatest difference was in the BCLP group and the second greatest in the UCLP group. The study of asymmetry indicated different degrees and differences in the nature of asymmetry that characterize different cleft lip and palate (CLP) deformities. Principal component analyses (PCA) of form space and of means, plus reflected means, were informative with respect to the differences in facial size and shape and asymmetry between these groups. The results highlight differences in the aetiology of ICP and CLP groups and underline the potential value of statistical shape analysis in assessing the outcomes of CLP treatment.

Oral health status and behaviour of Greek patients with cleft lip and palate

This was to record the oral health profile and more specifically the prevalence of carious and hypoplastic lesions in children and adolescents with cleft lip and palate (CLP). The study group consisted of 41 children and adolescents (4-18 years-old) with CLP group while a similar number of non-cleft persons (HLP) matched for sex, age and orthodontic treatment (75.6%), was used as the control group. Information regarding the oral health habits, medical and dental history were collected using a questionnaire. Stimulated saliva was collected to evaluate the flow rate and buffering capacity as well as the levels of mutans streptococci and lactobacilli using the chair-test CRT(R) (Ivoclar -Vivadent). Oral hygiene (OH) was assessed using the index of Silness and Loe [1964]. The prevalence of initial/white spot and cavitated carious lesions as well as hypoplasia was evaluated based on the criteria by ICDAS [2005] and Nyvad et al [2008] as well as Koch et al [1987] respectively. The statistical analysis was carried out using the t-test and the chi- square test. Approximately half of the CLP and HLP subjects were brushing their teeth 2 x per day. Both groups reported an average of 3 main and 2 snack meals per day. Levels of mutans streptococci and lactobacilli as well as the quality of the saliva were similar for both groups. The plaque index score was significantly higher in the CLP than in the control group (p=0.0003). The prevalence of cavitated carious lesions was similar in both groups but that of the initial/white spot lesions, especially at the area of maxillary incisors, was higher in the CLP group (85%, p=0.000). The increased numbers of initial/ white spot lesions combined with poor OH found in the CLP group predispose for an increased risk of further development to carious cavitated lesions. Taking into consideration that the majority of those patients were under orthodontic treatment, the application of an intensive individualized oral health preventive program, focused on remineralisation of the initial caries, is imperative.

Evaluation of 3-dimensional tooth crown size in cleft lip and palate patients

The aims of this study were to evaluate 3-dimensional (3D) tooth crown sizes in patients with cleft lip and palate (CLP) and to compare them with those of a Class I control group. Orthodontic dental casts were used of 72 subjects with CLP (20 bilateral [BCLP], 34 unilateral left [ULCLP], 18 unilateral right [URCLP]) and 53 adolescents in the permanent dentition stage with Class I occlusion. Mesiodistal (MD), labiolingual (LL), and occlusogingival (OG) measurements were recorded by the same examiner using a digital caliper. Statistical analyses were conducted, including repeatability, analysis of variance (ANOVA), and the Duncan tests. Maxillary and mandibular premolar MD dimensions were larger in the CLP groups than in the control group. The smallest MD dimensions were those of the maxillary right lateral incisors in the BCLP group (P <0.05). The maxillary left lateral incisor MD dimensions in the ULCLP group were smaller when compared with other CLP groups (P <0.001). In general, all LL and OG measurements were smaller in the CLP groups than in the Class I group in both dental arches. In general, MD, LL, and OG dimensions of CLP patients were smaller than those of the Class I subjects, not only in the affected maxillary dental arch, but also in the mandibular dental arch. Variations in 3D tooth dimensions were found among all CLP types. The lateral incisor in the cleft region was the smallest. A 3D tooth-size evaluation should be included in the diagnostic records to determine precise treatment planning and final occlusion in CLP patients.

Activities of the Muscles Involved in Swallowing in Patients with Cleft Lip and Palate

This study was designed to examine the nature of the activity of swallowing muscles in patients with cleft lip and palate (CLP). The electromyographic activity of the thyrohyoid muscle (TH), the geniohyoid muscle (GH), and the myohyoid muscle (MH) of patients with CLP (CLP group) was analyzed and compared with noncleft subjects (control group) during swallowing and drinking water with and without artificial nasal obstruction. In the normal situation without nasal obstruction, a significant (p < 0.01) difference in muscle activity between the two groups was found only for TH. In the control group, the duration and magnitude of muscle activity were significantly (p < 0.01) larger in all the muscles when a nasal obstruction was applied. Meanwhile, in the CLP group these values exhibited a significant (p < 0.05) increase in GH and MH only. With nasal obstruction, the burst durations of GH and MH became significantly (p < 0.01) longer in the control group than in the CLP group. The amplitude of GH activity during swallowing was significantly (p < 0.05) larger in the control group than in the CLP group. These results suggest that in CLP patients during swallowing, TH working from the pharyngeal stage compensates for the weakness of GH and MH working in the oral phase. This may cause a premature transfer of the bolus to the pharynx before making it properly into the oral cavity.

Finite element growth analysis for the craniofacial skeleton in patients with cleft lip and palate

The purpose of this study was to clarify the differences in the nature of craniofacial growth between subjects with normal occlusion and patients with unilateral cleft lip and palate (CLP) in terms of the size, shape and principal growth direction of craniofacial skeleton using finite element method (FEM). Lateral cephalograms were taken of 40 subjects as normal group and 178 patients as CLP group. These subjects were divided into seven developmental ages of 4-, 6-, 8-, 10-, 12-, 14- and 18-year-old. For the finite element analysis, the craniofacial complex was discretized into seven structures or elements with three nodal points in each after tracing each lateral cephalogram on acetate paper. For each stage, the growth parameters in CLP group were compared to those in normal group. The growth of upper facial skeleton and maxillary complex was more remarkably inhibited in CLP than in normal group. Especially, the growth inhibition of posterior maxillary complex in a vertical direction was remarkable in CLP group at any ages. Difference in the size and shape of entire mandibular skeleton between CLP and normal groups was not apparent. It is suggested that grow timing and peak velocity, an essential and key determinant to the success in orthodontic treatment, have been clarified in this study more clearly than in previous studies. It is hopefully anticipated to explore some key determinants to predict individual growth of the craniofacial skeleton near future.