Cleft Lip And Palate Patients Research Articles

Speech Assessments in Hypoplastic Cleft Maxilla Treated by Anterior Segmental Distraction Osteogenesis

Introduction: Cleft lip and palate (CLP) affect the craniofacial region, with significant implications for speech, hearing, feeding, and facial aesthetics. This study aimed to evaluate the impact of anterior maxillary segmental distraction osteogenesis (AMSDO) using an internal distractor on speech outcomes in CLP patients, assessed using the Pittsburgh Weighted Speech Scale (PWSS).Methodology: A single-center prospective study was conducted between March 2022 and April 2024. Twelve CLP patients with maxillary hypoplasia, aged 17.8 to 32.6 years, were included. Purposive sampling was done to include patients with complete unilateral or bilateral CLP who exhibited Class III skeletal relationships with reverse overjet greater than 7 mm. Speech assessments were conducted preoperatively (1-3 months before surgery) and postoperatively (5-7 months after distraction). Speech samples were recorded and evaluated by a licensed speech-language pathologist using the PWSS. Statistical analysis was performed using paired t-tests and Chi-square tests.Results: Significant improvements were observed in the total PWSS score (p = 0.03), nasality (p < 0.001), phonation (p < 0.001), and articulation errors (p = 0.004) postoperatively. No significant changes were seen in nasal emission and facial grimace. No correlation was found between the amount of distraction and speech outcomes. Unilateral cleft patients showed better outcomes than bilateral cleft patients, though not statistically significant.Conclusion: AMSDO significantly improves speech outcomes in CLP patients with maxillary hypoplasia. The PWSS is a reliable tool for assessing these changes. Further research with larger samples and longer follow-ups is warranted to confirm these findings.

Assessment of Zygomaticomaxillary Suture Maturation in Patients With Unilateral Cleft Lip and Palate: Implications for Orthodontic Treatment Planning.

Introduction The zygomaticomaxillary suture (ZMS) is vital for craniofacial development and orthodontic treatment planning. Located at the junction of the zygomatic and maxillary bones, the ZMS undergoes significant changes during growth, affecting midfacial morphology and stability. Understanding ZMS maturation is essential for optimizing orthodontic interventions, especially in patients with cleft lip and palate (CLP), who often exhibit altered craniofacial growth patterns due to congenital deformities and surgical interventions. Methodology A retrospective analysis was conducted with 50 participants, including 25 patients with unilateral CLP and 25 age-matched controls. Clinical and radiographic data, including lateral cephalometric radiographs and cone-beam computed tomography (CBCT) scans, were collected to assess ZMS maturation stages. The stages, ranging from immature (stage 0) to fully mature (stage 4), were evaluated using established radiographic criteria. Statistical analyses, including Chi-square tests and logistic regression, were performed to compare the distribution of maturation stages between groups. Results Significant differences were observed in ZMS maturation stages between the cleft side, non-cleft side, and control group. The cleft side exhibited a higher prevalence of immature (stage 0) and early maturation (stage 1) stages compared to the control group, with mean values of 4 ± 1.2 and 5 ± 1.3, respectively. The control group showed a higher prevalence of fully mature (stage 4) sutures, with a mean value of 8 ± 1.4. The p-values for stages 0, 1, and 4 were 0.045, 0.034, and 0.039, respectively, indicating statistical significance. The findings highlight distinct maturation patterns in CLP patients, with delayed ZMS maturation on the cleft side. This suggests the need for tailored orthodontic interventions to accommodate prolonged growth phases in CLP patients. The study underscores the importance of detailed ZMS assessments for personalized treatment planning. Future research should focus on longitudinal studies to further understand CLP's impact on craniofacial development. Conclusion Assessing ZMS maturation provides critical insights for optimizing orthodontic and surgical treatment outcomes in CLP patients. By identifying specific developmental delays and tailoring interventions accordingly, clinicians can improve the effectiveness and stability of treatments. This study contributes to the growing body of evidence supporting individualized treatment plans based on precise developmental assessments.

Impact of Geopolitical Unrest on Surgical Delays and Outcomes in Immigrant Populations With Cleft Lip and Palate

Background: Geopolitical conflicts in the Middle East have led to mass migrations, with Turkey becoming a major host country. This influx has strained the health care system, particularly regarding specialized care for conditions like cleft lip and palate (CLP). Timely intervention is crucial for optimal outcomes, but cultural, socioeconomic, and logistical barriers often cause delays, impacting physical, functional, and psychosocial development. Methods: This retrospective study analyzed 72 immigrant pediatric CLP patients treated in Turkey between 2012 and 2022. Data on demographics, medical history, surgical interventions, complications, and treatment delays were collected. Surgical timing was compared with American Cleft Palate Craniofacial Association guidelines, and the impact of socioeconomic status on delays was assessed. Results: Seventy-two patients underwent a total of 91 surgical interventions, including 29 cleft lip repairs, 22 cleft palate repairs, 6 pharyngeal flaps, 15 fistula closures, 8 corrections of secondary lip scars and whistling deformities, and 11 alveolar bone graftings. A majority (73.6%) had poor socioeconomic status. The average delays for cleft lip, cleft palate, and alveolar bone grafting surgeries were 5.3±4, 7.3±6.1, and 34.1±23.5 months, respectively, and were significantly longer for patients with poor socioeconomic status (P=0.00502, 0.030741, and 0.041878). The average delay for pharyngeal flap surgery, performed in patients with poor socioeconomic status (except for one), was 43.7±14.1 months. Conclusions: This study highlights the challenges and disparities in CLP care for immigrant children in Turkey due to geopolitical conflict. While surgical complication rates are similar to established data, delays in treatment, especially among those with lower socioeconomic status, are a significant concern. The findings emphasize the need for comprehensive, culturally sensitive care and systemic interventions to improve access and outcomes for this vulnerable population.

Evaluation of Sphenoid Sinus Variations in Cleft Lip and Palate Patients: A Comprehensive Cone Beam Computed Tomography Analysis.

This study aims to compare sphenoid sinus variations between unilateral and bilateral cleft lip and palate (CLP) patients and healthy controls using CBCT images. It is notable for its large sample size and comparison of unilateral and bilateral cleft patients, cleft and noncleft sides, and different age groups. Retrospective cohort study. University Hospital. CBCT images of 97 CLP patients (76 unilateral, 21 bilateral) and 97 healthy controls were evaluated.Main Outcome Measures: Sphenoid sinus main types, sellar subtypes, clival, and lateral extensions were assessed for all groups. A significant increase in the anterior type was observed in both unilateral and bilateral CLP groups. The bilateral CLP group had a higher prevalence of the lesser wing type. In CLP and control groups, lesser wing, combined type, and lateral type were statistically significantly lower under 13 years of age. The study highlights an elevated prevalence of anterior pneumatization in unilateral and bilateral CLP individuals, emphasizing its significance in surgery planning due to proximity to critical structures like the optic nerve and sphenopalatine artery. The increased prevalence of the lesser wing type in bilateral CLP patients requires extra caution during anterior clinoidectomy. Lower pneumatization rates in CLP patients under 13 suggest their sphenoid sinus development is similar to that of healthy individuals. Understanding these variations is crucial for appropriate surgical planning and avoiding complications during transsphenoidal surgery.

The Use of Stem Cells in Bone Regeneration of Cleft Lip and Palate Patients: A Systematic Review.

Background and Objectives: Cleft lip alone or a combination of cleft lip and palate (CLP) is a common developmental abnormality in the craniofacial region. This umbrella review aims to identify promising avenues for treatment using stem cell therapy. Materials and Methods: Systematic reviews from 2014 to 2024 were searched among databases like PubMed, Medline, and Google Scholar. PRISMA guidelines were employed to ensure the thoroughness of the search. A quality assessment (ROBIS) of the included reviews was conducted to ensure the reliability and validity of the synthesized evidence. Results: Five systematic reviews were selected for this umbrella review. Results show that stem cell therapy, specifically using mesenchymal stem cells (MSCs) and adipocyte stem cells (ADSCs), promotes bone regeneration in CLP deformities. Although multiple studies have established the effectiveness of diverse types of stem cells in treating CLP, important considerations including safety concerns, methodological variability, and the need for standardization have been identified. The fact that the number of relevant systematic reviews that matched our inclusion criteria was limited could affect this research's robustness and may limit the breadth and depth of evidence synthesis. Definitive conclusions could not be reached due to variation among treatments and outcomes. Conclusions: The examined studies highlight the potential of stem cell therapy as a complementary approach to existing treatments for CLP. However, there are challenges that need to be addressed, including concerns regarding safety, variations in methodologies, and the need for standardization. Exploring the potential of other stem cell types may further enhance treatment outcomes for CLP patients.

Cleft lip and palate surgery in the Otolaryngology and Head-neck surgery department of a Medical College Hospital in Bangladesh

Background: Cleft lip and palate (CLP) are one of the most common developmental anomalies in orofacial region. CLP surgery lies in the anatomical domain of Ear Nose Throat and Head - Neck Surgery. In Bangladesh specialty of plastic surgery is still in developing stage and plastic surgeons are not easily available everywhere. ENT and Head-Neck surgeon had to take up the responsibility of some of cleft patients. This article is a retrospective analysis of a series of 200 cases of cheiloplasty and palatoplasty done in ENT and Head-Neck Surgery department of Khulna City Medical College Hospital, Bangladesh. Results were satisfactory in our, patient and parent's consideration. Objective: Our aim is to discuss the demographic profile, presentations, degree & type of cleft and outcome of CLP surgery in Otolaryngology and Head-Neck Surgery department of a Medical College Hospital of Bangladesh. We will also discuss the embryology of face & historical background of the cleft surgery. Materials and Methods: This is a retrospective analysis of CLP surgery for 200 cleft patients. We based on inclusion and exclusion criteria for selection of patients. Majority of cleft lip patients were operated following the Millard modified rotation advancement technique and isolated cleft palate patients were operated following Von Langenbeck bipedicle flap and Veau-Wardil-Kilner V-Y pushback technique in the ENT and Head-Neck Surgery Department of a Medical College Hospital. Patients were advised for periodic follow up. Results: Total of 200 patients of CLP were operated in our department out of which male was 92 (46%) and female was108 (54%)), male and female ratio being 1:1.08. The age range was 3 months to 40 years with a mean of 8.38 years. Pre alveolar group both male and female comprised of 134 (67%) and alveolar group 66 (33%) patients and that of isolated cleft palate 7 (10.60%) patients. Pre alveolar unilateral CLP was high. The results of surgery were satisfactory in our postoperative evaluation. Patients and parents were also satisfied with the outcome. Conclusion: Majority of CLP patients don’t suffer functional problem apart from facial disfigurement. Restoration of normal anatomy, facial appearance and function can be achieved by surgery in appropriate time and age. Few cases may be associated with feeding difficulties, dental and hearing problems. Some cases are associated with other congenital anomalies and syndromes. Those cases demand team approach of different specialty.

A Comparative Analysis of Sector Classification and the Impacted Canine Grading System by Kumar and Daigavane in Patients With Unilateral Cleft Lip and Palate Utilizing Orthopantomogram (OPG) as a Diagnostic Tool.

Introduction Non-syndromic oral clefts, affecting one in 700 newborns in India, are the most prevalent craniofacial anomalies, with genetic or environmental causes impacting various life aspects. Studies indicate higher dental disturbances, particularly impacted canines, in cleft lip and palate (CLP) patients compared to non-cleft individuals. Impacted canines, trapped by hard tissues, require early diagnosis to prevent orthodontic issues. The widely used Ericson and Kurol method employs orthopantomograms (OPGs) to classify canine impaction in typical children. However, diagnosing canines in CLP patients is challenging due to palate defects and post-grafting complications. This study aims to compare the utility of the Kumar and Daigavane (KD) grading system and the sector classification to determine the best method for diagnosing impacted canine eruption paths. Method This cross-sectional comparative observational study was conducted at Sharad Pawar Dental College's Department of Orthodontics and Dentofacial Orthopaedics. The sample size, calculated using a significance level of 5% and a prevalence of 1%, required a minimum of 16 participants aged 9-11 years with non-syndromic clefts and impacted canines. Patients with systemic diseases or over 12 years of age were excluded. The sectoral and KD classification systems collected and evaluated OPGs from qualifying cleft patients. Sector classification considered the angle between the occlusal plane or canine tip and the adjacent tooth's long axis, while KD's classification considered the Frankfort horizontal plane, occlusal plane, vertical height from the occlusal plane, canine apex root position, and canine exposure to the cleft defect. Results The study found an 81.25% agreement between the KD grading system and the sector classification, with a Cohen's kappa value of 0.586, indicating a moderate agreement. The KD system showed 81.82% sensitivity and 80.00% specificity, with positive and negative predictive values of 90.00% and 66.67%, respectively. The receiver operating characteristic (ROC) curve analysis revealed the KD system's superior performance in identifying impacted and non-impacted canines compared to the sector classification. Conclusion The KD grading system demonstrated higher efficacy than the sector classification for evaluating the impacted canines in children with unilateral cleft lip and palate (UCLP). The KD system's high sensitivity and specificity make it a valuable tool for predicting canine eruption paths and addressing anatomical challenges in cleft conditions. This study highlights the need for accurate diagnostic tools tailored to cleft patients and contributes to advancing orthodontic treatment outcomes through improved classification systems.

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.

Comparison of temporomandibular joint osseous components in unilateral and bilateral cleft lip and palate patients and normal controls: A CBCT study

ObjectiveThe objective of this study was to conduct a comparative analysis of the components of the temporomandibular joint in individuals with unilateral, bilateral cleft lip and palate (CLP), and in healthy individuals, utilizing cone beam computed tomography (CBCT) images. Method and materialThe present study employed a cross-sectional design and recruited participants aged 18 to 30 years. The participants were categorized into three groups: a control group consisting of 36 individuals without any cleft, a group of 35 patients with unilateral cleft lip and palate (UCLP), and a group of 15 patients with bilateral cleft lip and palate (BCLP). The analysis of CBCT images encompassed the examination of condylar height and angulation, glenoid fossa height and width, articular eminence inclination, as well as joint spaces across all three groups. The Kruskal-Wallis and Mann-Whitney tests were employed to ascertain the significant differences among the three groups. ResultsThe UCLP and BCLP groups demonstrated a statistically significant reduction in condylar height and articular eminence inclination in comparison to the control group. Furthermore, a significant difference in the width of the glenoid fossa was seen between the group with clefts and the control group. ConclusionThe CBCT images showed significant differences in several aspects of the temporomandibular joint, including condylar height, articular eminence inclination, and glenoid fossa width, in individuals with cleft palate. These abnormalities can contribute to the development of temporomandibular joint diseases. Therefore, recognizing these distinctions can help prevent further deterioration and progression of temporomandibular disorders (TMD) in CLP patients.

Investigating oral microbiome profiles in patients with cleft lip and palate compared with the healthy control

BackgroundPatients with cleft lip and palate (CLP) have an oronasal communication differed from the closed state in healthy individuals, leading to a unique oral microbiome. This study aimed to determine if variances in the oral microbiota persist among CLP patients who have received treatments for the closure of these fistulas compared to the microbiota of healthy individuals.MethodsSaliva samples were collected from a cohort comprising 28 CLP patients (CLP group) and 30 healthy controls (HC group). Utilizing 16S rRNA sequencing on the Illumina NovaSeq platform, we conducted a comprehensive analysis of the diversity and composition of the oral microbiota.ResultsThe analysis of the microbiota in the saliva samples revealed a total of 23 microbial phyla, 38 classes, 111 orders, 184 families, 327 genera and 612 species. The alpha diversity with microbial abundance and evenness indicated the significant difference between the CLP and HC groups. Principal coordinate analysis (PCoA) and the ADONIS test further supported the presence of distinct microorganisms between the two groups. The CLP group displayed elevated abundances of Neisseria, Haemophilus, Porphyromonas, and Granulicatella, as indicated by LefSe analysis. Conversely, Rothia, Veillonella, and Pauljensenia exhibited significant reductions in abundance in the CLP group. The results of the PICRUSt analysis indicated significant differences in the relative abundance of 25 KEGG pathways within the CLP group. Through Spearman correlation analysis, strong associations between Rothia, Veillonella, and Pauljensenia and 25 functional pathways linked to CLP were identified.ConclusionFindings of this study offer a thorough comprehension of the microbiome profiles of CLP patients after the restoration of oronasal structure and are anticipated to present innovative concepts for the treatment of CLP.

Self-perceived oral health and orofacial aesthetics of cleft patients

PurposeTo evaluate the self-perceived oral health and aesthetics of the dentition and jaw in patients with different types of oral cleft, measured by patient-reported outcome measures (PROMs). Additionally, to compare the results of the PROMs between cleft lip and or/palate (CL/P) patients and non-affected controls.Methods420 CL/P patients treated at the cleft team of the Erasmus Medical Center, Rotterdam, The Netherlands, were included, and 138 non-cleft patients were recruited as control-group. Patient’s perceptions were retrospectively evaluated using the CLEFT-Q Teeth for dental aesthetics at ages 8, 12 and 22, CLEFT-Q Jaw for jaw aesthetics at ages 12 and 22, and the Child Oral Health Impact Profile—Oral Symptoms Subscale (COHIP-OSS) for oral health at ages 8 and 12. One-way ANOVA was used to compare differences in oral health and aesthetic perceptions among age-groups, cleft types, as well as between cases and controls.ResultsCL/P patients were significantly less satisfied than controls with their dental aesthetics (p = 0.001). CL/P patients reported significantly lower satisfaction on CLEFT-Q Teeth scores at ages 8 and 12, than at 22 years (p < 0.001). Patients with the most extensive cleft phenotype, Cleft Lip and Palate (CLAP), reported lowest satisfaction on the CLEFT-Q Teeth. No differences in perceptions of oral health nor in aesthetics of the jaw were found in the different cleft types, ages, nor in study versus control group.ConclusionThis study found differences in self-perceived dental aesthetics: CL/P patients are less satisfied than non-affected controls. CLAP patients are least satisfied, but satisfaction increases with age.

Cortical Block Grafting Successfully Augments Alveolar Cleft Sites for Dental Implant Placement

BackgroundSupplemental bone grafting is regularly required before dental implant placement in patients with cleft lip and palate (CLP). PurposeThe study purpose was to measure and compare implant osseointegration and changes in graft dimensions following lateral incisor onlay cortical bone grafting in CLP and non-CLP patients. Study design, setting, sampleRetrospective cohort study composed of patients who presented to Boston Children’s Hospital and underwent autogenous onlay cortical block bone grafting at lateral incisor sites from 2015 through 2023. Patients were excluded if the cone beam computed tomography (CBCT) quality was insufficient for accurate measurements. Predictor variableThe predictor variable was CLP status coded as CLP or non-CLP. Main outcome variableThe primary outcome variable was successful implant osseointegration confirmed by a torque of 35 N/cm or more after 3 months of implant healing. Secondary outcomes were change in bone width between pre- and post-operative CBCT scans at lateral incisor sites and the need for additional bone augmentation prior to or during implant placement. CovariatesCovariates were age, sex, cleft location, and time from bone graft to postoperative CBCT and implant placement. AnalysesData analyses were performed using T-tests, Fisher’s Exact Tests, Mann-Whitney U Tests, and Pearson’s correlation. P<0.05 was considered statistically significant. ResultsA total of 22 subjects (16 with CLP) were evaluated. The mean age at the time of graft was 19.3 ± 2.4 years with 52.6% males. Implants osseointegrated at 20 of 22 lateral incisor sites (one CLP failure, one non-CLP failure). There was significant change in bone width after grafting for patients with CLP (p<0.001). Patients with CLP experienced a 3.32 (± 1.80) mm and 2.99 (± 1.61) mm increase in bone width at two different levels. Patients with CLP achieved greater boney changes near the alveolar crest than non-cleft patients (p=0.008) but the change was not significantly different more apically (p=0.86). One subject with CLP required additional grafting during implant placement. Conclusions and RelevanceCortical block onlay bone grafting is a predictable technique to augment lateral incisor sites in patients with cleft lip and palate for placement of a dental implant.

EVALUATING SINUS PATHOLOGIES IN CLEFT LIP AND PALATE PATIENTS: A CBCT ANALYSIS

This study presents a comprehensive assessment of sinus pathologies in cleft lip and palate (CLP) patients utilizing cone-beam computed tomography (CBCT). Cleft lip and palate patients often exhibit abnormalities in the maxillary sinus region due to congenital malformations and surgical interventions. The objective of this analysis is to investigate the prevalence, types, and severity of sinus pathologies in CLP patients using CBCT imaging. A retrospective review of CBCT scans from CLP patients was conducted, and sinus abnormalities such as mucosal thickening, sinus opacification, and anatomical variations were identified and analyzed. The findings shed light on the spectrum of sinus pathologies in CLP patients and underscore the importance of comprehensive evaluation in treatment planning and management.

Liposomal Bupivacaine Use During Orthognathic Surgery in Cleft Lip and Palate Patients.

Effective pain management is crucial in cleft lip and palate (CLP) patients undergoing orthognathic surgery for earlier recovery and decreased opioid reliance. Liposomal bupivacaine (Exparel) is a local anesthetic that provides extended postoperative analgesia in adult patients; however, research on its use in adolescents is limited. This study explores the efficacy of liposomal bupivacaine for postoperative pain management in adolescent CLP patients undergoing orthognathic surgery. The authors performed a retrospective chart review at their institution between July 2020 and December 2022 to identify patients who underwent LeFort I or mandibular osteotomy. Two cohorts were compared: patients who received liposomal bupivacaine and patients who received standard pain medications alone. Outcome measures included intraoperative pain medications, length of stay, breakthrough opioid use, time to first oral intake, volume of oral intake, and opioids prescribed at discharge. This study included 22 patients who underwent orthognathic surgery. The liposomal bupivacaine group (n=10) demonstrated earlier and greater oral intake during hospitalization compared with controls (n=12). The most significant difference was observed in total breakthrough opioid use, with an average of 8.60 morphine milligram equivalents for liposomal bupivacaine patients compared with 35.1 morphine milligram equivalents for controls (P=0.037). This study provides the first analysis of liposomal bupivacaine use in adolescent CLP patients undergoing orthognathic surgery, demonstrating a significant reduction in postoperative opioid consumption compared with controls. These results may guide future studies of liposomal bupivacaine within CLP patients, potentially as a component of enhanced recovery after surgery guidelines, as well as in cost-analysis studies.

A meta-analysis of alveolar bone grafting using bone substitutes in cleft lip and palate patients.

In individuals with cleft lip and palate (CLP), an alveolar bone graft (ABG) is carried out for alveolar cleft closure. Several sources for ABG include autologous bone, xenologous bone, and alloplastic substitutes. Autologous bone has been the preferred source for ABG. Alloplastic substitutes might serve as an alternative. This study aimed to compare the outcomes between autologous and alloplastic as sources for ABG. This study made use of eight web databases. Randomized control trials (RCTs) and non-RCTs were included. CLP patients with alveolar cleft with imaging studies, computed tomography (CT scan) and/or cone beam CT scan, and bone graft volume within 6-12 months postintervention were selected. Bone graft volume within 6-12 months postintervention was assessed. Three studies met the inclusion criteria. After 6-12 months of follow-up, there were no statistically significant differences in bone graft volume between autologous and alloplastic bone grafts (fixed-effect model estimate value = 0.21; confidence interval - 0.301-0.730; P = 0.414). The limitations include small research sample sizes, a high likelihood of bias among included studies, and different alloplastic materials from each included study. Autologous and alloplastic bone grafts showed similar effectiveness in alveolar bone grafting. Further clinical trial studies with bigger sample sizes and similar interventions are needed as evidence for future reviews.

Limonene synergistically augments fluconazole susceptibility in clinical Candida isolates from cleft lip and palate patients.

Cleft lip and palate (CLP) patients are prone to Candida infections (oral thrush) mainly due to poor oral hygiene, repetitive surgeries, and orthodontic procedures. This study was undertaken to evaluate the antifungal efficacy of limonene against clinical Candida isolates from CLP patients. The antifungal efficacy of limonene was studied alone and in combination with fluconazole (FLC) against six standards, twenty nine FLC sensitive, and three FLC resistant clinical strains using broth dilution, checkerboard microdilution, agar disk diffusion, growth curves, and spot assays. This nontoxic monoterpene gave low minimum inhibitory concentration (MIC) values of 300-375 µg/mL and 500-520 µg/mL for FLC susceptible and FLC resistant strains, respectively. It showed synergistic interaction with FLC in all clinical and standard Candida strains (fractional inhibitory concentration (FIC) index ≤0.5). Significant chemosensitization of FLC was observed even against resistant clinical isolates. Complete suppression of fungal growth was observed when using combinations. Negligible toxicity, easy availability, and potent antifungal properties suggest that limonene and FLC combinations in appropriate doses can make excellent antifungal mouthwashes during CLP treatment pre and post surgery. Impending in vivo studies are needed to validate the present data.

Assessment of Brazilian hospital and healthcare service infrastructure for cleft lip and palate patients.

Cleft lip and palate (CLP) represent the most frequently reported congenital anomaly affecting the craniofacial region. The aim of this study was to assess the output (in number of procedures) of the Brazilian hospitals accredited for the treatment of CLP patients, examine the referral flow of patients requiring this type of care, and ascertain the adequacy of the corresponding infrastructure of these healthcare facilities. Methodologically, the study used an observational, cross-sectional, and ecological design. Output data, categorized by state and macro-region, and patient referral flow records were accessible through the Outpatient Information System (SIA, in its Portuguese acronym) and the Hospital Information System (SIH, in Portuguese), respectively. Infrastructure assessment relied on data sourced from the National Register of Health Establishments (CNES, in Portuguese). Analysis encompassed data from 28 accredited hospitals. Concerning output metrics, the state of São Paulo ranked first in the number of procedures conducted. The establishments exhibiting the lowest output performance comprised six hospitals located in the Southeast region and two in the Center-West region. Examination of patient referral flow corroborated the concentration of procedures predominantly conducted in the Southeast, notably within São Paulo state. Infrastructure evaluation encompassed the following categories: physical facilities, diagnostic and therapeutic support services, equipment, and comprehensive multidisciplinary care services. The data showed that roughly 61% of the hospitals surveyed possessed less than half of the recommended items. The primary deficiency identified pertained to inadequacies in equipment availability. Conversely, the best outcomes were associated with diagnostic and therapeutic support services. It was concluded that enhancing hospital infrastructure is imperative for the amelioration of care provision to patients with CLP across all Brazilian states.

The prevalence of dental agenesis among children with cleft lip and palate patients in Lahore, Pakistan.

This retrospective, cross-sectional analytical study investigated the incidence of tooth agenesis in cleft lip and palate (CLP) patients. Cone Beam Computed Tomography (CBCT) radiographs of the CLP children were examined for congenitally missing teeth. This study was conducted at three radiology centers in Lahore, namely, the Pakistan Jinnah MRI and Body Scan Centre, the University of Lahore Radiology Centres, and Fatima Memorial Hospital, from September 2021 to August 2022. The CLP patients were divided into four groups based on the location of the cleft: Cleft Lip and Palate Right (CLPR), Cleft Lip and Palate Left (CLPL), Bilateral Cleft (CLPB), and Midline Cleft (CLPM), inside and outside the cleft region. Two-way ANOVA was employed to compare the means of agenesis. Tukey's test was utilized to ascertain where the difference lies. The significance level was set at p ≤ 0.05. Moreover, a significant number of missing teeth were found inside the cleft. This study observed the CLPL (42.3%) and CLPR (13.6%) types more in number. Maxillary first premolars were found more missing outside the cleft region in CLPL and CLPB types. Although CLPB and CLPM types revealed a pattern of missing teeth, only a few cases were found in this study. Moreover, mean tooth agenesis was highest (4.5 SD.71) in the CLPM group, followed up by CLPB (2.75 SD 2.49), CLPR (1.23 SD 1.27), and CLPL Group (1.15 SD 1.12). Unilateral cleft lip and palate patients reported significant agenesis patttern compared to bilateral and median cleft cases.

CleftED: A National Collaborative Study of Undergraduate Education and Exposure to Cleft lip and Palate Within the United Kingdom

Introduction Cleft Lip and/or Palate (CLP) are the most common congenital orofacial anomalies. Those involved in CLP care may extend beyond the core members of the Cleft multidisciplinary team (MDT) with a variety of medical healthcare professionals destined to contribute to the management of CLP patients at some point during their respective careers. Therefore, it seems essential that a basic understanding of CLP, CLP-associated problems, and potential avenues for direct or indirect involvement in CLP care be introduced at undergraduate level. Aims To investigate penultimate and final year undergraduate medical student CLP knowledge and exposure obtained whilst at medical school. Methodology An online questionnaire was distributed to penultimate and final year medical students throughout the UK. Results A total of 3102 responses were received from 35 medical schools. 44.3% (n = 1374) of respondents had no exposure to CLP teaching up until their current year of education. 61.3% (n = 1903) of respondents had never been involved in the care of a CLP patient. 53.6% (n = 1662) of respondents were not confident in their current knowledge of CLP. 78.5% (n = 2257) of respondents indicated a desire to be involved in the care of CLP patients in their future career. Conclusion More than half of the medical student survey respondents were not confident in their current knowledge of CLP and had limited involvement in CLP care. This may translate to a delay in diagnosis when students qualify. Improving CLP education and exposure during undergraduate training can help achieve national CLP standards for early diagnosis.

Classification of Skeletal Phenotypes of Adult Patients With Cleft Skeletal Class III Malocclusion Using Principal Component Analysis and Cluster Analysis.

The purpose of this study was to classify the skeletal phenotypes of adult patients with skeletal class III (C-III) malocclusion and unilateral or bilateral cleft lip and palate using principal component analysis and cluster analysis. The samples consisted of 81 adult C-III patients with cleft lip and palate (CLP) who underwent orthognathic surgery (OGS) or distraction osteogenesis (59 males and 22 females; 50 unilateral cleft lip and palate and 31 bilateral cleft lip and palate; mean age when lateral cephalograms were taken, 22.2±4.6y). Thirteen angular and one ratio cephalometric variables were measured. Using 4 representative variables obtained from principal component analysis (SNA, SNB, Gonial angle, and Bjork sum), K-means cluster analysis was performed to classify the phenotypes. Then, statistical analysis was conducted to characterize the differences in the variables among the clusters. Five clusters were obtained from 3 groups: severely retrusive maxilla and moderately retrusive mandible group: cluster-1 (23.5%, severely hyperdivergent pattern), cluster-4 (27.2%, moderately hyperdivergent pattern), and cluster-5 (11.1%, normodivergent pattern); moderately retrusive maxilla and normal mandible group: cluster-2 (30.9%, normodivergent pattern); normal maxilla and moderately protrusive mandible group: cluster-3 (7.4%, normodivergent pattern). Although skeletal phenotypes were diverse, distribution of sex and cleft type did not differ among 5 clusters ( P >0.05). Sixty-two percent of cleft patients showed a severely retrusive maxilla and moderately retrusive mandible (cluster-1, cluster-4, and cluster-5), which indicated that these are the main cause of skeletal C-III malocclusion in CLP patients who were treated with OGS. Therefore, it is necessary to consider presurgical orthodontic treatment and surgical planning based on the skeletal phenotypes of CLP patients.