Cleft Lip Group Research Articles

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

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

Need for orthognathic surgery in cleft patients from Northern Finland.

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

Salivary microbiome and asthma risk in children with orofacial defects.

Patients with congenital orofacial defects, cleft lip (CL),cleft palate (CP),and cleft lip and palate (CLP)have continuous exposure of the respiratory system to the microbiome from the oral environment, offering opportunities to develop mucosal immunity in the airway. This two-part study aims to analyze data on asthma occurrence in CL, CP, and CLP infants and the composition of the salivary microbiome, and to evaluate the oral microbiota and its association with the risk of developing childhood asthma. Patient data from the research database of Chang Gung Memorial Hospital from 2004 to 2015 were retrospectively analyzed by multivariable regression. Diseases diagnoses were defined by ICD codes. Asthma must also meet the criteria for receiving selective β2 agonistic or/and inhaled corticosteroid treatments twice within 1 year. Analysis of the saliva microbiome was performed prospectively from 2016 to 2020 in 10 healthy term infants and 10 CLP infants on postnatal 7th day, 1 month, and 6 months by next-generation sequencing. Asthma and nonasthma groups included 988 and 3952 patients, respectively. The incidence of asthma development was higher in patients with CP than in CL and CLP groups (aOR: 5.644, CI: 1.423-22.376). The species composition of the microbiome at 1 and 6 months was significantly different between infants with CLP and healthy infants. Children with orofacial defects have a higher risk of developing asthma with a possible contribution from oral microbiota in the early months of life.

Root Curvature in Non-Syndromic Oral Clefts: A Case-Control Study in a Brazilian Population.

This study assesses the degree of root curvature in patients with non-syndromic cleft lip and/or palate (NSCL/P). Retrospective. Case-control study. Root curvature was assessed in lower premolars and molars in 800 panoramic radiographs: 400 from patients with cleft and 400 from healthy control individuals. Root curvature was classified according to its angulation, as well as its apical, medial, or coronal localization. The frequency of mild curvature in the NSCL/P group compared to the control group was higher in premolars especially in the left second premolar in cleft palate (OR: 6.91; 95% CI: 3.23-14.77; P < .0001). The frequency of moderate curvature in molars was significantly higher in the cleft group, with the highest risk in the right first molar in the cleft lip group (OR: 2.74; 95% CI: 1.67-4.52; P < .0001). Inclination was more frequently observed in the apical third of the root in the group with cleft, whereas for the control group, the curvature was more frequent in the medial third. In patients with cleft, the OR of curvature in the apical third was significant in premolars (left lower second premolar: Cleft lip, OR: 1.91; 95% CI: 1.04-3.52; P = .03; right lower second premolar: Cleft lip, OR: 1.91, 95% CI: 1.04-3.50; P = .03, cleft lip and palate, OR: 1.75; 95% CI: 1.12-2.73; P = .01). The results of the current study indicate differences in root curvature in patients with non-syndromic cleft lip and/or palate, which should be considered during the dental treatment planning of patients.

Peer Assessment Rating (PAR) scoring of cleft patients treated within a regional cleft centre in the United Kingdom.

To assess static occlusal outcomes for patients with cleft lip and/or palate (CLP) and cleft palate (CP) managed within a UK Regional Cleft Service and to compare with previously published Peer Assessment Rating (PAR) scores from a non-cleft population of patients treated within a UK consultant-led hospital service. Retrospective multicentre study. Eight orthodontic hospital units within the Spires Cleft Service, UK. Patients born with CLP or CP between 1985 and 1995 treated within the service. Patients were assigned to groups by cleft type and whether they were treated by orthodontics only or a combination of orthodontics and orthognathic surgery. PAR was recorded before and after treatment from study models. Data were collected for 171 patients included in the study. Median pre-treatment PAR was 42 and post-treatment 11. Median percentage change in PAR for all patients was 73%, although 12% of cleft patients had a PAR improvement that was worse or no different. Median change in PAR score was 71% for those treated with orthodontics only and 83% for those who had an osteotomy. Median PAR improvement for those treated with orthodontics only was 73% in the cleft lip group, 77% in the CP group, 66% in the unilateral CLP group and 53% in the bilateral CLP group. Median pre- and post-treatment PAR for the cleft group was higher and PAR reduction lower than those published for non-cleft patients. These data demonstrate high severity of malocclusion, complexity of orthodontic treatment and difficulty in achieving an ideal static occlusion for cleft patients. If PAR is to be used to assess orthodontic outcomes in cleft patients the findings of this study should be considered. A higher proportion of cases are likely to be classed as 'worse or no different', and a lower percentage change will be expected.

Beware of Optical Illusion of the Alar Base in Unilateral Cleft Lip Nasal Deformity.

Background:It is generally accepted that the alar base on the cleft side in the cleft lip nose is displaced outward and downward; therefore, it is rotated inward and upward in almost all procedures for cleft lip closure. However, nostril narrowing and collapse of the lower lateral cartilage on the cleft side are sometimes experienced. In this retrospective study, we investigated whether the preoperative alar base on the cleft side is displaced outward and downward.Methods:This was a retrospective evaluation using preoperative frontal images obtained from patients with unilateral cleft lip (n = 245). The midcolumellar and subalare points were placed, and each ratio was analyzed and compared to those of age-matched controls (n = 40).Results:The subalare on the noncleft side and subnasale were displaced upward and outward. In contrast, the subalare on the cleft side was displaced downward and inward. The displacement of the subalare was greater on the noncleft than on the cleft side. There were no significant differences between male and female patients and between the left and right sides. Among the complete cleft lip and palate, incomplete cleft lip and palate, complete cleft lip and alveolus, incomplete cleft lip and alveolus, and microform cleft lip groups, the complete cleft lip and palate group showed the greatest displacement.Conclusion:The cleft alar base appeared to shift outward and downward because of an optical illusion, but in fact, both alar bases shifted; the alar base on the cleft side was displaced inward and downward, and the alar base on the noncleft side was displaced outward and upward.

Orofacial clefts associated with cardiac anomalies

AIMS: Orofacial clefts (OFC) are a heterogeneous group of birth defects arising in about 1.7/1000 newborns. They can occur with other congenital anomalies, including heart defects. We aim to describe a population with orofacial clefts and associated cardiac anomalies.METHODS: Retrospective study of patients attended in the Cleft Lip and Palate Multidisciplinary Group outpatient clinic at Hospital Universitario São João, Porto-Portugal. Medical records from January 1992 through December 2018 were reviewed. Patients were divided into four groups according to the Spina classification: cleft lip (CL), cleft lip and palate (CLP), isolated cleft palate (CP) and atypical cleft (AC). Further categorization included gender, affected relatives, associated congenital anomalies and syndromes.RESULTS: From the 588 patients included, 77 (13%) presented cardiac anomalies. Of those with orofacial cleft and cardiac anomalies, 53% were males and 17% had known affected relatives. CP was the most common cleft among patients with cardiac anomaly (~56%). Additional congenital anomalies were found in 89.7% of patients, namely facial defects, central nervous system, renal and skeletal malformations. A recognizable syndrome was identified in 61.5%, being Pierre-Robin the most common (n=22), followed by 22q11.2 microdeletion (n=9). Both additional congenital anomalies and recognizable syndromes were significantly more prevalent in patients with heart disease (p&lt;0.05). The main groups of cardiac anomalies were left-to-right shunt (n=47) and right ventricular outflow tract obstruction (n=14). From these, 26 had a ventricular septal defect, 15 atrial septal defect and seven patients had tetralogy of Fallot. Five patients had dysrhythmias.CONCLUSIONS: Due to the high prevalence of cardiac anomalies in the cleft population, a routine cardiac evaluation should be performed in all these patients.

Assessment of dental arch stability after orthodontic treatment and oral rehabilitation in complete unilateral cleft lip and palate and non-clefts patients using 3D stereophotogrammetry

BackgroundAlthough arch stability has been studied in patients without a cleft, evidence for patients with a cleft is sparse. Therefore, we compared the dimensions and stability of dental arches in cleft lip and palate patients and those without a cleft.MethodsForty participants, 20 with a complete unilateral cleft lip and palate and 20 non-cleft patients aged from 18 to 30 years, with anterior and/or posterior crossbite and receiving orthodontic treatment were evaluated retrospectively. Eighty gypsum casts were digitized using a laser model scanner casts for both groups made immediately after the orthodontic treatment was completed (T1). Also, for the Cleft Lip and Palate group, casts were obtained and digitized 1 year after implant-supported rehabilitation (T2) and for the Non-Cleft Lip and Palate group, 1 year after the conclusion of the orthodontic treatment (T2). The formula: Δ = T2-T1 evaluated the stability of dental arches for inter-canine distances (C-C′), inter-molar distances (M-M’), arch length (I-M), palate surface and volume. The dimensions of the dental arches were measured digitally. The independent t test was used for statistical analysis (α = 0.05).ResultsA statistical difference was found in the stability of the groups for inter-canine (cleft area) measurement. At the times T1 and T2, a statistically significant difference was found in the arch length, surface and volume.ConclusionsThis study concluded that in the Cleft Lip and Palate group, the maxillary dimensions were not stabilized after 1 year of orthodontic and prosthodontic treatment (mainly for the inter-canine linear measurement) and that the transverse arch dimensions were smaller compared with those of non-cleft patients.

Effect of Cleft Types on Outcome of Unilateral Cleft Lip Repair.

Introduction:It is generally assumed that the major phenotypes of unilateral cleft lip (UCL) represent its extent of severity. There are a few studies on this, but objectivity has been lacking. It was the aim of this study to assess the effect of different phenotypes of UCL on the outcome of surgical repair.Methodology:This study was a case series of the effect of phenotypes of cleft on the outcome of repair of UCL. Fifteen subjects each were in three UCL phenotype groups. Surgical outcome was assessed quantitatively with anthropometric measurements recorded from a full frontal face photograph of subjects. The analysis was done using Student's t-test and one-way ANOVA at P = 0.05.Results:The mean values of the preoperative horizontal and vertical lip height, and nasal width on the cleft side in the cleft lip (CL) group were closest to those of the noncleft side and control. The postoperative mean values of the horizontal and vertical lip height, and nasal width on the cleft side in the CL group were closest to those of the noncleft side and control, while those of the CL, alveolus and palate group were farthest from those of the noncleft side and the control.Discussion:The different phenotypes of UCL have different degrees of tissue distortion and deficiencies. CL group had its measurements closest to that of the noncleft sides and control, suggesting that it has the least distortion.Conclusion:The comparison between the three groups did not reveal any difference, suggesting that the skill of the surgeon and the selection of a well proven technique are more important factors in the outcome of repair of unilateral cleft lip.

OP02.05: The nasofrontal angle can help to identify palate involvement in fetuses with facial clefts

It is often difficult to differentiate between a facial cleft with and without palate involvement. We measured the nasofrontal angle (NFA) in fetuses with facial clefts in order to investigate usability of this angle to diagnose cleft palate. We measured the NFA (angle between the nasal and the frontal bones in the midsagittal plane) in volumes of second and third trimester fetuses with facial clefts. EJP and MH measured the NFA twice, blinded for each other's results. The mean of the 4 measurements was used for analysis and compared with a reference range derived from 109 normal fetuses in an earlier study (EJP et al. UOG 2017;50:297). In these normal fetuses the NFA did not change significantly with gestational age with a mean of 117° (10th and 90th centile, were 105° and 129° respectively). In the present study we excluded fetuses with a midline, atypical or isolated palate cleft, a genetic condition or suspicion for a forehead anomaly. Fetuses with a facial cleft were divided in a cleft lip group (CL), a unilateral cleft lip-alveolus group (UCLA), a unilateral cleft lip-alveolus-palate group (UCLAP) and a bilateral cleft lip-alveolus-palate group (BCLAP). We used Student's T-test and Mann-Whitney U tests and considered P < 0.05 statistically significant. 34 volumes were suitable for analysis (mean gestational age: 24.4 wks, range: 18-41 wks). In 9 UCL, 4 UCLA, 11 UCLAP and 10 BCLAP fetuses the mean NFA was 123.4°(SD 4.4), 120.2°(SD 8.8), 128,8°(SD 4.8) and 128.2°(SD 4.5) respectively. In all groups the NFA was larger than in the normal group, however only in the UCLAP and BCLAP group the differences were significant. The NFA in UCLAP + BCLAP fetuses was also significant larger than the NFA in CL + UCLA fetuses. When a facial cleft includes the palate the NFA is significantly larger than when the palate is intact. NFA measurement can increase confidence in the diagnosis of a cleft palate in fetuses with facial clefts. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Microbial Profile and Dental Caries in Cleft Lip and Palate Babies Between 0 and 3 Years Old.

The aim of this study was to examine the microbiological changes in newborn babies with cleft lip palate from birth up to age 3 and to correlate them with their caries levels and mothers' microbiological data and to compare with normal infants. Prospective. Marmara University, Faculty of Dentistry, Pediatric Dentistry Clinic, and Şişli Hamidiye Etfal Education and Research Hospital New Born Clinic. Cleft lip palate (n = 21) and healthy (n = 13) newborns and their mothers. Intraoral samples were taken from babies in each group at least 3 times over the 3 years. Saliva samples of the mothers were collected just after the birth of the babies and examined microbiologically. Dental caries was noted as either present or absent. The most frequent microorganisms were candida, found at birth (n = 9, 42%) in cleft palate with or without cleft lip (CP±L) group. The number of babies infected with Lactobacilli were found to be significantly higher in the CP±L group than in the control group at birth ( P = .029) and after eruption of the first primary tooth ( P = .030). Mutans Streptococci were found in 10% of babies with CP±L at birth. Initial caries was identified in 20% of the babies with an oral cleft compared with 0% of the controls after eruption of the first primary incisors. The results show that the CP±L babies must be considered as a group with an increased caries risk.

Trends in Enteral Access Placement Among Patients With Oral Clefts: Evaluation of 46 617 Patient Admissions.

It is well known that patients with oral clefts have challenges with feeding. Enteral feeding access, in the form of gastrostomy, is often utilized to supplement or replace oral intake. Although commonly performed, these procedures have reported complication rates as high as 83%. We intend to discover rates of enteral access in patients with oral clefts and report-related outcomes. The Healthcare Cost Utilization Project Kids' Inpatient Database from 2000 to 2012 was analyzed using patients with oral clefts and enteral access procedures. The χ2 test was used for univariate analyses of proportions, and linear regression was used to analyze trends. Multivariate logistic regression was used to analyze odds ratios. Of the 46 617 patient admissions included, 14.6% had isolated cleft lip (CL), 51.7% cleft lip and palate (CLP), and 43.7% isolated cleft palate. The rates of enteral access in the oral cleft population increased from 3.7% in 2000 to 5.8% in 2012 ( P < .001). Increased rates were identified in patients with ( P = .019) and without ( P < .001) complex conditions. A significant increase in the rate of enteral access was seen in patients with CLP ( P < .001) and isolated cleft palate ( P < .001). No difference was seen in the isolated CL group ( P = .096). Patients with complex conditions were at a 4.4-fold increased risk and those admitted to urban, teaching hospitals were at a 4.7-fold risk of enteral access placement. The rates for enteral feeding access increased significantly from 2000 to 2012. The reasons for the increased incidence are unclear. Invasive enteral access procedures have been shown to have a multitude of complications. Careful patient selection should be done before placement of invasive enteral access.

Surgical Closure of the Cleft Palate Has a Transient Obstructive Effect on the Upper Airway in Children.

To prospectively investigate the occurrence of respiratory symptoms related to obstructive sleep apnea (OSA) following primary palatoplasty in children with cleft palate (CP). Fifty-six nonsyndromic children presenting CP with a previously repaired cleft lip (CL) or without CL were assessed before and after palate repair. Twenty nonsyndromic children with isolated CL were analyzed as controls before and after lip repair. Respiratory symptoms were investigated preoperatively, and at early and late postoperative periods. Based on the parent reports of "difficulty of breathing (D), apnea events (A) and/or snoring (S) during sleep, a validated OSA index (1.42D + 1.41A + 0.71S - 3.83) was used to predict absence of OSA, possible OSA, and presence of OSA, at the 3 periods analyzed. Screening for OSA showed that the CP group exhibited an increased mean index at the early postoperative assessment, suggesting "possible OSA," and a higher frequency of snoring at the early and late postoperative assessments, as compared to the CL group (P < .05). Sleep apnea events were not reported. Surgical closure of the palate has an obstructive effect on the upper airway in the short term, causing OSA-related respiratory symptoms, mostly transient. However, the high prevalence of snoring still observed in the long term indicate that children with a palatal cleft who undergo surgical repair are at risk for OSA. The results support the conclusion that OSA is underappreciated in this population.

Hypertelorism and Orofacial Clefting Revisited: An Anthropometric Investigation.

Since the 1960s, multiple studies have reported a tendency toward hypertelorism in individuals with nonsyndromic orofacial clefts (OFCs). However, the association between specific cleft types and increased interorbital distance has been inconsistent. Using three-dimensional (3D) surface imaging, we tested whether different forms of clefting showed evidence of increased interorbital distance. Intercanthal and outercanthal distances and intercanthal indices were calculated from 3D facial surface images of 287 individuals with repaired OFCs. Raw measurements were converted to sex and age-normalized Z-scores. Mean Z-scores for individuals with cleft lip (CL), cleft lip and palate (CLP), and cleft palate (CP) were compared with reference normative values (controls) and one another directly using t tests and analysis of variance. The CLP group showed a significant increase in intercanthal width (P = .001) and intercanthal index (P < .001) compared with reference norms. The CP group showed a significant decrease (P < .001) in outercanthal width. The CL group showed no difference from reference norms. The proportion of clinically hyperteloric individuals was generally low but highest in the CLP group (7.4%). Cleft severity had little effect on interorbital spacing. Individuals with CLP exhibited on average a tendency toward mild hypertelorism, driven primarily by an increase in intercanthal distance. This tendency was not seen in CL or CP.

Caries Experience in Filipino Children with Cleft Lip and/or Palate from the Noordhoff Craniofacial Foundation, Philippines

Objective. This study aims to provide an overview and statistical data on the prevalence of dental caries and caries index scores in Filipino children from the Noordhoff Craniofacial Foundation Philippines, Incorporated (NCFPI). Methods. A retrospective quantitative descriptive study was undertaken based on pretreatment records of 332 children aged 2 to12 years, with cleft lip (CL), cleft palate (CP), or cleft lip and palate (CLP). Results. The prevalence of caries ranged from 81% to 100%. There were significant differences in dmft scores between the 2 to 5 year-olds and the 6 to 9 year-olds (p&lt;0.0001), and between the 6 to 9 year-olds and the 10 to 12 year-olds (p&lt;0.0001). There were also significant differences between the DMFT scores of the 6 to 9 year-olds and the 10 to 12 year-olds (p&lt;0.0001), between the CL and CP groups (p&lt;0.0001), and between the CL and CLP groups(p&lt;0.0001). There were no significant differences in dmft and DMFT scores between the males and females. Conclusion. There is high caries prevalence in children with CL, CP and CLP. Caries index scores are higher with increasing age. Poor oral hygiene and the presence of other predisposing factors increase their susceptibility to caries.

Evaluation of the bony nasal septum development of cleft lip and palate patients using three-dimensional computed tomography measurement

Objective: To evaluate the development of bony nasal septum of cleft lip and palate patients. Methods: This retrospective study included 157 patients aged over 14 years with cleft lip and palate (CLP) and 54 normal people. The three-dimensional computed tomography reconstruction images of the posterior and inferior part of the bony nasal septum were measured. We evaluated the development of the bony nasal septum. Results: There were 39 patients with cleft lip only (CLO), 38 patients with cleft palate only (CPO), 80 patients with CLP. The L1, L2, and S of CLO and/or CPO patients were smaller than the normal control group. The L1 and S of cleft palate group and CLP group were smaller than cleft lip group, there was no significant difference for L2 between the three groups. Compared with the postoperative cleft palate group, the S of preoperative group was significantly bigger, the L2 was bigger without significant difference; but compared with the normal group, L1 and S of preoperative group was significantly smaller, L2 was not significantly different. Conclusions: The patients with cleft palate only were most affected. There was not only decrease of the fusion of maxilla and vomer, but also growth inhibition of the sutura between vomer and nasal septum cartilages, vertical plate of ethmoid bone in patients with cleft lip and palate. The adverse effects of the cleft palate operation to bony nasal septal development mainly lie in anterior inferior direction.

Comparison of craniodentofacial morphology of children with and without unilateral cleft lip and palate

Background: This retrospective case-control study was done to investigate the cranio-dento-facial morphology of Turkish children with unilateral complete cleft lip and palate from Ege University and compare them with a normal group to highlight the effect of surgical correction on craniofacial development. Methods: 60 patients with unilateral complete cleft lip and palate were compared with 55 control children without cleft at mean ages of 13 and 15 years. The cleft lip was operated with modified Millard technique at 3 months, cleft palate was operated with von Langenbeck technique at 12 months. The patients were not given any orthopaedic or orthodontic treatment also. Angular and linear measurements of cranio-dento-facial complex were measured by using Dolphin Imaging 11.5 software programme, and the resulting data were evaluated statistically. Results: The children with unilateral complete cleft lip and palate had considerable morphological deviations when compared with the matched children without clefts. The most striking findings in the unilateral complete cleft lip and palate group: Maxillary and mandibular complex and nasal projections were retruded when compared with normal (P<0.001). Also, nasal airway dimensions were higher in control group (P<0.001). Soft tissue structure, especially upper lip thickness, upper and lower lip lengths were decreased (P<0.001, P<0.001, P<0.05, respectively) in cleft group. Maxillar anterior height was decreased (P<0.001). Besides, nasolabial angle and upper incisor inclination according to the maxillary occlusal plane (P<0.001) were increased while overjet (Mx1-Md1) were decreased (P<0.001). Conclusion: The surgical technique and the number of operations seem to be the most effective factors for maxillary retrusion in patients with unilateral complete cleft lip and palate.

Comparison of dental arch dimensions in models of preschool children with cleft lip/palate repaired by means of surgery alone versus controls.

Cleft lip and palate (CLP) anomaly is one of the most prevalent congenital defects causing disturbances of dental arch dimensions. This study aimed at investigating differences in these dimensions between preschool children with cleft lip/palate and a matched control group representing healthy individuals with normal occlusion (NO). The sample of this cross-sectional analytical study consisted of 108 plaster models of children aged from 4 to 5.5 years. They were divided into five groups: the cleft lip group, the cleft palate (CP) group, the unilateral cleft lip and palate group, the bilateral cleft lip and palate group, and the NO group. The NO group was used as a control group. All cleft-affected children were treated only with surgery. Dental arch length and widths were measured. The dental arch dimensions of the cleft lip group were nearly similar to those in the controls. Moreover, the mandibular transverse widths of the CP group were close to those in the controls. However, the mandibular arch length and all maxillary dimensions of the CP group were smaller than those in the controls. In the unilateral cleft lip and palate group, the arch lengths in both jaws and the maxillary transverse widths were smaller than those in the controls, whereas the mandibular transverse widths were similar to those in the controls. In the bilateral cleft lip and palate group, the arch lengths in both jaws were close to those in the controls, but both arches were narrower than those in the controls. The various types of CLP were found to be associated with differences in most maxillary and some mandibular arch dimensions. These data can be used for cleft patient counseling and treatment planning.

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.

Not All Clefts Are Created Equal: Patterns of Hospital-Based Care Use among Children with Cleft Lip and Palate within 4 Years of Initial Surgery.

This study compares hospital-based care and associated charges among children with cleft lip, cleft palate, or both, and identifies subgroups generating the greatest cumulative hospital charges. The authors conducted a retrospective cohort study of cleft lip, cleft palate, or cleft lip and palate who underwent initial surgery from 2006 to 2008 in four U.S. states. Primary outcome was hospital-based care-emergency, outpatient, inpatient-within 4 years of surgery. Regression models compared outcomes and classification tree analysis identified patients at risk for being in the highest quartile of cumulative hospital charges. The authors identified 4571 children with cleft lip (18.2 percent), cleft palate (39.2 percent), or cleft lip and palate (42.6 percent). Medical comorbidity was frequent across all groups, with feeding difficulty (cleft lip, 2.4 percent; cleft palate, 13.4 percent; cleft lip and palate, 6.0 percent; p < 0.001) and developmental delay (cleft lip, 1.8 percent; cleft palate, 9.4 percent; cleft lip and palate, 3.6 percent; p < 0.001) being most common. Within 30 days of surgery, those with cleft palate were most likely to return to the hospital (p < 0.001). Hospital-based care per 100 children within 4 years was lowest among the cleft lip group, yet comparable among those with cleft palate and cleft lip and palate (p < 0.001). Cumulative 4-year charges, however, were highest among the cleft palate cohort (cleft lip, $56,966; cleft palate, $106,090; cleft lip and palate, $91,263; p < 0.001). Comorbidity, diagnosis (cleft lip versus cleft palate with or without cleft lip), and age at initial surgery were the most important factors associated with the highest quartile of cumulative hospital charges. Cleft lip and palate children experience a high rate of hospital-based care early in life, with degree of medical comorbidity being a significant burden. Understanding this relationship and associated needs may help deliver more efficient, patient-centered care.