Cleft Lip Patients Research Articles

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

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

Perspectives on the state of cleft lip and cleft palate patient care in Africa.

Patients with cleft lip -palate (CLP) experience morbidity and social stigma, particularly in low-income and middle-income countries (LMICs) such as those of sub-Saharan Africa (SSA). Delays in treatment secondary either to lack of awareness, skills, equipment and consumables; poor health infrastructure, limited resources or a combination of them, has led to SSA having the highest rates of death and second highest rates of disability-adjusted life years in patients with CLP globally. Here we review current perspectives on the state of comprehensive cleft lip and palate repair in Africa. To bridge gaps in government health services, nongovernmental organizations (NGOs) have emerged to provide care through short-term surgical interventions (STSIs). These groups can effect change through direct provision of care, whereas others strengthen internal system. However, sustainability is lacking as there continue to be barriers to achieving comprehensive and longitudinal cleft care in SSA, including a lack of awareness of CLP as a treatable condition, prohibitive costs, poor follow-up, and insufficient surgical infrastructure. With dedicated local champions, a comprehensive approach, and reliable partners, establishing sustainable CLP services is possible in countries with limited resources. The replacement of CLP 'missions' with locally initiated, internationally supported capacity building initiatives, integrated into local healthcare systems will prove sustainable in the long-term.

3-Dimensional Evaluation of Two PNAM Techniques (Modified Grayson & AlignerNAM) on Facial Soft Tissue Morphology: A Randomised Clinical Trial.

Evaluate facial changes after Presurgical Naso-Alveolar Molding (PNAM) in unilateral cleft lip and palate (UCLP) patients treated with Modified Grayson Technique and AlignerNAM (with DynaCleft nasal elevator) using a 3D facial scan. Randomised clinical trial. Institutional study. Participants: 20 UCLP patients allocated to two groups (10 patients each). Group A patients underwent PNAM with Modified Grayson Technique and Group B patients underwent AlignerNAM (with DynaCleft nasal elevator). Their 3D facial scans were obtained by using an iOSbased application (Bellus3D FaceApp) mounted on a novel frame. These .stl files were analysed using 3D software (GOM INSPECT) at three-time intervals; before intervention (T0), after intervention (T1) and one month after lip repair surgery (T2). Changes in facial and nasolabial morphology. Both techniques brought significant improvement in the columellar length, nasal tip projection, columella angle, nasal tip angle and a significant reduction in cleft width. At T1, a statistically significant difference in angular and linear measurements was present in both groups. At T2, no statistically significant difference in linear parameters was observed between the two groups except for the outer lateral height of the non-cleft side, basal lateral height of the non-cleft side, and philtrum width. Similar pattern was observed in angular measurements with no statistically significant difference between the two groups except in nasolabial angle, anterior nasal base triangle III, and anterior nasal root triangle. Aligner NAM and Modified Grayson technique are equally effective PNAM methods with similar clinical results in nasolabial morphology after lip repair surgery.

First Nations Patients’ Experience Receiving Care for Cleft Lip and Palate in a Multidisciplinary Clinic Setting

Purpose: Our small-scale qualitative study sought to explore the experiences of Indigenous patients receiving care for cleft lip and/or palate at a multidisciplinary clinic. There currently are no published studies that demonstrate the experiences of cleft lip and/or palate patients receiving care in multidisciplinary clinics in Canada. This work is foundational to informing future care in a way that is reflective and cognizant of Indigenous ways of life and lived experiences. Method: Participants were recruited via purposive and snowball sampling through community networks and public advertising in relevant healthcare spaces. Semi-structured interviews were completed; transcribed verbatim and descriptive codes were generated using Indigenist research methodologies through the Blackfoot medicine wheel. Results: Five participants that included patients, parents of patients with cleft lip and/or palate, and Indigenous health liasions were interviewed. Participants indicated a lack of spiritual health, the physical demands of having a cleft lip and/or palate on a patient and their families, the fear and unknown associated with a new cleft lip and/or palate diagnosis, and lack of cultural support, awareness and racism may negatively impact mental health. Conclusion: Indigenous patients must receive cleft lip and/or palate care that is cognizant of both their cultural needs identified in our study but also reflective of the ways in which health may be conceptualized for Indigenous patients. The following models of care suggested in our study must also seek to address historic mandates that include UNDRIP and the Truth and Reconciliation Commission's Calls to Action.

Presurgical Naso-alveolar molding in cleft lip and palate patients – A critical review

Purpose: To evaluate and assess the current scientific evidence pertains to the efficiency and usefulness of Presurgical Naso-alveolar molding (PSNAM) in cleft lip and cleft palate patients. Methods: A comprehensive scientific literature search was carried out using PUBMED electronic database which focus on the current concept of PSNAM and those which critically analyse its long term effects in the treatment of cleft lip, palate and nasal deformity, using different terminologies like the ‘presurgical nasoalveolar molding’, ‘nasal moulding’ and ‘infant orthopaedics’ and documented articles over a period of 30 years were selected for the critical review. Results: Following PUBMED search, a total of 58 articles were retrieved. These 58 articles were investigations pertaining to the effect of PSNAM on different aspects of cleft including effects of PSNAM on facial growth, maxillary arch, dentition and occlusion, its effects on nasal symmetry and nasolabial appearance, and on speech. Conclusions: Presurgical Naso-alveolar molding can be a useful adjunctive treatment modality for management of cleft lip and palate patients. This technique being a cost effective is more beneficial in reducing the number of future surgeries required in the management of cleft lip and palate patients.

Effects of anemia and peri-operative medication on wound healing in cleft lip and palate patients

Introduction: Wound healing complications among cleft lip and palate patients pose risks of additional surgeries, reduced scar quality, and increased patient morbidity. This literature review aims to explore the impact of anemia and drug usage associated with respiratory complications, frequently encountered in these patients, on wound healing. Materials and Method: We conducted an extensive literature search without time constraints using PubMed and Google Scholar databases. The investigation into the effects of anemia and medications on wound healing was divided into three stages. The first stage examined the general effects of anemia and medications on wound healing. The second and final stages assessed wound healing in craniofacial and cleft lip/palate surgeries, respectively. Results: Preoperative anemia exerts no substantial influence on wound healing unless hemoglobin levels drop below 5 g/dl. No studies reported detrimental effects of glucocorticoids on wound healing. The impact of salbutamol use on wound healing remains controversial, while data regarding ipratropium usage are insufficient. Conclusion: Severe anemia is the only significant concern for wound healing, necessitating transfusion or improvement in anemia. It appears that short-term use of glucocorticoids after surgery does not have a negative effect on wound healing.It is worth noting that salbutamol and ipratropium usage may have detrimental effects, and while complete avoidance may not be feasible, their potential impact on wound healing should be considered.

The Effect of Platelet-Rich Fibrin and Platelet-Rich Plasma in Secondary Alveolar Bone Grafting in Cleft Lip and Palate Patients: A Systematic Review.

(1) Background: Cleft lip, alveolus, and palate are the most common congenital abnormalities in the world, occurring in one in seven hundred live births. Secondary alveolar bone grafting (SABG) is usually performed when the permanent canine root shows one-half to two-thirds of root development. To improve the surgical outcome, supplemental grafting materials such as platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) have been used as an adjunct. This review is designed to assess the efficacy of PRF and PRP in improving the outcome of SABG. (2) Methods: A comprehensive literature search was performed until 13 October 2022 on MEDLINE, EMBASE, The Cochrane Library, and Pubmed. The full text of potentially relevant studies was reviewed, and only randomised clinical trials (RCTs) were included based on the inclusion criteria. (3) Results: A total of 656 studies were screened, of which four were included for final review. All of the four included studies that evaluated the quantitative or qualitative surgical outcome in varied ways. (4) Conclusions: Results of this review suggest that both PRF or PRP and control group (without the use of PRF/PRP) achieved similar successful outcomes in bone height, bone density, and bone volume in both qualitative and quantitative assessment.

The Use of Platelet-rich Fibrin (PRF) in Cleft Lip and Palate Patients: A Review Article

The Use of Platelet-rich Fibrin (PRF) in Cleft Lip and Palate Patients: A Review Article

The Use of Platelet-rich Fibrin (PRF) in Cleft Lip and Palate Patients: A Review Article

The Use of Platelet-rich Fibrin (PRF) in Cleft Lip and Palate Patients: A Review Article

Questioning the Relevance of Normal White Blood Cell Count under 10,000 Cells per Microlitre in Millard Criteria as an Absolutely Required Parameter for Cleft Lip Repair Surgeries: A Case-Based Literature Review

Leukocytosis, defined as an elevated white blood cell count, has long been regarded as a crucial indicator of inflammation or infection in surgical procedures. In the context of cleft lip surgeries, normal white blood cell count has often been considered an absolute requirement for proceeding with the procedure, as it is believed to signal the presence of a potentially infectious or inflammatory state. Therefore, leukocytosis is thought to be a strong precautionary factor. However, recent evidence challenges this long-held belief, suggesting that elevated white blood cell counts may not necessarily be indicative of adverse outcomes in cleft lip surgeries. To explore this notion, we conducted a comprehensive literature review focusing on two case studies involving unilateral cleft lip patients with presurgical white blood cell counts exceeding 10,000 per microlitre. Both cases underwent successful cleft lip repair and demonstrated excellent post-surgical outcomes without any signs of inflammation or infection. Both cleft lip repair surgeries results showed no complications, and the patient exhibited optimal wound healing and an aesthetically pleasing outcome at the follow-up appointments. These cases challenge the assumption that normal white blood cell count is an absolute requirement for cleft lip surgeries and call for a reconsideration of its significance in predicting post-surgical outcomes. While leukocytosis is an essential parameter to identify potential infectious or inflammatory states, our findings suggest that it should not be solely relied upon in isolation when assessing the suitability for cleft lip surgery and predicting the adverse outcomes in cleft lip surgeries. Further studies are warranted to establish a more nuanced understanding of leukocytosis in the context of cleft lip surgeries, including its association with other clinical parameters and potential alternatives for evaluating surgical candidacy and predicting the adverse outcomes in cleft lip surgeries.

A Comparative Analysis of Skeletal and Dental Parameters in Bilateral Cleft Lip and Palate vs. Non-bilateral Cleft Lip and Palate Patients in the Central Indian Population: A NemoCeph Study.

Introduction Orthodontic diagnosis and treatment planning encounter distinctive complexities when dealing with cleft lip and palate anomalies. This research endeavors to thoroughly examine skeletal and dental characteristics through cephalometric analyses among individuals with bilateral cleft lip and palate (BCLP) within the central Indian population. Due to anatomical variations and growth constraints, traditional cephalometric mean values derived from standard population studies are often inadequate for these cases. Advanced technology, such as NemoCeph (Nemotech, Madrid, Spain) software, enhances measurement accuracy. Methods Fifty patients, including 25 with BCLP and 25 without BCLP, aged 10 to 18, were selected for this cross-sectional study. Lateral cephalograms were traced and analyzed using NemoCeph software. Skeletal and dental parameters were measured, and a comparison was made between BCLP patients and the general population. Statistical analysis was conducted using the Student's unpaired t-test. Both SPSS Statistics Version 24.0 (IBM Corp., Armonk, NY, USA) and GraphPad Prism Version 7.0 (GraphPad Software, San Diego, CA, USA) were used for data analysis. Results The investigation revealed significant disparities across several parameters, including sella-nasion-A point angle (SNA), sella-nasion-B point angle (SNB), A point-nasion-B point angle (ANB), the inter-incisal angle (the angle between the long axes of the upper and lower incisors), and UP 1 to A-pog (a specific vertical measurement between anatomical markers labeled "upper 1" and "A point to pogonion"), with associated p-values for the skeletal and dental parameters of 0.310, 0.259, 0.195, 0.0001, and 0.0001, respectively. A comparison between manual tracing and digital methods indicated a reduction in errors and an improvement in measurement precision. Notably, patients diagnosed with BCLP exhibited distinctive skeletal and dental traits, highlighting the necessity for tailored treatment approaches. Conclusion This study emphasizes the importance of personalized cephalometric evaluations for patients with BCLP. Standard mean values may not be applicable due to unique anatomical considerations in these cases. Advanced technology and patient-specific assessments are crucial for accurate diagnosis, treatment planning, and orthognathic procedures in individuals with cleft lip and palate conditions. Embracing digital tools and tailored approaches can enhance patient care quality and lead to better clinical outcomes.

Improving labial and nasal outcome in a secondary bilateral cleft lip and palate patient using the Mulliken method of repair

Improving labial and nasal outcome in a secondary bilateral cleft lip and palate patient using the Mulliken method of repair

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.

Three-dimensional evaluation of secondary alveolar bone grafting in patients with unilateral cleft lip and palate: A 2-3 year post-operative follow-up.

The present study aims to quantitatively assess secondary alveolar bone graft (SABG) resorption in unilateral cleft lip, alveolus and palate (UCLAP) patients in a 2-3 year longitudinal follow-up setting by using a validated 3D protocol. Furthermore, the potential relation of SABG resorption with maxillary canine position and a number of patient-related factors was investigated. UCLAP patients who underwent SABG and had good quality CBCT images at the following timepoints were included in the study: pre-operative (T0), immediate (T1), 6 months (T2) and either 1-2 years (T3) or 2-3 years (T4) post-operative. The final bone grafted region was defined on the T1 scans and refined in the registered T0 scans. The bone graft after resorption was determined by applying threshold-based segmentation on the registered T2, T3 or T4 scans within the segmented bone graft volume. The position of the canines was determined at every timepoint at the cleft and non-cleft side. Forty-five UCLAP patients (mean age 9.0 ± 1.3 years) were included. In the first 6 months after SABG, 43.6% bone resorption was recorded. 2-3 years post-operative, 56% bone resorption was found if the maxillary canine was not yet erupted and 42.7% if it erupted through the graft. The vertical position of the canines was significantly higher on the cleft side at T3. The present study reports significant SABG resorption over time. However, no correlation was found between SABG resorption and canine position, nor between other patient-related factors.

Characteristics of patients with cleft lip and palate during the community services in East Nusa Tenggara, Indonesia, 2017-2018

Background: Cleft lip and palate is a congenital abnormality that occurs early in during embryonic development. This disorder can cause speech, hearing, malnutrition and mental and social development disorders. The prevalence of cleft lip and palate in the world varies greatly, with the highest incidence rate in Asia. Purpose: This research aims to determine the characteristics of patients with cleft lip and palate during the community services in East Nusa Tenggara, Indonesia, from 2017 to 2018. Methods: The type of research is descriptive research with a population of 48 patients who attended the community service event for cleft lip and palate surgery. Patient data characteristics were grouped based on age, gender, and cleft lip and palate type. Results: The distribution of patients with cleft palate was mostly aged 0-5 years (47%), the gender was the same between men and women (50%), and the most common type of cleft palate was cleft of the anterior (primary) palate (54%). Conclusion: Understanding cleft lip and palate patients in East Nusa Tenggara helps determine incidence rates and risk factors. This helps in customizing services, facilitating educational efforts, and involving the local government for effective community support.

Prospective study of nasal growth in bilateral cleft lip and palate patients after naso-alveolar moulding and primary columella lengthening compared to controls at 5, 10 and 20 years.

A short columella, wide nostrils and a flat nasal tip are common features in patients with bilateral complete cleft lip and palate (BCLP). The objective of this study was to evaluate nasal morphology during growth in patients treated with naso-alveolar moulding (NAM) and primary surgical columella lengthening (PCL) compared with matched non-cleft individuals. Prospective longitudinal case-control study. Thirty-four consecutively treated BCLP patients at 5 and 10 years and at the end of growth (19.7 ± 2.0 years) were compared through normalized photogrammetry to a control of 34 age and sex-matched non-cleft individuals. Regression Models for Panel Data assessed how nasal measurements were influenced by surgery, age and gender. Nasal protrusion was equal to non-cleft controls at all ages. Length of the columella was also comparable to controls at 5 and 10 years, but significantly shorter at the end of growth. Inter-alar and nasal tip width and nasolabial angle were significantly wider than controls at all ages: More than 60% of the patients have asked for correction of the nasal width, but no early surgery for columella lengthening was needed. NAM and PCL have provided a nasal projection close to that of non-cleft individuals until adulthood, while length of the columella was physiological at 5 and 10, but shorter than controls at age 20. Width of the nasal tip and width of the alar bases were significantly wider than the controls and eventually required secondary nasal width correction in over two thirds of the sample.

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.

Biomechanical Property and Biocompatibility of a New Silicone Rubber Nasal Retainer (Nostriloo).

Nasal retainers have been utilized to maintain the position of the nose after primary rhinoplasty in cleft lip patients. However, commercial nasal retainers made from silicone are quite expensive. To address this issue, the authors designed an alternative nasal retainer that is affordable, safe, and has similar biomechanical and biocompatibility properties to other commercial nasal retainers. Three types of nasal retainers were tested: our own (Nostriloo), a commercial nasal retainer from Turkey, and another one from Taiwan. There were 3 samples on each group, with a total sample of 9 retainers. Each sample was tested for biomechanical property and biocompatibility. Elasticity modulus, tensile strength, and direct and indirect toxicity were analyzed. Nostriloo had the least durable tensile strength but showed similar elastic modulus (2.76 ± 0.41MPa) compared with human lower lateral cartilage (2.09 ± 0.81 MPa). On the basis of direct and indirect toxicity tests, Nostriloo is considered nontoxic. Nostriloo can be utilized for small-scale production and use. Further experiment is needed to produce higher-quality nasal retainers.

Differential evolution for cleft lip and/or cleft palate patient treatment scheduling problems: a northern Thailand hospital case study

Cleft lip and/or cleft palate (CL/P) are the common birth defects that result when facial structures developing in an unborn baby do not close completely. To design for treatment schedule, some constraints including hospital eligibility constraints, capacity limitations, treatment age limitations, multi-hospital assignment, and multidisciplinary care team assignment should be determined. However, efficient treatment scheduling is difficult owing to the complicated conditions of specific treatment. This paper presents a multi-objective mathematical model of the CL/P patient treatment scheduling problem in order to minimize the makespan, travel distance, and total least preference assignment score. Since the problem is NP-hard, a solution method is developed based on differential evolution (DE) with particular encoding and decoding schemes for solving the CL/P patient treatment scheduling problem. The performance of DE is evaluated and compared the results with those obtained from the modified particle swarm optimization. The results show that DE is capable of finding high-quality solutions with fast convergence. To apply the proposed approach for a case study, the CL/P patient treatment scheduling program is formulated. The program can be a decision support system in helping the administrators to schedule the patients in order to identify a list of selected treatments, assign each operation of patients to the selected hospital, and intelligently identify the period of the selected treatments.

Should left- and right-sided unilateral cleft lip and palate patients be grouped together when reporting the outcomes?

Investigate associations between cleft laterality in patients with non-syndromic unilateral cleft lip and palate (UCLP) and oral-health, dental-arch, speech, audiological, psychological and nasolabial-aesthetic outcomes. Secondary data analysis of the outcomes of 5-year-old children with non-syndromic complete UCLP identified from three studies: Cleft Collective (n = 155), Cleft Care UK (CCUK) (n = 266) and Clinical Standards Advisory Group (CSAG) study (n = 238). Outcome measures included occlusal assessment using the 5-year-old's index score, speech intelligibility rating using the CAPS-A Audit tool, audiological assessment using pure tone audiometry, nasolabial aesthetic assessment using the Asher-McDade tool, oral-health assessment using decayed, missing, filled teeth scores and parent-reported outcomes. Logistic regression with adjustment for age, sex and index-of-multiple-deprivation scores were performed. No differences were found in patient-reported outcomes between the left and right clefts in the Cleft Collective study. From the CCUK study, right clefts had poorer speech (n = 236; 95% CI 1.09, 3.42; and P = .03) and hearing outcomes (n = 211; 95% CI 1.03, 3.43; P = .04). In the CSAG study, patients with left clefts were more likely to be teased (n = 213; 95% CI 0.26, 0.85; and P = .01). Weak associations between cleft laterality, speech, hearing and psychological outcomes were found, however the findings were inconsistent across the studies. This study contributes to evidence of associations between laterality and outcomes in children born with UCLP.