Cleft Lip Research Articles

Naso-alveolar Asymmetry in Unilateral Cleft Lip and Palate Patients-CT Analysis of the Paranasal Region.

Secondary deformities to the midfacial area in adolescence and adulthood are common sequelae after primary cleft lip and palate repair and lead to significant functional, aesthetic and psychosocial challenges. Treatment for patients with normal occlusion or treated malocclusion and remaining midfacial hypoplasia includes autologous and alloplastic augmentation of the maxilla. Because of the great variation of deformities, accurate evaluation is essential for appropriate treatment planning. To provide insights in the altered midfacial anatomy in cleft patients, a retrospective computed tomography morphologic analysis of the anterior projection of the maxilla in the paranasal region, soft tissue thickness, and relation of soft tissue to bony landmarks was performed in adolescent, unilateral, non-syndromic complete cleft and palate patients. The anterior projection of the maxilla was very variable with the cleft side bone surface being more anterior relative to the non-cleft side in some patients. Soft tissue thickness was not significantly different between cleft and non-cleft side. The lateral distance from the most anterior point of the maxilla to subalare was significantly smaller on the cleft side as compared with the non-cleft side. The authors' study demonstrates that in cleft lip and palate patients midfacial anatomy with regards to maxilla projection at the pyriform aperture is very variable making accurate evaluation of the bone morphology and an individualized treatment plan a prerequisite for successful correction of nasomaxillary deformities.

Prenatal to Adulthood: The Responsibility of the Speech-Language Pathologist on the Comprehensive Cleft Palate and Craniofacial Team.

Comprehensive cleft care is an important component when caring for a child with cleft palate with or without cleft lip (CP ± L). Speech-language pathologists (SLPs) serve different capacities on comprehensive cleft palate and craniofacial teams. This tutorial highlights the role of the SLP on the cleft palate and craniofacial team from the prenatal consultation to adulthood. This tutorial emphasizes the importance of collaboration between the cleft team SLP and other professionals on a comprehensive cleft team. Additionally, the tutorial provides education for feeding infants with CP ± L and focuses on assessment and treatment of children with CP ± L before and after the palate repair. Finally, this tutorial underscores the importance of working as part of and collaborating with interdisciplinary team members. SLPs are an essential member of comprehensive cleft teams in addition to other medical providers. SLPs play a critical role on these multidisciplinary teams and are fundamental to the assessment and treatment of feeding, speech, language, and resonance disorders in children with CP ± L. It is critical that SLPs are involved in comprehensive cleft team care from the prenatal consultation through adulthood to monitor resonance, speech, and language development and outcomes.

Changes in the Periodontal Gap After Long-Term Tooth Movement into Augmented Critical-Sized Defects in the Jaws of Beagle Dogs

Background/Objectives: Extensive and closely coordinated remodeling processes take place in the periodontal ligament (PDL) and the adjacent bone during orthodontic tooth movement. In complex orthodontic cases, it is necessary to move teeth into an augmented bony defect, for example, in patients with cleft lip, alveolus, and palate. The important role of the PDL during tooth movement is well accepted but not fully understood. Therefore, the present study investigated the PDL after 23 weeks of tooth movement into an augmented critical-sized defect. Methods: The second molars of four beagle dogs were moved into a critical-sized defect, which was filled with bovine xenograft or nanocrystalline hydroxyapatite. Autogenous bone served as control. After 23 weeks, histological samples were microscopically analyzed, and the dimension of the PDL was measured. For statistical calculations, a Wilcoxon–Mann–Whitney test was used. Results: The PDL was significantly wider on the tension side compared with the compression side for all replacement materials analyzed (p ≤ 0.05). These results apply to both the mesial and distal roots. Conclusions: The remodeling processes reached equilibrium within 23 weeks, resulting in a wider gap on the tension side, which contrasts with the situation a few days after the initial force application.

Long-term Outcomes of a Modified Straight-line Palate Repair Technique: Low Speech Correcting Surgery and Fistula Rates.

The goal of cleft palate (CP) repair is to restore normal speech, however, rates of velopharyngeal insufficiency (VPI) after palatoplasty remain high. We present a modified straight-line palate repair (SLR) technique that facilitates velum length to alleviate VPI. The technique releases nasal mucosa with the levator muscle off the hard palate. This study assesses speech outcomes of this modified SLR technique. Secondary aims are to assess fistula outcomes. A retrospective review evaluated non-syndromic patients with Veau III or IV CP ± cleft lip who underwent SLR from 1993-2023. Patients undergoing modified SLR were compared to those receiving traditional SLR. Outcomes included postoperative palatal fistula, fistula location, fistula repair rates, and velopharyngeal insufficiency (VPI) correcting surgery rates. Multivariable logistic regression was performed. Overall, 343 patients were included (160 modified SLR, 183 traditional SLR). Average length of follow-up from palatoplasty was 6.4±5.3 years. Modified SLR was associated with fewer fistulas than traditional SLR (3.1% vs 15.3%, Odds Ratio [OR]: 0.19; p=0.001), lower fistula repair rates (0.6% vs 13.1%, OR: 0.26; p=0.022), and lower secondary speech surgery rates (0.8% vs 16.0%, OR: 0.046; p=0.003). The modified SLR technique resulted in lower rates of VPI surgery, as well as fewer fistulas and lower rates of fistula repairs compared to traditional SLR at six years postoperatively. We hypothesize that releasing the nasal mucosa off the hard palate facilitates more posterior positioning of the levator muscle and less restricted medial mobilization of the oral mucosa, which lengthens the velum to alleviate VPI.

Assembly of Custom Implant and Ready-Made Distractor for Precise Maxillary Movement Vector Control in Cleft Patient With Midfacial Hypoplasia.

This study presents a novel approach for maxillary advancement in a patient with cleft lip and palate, utilizing the assembly of a custom titanium implant and a ready-made distractor. The patient exhibited significant maxillary hypoplasia and had concerns regarding the possible deterioration of hypernasality after conventional surgical methods. Distraction osteogenesis was initiated to address these challenges. A custom plate was designed using 3-dimensional printing technology. Integrating the plates with off-the-shelf distractors enables precise control of the distraction vector to optimize surgical precision and outcomes. The treatment plan involved Le Fort I osteotomy, followed by a distraction protocol that achieved a skeletal Class I relationship and total advancement of 7.5mm and elongation of 2mm, with no reported complications. This case demonstrates that combining custom implants with standard distractors can provide precise maxillary repositioning at reasonable costs, while mitigating the risks associated with traditional surgical interventions and reducing the need for secondary corrective surgeries.

"The Septum and Nasomaxillary Vault Associated with Unrepaired Unilateral Cleft Lip and Palate: A Data-Driven 3D Model".

Defining the nature of the unilateral cleft lip and palate nasal deformity (uCLND) and its optimal surgical correction continues to be a challenge. The purpose of this study was to develop a data-driven model of the primary unrepaired osseocartilaginous skeleton of the nasomaxillary complex. CT scans of nineteen 3-month-old infants with unrepaired unilateral cleft lip and palate and nineteen age- and race-matched controls were analyzed. Osseous landmark deviation in subjects with clefts was compared to controls. Segmentation of the osseocartilaginous septum was performed, and deformational differences were calculated between cleft and non-cleft cohorts. Compared to controls, the rhinion, non-cleft nasomaxillary junction, and cleft nasomaxillary junction deviated towards the non-cleft side. The piriform margins each diverge away from midline with the non-cleft side deviating lateral and superior, and the cleft side deviating lateral and posterior. These alterations result in a bony torsion with sigmoidal configuration of the cleft side aperture, vertical shortening of the central midface, and de-projection of the nasal pyramid. Segmentation of the septum revealed anterior deviation toward the non-cleft side with a single convexity toward the cleft. This three-dimensional data-driven model contradicts prior models and confirms a collapsing twist of the cleft side aperture and medialization of the bony margin of the nasal airway with deviation of the nasal bone complex toward the non-cleft side. This analysis defines the critical anatomic characteristics of the cleft nasal deformity and informs the goals of nasal correction at the time of primary repair.

Evaluation of Posterior Superior Alveolar Canal in Individuals With Cleft Lip and Palate Using Cone Beam Computed Tomography.

To evaluate the posterior superior alveolar canal (PSAC) in individuals with cleft lip and palate (CLP) by comparing them with individuals with no cleft lip and palate (NC) using cone beam computed tomography (CBCT). This is a cross-sectional, analytical study with a prospective sample. CBCT scans of 29 individuals with no cleft and palate (Group I) and 29 individuals with cleft lip and palate (Group II) were used. PSAC was evaluated and compared for its position, diameter, and distance between the individuals with CLP and NC using CBCT scans. The mean age of individuals in Group I and II were 12.93 and 11.82 years, respectively. The distribution of individuals based on gender comprised of 51.7% males and 48.3% females in both the study groups. PSAC was present in both right and left maxillary sinus in 100% of the study subjects of Group I and Group II. The most prevalent position of PSAC in Group I and Group II was on the lower third and middle third of lateral wall of maxillary sinus, respectively. The mean diameter was higher in Group II (1.2962 mm) when compared to Group I (1.0897 mm) which showed statistically significant value (P = .008). The promising results obtained from the present study demonstrates the importance of knowing the precise anatomical location of the PSAC in individuals with cleft lip and palate by using CBCT which is reliable, less time consuming and cost effective imaging tool.

Morphometric Evaluation of the Greater Palatine Foramen in Patients With Cleft lip and Palate (CLP) and Controls: A CBCT Study.

This study aimed to use cone beam computed tomography (CBCT) scans to compare the morphometric characteristics of the greater palatine foramen (GPF) in unilateral and bilateral cleft lip/palate patients (CL/P) and non-cleft (NC) individuals. One hundred patients with CL/P (78 unilateral and 22 bilateral) and 100 non-cleft individuals had their GPF morphometrically assessed in CBCT images. The antero-posterior width and medio-lateral width of the GPF, the distance between the right and left GPFs, the mesio-distal location of the GPF with respect to the molar teeth, the distance between the GPF and the hamulus of the medial pterygoid plate, and the distance between the GPF and the palatine alveolar ridge were measured on these images. The Kruskal-Wallis and Chi-square tests were employed to ascertain if there were any notable disparities across the 3 groups. The GPF's antero-posterior width and medio-lateral width, and distance from the hamulus and palatine alveolar ridge were considerably smaller in the unilateral cleft lip/palate (UCL/P) and bilateral cleft lip/palate (BCL/P) patients than in the NC individuals. However, no significant difference was observed between the BCL/P and UCL/P groups in terms of these parameters. The distance between GPFs and the location of the GPF did not exhibit any significant differences among the 3 groups. Certain morphometric parameters of the GPF were significantly different in CL/P patients. Understanding the anatomy of this area is crucial for successful treatment of individuals with CL/P with minimal complications.

Cranial Base Changes After Trans-sutural Distraction Osteogenesis in Growing Patients With Cleft Lip/Palate and Midface Hypoplasia

Background: Transesutural distraction osteogenesis (TSDO) is a method of correcting midfacial hypoplasia (MH) secondary to cleft lip and palate (CLP) without osteotomy. However, there has been little research on how the morphology of the cranial base changes postoperatively or whether any correction of the cranial base occurs. Materials and Methods: This retrospective study included 35 pediatric patients with MH secondary to CLP, who underwent TSDO treatment. Pre-treatment and post-treatment cranial computed tomography (CT) images were collected for cranial base measurements using 3-dimensional (3D) modeling reconstruction. For the comparative analysis, 102 children with normal craniofacial CT images were selected after matching for age and sex. Results: Comparison with normal children of the same age showed that the lengths and angles of several cranial base segments approached normal levels after treatment. In total, the authors found extreme extension in the anterior segment of the sphenoid bone, and in the middle cranial fossa. Simultaneously, TSDO therapy led to the anteroposterior diameter of the lateral pterygoid processes and vomer bone greatly exceeding the normal range, thus causing forward development of the midface skeleton. Conclusion: After the TSDO procedure, the cranial base length and angles approached normal dimensions, accompanied by the forward advancement of the midfacial skeleton. Among the cranial base structures, TSDO resulted in the most noticeable increase in the sphenoid bone in terms of linear measurements and angles, thus promoting midfacial development in children.

Unilateral cleft lip surgery symmetry observation with Millard I and Tennison techniques

Background: In line with the development of Millard I and Tennison cleft lip surgery techniques, there are also advantages and disadvantages to each technique. The Cleft Lip Symmetry Index (CLCSI) was used to measure the symmetry of each measurement variable from the results of unilateral cleft lip surgery so that it could be represented by an objective number. Purpose: This study aims to observe the surgery results using Millard I and Tennison techniques in unilateral cleft lip patients. Methods: This study used descriptive study by observing the symmetry of lateral philtrum height, vermillion height, cupid’s bow width, cupid’s bow height, and nostril width after labioplasty using the Millard and Tennison technique in unilateral cleft lip patients in Surabaya, Madura, and Malang. Results: The results of the CLCSI modification for the Millard technique can be summarized that nostril width ranged from 78.82 - 195.04. Lateral philtrum height ranged from 62.5 - 107.62. Cupid’s bow width ranged from 72.17 - 155.29. Cupid’s bow height ranged from 96.43 - 487.5. Vermilion height ranged from 84.62 - 131.11. The results of the CLCSI modification for the Tennison technique can be summarized that nostril width ranged from 88.89 - 171.43. Lateral philtrum height ranged from 48.92 - 109.04. Cupid’s bow width ranged from 89.26 - 166.15. Cupid’s bow height ranged from 73.81 - 311.11. Vermilion height ranged from 72.14 - 138.46. Conclusion: It’s difficult to obtain completely symmetrical surgical results because of many factors that affect the outcome of the operation in both Millard I and Tennison methods.

Preliminary study of environmental risk and protective factors during pregnancy for cleft lip with or without palate in the Korean population.

To investigate which types of environmental exposure during pregnancy are risk and protective factors for cleft lip with or without cleft palate (CL/P). This case-control study included 278 orthodontic patients with CL/P (CL/P group) and 51 without CL/P (non-CL/P group). Demographic and environmental exposure data were collected using questionnaires completed by the parents. Statistical analyses were performed to identify the potential risk and protective factors for CL/P. The two groups did not show significant difference in (1) body weight at birth and number of previous births; (2) fathers' ages at birth and occupation; (3) parents' chronic diseases, alcohol consumption, and exposure to harmful substances; and (4) mothers' smoking, secondhand smoking, and vitamin and calcium intake. Most patients with CL/P were born at normal term (≥ 37 weeks, 93.2%) with normal body weight (2.9-3.7 kg, 63.7%) and as either the first or second child (90.3%). In the CL/P group, the percentages of mothers who were very young or old (≤ 19 years, ≥ 40 years) and with physical labor in their occupation were low (1.8% and 2.2%, respectively). Compared with the non-CL/P group, the CL/P group showed a lower percentage of maternal folic acid intake (68.6% vs. 20.9%, odds ratio [OR] = 0.121; P < 0.001) and higher percentages of mothers' drug intake and fathers' smoking habits (3.9% vs. 16.2%, OR = 4.73, P < 0.05; 39.2% vs. 61.2%, OR = 2.44, P < 0.01). The findings of this study may explain the association between environmental factors and CL/P risk.

Utilization of a Perioperative Care Pathway for Pediatric Alveolar Bone Grafting: A Quality Improvement Initiative.

To develop, implement, and evaluate a standardized perioperative care pathway for pediatric patients undergoing alveolar bone grafting from the anterior iliac crest. A historical control group of 40 patients was reviewed retrospectively and compared to a prospectively collected treatment group of 40 patients who were treated with the new pathway. Tertiary-level academic pediatric hospital between 2018 and 2021. Pediatric patients with nonsyndromic cleft lip and palate undergoing alveolar bone grafting. A perioperative clinical care pathway was specifically designed for patients undergoing alveolar bone grafting from the anterior iliac crest. The pathway involved standardization of perioperative care, ultrasound-guided regional anesthesia for both surgical sites, and scheduled postoperative analgesia. (1) Length of hospital stay; (2) opioid consumption postoperatively; and (3) volume of oral intake in the first 24 h postoperatively. Data was analyzed via comparison of means (Student's t-test for continuous data and Chi-square test for categorical data) and control chart analysis. Compared to the control group, patients in the treatment group had lower mean length of stay (26.8 vs 37.8 h, p < .001), lower mean morphine consumption postoperatively (8 vs 34 mcg/kg, p = .008), and a higher proportion of patients not requiring any postoperative opioid use (80% vs 50%, p = .005). Implementation of a standardized clinical care pathway for pediatric patients undergoing alveolar bone grafting from the anterior iliac crest is feasible and was associated with significant reductions in postoperative length of stay and postoperative opioid requirements.

Pattern of Cleft Lip and Palate According to Gender in Children of Bangladesh

Background: Cleft defects are the most common congenital anomalies of the orofacial region. The typical distribution of cleft type is cleft lip, cleft palate and combined cleft lip and palate. To determine the frequency of Cleft Lip (CL), Cleft Palate (CP) and combined cleft lip and palate (CLP) according to gender. Materials and methods: It is a cross sectional observational study with some analytical components which was carried out in the Department of Anatomy of Chittagong Medical College From April 2021 to March 2022. It was conducted among 100 children of cleft lip and palate. Data was collected from LMRF (Lions Mukhlesur Rahman Foundation) Children Hospital, Smile train (CMSOGH) cleft project and Chattogram Maa Shishu O General Hospital, Agrabad Chattogram. The data were recorded in a predesigned questionnaire. Variables were presented as percentages (%) and were compared by Chi-Square test. All statistical analysis were performed using SPSS statistics for Windows, version 26.0. Finally the results were presented using tables and figures. Results: Among the 100 participants there were 58 male and 42 female children with a ratio of 1.38:1. 68% had combined cleft lip and palate, 22% had isolated cleft palate and only 10% had isolated cleft lip. Among the 10 children with cleft lip 4 were male and 6 were female. 80% of the cleft lip was on the left side. Among 22 children of cleft palate 9 were male and 13 were female. Lastly among 68 children of cleft lip and palate 45 were male and only 23 were female. 44% of cleft lip and palate was on the left side, 32% bilateral and only 24% was on the right side. Conclusion: This study reported the pattern of cleft defects with gender distribution in our country which shows females are more likely to have isolated CL and CP and males have CLP predominantly. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 3-7

Surgical Assisted Rapid Maxillary Expansion in Hemifacial Syndrome Patient Post Primary Cleft Treatment: A Case Report

Introduction: Cleft lip and palate is a congenital malformation resulting from an incomplete or incorrect fusion during embryonic development. Hemifacial syndrome is one of rare orofacial anomalies with midface hypoplasia. Maxillomandibular deformity repair for maxillary hypoplasia can be achieved by repositioning the maxilla and mandible to correct occlusion, mastication, functional issues, cosmetic concerns, and facial symmetry. The main concerns in the case of maxillary hypoplasia are the repair of transverse (narrowing of the maxilla), sagittal (anterior posterior), and vertical (facial proportion) aspects. This study aimed to elucidate the treatment for patients with maxillary hypoplasia by utilizing the surgical assessment of rapid maxillary expansion (SARME) following cleft lip and palate surgery. Case Report: A 21-year-old female patient had symptoms of a truncated maxilla, compromised speech, and challenges with mastication and ingestion. The patient’s surgical history includes having undergone labioplasty, palatoplasty in 2002, and gnatoplasty in 2023. The recommended treatment for this situation involves SARME. The patient’s speaking and feeding difficulties were caused by both transversal and vertical problems in the patient with maxillary hypoplasia. This is why the therapy was necessary. Case Management: Implementation of surgical assessment rapid maxillary expansion (SARME). Conclusions: This case report concludes a notable improvement in the upper and lower jaw’s functional, masticatory, and aesthetic aspects in a patient with maxillary hypoplasia. This improvement was achieved with surgical assisted of rapid maxillary expansion (SARME) following primary cleft lip and palate surgery. Keywords: Cleft lip and palate, Hemifacial syndrome, SARME

Impact of WHO's Surgical Safety Checklist-Based Program on Cleft-lip and Palate Repair Outcomes in LMICs-The CLEAN CLEFT Program.

"Clean Cleft" (CC) is an adaptation of the Lifebox Clean Cut program, designed to reduce surgical site infections (SSIs) in cleft lip and palate repairs. It focuses on 6 key processes: hand and site decontamination, surgical linen integrity, instrument sterility, timely antibiotic use, gauze counting, and WHO Surgical Safety Checklist compliance. The study explores CC's effectiveness in reducing infections, other complications, and enhancing early recovery. CC was piloted in 2 Ethiopian hospitals and 1 in Côte d'Ivoire, the primary public cleft care centers in each country. Baseline data were collected through direct observation in the operating room, with patients monitored postoperatively for infections and complications through daily ward visits and follow-up calls or clinic visits at 30 days. Post-intervention data were collected for 5 months. Data was captured in DHIS2 software and analyzed using SPSS version 26. The program enrolled 275 patients, with 156 during baseline and 119 post-implementation. Complications significantly dropped from 21.7% to 8.7% (P = .008), a 60% decrease. SSI rates fell from 18.1% to 8.0% (P = .03), while palatal fistulas decreased from 13.0% to 6.1% (P = .1) and wound dehiscence from 18.0% to 8.0% (P = .03). Adherence to perioperative standards improved, except for hand and skin preparation while pain management remained effective throughout the program. CC improved perioperative practices, significantly reducing infections, palatal fistulas, and wound dehiscence, supporting the broader program expansion to any subspecialty.

A Novel Classificationof Nasal SillMorphologyProvides Strategies for Secondary Cleft Rhinoplasty.

Inconsistent and suboptimal outcomes in secondary cleft lip deformity repairs stem from the absence of a standardized classification system for nasolabial deformities, causing surgeons to rely heavily on their experience to determine surgical strategies. Nasal sill morphology reflects the severity of nasolabial deformities and plays a crucial role in facial aesthetics. This study introduces a novel classification for secondary cleft nasolabial deformities based on nasal sill morphology from the base view and provides tailored surgical techniques for each type. The study included 276 patients who underwent secondary cleft nasolabial correction at Peking University Third Hospital between August 2019 and July 2024. Patients were categorized according to the novel classification system and received surgeries tailored to their specific deformity type. Among the 276 patients, 13 (4.71%) were categorized as type I, 25 (9.06%) as type II, 73 (26.45%) as type III, and 165 (59.78%) as type IV. All patients achieved improved nasal sill aesthetics and enhanced nasal symmetry. This novel classification system, based on nasal sill morphology, accurately characterizes secondary nasolabial deformities and offers a structured approach for surgeons to tailor surgical strategies to each patient's deformity type. The present study tries to help establish an objective standard for secondary surgery of cleft nasolabial deformity for the first time. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Lateral Rectangular Flap for Augmenting Vermilion Deficiency in Unilateral Cleft Lip Repair

Background and Objective: Cleft lip and palate are common congenital anomalies that require precise management with main component of repairing lip is the aesthetic outcome. Using lateral rectangular flap is a new method to optimize the medial vermilion deficiency. The goal of this study is to evaluate the efficacy of lateral rectangular flap for augmenting medial vermilion deficiency in unilateral cleft lip repair.Methods: This is a clinical trial was conducted in Rizgary Teaching Hospital and several private hospitals in Erbil, Iraqi Kurdistan Region from June 2021 to June 2023. A total of 18 patients with unilateral, complete and incomplete, isolated cleft lip and cleft lip and palate were included. Preoperative and postoperative photos were documented. Outcomes were analyzed up to one year following the repair.Results: The included patients had either isolated cleft lip (44.4%) or cleft lip and palate (55.6%). Cleft side was right (38.9%) or left (61.1%). Cleft was incomplete in only 2 patients (11.1%) and complete in 16 patients (88.9.%). No early postoperative complications were reported; however 5 patients complained of scar later after surgery. Outcome evaluation score for Cubid’s bow was 1 for 5 patients and 2 for 13 patients. On the other hand, score for lateral vermilion deficiency was 2 for all patients. No significant association was detected between patients’clinical data and the type of cleft. Conclusion: We found that lateral rectangular flap for augmenting medial vermilion deficiency in unilateral cleft lip repair was effective with excellent surgical outcome and minimal patients’ morbidity.

Healthcare Trajectories of Adolescent Patients With Cleft Lip and/or Palate According to Health Insurance Coverage in Medellin, Colombia.

To describe and compare the healthcare trajectories of patients with CL/P under two different income-based programs for health coverage in Colombia, known in Colombia as a health insurance regime (contributory and subsidized), in Medellín, 2021. Non-experimental, cross-sectional questionnaire-based study. Primary level of clinical care in Medellín, Colombia. Twenty-eight 15- to 21-year-olds with CL/P and primary caregivers. Individuals with CL/P answered the survey. Patients with syndromic CL/P and patients with cognitive disabilities were excluded. The calculation of the probabilistic sample was performed based on the formula for finite populations using databases from 2 health insurance companies. The analysis was descriptive and bivariate. Chi-square and Fisher tests were used to analyze the variables of interest. Continuity of the care pathway was measured with proxy indicators: (1) access to comprehensive CL/P treatment; (2) timeliness of access to comprehensive CL/P treatment; (3) differences in access to and timeliness of comprehensive CL/P treatment between patients under both health insurance coverage. No differences were found when comparing the healthcare trajectories of young patients with CL/P who were in both health coverage. Differences were observed in the timeliness of care for patients with CL/P under the subsidized coverage who were more economically vulnerable. Delays in care were mainly linked to administrative procedures required for orthodontic procedures, bone grafts, and maxillofacial surgeries. Despite the health system's guarantee of equal care across income levels, differences in the timeliness of care persist for patients from lower-income families.

Efficacy of the maxillary anterior segmental distraction osteogenesis in patients with cleft lip and palate.

Cleft lip and palate (CLP) is one of the most common birth defects worldwide. It typically results in significant maxillary dysplasia, causing severe oral function problems and substantially affecting the patient's facial aesthetics. Maxillary anterior segmental distraction osteogenesis (MASDO) has gained popularity in recent years as an effective treatment for correcting maxillary dysplasia. However, the evaluation of its effectiveness in patients with CLP varies across different studies. Our research was aimed at providing evidence of the effects of MASDO among CLP patients. A meta-analysis covered Medline, Web of Science, Embase, Scopus, and Cochrane Library. Controlled clinical trial studies published before February 2024 and analyzed changes in maxillary cephalometric landmarks before and after MASDO among patients with maxillary hypoplasia and CLP were included. Our meta-analysis included 10 papers in total. One study was at low risk of bias, seven were at medium risk, and two were at serious risk. MASDO significantly increased the maxillary length. The mean SNA angle increased by 6.43° (95% CI, 4.11° to 8.74°) and A-McNamara rose by 7.29mm (95% CI, 6.21mm to 8.37mm). The maxilla also showed a slight counterclockwise rotation; however, this reached no statistical significance. The mandibular position did not vary remarkably. Moreover, a significant increase in upper anterior tooth tipping and overjet, a decrease in overbite, and an improvement in nasolabial soft tissue were observed. MASDO might be a valid therapy option for CLP patients. It causes a significant increase in the maxillary length, anterior tooth crossbite, and nasolabial soft tissue were also greatly improved.

Prenatal exposure to antibiotics and the risk of orofacial clefts: a protocol for a systematic review and meta-analysis

IntroductionOrofacial clefts (OFCs), including cleft lip, cleft palate and combined cleft lip and palate, are among the most common craniofacial malformations in newborns and present significant healthcare challenges. Emerging evidence...