Clefts Of Lip Research Articles

Primary Repair in Patients With Unilateral Complete Cleft of Lip and Primary Palate: Assessment of Outcomes.

Asymmetry of median facial structures is a major concern for patients with unilateral cleft lip and palate, and the principal goal of its treatment is to restore symmetry. Unilateral complete cleft of lip and primary palate (UCCLPP) is an uncommon subgroup and rarely reported. Patients with UCCLPP have protruding and deviating premaxilla, rendering a primary repair difficult. This study evaluated consecutive patients with UCCLPP and presented their treatment outcome. We assessed 36 patients with UCCLPP and collected clinical information. Surgical repair was performed at 3 months of age by using a modified rotation-advancement method and primary nasal reconstruction. A single surgeon performed all surgical procedures. A postoperative nasal stent was used for 6 months. Follow-up standardized photographs were collected. Landmarks were identified, and nose and lip dimensions measured. The ratios of the corresponding parameters (cleft vs noncleft side) were obtained for evaluating nose and lip symmetry. No surgical complication was noted in any patient. The overall lip and nose outcome after the primary repair were adequate, and all ratios were close to 1. The nostril width was slightly wider on the cleft side, but the alar width and height were acceptable. The lip heights were balanced between the 2 sides. Patients who received presurgical nasoalveolar molding did not show more favorable lip and nose dimensions, except for the medial philtral height. Even in the presence of protruding and deviating premaxilla, our patients with UCCLPP obtained adequate lip and nose outcome after undergoing primary lip repair and nasal reconstruction.

Use of metacognitive strategies in the speech and language intervention of Marathi speaking individuals with cleft of lip and/or palate

Introduction: Compensatory Articulation Disorder (CAD) is frequently seen in individuals with Cleft of lip and Palate (CLP). Speech intervention with metacognitive strategies in these individuals requires a long period of time. Objective: To study the use of metacognitive strategies in therapeutic intervention of individuals with Cleft of Lip and Palate. Methodology: 14 Marathi speaking Children with CLP between 4 to 6 years of age were evaluated for language and articulation. 7 Speech Language Pathologists devised Percentage Correct Consonants on the Photo Articulation Test for Articulation pre and post intervention. Language measures were compared pre and post therapy on the Receptive Expressive Emergent Language Scale. Results: There was a significant difference between articulation and language measures pre and post intervention respectively which is attributed to the use of metacognition strategies. Conclusion: Severity of CAD and effectiveness of strategies used for correcting articulation errors are linked to one another. Assessment of CAD and therapy scaffolding metacognition strategies can be used in Speech treatment of individuals with CLP.

Oral-Facial-Digital Syndrome Type II (Mohr Syndrome) in Palestine

Oral-facial-digital syndrome (OFDS) is a group of disorders characterized by oral cavity malformation, facial deformities and digits anomalies. There are at least 13 forms of OFDS, in which most of them have brain anomalies and different degrees of mental retardation. We have reported two cases with quite different dysmorphic features. The first case was a female and had small wide-spaced eyes, wide nose bridge, middle line cleft of upper lip, cleft hard palate, microglossia, micrognathia, polydactyly and syndactyly of the upper and lower limbs. Moreover, she had congenital hypotonia. Brain and abdominal ultrasound studies were normal. The baby's mother had a history of losing her first pregnancy resulted from intrauterine fetal death who was presented with similar dysmorphic features. The second case was a 4-year-old male who had dysmorphic features; Antimongoloid eye slant, prominent ears, broad nose bridge, high arched palate, cleft soft palate, lingual nodule, preaxial and posaxial polydactyly with syndactyly in both hands, bilateral bifid thumbs and bilateral clinodactyly. Feet had polydactyly with syndactyly, and bifid big toe shape. The first time, that two cases with characteristic features of oral facial digital syndrome type II to be diagnosed in two Palestinian siblings of different family with consanguineous marriage.

A rare case of median cleft of lower lip in Goldenhar syndrome

A rare case of median cleft of lower lip in Goldenhar syndrome

Clinical and genetic aspects of congenital lip and palate clefts in children of Yakutia

Clinical and genetic aspects of congenital lip and palate clefts in children of Yakutia

Prevalence of True Median Cleft of Upper Lip as Reflected from a Small Central Indian Population: Attempt to Report and Review the True Median Cleft of Upper Lip.

The median clefts of the facial skeleton and soft tissue are least in occurrence. Here we have attempted to analyze and review the prevalence of median clefts in our center. All the patients who reported with congenital deformities from January 2013 to June 2016 were included in the study. A detailed list of patients was then re-evaluated to preclude duplication of the record which could have occurred during the admission process. All the characteristics which can be evaluated epidemiologically were individually tabulated and evaluated in detail. Out of the 1184 patients included in the study only 2 were affected with median cleft. The prevalence of true median cleft was hence determined to be 0.17% among the cleft population. The prevalence of the true median cleft lip is rare and hence makes it difficult to classify these clefts, and also the treatment protocol needs to be fabricated for the treatment of such clefts.

CRANIOFACIAL STRESS PATTERNS AND DISPLACEMENTS AFTER ACTIVATION OF HYRAX DEVICE: FINITE ELEMENT MODELLING

Rapid maxillary expansion is employed for the treatment of cross-bite and deficiency of transversal dimension of the maxilla in patients with and without cleft of palate and lip. For this procedure, generally, different orthodontic appliances and devices generating significant transversal forces are used. The aim of this study is the finite-element analysis of stresses and displacements of the skull without palate cleft and the skull with unilateral and bilateral cleft after activation of the Hyrax orthodontic device. Two different constructions of the orthodontic device Hyrax with different positions of the screw relative palate are considered. In the first case, the screw is in the occlusal horizontal plane, and in the other, the screw is located near the palate. Activation of the orthodontic device corresponds to the rotation of the screw on one-quarter turn. It is established that the screw position significantly affects the distributions of stresses in skull and displacements of the cranium without palate cleft and with unilateral or bilateral palate cleft. Stresses in the bone structures of the craniums without cleft and with cleft are transferred from the maxilla to the pterygoid plate and pharyngeal tubercle if the screw displaces from the occlusal plane to the palate. Depending on the construction of the orthodontic appliance, the maxilla halves in the transversal plane are unfolded or the whole skull is entirely rotated in the sagittal plane. The stresses patterns and displacements of the skull with bilateral palate cleft are almost unchanged after activation of the orthodontic devices with different positions of the screw, only magnitudes of stresses and displacements are changed. The obtained results can be used for design of orthodontic appliances with the Hyrax screw, as well as for planning of osteotomies during the surgical assistance of the rapid maxillary expansion.

Validation of the Unilateral Cleft Lip Severity Index for Surgeons and Laypersons.

Severity of the primary unilateral cleft lip/nose deformity (UCL/N) is postulated to play a key role in postoperative complications, aesthetic result, and need for secondary surgery. There is no validated and widely accepted classification scheme of initial cleft severity. The purpose of this study was to validate the Unilateral Cleft Lip Cleft Severity Index as a reliable tool for evaluating presurgical UCL/N deformity by both surgeons and laypersons. Twenty-five participants (10 surgeons and 15 laypeople) evaluated 25 sets of randomly selected presurgical standardized photographs of UCL/N patients. Each participant rated patients on a scale of 1-4 using the Cleft Severity Index. Interrater reliability for surgeons, laypersons, and all participants was determined using an intraclass correlation coefficient. Histograms and regression analysis were performed to compare average ratings between groups. Interrater reliability for all groups was classified as "very good" determined by intraclass correlation coefficients of 0.837 (laymen), 0.885 (surgeons), and 0.848 (all participants). These results indicate that there was a high degree of interrater across all 3 groups and that both surgeons and laypersons can reliability rate cleft severity using the Cleft Severity Index. This study validates the use of the Cleft Severity Index by both surgeons and laypersons as a reliable tool for evaluating the degree of presurgical severity of patients with UCL/N. The Unilateral Cleft Lip Cleft Severity Index can thus serve as a reproducible and reliable grading system for primary UCL/N deformity and to categorize patients for future outcomes studies.

PRENATAL ULTRASONIC DETECTION OF CONGENITAL CLEFTS OF LIP AND PALATE IN KRASNODARSKII KRAI

The goal of our study was investigation of prenatal diagnostics of pathology and distribution of associated anomalies in the group of children - patients of clinic with congenital maxillofacial anomalies. Basing on oral poll of mothers given birth to children with the pathology during the period 2012-2014 in Krasnodarskii krai (358 cases), the efficiency of prenatal detection of congenital clefts of lip and palate (diagnosis Q36, Q35 and Q37 by MKB-10) by ultrasonic investigation was studied. Prenatal 2D ultrasonic investigation is performed three times during pregnancy on 12, 18-24 and 32-34 weeks of pregnancy. Cleft lip or palate were detected on the second and third ultrasonic investigation: cleft palate (Q35) was revealed only in 5,6% cases of children born with cleft palate, and cleft palate (Q36 and Q37) - in 33,8% cases. Importance of prenatal ultrasonic diagnostics of pathology is not only predetermined by the necessity of mental conditioning of parents for the most urgent and proper rehabilitation of ill children, but, also, by the fact that patients with clefts of lip or palate frequently have associated pathology of other organs and chromosomal anomaly. For proper prenatal detection of cleft palate 3D ultrasonic investigation is necessary. We also studied the presence of associated pathology distribution for the cases of isolated clefts of lip or palate. Higher efficiency of cleft lip and palate detection in prenatal period by ultrasonic diagnostics would support more successful rehabilitation by well-timed mental conditioning and informing of parents about stages of rehabilitation in the process of child growing. Ethical aspects of probable abortion because of detected pathology during ultrasonic investigation.

Survey of malformations at birth in Al-najaf Al-ashraf province

This study was conducted surveys to collect cases of congenital anomalies of the years 2005, 2006.2007 and 2008 live births in the maternity hospital and children in the province of Najaf, where the results were 378 cases deformation (deformation of the brain and neural tube defect, small head size, congenital cardiovascular, lip clefts, palate clefts, the structural defects, hydrocephalus, malformations of the digestive system) of the total 9653 live births, which was increased by 222 (58.7%) case of females, while males were increased by 158 cases (41.3%). The on the basis of the distribution of cases, depending on years of study was the year 2006, more frequent and the least of the past year 2008. The results of this study showed a higher rate of malformations of the brain and spinal cord and the least of which is the spine bifida Over the years of study. In 2005, the more abnormalities (19) the case of mothers aged 24-20 years, but 2006 was the number of cases (69) status of mothers aged 44-40 years, while the year 2007 resembled 2006 more than that age group is 44-40 in the occurrence of cases, and the year2008 were the highest in the age group 29-25 years (35.3%).

An Interesting Case of Lower Lip Cleft with Syndromic Features

Observation of a patient named Sanjay, a 23 year old male, revealed a case of anatomical curiosity, an uncommon variant of a developmental anomaly and masochistic habit, an atypical median mandibular cleft with distinctive facial appearance and intellectual disability. Facial gestalt is characterized by a round face, the heavy horizontal eyebrows with narrow palpebral fissures.

Accompanying defects of development in children with congenital cleft of lip and palate

Accompanying defects of development in children with congenital cleft of lip and palate

Long-term follow-up study of patients with a unilateral complete cleft of lip, alveolus, and palate following the Utrecht treatment protocol: Dental arch relationships

ObjectiveThis study sought to evaluate long-term dental arch relationships in adults with a unilateral complete cleft lip and palate (UCLP) treated by the Utrecht protocol and to compare results with the centers from the Eurocleft study. Materials and methodsRetrospective analysis of UCLP patients age 17 or older, treated by two-stage palate closure at the Wilhelmina Children's Hospital, a tertiary center for cleft surgery in Utrecht, the Netherlands. Patients were invited to the clinic for a long-term evaluation. Casts were obtained on the day of follow-up and assessed by the modified Goslon Yardstick for permanent dentition. Dental casts were scored twice by 3 different examiners. ResultsIntra-rater agreement varied from 0.743 to 0.844, the inter-rater agreement from 0.552 to 0.718. The mean Goslon Yardstick score was 3.3. Thirty-three percent of the patients had a Goslon score of 1 or 2, 45% had a score of 4 or 5. ConclusionsThe present study found unfavourable results regarding dental arch relationships after delayed hard palate closure at 3 years old. The mean Goslon Yardstick score was 3.3 (SD 1.4) and 45% of the casts were allocated to group 4 or 5 despite extensive orthodontic treatment. We observed a high number of secondary surgical interventions but no evident benefit regarding dental occlusion following the Utrecht treatment protocol, which includes a two-stage palatoplasty. Other factors than the timing of palate closure are likely of influence.

ОПЫТ ПРИМЕНЕНИЯ РАЗЛИЧНЫХ МЕТОДИК ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ВРОЖДЁННОЙ РАСЩЕЛИНЫ ГУБЫ И НЁБА

Objective: To study the results of surgical treatment of patients with cheiloschisis and palate. Methods: 230 patients with cheiloschisis and palate were examined in the period from 2009 to 2016. Patients with a congenital cleft of the upper lip were 55; patients with isolated cleft palate 152; and other patients have combined defects. Results: A total of 287 surgical interventions were performed. It was established that the use of Millard’s operation in the congenital cleft of the upper lip is preferable to the Tennesy operation, despite the great difficulties in performing the first. When the defects of the soft palate were eliminated, the technique of using the posterior-pharyngeal flaps was most effective. Conclusion: The choice of the method of surgical treatment of cheiloschisis and palate should be strictly individual, which ultimately contributes to a significant decrease of frequency of postoperative complications. Keywords: Congenital cleft, muscles of soft palate, veloplasty, uranoplasty.

Median cleft lip: A case series from a rural cleft center

Median cleft lip is a midline craniofacial cleft through upper lip. The incidence of craniofacial clefts is about 1:1,000,000 of live births. It indicates the rarity of this anomaly. Hence, this series is being presented. From January 2010 to December 2017, eight cases of the median cleft of upper lip attended the cleft clinic based in rural India. All eight patients had partial midline cleft lip. One patient had abnormal soft tissue mass and one patient had hypertelorism with nasal deformity. All of them underwent surgical repair of median cleft lip using inverted-U incision along with repair of orbicularis oris muscle in the midline. The postoperative symmetry was achieved in 100% of patients with good reconstruction of the philtrum. The associated deformities were left to be managed in second stage. A series of eight cases of partial midline cleft lip has been presented with good surgical outcome.

Autologous alveolar bone graft integration based on the Bergland scale in patients with primary lip and palate cleft: Experience in a third level hospital in Mexico City

Introduction: Alveolar bone graft surgery is of crucial importance in the cleft lip and palate patient. Adequate integration of the bone promotes dentition and esthetic of the face. The aim of this study is to evaluate the integration of the bone graft in patients with primary palate cleft. Patients and Methods: We made a retrospective analysis of medical records and plain X-ray films of 37 patients undergoing bone graft surgery in a tertiary care center. To assess the integration rate, we used the Bergland scale. Integration of alveolar bone graft evaluated with orthopantomography and relation between sex and the type of alveolar cleft surgery in the bone integration. Results: About 65% of the patients in our series were male (24). There was no statistical difference between the age, sex, and diagnosis. Mean age of the patients was 10.2 years. Successful integration (Bergland scale I and II) was achieved in 49% of the patients (Grade I: 30% and Grade II: 19%). Unfavorable integration (Bergland scale III and IV) was demonstrated in 51% of the patients, (Grade III: 43% and Grade IV: 8%). We found no difference between the integration rate and the type of alveolar graft surgery (primary, conventional secondary, and late secondary). Conclusions: Using the Bergland scale, we demonstrated 49% successful integration of the alveolar bone analyzed by two experts. Age has no impact on the integration rates in these groups of patients.

Studying the impact of cleft of lip and palate among adults using the international classification of functioning, disability and health framework

Objectives: The study was conducted to document the impact of the cleft of lip and palate among adults using International Classification of Functioning, Disability and Health (ICF) framework. Design: This was a cross-sectional study. Participants: A total of 32 adults with cleft lip and palate (CLP) and a matched control group of 32 adults without CLP (non-CLP [NCLP]) were included in the study. Methods: To identify a set of items from ICF framework that is relevant to adults with CLP (ICF-CLP item set) from the components of activity participation and environmental factors. Two expert teams were involved in the selection of the final set of items from both the components. Then, the item set (ICF-CLP item set) was developed in Tamil. ICF-CLP item set in Tamil was piloted on 32 adults with repaired CLP and a matched control group of adults without CLP (NCLP) group by self-administering method. Results: There was a significant difference (P = 0.000) between CLP and NCLP group, in both the components –activity participation and environmental factors. In the item-wise comparison, individuals with CLP had a greater limitation in activity, restriction in participation in the domains of communication, maintaining interpersonal interactions and relationships, employment, and major life areas. In environmental factors, the domains of support, relationship, health services, education training systems and policies, attitudes of authorities, and strangers were projected as barriers by individuals with CLP. Conclusion: This study helps us in understanding the overall impact of the cleft of lip and palate among adults in the components of activity participation and environmental factors using the ICF framework. On the other hand, the ICF-CLP item set developed is clinically relevant in identifying conditions which limit activities/participation and serve as barriers/facilitators in their environments both in CLP population as well as in normal individuals.

Use of Pfeifer incision for treatment of unilateral incomplete cleft of lip

Cleft lip (CL) is commonly classified as complete or incomplete. In incomplete CL, there is a minimal distortion of orofacial region. Most of the times, it is treated with incisions which are used for complete CL. Here, we reported the use of Pfeifer incision for treatment of incomplete CL. The logic behind using this incision was that it does not involve noncleft tissue of lip in incomplete CL. Two patients were treated using this technique. Postoperatively following parameters were assessed: white roll match, vermilion match, and lip length postoperative scar and cupids bow form to determine the success of the technique. All the patients were successfully treated.

COMPARATIVE ANALYSIS OF DENTAL CARIES IN CHILDREN WITH NEUROPSYCHIATRIC DISORDERS AND CONGENITAL CLEFT OF LIP AND PALATE LIVING IN KRASNODAR

Examined three groups of children aged 6 to 17 years: the first 96 children with CCLP (congenital cleft of lip and/or palate), the second 112 children with neuropsychiatric disorders (NPD) and the third (control) 86 somatically healthy children. On the basis of the index of KPU + kp and KPU in children with CCLP and in children with NPD high rates of prevalence and intensity of dental caries were found compared with the control group. The highest rates of prevalence of dental caries were found in children with CCLP and intensity of dental caries in children with NPD that is the most prominent in the children with NPD at the age from 6 to 12 years old. In children with CCLP and in children with NPD, the level of oral hygiene has significantly worse values compared to the control, which suggests the possibility of preventing tooth decay through improving oral hygiene of the mouth. The lowest level of oral hygiene was observed in children with CCLP that is mediated by severe congenital pathology.

The V-shaped mini flap method for microform cleft lip repair

Background We have devised a new operative technique for microform cleft lip repair via the use of a V-shaped flap method. From 2006 to 2015, nine patients with unilateral cleft lip diagnosed as mini-microform cleft lip or microform cleft lip by the classification of Yuzuriha and Mulliken, were recorded.