Cleft Palate Center Research Articles

Clinical Study on Submucous Cleft Palate Patients in the Cleft Lip and Palate Center, Fujita Health University Hospital

Clinical Study on Submucous Cleft Palate Patients in the Cleft Lip and Palate Center, Fujita Health University Hospital

Epidemiological Analysis of Cleft Lip and/or Palate by Cleft Pattern

To analyze gender differences in cleft pattern by the clinical statistical study of Japanese patients with cleft lip and/or cleft palate. Cleft pattern modeling was used to analyze 782 patients with cleft lip and/or cleft palate (417 males and 365 females) who had been examined at the Cleft Lip and Palate Center, Aichi-Gakuin University Hospital, and whose details could be confirmed. Relationships between gender and cleft type were analyzed with chi-squared test. A comparison of gender differences by cleft type revealed that a greater percentage of males had milder cleft lip, cleft lip and palate, or cleft palate, whereas the percentage of females tended to be greater as cleft severity increased. Modeling of cleft patterns enables more detailed classification of cleft lip and palate, and can lead to a greater understanding of pathology.

The Effects of Unrepaired Cleft Palate on Early Language Development in Chinese Infants

To investigate the effects of unrepaired cleft palate on the development of vocabulary comprehension and expression of Chinese children aged 8 to 15 months. The parents or caregivers of 40 infants with unrepaired cleft palate were recruited from the Cleft Lip and Palate Center at the Stomatology School of Peking University. Vocabulary development was assessed using a parent report protocol, the Chinese Communicative Development Inventory: Infant, for Putonghua (PCDI: Infant). The scores for vocabulary comprehension and expression of infants with clefts were compared with typically developing infants in the same age group. All infants with unrepaired cleft palate performed below the typically developing infants in vocabulary comprehension, but there were no significant differences from 8 to 15 months of age. No significant differences were found from 8 to 13 months of age on the expressive vocabulary portion of the Chinese Communicative Development Inventory: Infant, for Putonghua. However, a significant difference appeared at 14 and 15 months, with infants with cleft palate performing at a significantly lower level than the typically developing infants. The development of vocabulary comprehension in Chinese infants younger than 14 months with unrepaired cleft palate is not significantly delayed. At 14 and 15 months, however, the development of vocabulary expression is delayed. The reasons may be found in the specific phonetic characteristics of Putonghua.

The morphology of the sella turcica in velocardiofacial syndrome suggests involvement of a neural crest developmental field

We described the morphology of the sella turcica in individuals with velocardiofacial syndrome (VCFS), also known as chromosome 22q11.2 deletion syndrome, and compared the morphology with that of a control group of individuals from the Oslo University Craniofacial Growth Archive. The aim was to measure the cranial base angles in individuals with VCFS and, if possible, to discover the developmental field that may be involved in the condition. The study included 33 patients with VCFS from the Copenhagen Cleft Palate Center, Denmark. The genotype was confirmed by fluorescence in situ hybridization. The morphology of the sella turcica was described and measurements of the cranial base angles were performed on lateral cephalometric radiographs. The VCFS individuals had larger deviations in the morphology of the sella turcica compared to individuals from the Oslo University Craniofacial Growth archive. The deviations were mostly in the posterior part of the dorsum sellae. Individuals with VCFS had increased cranial base angles. The results of this study combined with the information in the literature on the main defects in VCFS (palatal abnormalities, cardiac anomalies, thymic hypoplasia or aplasia, hypothyroidism, and posterior brain abnormality), suggest involvement of a specific developmental field.

Objective Assessment of the Nasal Airway in Unilateral Cleft Lip and Palate—A Long-Term Study

To objectively evaluate the nasal function in adults operated on for unilateral cleft lip and palate with one-stage or two-stage palate closure. The population consists of all unilateral cleft lip and palate patients born from 1960 to 1987 and treated at the Cleft Lip and Palate Center, Uppsala University Hospital, Sweden. The patients were treated according to the same protocol except for palate closure, which was performed in one stage until 1977 and in two stages thereafter. Eighty-three patients participated. Mean follow-up time after primary surgery was 32 years. An age-matched control group underwent the same examinations. Nasal minimum cross-sectional area (cm(2)) and volume (cm(3)) were assessed (acoustic rhinometry). Airflow resistance (Pa s/cm(3)) (rhinomanometry), peak inspiratory flow (L/min) (peak nasal inspiratory flow), and number of identified odors (Scandinavian Odor Identification Test) were determined. The cleft side of unilateral cleft lip and palate patients had significantly lower values for all parameters compared with controls (p < .001). No difference was found between one-stage and two-stage procedures in values for the cleft side. However, the nasal area and volume of the noncleft side were significantly larger in patients who underwent one-stage as compared with two-stage procedures (p < .05). The nasal airway of unilateral cleft lip and palate patients demonstrates a wide range of impairments that can be quantified by objective measurements. However, the measurements used did not differentiate between patients operated on with the one-stage and two-stage procedures except for values of the noncleft side.

Skull thickness in patients with clefts

The purpose was to analyze skull thickness in incomplete cleft lip (CL), cleft palate (CP), and combined cleft lip and palate (UCLP). Copenhagen School of Dentistry and Copenhagen Cleft Lip and Palate Centre. Patients with cleft lip, cleft palate, and combined cleft lip and palate and normal adult men. Four groups of patients comprised the study. One group of patients with CL (24 patients; 7 women, mean age 6; 17 men, mean age 7.1), one group of patients with UCLP (28 patients; 11 women, mean age 6.6; 17 men, mean age 6.7), one group of patients with CP (57 male patients aged 18-33), and one normal adult male control group. The CL and UCLP groups were compared. The CP group was compared with the normal adult male control group. CL women had a significantly thinner occipital bone compared with CL men (p = 0.027). Women with UCLP had significantly thicker occipital bone than the control women (incomplete CL) (p = 0.014). The study showed gender differences in skull thickness in different cleft types. It also demonstrated that particularly the occipital bone deviated in patients with UCLP, which may explain the considerable deviations in jaw shape and position, previously registered in patients with UCLP.

A Longitudinal Three-Center Study of Dental Arch Relationship in Patients with Bilateral Cleft Lip and Palate

To compare and evaluate longitudinally the dental arch relationships from 4.5 to 13.5 years of age with the Bauru-BCLP Yardstick in a large sample of patients with bilateral cleft lip and palate (BCLP). Retrospective longitudinal intercenter outcome study. Dental casts of 204 consecutive patients with complete BCLP were evaluated at 6, 9, and 12 years of age. All models were identified only by random identification numbers. Three cleft palate centers with different treatment protocols. Dental arch relationships were categorized with the Bauru-BCLP yardstick. Increments for each interval (from 6 to 9 years, 6 to 12 years, and 9 to 12 years) were analyzed by logistic and linear regression models. There were no significant differences in outcome measures between the centers at age 12 or at age 9. At age 6, center B showed significantly better results (p=.027), but this difference diminished as the yardstick score for this group increased over time (linear regression analysis), the difference with the reference category (center C, boys) for the intervals 6 to 12 and 9 to 12 years being 10.4% (p=.041) and 12.9% (p=.009), respectively. Despite different treatment protocols, dental arch relationships in the three centers were comparable in final scores at age 9 and 12 years. Delaying hard palate closure and employing infant orthopedics did not appear to be advantageous in the long run. Premaxillary osteotomy employed in center B appeared to be associated with less favorable development of the dental arch relationship between 9 and 12 years.

A Longitudinal Three-Center Study of Dental Arch Relationship in Patients With Bilateral Cleft Lip and Palate

To compare and evaluate longitudinally the dental arch relationships from 4.5 to 13.5 years of age with the Bauru-BCLP Yardstick in a large sample of patients with bilateral cleft lip and palate (BCLP).Retrospective longitudinal intercenter outcome study.Dental casts of 204 consecutive patients with complete BCLP were evaluated at 6, 9, and 12 years of age. All models were identified only by random identification numbers.Three cleft palate centers with different treatment protocols.Dental arch relationships were categorized with the Bauru-BCLP yardstick. Increments for each interval (from 6 to 9 years, 6 to 12 years, and 9 to 12 years) were analyzed by logistic and linear regression models.There were no significant differences in outcome measures between the centers at age 12 or at age 9. At age 6, center B showed significantly better results (p=.027), but this difference diminished as the yardstick score for this group increased over time (linear regression analysis), the difference with the reference category (center C, boys) for the intervals 6 to 12 and 9 to 12 years being 10.4% (p=.041) and 12.9% (p=.009), respectively.Despite different treatment protocols, dental arch relationships in the three centers were comparable in final scores at age 9 and 12 years. Delaying hard palate closure and employing infant orthopedics did not appear to be advantageous in the long run. Premaxillary osteotomy employed in center B appeared to be associated with less favorable development of the dental arch relationship between 9 and 12 years.

Parental Attitude towards the Provision of Nonsurgical Oral Health Care to Children with Oral Clefts: An Epidemiological Survey.

AimTo evaluate the attitudes of parents of 3 to 8 years old children with cleft lip and palate towards the provision of pediatric dental health care and assess the experience of dentistry in general dental practice.Materials and methodsA questionnaire was distributed to parents of 100 children in the age group of 3 to 8 years old with cleft lip and palate who visited the cleft lip and palate center in KS Hegde Medical Academy, Mangalore.ResultsOut of the hundred patients, 66% of the patients registered directly at the cleft center for their deformity. Only 20% of these children visited a local dental practitioner for their dental health care. 42% had neither undergone any dental treatment nor received any dietary or oral hygiene advices. Regarding the provision of the dental treatment, 74% wanted a pediatric dentist to provide dental check-up and treatment at the cleft center, whereas, 24% preferred a dental practitioner close to their home and 2% does not want treatment anywhere.ConclusionThe survey indicates that there is parental support for the pediatric dental assessment at the cleft center with subsequent arrangement of dental treatment with their local dental practitioners. The majority wanted a pediatric dentist to provide the dental check-up and treatment at the cleft center.

Infant Orthopedics and Facial Growth in Complete Unilateral Cleft Lip and Palate until Six Years of Age (Dutchcleft)

To evaluate longitudinally the effect of infant orthopedics (IO) on dentofacial cephalometric variables in unilateral cleft lip and palate (UCLP) patients from 4 to 6 years of age. Prospective two-arm randomized controlled clinical trial in three cleft palate centers in The Netherlands (Dutchcleft trial). Fifty-four children with complete UCLP. Patients were divided randomly into two groups. Half of the patients (IO+) had IO until surgical closure of the soft palate at the age of +/-52 weeks; the other half (IO-) received no intervention. Cephalometric values representing soft tissue, hard tissue, and dental structures, measured on lateral headfilms made at 4 and 6 years of age. In the IO+ group, 21 patients were analyzed; in the IO- group, 20 patients were analyzed at age 4 and 22 at age 6. No differences were found between IO+ and IO-, except for two measurements: The interincisal angle was larger and the mentolabial angle was smaller in the IO+ group. For infants with UCLP whose surgical management included soft palate repair at 12 months and delayed hard palate closure, cephalometric outcomes at ages 4 and 6 provide no indication for the type of IO used in this study.

The Foundations of the Cleft Palate Center and Training Program at the University of Illinois

Abstract No Abstract Available. Presented at the Reunion Meeting of the Graduate Department of Orthodontia, University of Illinois, March 5, 1956, Chicago, Illinois.

Early Secondary Gingivo-Alveolo-Plasty in the treatment of unilateral cleft lip and palate patients: 20 years experience

Since 1988, the Milano surgical protocol has included lip, nose and soft palate repair at 6-9 months of age and closure of the hard palate at 18-36 months together with an Early Secondary Gingivo-Alveolo-Plasty (ESGAP). Prior to 1988 the alveolar cleft was repaired in a third step by bone grafting at 9-11 years of age. The goal of this study was to evaluate the long-term maxillary growth in unilateral cleft lip and palate (UCLP) patients who have undergone ESGAP. Alveolar ossification after ESGAP was also studied in the permanent dentition. Growth assessment was carried out comparing lateral X-ray cephalograms of a UCLP ESGAP sample (15 consecutive patients with a mean age of 18.2 +/-1.2 years) and of the UCLP bone graft sample (10 consecutive patients with a mean age of 18.7 +/-1.1 years) and a sample from the Oslo cleft lip and palate (CLP) centre sample (15 patients with a mean age of 18.1 +/-0.8 years). Alveolar ossification in the sample which had undergone ESGAP was evaluated through a sample of panoramic X-rays of UCLP in the permanent dentition. Alveolar bridging was assessed using a modified Bergland's scoring system. From the results it seems that ESGAP allows for an excellent alveolar ossification, but patients show an inhibition of maxillary growth compared with the secondary bone graft group and with the Oslo group. Although ESGAP allows for early repair of the alveolus together with palate repair, thus eliminating in all patients the need for secondary bone grafting, it seems to have an inhibiting influence on maxillary growth which increases the need for Le Fort I osteotomies. It is however fair to recall, that, even with an adjunctive Le Fort I osteotomy, ESGAP enables the total number of operations to be reduced to three, instead of most European protocols (4-5 procedures).

Crown Morphologic Abnormalities in the Permanent

The purpose of this study was to investigate crown morphologic abnormalities in the permanent dentition of subjects with clefts and unaffected controls. This is a prospective study of 100 patients and 60 control subjects. The study was carried out at the Cleft Lip and Palate Center at the King Abdullah University Hospital and at the Maxillofacial Unit at Jordan University of Science and Technology during the period November 2003 to September 2005. Eleven kinds of crown morphology abnormalities commonly described in the permanent dentition were recorded using the Arizona State University Dental Anthropology System. There were 1525 teeth examined in 100 subjects with clefts, and 203 crown morphologic abnormalities were recorded, resulting in a mean of 2 abnormalities per individual. No significant difference between the unilateral and bilateral cleft lip and palate groups was found; however, the difference between the cleft group and the control group was highly significant. Crown morphologic abnormalities were more frequent in the maxillary cleft teeth than in the mandibular teeth and in the anterior teeth than in posterior teeth, with a statistically significant difference. The most frequently found abnormalities in subjects with clefts were peg-shaped maxillary incisors and missing hypocone, followed by excess mammelons. In conclusion, there was a significant increase in the frequency of crown morphologic abnormalities in individuals with clefts when compared with subjects without clefts. Crown morphologic abnormalities occurred throughout the entire dentition and did not follow any predictable pattern.

Clinical Results of Cleft Lip and/or Palate Patients in the Cleft Lip and Palate Center, Fujita Health University Hospital

Clinical Results of Cleft Lip and/or Palate Patients in the Cleft Lip and Palate Center, Fujita Health University Hospital

Effect of Infant Orthopedics on Facial Appearance of Toddlers with Complete Unilateral Cleft Lip and Palate (Dutchcleft)

To evaluate the effect of infant orthopedics (IO) on facial appearance of 54 patients with unilateral cleft lip and palate (UCLP), aged 4 and 6 years. Prospective two-arm randomized controlled clinical trial in three Cleft Palate Centers in the Netherlands (Dutchcleft-trial). Patients were divided randomly into two groups. Half of the patients (IO+) had a plate until surgical closure of the soft palate at the age of +/- 52 weeks; the other half (IO-) received no intervention. Facial appearance at 4 and 6 years of age assessed on full face photographs and photographs showing only nose and mouth. Ratings were performed on a VAS-scale by professionals and laymen. At 4 years of age the full face pictures of IO+ children were scored to be more attractive than those of IO- children. However, this difference had disappeared at 6 years of age. At the age of 6, only professionals saw a significant difference on nasolabial photographs between IO+ and IO-. Regression analysis showed a minor effect of occlusion, lip revision, or type of nose reconstruction on the esthetic results. IO had a positive effect on full facial appearance of UCLP children at the age of 4 years, but at the age of 6, only professionals saw a positive effect of IO on the nasolabial photographs. This is irrelevant for UCLP patients since they deal with laymen in their daily life.

Presurgical Orthopedics and Satisfaction in Motherhood: A Randomized Clinical Trial (dutchcleft)

To study the effect of infant orthopedics on satisfaction in motherhood. Prospective two-arm randomized controlled trial in parallel with three participating academic cleft palate centers. Treatment allocation was concealed and was performed by means of a computerized balanced allocation method. Cleft palate centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. Two groups of infants with complete unilateral cleft lip and palate and no other malformations. Group IO+ (n = 27) wore passive maxillary plates during the first year of life, group IO- (n = 27) did not. Mean satisfaction scores were obtained from completed questionnaires at 6, 24, and 58 weeks of age. A 4-point scale was used (1 = very satisfactory to 4 = very unsatisfactory). The range of the mean scores for the individual items on the questionnaires for both groups ranged between 1.1 and 2.4. No differences were found between groups. Mothers appear to be satisfied in motherhood, least satisfied with the available time for themselves, and very satisfied with hugging and walking their babies. No differences were found between groups. Results from the present study show that infant orthopedics, with a passive plate during the first year of life, in children with a unilateral cleft lip and palate has no influence on the mothers' satisfaction in motherhood.

Outcome of Secondary Alveolar Bone Grafting Before and After Eruption of the Canine in Jordanian Patients With Cleft Lip and Palate

This prospective study was carried out at the Cleft Lip and Palate Centre at King Abdullah University Hospital and Maxillofacial Unit at Jordan University of Science and Technology during the period of 2000 to 2006. The sample consisted of 77 secondary alveolar bone grafts (62 patients), which were performed according to the same standardized surgical technique by a single maxillofacial surgeon. The objective was to assess the outcome of secondary alveolar bone grafting (SABG) before (early SABG) and after (late SABG) the eruption of the permanent maxillary canine in unilateral and bilateral Jordanian cleft subjects. Patients were divided into four groups: early unilateral SABG (22), late unilateral SABG (25), early bilateral SABG (8), and late bilateral SABG (7). Follow-up period ranged from 6 months to 5 years. Periapical or occlusal radiographs were used to assess the outcome of SABG. The degree of bony fill in the cleft area was assessed using the 4-point Kindelan scale. Only Grade 1 (more than 75% bony fill) cases were considered successful. Early unilateral SABG had a success rate of 90% while late unilateral SABG rate was 80%. The overall success rate of the unilateral SABG (85%) was higher than the rate for the bilateral cases (56%). Our findings support the conclusion that the outcome of early SABG is superior to late SABG. The overall success rate of SABG sample (74%) compared relatively well with other published results.

Early Surgical Outcomes in 5-Year-Old Patients with Repaired Unilateral Cleft Lip and Palate

To assess the surgical outcome of 5-year-old subjects with repaired unilateral cleft lip and palate who had been operated on by a single surgeon. Retrospective consecutive outcome study. The cleft lip and palate center at Frenchay Hospital, North Bristol NHS Trust, U.K. All patients born with unilateral cleft lip and palate between May 1992 and April 1998 were identified and their study models were located. The reasons for failing to obtain study models were recorded. The "test" study models were combined randomly with a "gold standard" set of study models to give a group of 53 for assessment purposes. These study models were assessed twice by two examiners independently using the 5-Year-Olds' Index. The weighted kappa (kappa) statistic and components of variance were used to establish the levels of agreement within and between examiners, as well as between the gold standard and the examiners. Thirty sets of study models out of a possible 43 were located. The most common reason for not obtaining records was poor cooperation. More than 50% of study models were assessed as being good outcomes (Index groups 1 and 2), whereas fewer than 20% of the records were evaluated as being poor outcomes (Index groups 4 and 5). There was good inter- and intraexaminer agreement and agreement with the gold standard values. Study model collection in this age group can be difficult due to patient cooperation.

The national CLEFTNET project for individuals with speech disorders associated with cleft palate

Although previous studies have demonstrated the benefits of using electropalatography (EPG) for treating therapy-resistant articulation errors associated with cleft palate, until recently access to this form of treatment has been limited. For the past 10 years, however, the CLEFTNET Scotland project has provided individuals with cleft palate access to EPG therapy. CLEFTNET Scotland represented a novel form of EPG service delivery—it linked the cleft palate centres throughout Scotland to Queen Margaret University College (QMUC) in Edinburgh through an electronic network. EPG data collected in the centres were sent to QMUC, where experts conducted detailed analysis leading to a precise diagnosis of each individual's specific articulation difficulty and suggested therapy guidelines to the specialist speech-language therapists based on their analysis. This form of service delivery has recently extended to include England, Wales and Northern Ireland to form CLEFTNET UK. This paper describes the CLEFTNET projec...

Infant Orthopedics Has No Effect on Maxillary Arch Dimensions in the Deciduous Dentition of Children with Complete Unilateral Cleft Lip and Palate (Dutchcleft)

Evaluation of the effect of infant orthopedics on maxillary arch dimensions in the deciduous dentition in patients with unilateral cleft lip and palate. Prospective two-arm randomized controlled clinical trial with three participating cleft palate centers. Cleft palate centers of the Radboud University Nijmegen Medical Center, Academic Center of Dentistry Amsterdam, and University Medical Center Rotterdam, the Netherlands. Children with complete unilateral cleft lip and palate (n = 54) were included. Patients were randomly divided into two groups. Half of the patients (IO+) had a presurgical orthopedic plate until surgical closure of the soft palate at the age of 52 weeks; the other half (IO-) did not undergo presurgical orthopedics. Maxillary arch dimensions were assessed on dental casts at 4 and 6 years of age with measurements for arch width, arch depth, arch length, arch form, and the vertical position of the lesser segment. Contact and collapse were assessed also. There were no clinically significant differences found between IO+ and IO- for any of the variables. Infant orthopedics had no observable effect on the maxillary arch dimensions or on the contact and collapse scores in the deciduous dentition at the ages of 4 and 6 years. Considering the Dutchcleft results to date, there is no need to perform infant orthopedics for unilateral cleft lip and palate patients.