Cleft Palate Research Articles

A Realistic Ingeniously Designed Cleft Palate Simulator for Training of Residents: Bridging the Gap Between Theory and Practice.

Cleft palate is a congenital deformity that presents significant challenges in surgical correction. Proper training with an educational model for can greatly enhance the learning curve and improve patient outcomes. This article discusses the development and evaluation of an economical cleft palate model designed to enhance surgical skills and confidence among residents. The model was constructed using dental casts, acrylic resin, foam sheets, double-sided adhesives, infant feeding tubes, and red dye. Tertiary care center. Surgical residents. The assembly time and material costs were recorded. To evaluate its effectiveness, participants' feedbacks were collected and analyzed. The cleft palate model was produced at a cost of 250 INR per unit, with assembly taking approximately 15 minutes. Overall, 32 residents completed the simulation exercise of cleft surgery on the model. Participants gave the model an average score of 4 (±0.60) for realistic anatomical appearance, 3.5 (±1.3) for replicating the tactile nature of human tissue. Anatomical accuracy and ability to manipulate tissue and perform suturing received a rating of 3.4 (±1.1) and 3.7 (±0.81), respectively. The model's value as a training tool scored 4.4 (±0.51), with an overall satisfaction rating of 4.6 (±0.22) among residents. Our cleft palate model offers an economical, practical, and accessible solution for surgical training. This model is a viable alternative to more complex and expensive training tools and potentially enhancing the training of healthcare professionals in cleft palate repair.

Quality of Life After Microvascular Alveolar Ridge Reconstruction with Subsequent Dental Rehabilitation

Background/Objectives: Defects in maxillary and mandibular alveolar ridges are common in maxillofacial practice. Reconstruction with microvascular bone grafts and subsequent prosthetic rehabilitation is the gold standard treatment. This study investigated patients’ quality of life (QoL) after microvascular alveolar ridge reconstruction with subsequent dental rehabilitation. The effect of the underlying disease and success rates of the prosthetic treatment on QoL were analysed. Methods: OHIP-49 was used to evaluate oral health-related QoL (OHrQoL). The SF-36 was used to assess disease-nonspecific QoL. Results: Fifty-eight patients were enrolled and divided into four diagnostic (malignancy, osteoradionecrosis, benign disease, and cleft palate) and five prosthetic groups (no prosthetics, removable partial dentures, complete dentures, implant-supported removable dentures, and implant-supported fixed dentures). There was a significant difference between the diagnostic groups in the total score of their OHIP-49 (p = 0.008). Patients with malignant disease and osteoradionecrosis had worse QoL scores than those with benign diseases and cleft palate. Implant-supported prostheses had the best OHrQoL. Removable partial dentures and patients in whom dental rehabilitation was not possible had the worst OHrQoL (p = 0.042). The SF-36 subscale score showed no statistically significant differences between the diagnostic and prosthetic groups (p > 0.05). Conclusions: OHrQoL after microvascular alveolar ridge reconstruction differs significantly based on underlying diagnoses and prosthetic restorations. Benign diseases and implant-supported dentures have the highest scores.

"Evaluation of palatal bone regeneration in cleft palate patients following a two-stage palatoplasty using a modified Furlow procedure".

A palatal cleft can be reconstructed using various palatoplasty techniques. Many techniques use local mucoperiosteal flaps to close the hard palate cleft, without closing the underlying bone defect. The purpose of this study was to explore the possibility of spontaneous bone regeneration in the remaining bone defect following a two-stage palatoplasty. Furthermore, the effect of this bone regeneration on transverse maxillary growth was studied. A retrospective study of unilateral cleft lip and palate patients was performed. Cleft size was measured at the hard-soft palate junction on plaster models obtained during palatoplasty. Residual bony cleft was evaluated at the time of alveolar process reconstruction using CBCT images. The presence of crossbites was evaluated through clinical photographs to evaluate transverse maxillary growth. Forty-six patients were included in this study. Thirteen patients (28%) presented with complete ossification of the hard palate at the age of six years. Six patients (13%) had no ossification, while twenty-seven patients (59%) demonstrated partial closure, averaging 75% of the total hard palate length. All patients with complete closure and 89% of patients with partial closure presented without lateral crossbites. Statistical analysis revealed no significant correlation between lateral crossbites and the extent of hard palate ossification (p = 0.4314). 87% of children presented with at least partial ossification of the hard palate after a two-stage palatoplasty, indicating the potential for spontaneous bone regeneration. Importantly, lateral crossbites demonstrated no correlation with palatal ossification (p = 0.1819), suggesting no detrimental impact of regenerated bone on transverse maxillary growth.

Central Auditory Processing Abilities in Children with Non-Syndromic Cleft Lip and Palate: An Electrophysiological Study.

The present study compared the central auditory processing abilities using electrophysiological tests in children with non-syndromic cleft lip and palate (NSCLP) and their age-matched control group. Thirty children aged 7 to 15 years were recruited for the study. Participants were divided into 2 groups. The clinical group (children with NSCLP) comprised 15 children, while the control group (craniofacially typical peers) comprised 15 children with normal hearing sensitivity and auditory processing skills. Electrophysiological tests, including auditory brainstem responses (ABR), binaural interaction component (BIC) of ABR, auditory late latency responses (ALLR), and P300 were assessed. The results showed deviant responses in ABR, BIC, and ALLR in children with NSCLP compared to craniofacially typical counterparts. However, no significant difference was observed in P300 between the two groups. Children with NSCLP may be at a higher risk of central auditory processing disorder due to their abnormal neural transmission in the auditory nervous system. Also, assessing auditory processing abilities in children with NSCLP should include electrophysiological tests in the test battery for additional information regarding neural transmission.

Parental Age and Severity of Non-Syndromic Orofacial Clefts: Relationship with De Novo Mutations

Background: This study investigates the relationship between paternal and maternal age, and the severity of orofacial clefts and the presence of de novo mutations in children. Methods: This was a retrospective study of individuals who were diagnosed with non-syndromic cleft lip and/or palate (CL/P) and their unaffected parents, from 2012 to 2019. We obtained data from the AfriCRAN project database for Nigerians with non-syndromic orofacial clefts. These individuals were recruited at the Oral and Maxillofacial Surgery Clinic, Lagos University Teaching Hospital, Lagos. Results: There was no statistically significant association between type of CL ± P and parental age in young fathers (p = 0.93). When older fathers were considered, the percentage of complete (more severe) CL ± P cases increased, especially when they were married to older mothers, and this was statistically significant (p = 0.036). In older fathers, the risk of CL ± P in their offspring was increased (OR: 2.66, CI: 1.04-6.80), and there was also an increased risk of developing right-sided CL ± P (OR: 1.61, CI: 1.0-2.59). There was a reduced risk of isolated clefts of the soft palate in younger fathers (OR: 0.36, CI: 0.07–1.71), but the risk increased when considering complete types (more severe) of isolated clefts of the hard and soft palates (OR: 1.63, CI: 0.7–1.7). There was an increase in de novo mutation in children as the difference between paternal and maternal age increased. Conclusion: The study showed that a higher risk of CL ± P and de novo mutations in children is associated with increased parental age.

Assessment of Knowledge and Awareness of Cleft Lip and Palate Management among Adult Population in Chennai

Assessment of Knowledge and Awareness of Cleft Lip and Palate Management among Adult Population in Chennai

Robert H. Ivy: The First Professor of Plastic Surgery and Cleft Palate Surgery Pioneer

Robert H. Ivy: The First Professor of Plastic Surgery and Cleft Palate Surgery Pioneer

A Case of Multiple Tongue Hamartomas with Cleft Palate: 7 Years of Follow-Up.

Hamartoma is a congenital benign lesion commonly found in the lungs, kidneys, colon, and other regions, but it is seldom seen in the oral cavity. Multiple hamartoma occurrences in the tongue are particularly rare. This article describes a 7-day-old female infant with multiple tongue tumors and a cleft palate, who had difficulty feeding and subsequently underwent tumor removal under general anesthesia. Nine months later, a cleft palate repair was performed. No genetic abnormalities were detected in the genetic testing. After the tumor removal, follow-ups were conducted every year to observe any recurrence of the tumors, the morphology and function of the tongue, and any systemic abnormalities. After 7 years of follow-up, there was no recurrence of the tumors, and the morphology and function of the tongue were normal, with no systemic diseases found. It is crucial to conduct multidisciplinary consultations for children diagnosed with multiple tongue hamartomas and to monitor their overall development while addressing oral lesions.

Comparing Three-dimensional Radiologic Outcomes Between Early Versus Late Secondary Alveolar Bone Grafting.

Secondary alveolar bone grafting (SABG) during mixed dentition is the standard of care for patients with complete cleft of lip and palate. Early SABG (E-SABG; 4 to 7y) occurs before the eruption of lateral incisors, whereas late SABG (L-SABG; 8 to 12y) occurs before the eruption of maxillary permanent canines. This study compares outcomes of E-SABG versus L-SABG among patients with unilateral cleft of lip and palate (UCLP). A prospective cohort study was conducted evaluating nonsyndromic patients with UCLP who underwent SABG from April 2018 to January 2020, 48 consecutive patients with UCLP were included. Preoperative and 6 to 10-month postoperative cone beam computed tomography imaging were obtained to assess graft and periodontal outcomes. Among 48 patients with UCLP, of which 21 were in the E-SABG group (6.9 ± 1.1y), and 28 were in the L-SABG cohort (10.4 ± 1.6y). The initial alveolar cleft width is significantly smaller in the E-SABG cohort compared with the L-SABG cohort (5.1 ± 1.5 versus 6.5 ± 2.0mm, P = 0.008). Compared with the L-SABG cohort, the E-SABG cohort had higher rates of bony bridge formation (77.3% versus 65.4%, P= 0.367), thicker bony bridges (5.7 ± 2.1 versus 3.9 ± 1.5mm, P= 0.004), lower Bergland scores [1.5 (interquartile range: 1 to 2) versus 2.25 (interquartile range: 1.5 to 3.5), P= 0.026], and greater alveolar bone coverage (79.8 ± 16.7% versus 67.9 ± 18.1%, 0.024). The authors' findings suggest that patients who undergo E-SABG at ∼7 years may have better graft outcomes and benefits to the periodontal bone support on cleft-adjacent incisor compared with L-SABG at 11 years.

Long-Term Nose Evaluation After Treatment of Bilateral Cleft Lip Using the Spina Technique.

Bilateral cleft lip (BCL) repair is a challenge due to anatomic and functional distortions, worse than unilateral cleft. With regard to the nose, BCL can result in certain characteristics, such as a short columella, a flattened and widened tip, and horizontally oriented nostrils. Lip and nose treatment is advocated by some surgeons to achieve a better outcome. One of the techniques used to treat this condition is the one recommended by Victor Spina, in a complex protocol involving more than one surgical procedure and long-term follow-up. The aim of this study is to evaluate the growth of the nose in patients treated using the Spina technique. This was a retrospective and analytical study of the medical records of patients who were treated using the Spina technique at the Assistance Center for Cleft Lip and Palate (CAIF) at Hospital do Trabalhador in Curitiba, Brazil. Anthropometric measurements of interalar distance and nose tip projection were made from frontal and submental photographs taken at three moments: pre-first surgery, pre-definitive surgery, and late follow-up. Furthermore, other analyzed parameters were: sex, date of birth, age at time of surgery, and late follow-up. With these data, a comparison of nose growth was made between patients with BCL and a population without craniofacial anomalies observed in a study by FARKAS et al (1992). The comparison also took sex and age variables into account. Regarding the interalar distance measurements, both sexes showed a widening of the nose before starting treatment. This widening was maintained throughout follow-up. The growth curve, in turn, remained similar among males, with an average growth rate of only 3.2% higher in patients with BCL. Among females, the difference was one of 16.92%. In terms of nasal tip projection, there was an average increase of 1.12cm (86.15%) in males and 0.69cm (57.02%) in females. It was possible to notice a nasal growth rate in those with BCL similar to the normal pattern and a significant improvement in nasal tip projection in male patients. However, with regard to the data of both sexes, but especially females, the low number of patients jeopardized the significance of the results.

Hospital-based Costs to the National Health Service (UK) for Children and Adolescents Born with Cleft from Birth to 20 Years.

The primary aim was to assess the cost (£) to the National Health Service (NHS) of hospital treatment for individuals born with bilateral cleft lip and palate (BCLP), unilateral cleft lip and palate (UCLP), and cleft palate (CP), from birth to 20 years. The secondary aim was to assess the number of scheduled clinical outpatient and inpatient/outpatient surgical visits for this cohort. Retrospective micro-costing analysis. Patients treated within the South West of England Cleft Service (UK). Twenty-three case-notes of children born with cleft (5 BCLP; 10 UCLP; 8 CP) were identified from birth up to and including secondary alveolar bone graft (ABG), and a second group of 23 hospital case-notes (3 BCLP; 10 UCLP; 10 CP) were identified, post-ABG to 20 years. Mean costs from birth to ABG were £17,004 (BCLP), £11,620 (UCLP), and £6137 (CP), and post-ABG to 20 years were £9,463, £7,945, and £3,816, respectively. The largest costs were for staff. Repeat surgery had a significant impact on costs. The mean number of clinical outpatient visits for BCLP, UCLP, and CP were 140, 110 and 83 respectively and 8, 6 and 2 for inpatient/outpatient surgical visits, respectively. Costs for provision of cleft care by the NHS are significant. The greatest costs were incurred with care for patients with BCLP. Patients were expected to attend many appointments, with BCLP experiencing the most visits. Engagement with quality improvement programmes to minimise repeat surgery, and remote consultation for certain appointments, to reduce the patient burden are recommended.

Considering the Environmental Impact of Cleft Lip and Palate Surgery.

We sought to calculate the waste generated by cleft lip and palate (CL/P) procedures and to increase awareness of the environmental impact of our speciality. Waste from 5 CL/P procedures was categorised into 5 streams and weighed. A carbon calculator tool was used to convert weight of waste in to estimated carbon emission over a 12-month period. The study was carried out in a university teaching hospital. This was an assessment of the waste produced from 5 paediatric CL/P procedures. Weight of waste produced as result of CL/P procedures, measured in kilograms (kg); weight of CO2, measured in kg. We found that 768.5 kg of surgical waste was generated by CL/P procedures at our centre annually. This equates to 2653 kg of CO2. This study serves as a reminder of surgeons' responsibility to oversee how the waste we produce is disposed of.

The Efficacy of Naso-Alveolar Molding on Premaxilla Pushback and Dentoalveolar Changes in Patients With Bilateral Cleft Lip and Palate.

To evaluate the extent of naso-alveolar molding (NAM) in pushing the premaxilla posteriorly in patients with bilateral cleft lip and palate (BCLP). Naso-alveolar molding application in cleft lip and palate cases bridges the cleft gap and increases nasal tip projection. In BCLP, NAM potentially mobilizes the premaxilla posteriorly to allow tension-free primary lip closure. However, some patients with BCLP with NAM history still necessitate osteotomy during labioplasty, questioning the efficacy of NAM for BCLP management. This single-center retrospective study was conducted using medical records of nonsyndromic patients with BCLP. Twenty-six patients with BCLP were enrolled over a 5-year period with a history of NAM application before primary labioplasty. The changes in premaxilla width (P), anterior arch width (A), posterior arch width (R), and anteroposterior projection of the premaxilla (P'-A') were statistically analyzed at 2 time points: (1) at the start of NAM application (T1) and (2) after completion of NAM before surgery (T2). The average age at NAM initiation was 46.2 ± 40.4 days, and the average duration of NAM usage was 125.14 ± 62.94 days. A and P-A showed significant differences between T1 and T2 (P < 0.0001), whereas the rest did not show significant differences in value following NAM application (P > 0.05). Naso-alveolar molding successfully pushed back the premaxilla portion about 4.68 ± 2.83mm on average. Naso-alveolar molding can push back the premaxillary protrusion up to 5mm, which can serve as a cutoff point for the consideration of combined modalities. Prenatal diagnosis, counseling, and cleft education should be the benchmark in cleft centers to improve overall patient outcomes.

Hairy Polyp Presenting With Respiratory Distress in an Infant With Cleft Palate

Hairy Polyp Presenting With Respiratory Distress in an Infant With Cleft Palate

The impact of surgical technique and cleft width on the rate of secondary surgery and velopharyngeal function in children with UCLP at 5 years of age

Several factors may influence speech outcome and the rate of secondary palatal surgery in patients with cleft palate. The aim of this study was to evaluate different types of intra-velar veloplasty within an otherwise uniform surgical protocol. The impact of cleft width and the surgeon’s experience on outcome measurements was examined. This cross-sectional study included 62 individuals with unilateral cleft lip and palate born in 2000–2015. Based on the surgical technique used, they were divided into three groups. The cleft width was measured on dental casts. Blinded speech and language pathologists assessed velopharyngeal function with the composite score for velopharyngeal competence (VPC-Sum) for single words. They rated velopharyngeal function on a three-point scale (VPC-R) in sentences. Target consonants in words were phonetically transcribed. The percentage of correct consonants (PCC) was calculated. Surgical technique was not associated with any outcome. Cleft width was associated with the rate of secondary palatal surgery (OR 1.141, 95% CI 1.021–1.275, p = .020) and velopharyngeal insufficiency when using VPC-R (OR 2.700, 95% CI 1.053–6.919, p = .039) but not when using VPC-Sum (OR 1.985, 95% CI.845–4.662, p = .116). PCC was not associated with cleft width and did not differ between surgical techniques. Radical muscle dissection did not exhibit superiority over intra-velar veloplasty reinforced by the palatopharyngeal muscle. Follow-ups at later ages with larger groups will be necessary to evaluate and compare surgical techniques accurately. Cleft width had a greater impact on the rate of secondary surgery and velopharyngeal function than surgical technique, but neither affected the PCC.

Orthodontic treatment of patients with cleft lip and palate from birth through maturity

Cleft lip and palate (CLP) is one of the most common congenital anomalies, requiring lifelong care by a team of craniofacial specialists. A key member of that team is the craniofacial orthodontist, who provides treatment for these patients throughout the lifetime. This care actually begins prenatally, when families first meet with a craniofacial team. The family is provided with resources to prepare for their child's arrival and counseled about future treatment. Presurgical infant orthopedics (PSIO) will usually begin within a week of birth and continues for 3–5 months. PSIO helps approximate the lip and alveolar segments and reshapes the nostrils to facilitate primary surgical repairs. This is followed by a phase of monitoring growth and dental development throughout childhood, as patients with CLP are at increased risk for dental anomalies. Once the maxillary canine roots are one-third developed, the patient will be prepared for secondary alveolar bone grafting. This may include expansion, alignment, and/or maxillary protraction via facemask therapy. A short phase of maxillary dental alignment might follow if functional or esthetic concerns arise. Comprehensive orthodontic treatment is then performed at skeletal maturity, and coordinated with orthognathic surgery when indicated. The orthodontist and surgeon will collaborate closely in planning and managing the surgical correction. It is crucial that each stage of orthodontics is followed by an appropriate retention protocol. Finally, surgical and esthetic finishing procedures take place after surgical orthodontics is complete. This may include surgery to address lip, nose, speech, and breathing concerns, as well as definitive dental restorations.

Abbe Flap for Secondary Cleft Lip Deformity.

The objective of cleft lip surgery is to restore the structure and function of the upper lip. Despite initial repair, some patients develop secondary cleft lip deformity encompassing a shortened philtrum, reduced vermillion height, with excessive tooth visibility. The Abbe flap is a well-described approach for the management of this deformity. The following case describes a 33-year-old female with a history of bilateral cleft lip and palate who presented with secondary cleft lip deformity. She was successfully treated with an Abbe lip-switch flap. Anthropometric measurements supported improved facial aesthetics similar to those in the supplemental literature review. This case also illustrates how oral mucosa from the resected, scarred philtrum can be used to repair nasolabial fistulae.

Repair of Cleft Palate in Adult Patients; Impact of Speech Therapy Following Surgical Intervention in Africa

Repair of Cleft Palate in Adult Patients; Impact of Speech Therapy Following Surgical Intervention in Africa

Cleft lip and palate and periconception COVID-19 infection in five arab countries.

Little is known about factors associated with the severity of cleft lip with or without cleft palate (CL/P) especially during the COVID-19 pandemic with its dramatic changes. The aim of this multi-national study is to measure the association between CL/P severity, COVID-19 infection, and fear of COVID-19 in five Arab countries. This cross-sectional study took place in major governmental hospitals in five Arab countries from November 2020 to April 2023. Participants were infants born with CL/P and their mothers who were in their 1st trimester during the COVID-19 pandemic. Clinical examination was carried out, and CL/P cases were grouped according to phenotype: cleft lip and palate (CLP) versus cleft lip (CL), cleft extension (incomplete versus complete), and site (unilateral versus bilateral) to assess severity. Information on maternal COVID-19 infection and fear of COVID-19 were gathered. The study recruited 273 CL/P infants. Maternal COVID-19 infection during one-month pre-gestation and 1st trimester was significantly associated with higher odds of CL/P severity (AOR = 2.707; P = 0.002) than mothers without the COVID-19 infection. Using supplements during pregnancy showed a protective effect (AOR = 0.573; P = 0.065). Mothers infected with COVID-19 before and during pregnancy had more than twofold higher odds of having an infant with a more severe CL/P phenotype.

Children with facial differences experience deficits in emotion skills.

Children with facial differences, such as repaired cleft lip and palate (CLP), may present with reduced capacity for sensorimotor simulation, particularly in the form of facial mimicry. This study examined whether facial mimicry, emotion recognition, and empathy skills are reduced in children with CLP when compared with sex/age-matched controls. A case-control design was utilized. Forty-five children between the ages of 8 and 12 with CLP, and 45 age/sex-matched controls were recruited. Participants completed a facial mimicry task, and facial movements were tracked and quantified using OpenFace. Participants also completed picture and context-based emotion recognition tasks. Picture-based assessment involved identifying emotions from the Dynamic FACES database. Context-based assessment consisted of identifying how a child might feel in various situations. Finally, participants and their parents completed the Empathy Questionnaire for Children and Adolescents (EmQue-CA). Children with CLP presented with significantly reduced facial mimicry (p = .017), picture-based (p < .001), and context-based emotion recognition scores (p < .001) when compared with controls. Better facial mimicry was associated with better picture-based emotion recognition scores in the control group only (r = .22, p < .01). Children with CLP also had significantly lower child and parent-proxy EmQue-CA scores (p < .001). Greater facial mimicry significantly predicted better parent-proxy EmQue-CA scores (p = .016) but did not predict child scores. Children with CLP presented with reduced facial mimicry, poorer emotion recognition, and empathy skills. These findings have a broader relevance as they suggest children with facial differences may present with reduced facial mimicry and/or deficits in emotion recognition. (PsycInfo Database Record (c) 2024 APA, all rights reserved).