Complete Cleft Lip And Palate Research Articles

Gingivoperiosteoplasty in Children with Cleft Lip and Palate: The Need for Alveolar Bone Grafting.

This study aimed to determine the efficacy of gingivoperiosteoplasty (GPP) in preventing alveolar bone grafting (ABG) among children with cleft lip and palate (CLP). Retrospective university hospital single center study. Children with CLP treated with GPP from 2000-2015 were included. Those under eight years of age, without definitive conclusions regarding need for ABG or with incomplete data were excluded. Included patients were analyzed for demographics, cleft type, age at GPP, associated cleft surgery, use of nasoalveolar molding (NAM), indication for ABG, operating surgeon and presence of residual alveolar fistula. T-tests and Fisher's exact tests were utilized for statistical analysis. The need for ABG. Of the 1682 children identified with CLP, 64 underwent GPP and met inclusion criteria. 78% of patients with CLP who underwent GPP were recommended for ABG. Those who received GPP at a younger age (P = .004) and at the time of initial cleft lip repair (P = .022) were less likely to be recommended for ABG. Patients with complete CLP were more likely to be recommended for ABG than patients with cleft lip and alveolus only (P = .015). The operating surgeon impacted the likelihood of ABG (P = .004). Patient gender, race, ethnicity, laterality, and NAM were not significantly associated with recommendation for ABG. GPP does not preclude the need for ABG. Therefore, the success of ABG after GPP and maxillary growth restriction should be analyzed further to determine if GPP is a worthwhile adjunct to ABG in cleft care.

Dental anomalies in cleft lip and palate: A case-control comparison of total and outside the cleft prevalence.

This study’s objective was to compare the total and outside the cleft prevalence of dental anomalies (DA) between patients with cleft lip and palate (CLP) and a control group. This retrospective cross-sectional study was done under a case–control design. The case group consisted of 192 non-syndromic patients with complete CLP, while the control group included 411 patients. All subjects had orthopantomography, intra, and extraoral photographs. The prevalence of dental agenesis, supernumerary teeth, impacted teeth, dental transposition, and microdontia were compared using a chi-squared test (P < .05). Next, a second test was made, but only the anomalies outside the cleft were considered for this study. Total prevalence was 89.1% for cases, and 20.9% for controls (P < .01). The prevalence of each DA was significantly higher for the case group. In the analysis of DAs outside the cleft, the total prevalence was still significantly associated (P < .01); however, only dental agenesis was statistically significant (P < .01). Further analysis found that a high rate of upper premolar absence (P < .01) could explain this event. Patients with CLP have a higher prevalence of DAs compared to controls. After considering only the DAs outside the cleft, the total prevalence remains significantly higher. However, this phenomenon is explained mainly by the elevated prevalence of upper premolars’ agenesis. This study’s results suggest that environmental factors are behind the high prevalence of DAs in subjects with CLP.

Clinical and socioenvironmental characterizations associated with the genealogical analysis of a group of Dominican patients with nonsyndromic cleft lip with or without cleft palate

AbstractIntroduction and AimIn the Dominican Republic, there is an important number of individuals affected by nonsyndromic cleft lip with or without cleft palate (NS CL/P); in the search for the etiology, this study sought to determine the inheritance pattern of NS CL/P and to establish possible associations with clinical and socioenvironmental characteristics in a group of affected patients.Materials and MethodsThe type of cleft was characterized according to the general phenotypic category, the family trees were built according to Bennett et al. (2008, 10.1007/s10897‐008‐9169‐9), the socioenvironmental factors analyzed were tobacco consumption, alcohol, and radiation exposure.ResultsSeventy‐eight patients were analyzed, among whom severe phenotypes were more prevalent, including complete cleft lip and palate (CLP) (61.53%) and bilateral clefts (64%). In the analysis of genealogies, it was determined that 81.5% of the families were sporadic cases, 12.3% were autosomal dominant inheritance, and 6.2% were presented with a multifactorial inheritance. The consumption of alcohol was the most common socioenvironmental factor. There were no reports on the evaluated socioenvironmental factors in cases where heredity was determined as autosomal dominant. No inbred relationships were observed.ConclusionThere were diverse inheritance models for NS CL/P in patients from the Dominican Republic. Sporadic cases constituted the most frequent condition, followed by the existing families with autosomal dominance, and multifactorial inheritance. The absence of socioenvironmental factors commonly associated with pathology in families with autosomal dominant inheritance supports the hypothesis of a more significant genetic influence in this type of inheritance.

Breastfeeding Promotion and Nursing Care for Infants with Cleft Palate and/or Cleft Lip in Northeastern Craniofacial Center, Thailand

Background:The common feeding problems in infants with Cleft Palate (CP) and/or Cleft Lip and Palate (CLP) are the inability to suck and swallow breastmilk. Difficulties in feeding may compromise normal growth and disrupt the bonding process.Objective:To evaluate the treatment and breastfeeding rate in infants with CP and CLP.Methods:A retrospective study of infants with CP and CLP who were admitted to the postpartum ward between July 2017 and June 2019 was conducted. Demographic data, type of feeding, nursing activities, and duration of breastfeeding after discharge were collected.Results:A total of 35 infants were included in the study. Twenty-seven cases were non-syndromic complete CLP (77.2%). On admission only 15 infants (42.8%) received breastmilk and alternative feeding techniques were applied for 26 (74.3%) infants. Breastfeeding promotion and nursing care were provided to mothers and infants by an interdisciplinary team at the Craniofacial Center. The median Length of Stay (LOS) was 8 days (range 5-9 days) and infants born at the affiliated hospital (inborn) had a significantly shorter LOS compared to infants referred from other health centers (p=0.019). None of the inborn groups received infant formula. The breastfeeding rate in all groups was 100% at discharge. Exclusive breastfeeding rates at 2-, 4-, and 6-months follow-up were 82.8%, 42.8%, and 31.4%, respectively.Conclusion:Breastfeeding promotion, education, and nursing care from an interdisciplinary team resulted in an improved ability of mothers to breastfeed infants with CLP, particularly in non-syndromic CLP. The exclusive breastfeeding rate after 6-months in this study was higher than in previous studies.

Two-Dimensional Intra-Oral Radiographs Compared to Three-Dimensional CBCT at Six-Month Post-Operative Evaluation of Secondary Bone-Grafting in Patients with Cleft Lip and Palate

Background: The aim of this study was to investigate whether a complementary Cone-Beam Computed Tomography (CBCT) in patients with Cleft Lip and Palate (CLP) after alveolar bone-grafting to clefts gave substantial additional information, and particularly whether such new information had any implications for the further care of the patients. Methods: Seventeen children, with complete CLP, 10 unilateral and seven bilateral clefts, in all 24 clefts, were evaluated six months after secondary alveolar bone-grafting with two-dimensional intra-oral radiographs complemented with CBCT. The mean age at bone-grafting was 8.8 years. Three different examiners evaluated the radiographic documentation. Results: The mean pre-operative cleft width was 5.8mm. In 15 of the 24 clefts the same interpretation was made on both two-dimensional radiographs and CBCT. In the remaining nine clefts, CBCT added important information to the treatment decision. Conclusions: For the evaluation six months post-operatively of the success of alveolar bone-grafting to clefts, the two-dimensional radiograph should be complemented with CBCT unless the two-dimensional radiograph without doubt reveals open residual cleft and clinical findings indicate graft failure.

Clinical and Descriptive Study of Orofacial Clefts in Colombia: 2069 Patients From Operation Smile Foundation.

Objective:To describe the population of patients with cleft lip and/or palate (CL/P) in terms of cleft phenotypes, gender, age, ethnic group, family history, clinical presentation (syndromic vs nonsyndromic), some environmental and behavioral factors, and some clinical features.Design:Descriptive retrospective study.Setting:Patients attending the genetics counseling practice in Operation Smile Foundation, Bogotá, Colombia, for over 8 years.Participants:No screening was conducted. All patients requiring clinical genetics assessment in Operation Smile Foundation were included in the study.Results:Left cleft lip and palate (CLP) and nonsyndromic forms were the most frequent types of malformations in this population. Psychomotor retardation and heart disease were the most frequent comorbidities in these patients. A low proportion of mothers exposed to passive smoking during pregnancy was observed and low birth weight accounted for an important number of cases. Aarskog, velocardiofacial, and orofaciodigital syndromes were the most frequent syndromic forms of CLP in this population.Conclusions:In this study, the most frequent type of CL/P was the nonsyndromic complete left CLP. Aarskog, velocardiofacial, and orofaciodigital syndromes were the most frequent syndromic forms of CL/P in this population.

Comparative clinical evaluation of modified and conventional Grayson's presurgical nasoalveolar molding technique in infants with complete unilateral cleft lip and palate

Presurgical nasoalveolar molding (PNAM) was introduced by Grayson et al., in 1993 to presurgically mold the alveolus, lip, and nose in infants with cleft lip and palate (CLP). The aim of this comparative clinical trial was to evaluate the efficacy and efficiency of Modified and Conventional Grayson's PNAM in patients concerning morphological and anatomical changes in maxillary alveolus, nasal symmetry, number of visits, and duration of treatment. In this comparative clinical trial study, 16 infants with unilateral complete CLP were equally divided into two groups: Group I (modified PNAM technique using titanium molybdenum alloy [TMA] wire nasal stent) and Group II (conventional PNAM technique using stainless steel wire nasal stent). Patient photographic evaluation of nasal symmetry and maxillary study model CAD-CAM analysis, pre- and post-operatively in both groups, were compared using a paired t-test between the groups using the Chi-square test with P < 0.05 as statistically significant. In both groups, on evaluating nasal measurements, statistically significant (P < 0.05) decrease in nasal width and increase in columella deviation angle, a decrease of nostril length, and an increase of columella length in Group I were observed. On maxillary study model evaluation, a statistically significant (P < 0.05) decrease in width of the alveolar cleft was noticed in both groups and lateral deviation of the incisal point in Group I and width of the palatal cleft in Group II was noticed. This study showed a morphological improvement in nasal symmetry and maxillary alveolar morphology in complete unilateral CLP patients, treated with both Modified and Conventional PNAM techniques, with the Modified PNAM technique being more efficient for treatment duration and the number of adjustments as there are less number of visits.

Intranasal splint removal after septal surgery: optimum timing

Objectives Complete cleft lip and palate (CLP) is a common congenital middle‑third facial defect, which has considerable medical, economic, social, and psychological consequences for the affected individuals and their families. Many surgical techniques had evolved for correction, but the displacement of the lower lateral nasal cartilage is considered a challenge for the surgeon. Preoperative naso‑alveolar molding (NAM) aims at alignment of tissues, thus improving the surgical outcome. The aim of the current study was to assess the outcome of the use of NAM as a presurgical orthodontic modality for the treatment of patients with unilateral complete CLP associated with nasal deformity. Patients and methods This prospective controlled study was conducted on 16 randomly selected patients with unilateral complete CLP associated with nasal deformity. They were divided randomly into two equal groups. One group included eight patients who underwent presurgical NAM therapy, and the other one included eight patients who underwent surgical repair only as a control. Results A statistically significant difference was found regarding the hemicolumellar height ratio. Although alar base width values were slightly smaller in presurgical NAM therapy group, no statistically significant difference was found for the alar base width values or the domal angles. Conclusion Presurgical NAM proved superior postsurgical nasal symmetry compared with controls regarding the nostril height. The parents of patients with unilateral complete CLP associated with nasal deformity should be counselled to have presurgical NAM to improve the surgical outcome. Keywords: cleft lip, cleft palate, orthodontics.

Bite force assessment before and after orthognathic surgery in individuals with repaired cleft lip and palate

ObjectiveTo evaluate the impact of orthognathic surgery on the masticatory system of individuals with repaired cleft lip and palate (CLP) by means of bite force (BF) assessment. Material and methodsForty individuals were prospectively divided into 2 groups: 1) Control group (CON): 20 individuals without CLP (10 males, 10 females, 23.7y±7.4), 2) Cleft lip and palate group (CLP): 20 individuals with complete CLP with indication for orthognathic surgery (OS) (11 males, 9 females, 23.6y±5.6; 10 unilateral CLP; 10 bilateral CLP). The BF was evaluated in the immediate preoperative period (PRE), 3 months postoperatively (POST3M) and 6 months postoperatively (POST6M), using a gnathodynamometer (IDDK Kratos, Cotia-SP, Brazil). ResultsThe BF of the CLP group was significantly lower than that of the CON in all evaluated periods. The BF of individuals with CLP was significantly lower in POST3M compared to PRE. Also, a significant increase in BF was observed between POST3M and POST6M. Though not significant, the BF was increased in POST6M when compared to PRE. The BF of unilateral and bilateral CLP individuals were statistically similar. Males presented a BF almost twice as high as females. ConclusionCleft lip and palate negatively impacts BF. Although there was a tendency for BF values to increase 6 months after OS, it was still significantly reduced when compared to controls, not reaching normative values.

Delayed maturation and reduced crown width of the permanent first mandibular molar in all subgroups of cleft lip and palate.

Surgical closure of the cleft damages nerves and blood supply in the area and may possibly negatively influence dental development in children with cleft lip and palate (CLP). Previous studies of the permanent first mandibular molar (M1inf ) in children with unilateral complete CLP found delayed maturation and decreased follicle/crown width before any surgical interventions. This study aimed to investigate if these findings are representative for the total population of individuals born with CLP. A population-based consecutive longitudinal sample of 224 children with clefts: 183 with CLP (66 with complete [47 unilateral, 19 bilateral], 117 with incomplete [70 unilateral, 47 bilateral], and 41 with unilateral incomplete cleft lip (controls), was examined pre- and post-lip closure (at 2 and 22months of age). In lateral cephalometric X-rays (obtained as part of a standard treatment protocol), M1inf follicle maturation and follicle/crown width were assessed. Mantel-Haenszel test and Pearson's correlation coefficient R were used to describe relationships. Differences between group means were tested using Wilcoxon rank sum test. Significance level was set to 5%. Follicle maturation was significantly delayed in all groups with CLP compared to that in controls (P<.01). Follicle and crown width were significantly reduced in all CLP groups compared with those in controls (P<.01). Sex did not influence these variables. Delayed follicle maturation and decreased follicle/crown/tooth size were found to be part of the congenital traits characterizing individuals with all types of CLP and not a result of surgical iatrogenesis.

Rapid Arch Expansion in Cleft Lip and Palate Children: Comparison Between Fan-Shaped Expander and Hyrax-Type Expander by Using Cone Beam Computed Tomography

Purpose: The aim of the current study was to evaluate the skeletal and dentoalveolar effects of rapid palatal expansion (RPE) in children with cleft lip and palate (CLP), ages 8 to 12 years treated with 2 expanders. Methods: Twenty Egyptian children with complete bilateral CLP exhibiting maxillary transverse deficiency were divided randomly into 2 groups according to the appliance used for expansion: (A) fan expander group. (B) hyrax expander group. Cone-beam computed tomography (CBCT) images were taken before and immediately after expansion procedure. Results: There was non-significant vertical movement of the maxilla for the 2 groups. On the transverse plane, there was more anterior expansion and posterior restriction for the fan group. However, the hyrax group showed significant posterior as well as anterior expansion. Both groups showed significant tipping between both sides posteriorly and anteriorly. Mandibular expansion was non-significant. Conclusion: Fan expander showed better results for children with cleft palate requiring anterior expansion only. Hyrax expander is better used for cases seeking for posterior and anterior expansion.

Impact of Temporomandibular Disorders and Sleep Bruxism on Oral Health-Related Quality of Life of Individuals With Complete Cleft Lip and Palate.

The temporomandibular disorders (TMDs) and sleep bruxism (SB) affect the quality of life (QoL) of the individuals in general. However, the literature lacks studies on individuals with cleft lip and palate (CLP). Thus, this study aimed to evaluate the impact of TMD and SB on the oral health-related quality of life (OHRQoL) of individuals with CLP. Thirty-six individuals, both genders, aged between 30 and 50 years, at routine treatment in the Dental Prosthesis Sector of Hospital for Rehabilitation of Craniofacial Anomalies-University of São Paulo were selected and divided into the following groups: G1-unilateral complete CLP (n = 22) and G2-bilateral complete CLP (n = 14). Three questionnaires were applied: Oral Health Impact Profile (OHIP-14), SB self-report and Research Diagnosis Criteria for TMD. Fisher test, Mann-Whitney test, and t test were applied to verify values between TMD, SB, gender, and OHIP-14 (P < 0.05). The mean OHIP-14 score was of 5.80, and females had higher (8.58) OHRQoL than males (3.31). There was association with gender and OHRQoL (t test, P = 0.006), TMD with OHRQoL (Mann-Whitney test, P = 0.036), and TMD and SB (Fisher test, P = 0.006). Temporomandibular disorder was diagnosed in 30% of the individuals. Of these, 16.66% did not present SB, while 13.88% presented it. The association TMD versus SB showed statistically significant differences and 83.33% of the individuals reporting SB also had TMD. Based on this study, the authors can conclude that: TMD impacts OHRQoL in CLP patients, females are more affected in their OHRQoL than males, SB was strongly associated with TMD.

Three-dimensional assessment of alveolar bone thickness in individuals with nonsyndromic unilateral complete cleft lip and palate

Background: Patients with cleft lip and palate (CLP) present with thin alveolar bone around the defect. Thin alveolar bone compromises orthodontic treatment. The aim of this study was to carry out three-dimensional (3D) assessment of the thickness of alveolar bone around the teeth adjacent to cleft and to compare the thickness of alveolar bone between cleft and noncleft side. Materials and Methods: Retrospective database of 16 cone-beam computed tomography (CBCT) scans of individuals with nonsyndromic unilateral complete CLP reported to two cleft centers in the year 2015 and 2016. Alveolar bone thickness of the teeth anterior and posterior to the cleft side in the buccal, lingual, mesial, and distal at three levels (3 mm, 6 mm, and 1 mm below the apex) from the cementoenamel junction (CEJ) using Dolphin 3D imaging software were measured. CBCT images of each cleft patient are divided into two groups, cleft and noncleft site. Each cleft side is subdivided into 1. Tooth anterior to the cleft 2. Tooth posterior to the cleft. Alveolar bone thickness of teeth at labial/buccal, palatal, and mesial/distal surfaces was measured. These subdivided groups were compared to contralateral teeth on the noncleft sites for individual surface. Statistical Analysis Used: Wilcoxon signed-ranks test and descriptive statistics were used. Results: The average alveolar bone thickness on the labial surface for teeth anterior to the cleft at 3 mm from CEJ is 0.15 (0, 0.80) mm and noncleft site is 0.85 (0.58, 1.28) mm (P

Neonatal tooth with bilateral cleft lip and palate: A case report with review of literature

Natal and neonatal teeth are present in the oral cavity at birth and during the first 30 days of life, respectively. Management of such teeth is a treatment challenge. The incidence of such natal and neonatal teeth is reported to be 1 in every 1125-30,000 births, respectively. Cleft lip and palate (CLP) is a common dentofacial congenital anomaly of the oral cavity and may be present unilaterally or bilaterally. The occurrence of association of such teeth with unilateral and bilateral CLP cases is reported to be 2% and 10%, respectively. The presence of natal/neonatal teeth in the cleft area complicates the child’s health only in few cases. There is a paucity of information in the literature regarding the simultaneous occurrence of neonatal teeth in bilateral CLP cases. The present paper reported the management of a neonatal tooth present in association with complete bilateral CLP in a 12-day-old male child with review of literature.

Dental Anomalies in a Brazilian Cleft Population.

The aim of this study was to radiographically investigate the prevalence of dental anomalies outside the cleft area in a group of Brazilian patients with nonsyndromic cleft lip and/or palate (NSCL/P). A retrospective analysis of 207 panoramic radiographs of patients with NSCL/P aged 12 to 45 years without history of tooth extraction and orthodontic treatment was performed. Dental anomalies were found in 75.4% of the patients, and tooth agenesis (29.2%) and supernumerary tooth (2.6%) were the most common anomalies. The risk of agenesis was higher among the individuals with cleft palate (CP) compared with individuals with cleft lip (CL) and cleft lip and palate (CLP) (agenesis: CP versus CL: odds ratio 6.27, 95% confidence interval 2.21-17.8, P = .0003; CP versus CLP: odds ratio 2.94; 95% confidence interval 1.27-6.81, P = .01). The frequency of dental agenesis was higher in patients with unilateral complete CLP (agenesis: P < .0001), incomplete bilateral CLP (agenesis: P = .0013), complete CP (agenesis: P < .0001), and incomplete CP (agenesis: P < .0001). The frequency of supernumerary teeth was higher in patients with bilateral complete CLP (P < .0001). The frequency of dental agenesis (P < .0001) and ectopic tooth (P = .009) was higher than the frequency estimated for general population. The prevalence of dental anomalies in patients with NSCL/P was higher than that reported in overall population. This study found preferential associations between dental anomalies and specific extensions of NSCL/P, suggesting that dental agenesis and ectopic tooth may be part of oral cleft subphenotypes.

Cleft characteristics and treatment outcomes in hemifacial microsomia compared to non-syndromic cleft lip/palate

The goal of this study was to describe the clinical characteristics and treatment outcomes of patients with hemifacial microsomia (HFM) and cleft lip/palate (CL/P), and to compare them to a historic cohort of patients with non-syndromic CL/P treated at the same centre. A retrospective review of patients with HFM and CL/P was performed; the main outcome measures assessed were cleft type/side, surgical outcome, midfacial retrusion, and speech. Twenty-six patients (13 male, 13 female; mean age 22.7±14.9, range 1–52 years) with cleft lip with/without cleft palate (CL±P) were identified: three with cleft lip (12%), two with cleft lip and alveolus and an intact secondary palate (8%), and 21 with cleft lip and palate (CLP) (81%; 15 unilateral and six bilateral). Four patients (19%) had a palatal fistula after palatoplasty. Twelve of 22 patients aged >5 years (55%) had midfacial retrusion and two (9%) required a pharyngeal flap for velopharyngeal insufficiency (VPI). Fisher's exact test demonstrated a higher frequency of complete labial clefting (P=0.004), CLP (P=0.009), midfacial retrusion (P=0.0009), and postoperative palatal fistula (P=0.03) in HFM compared to non-syndromic CL±P. There was no difference in VPI prevalence. This study revealed that patients with HFM and CL±P have more severe forms of orofacial clefting than patients with non-syndromic CL±P. Patients with HFM and CL±P have more severe midfacial retrusion and a higher palatal fistula rate compared to patients with non-syndromic CL±P.

Assessment of presurgical clefts and predicted surgical outcome in patients treated with and without nasoalveolar molding.

Obtaining an esthetic and functional primary surgical repair in patients with complete cleft lip and palate (CLP) can be challenging because of tissue deficiencies and alveolar ridge displacement. This study aimed to describe surgeons' assessments of presurgical deformity and predicted surgical outcomes in patients with complete unilateral and bilateral CLP (UCLP and BCLP, respectively) treated with and without nasoalveolar molding (NAM). Cleft surgeon members of the American Cleft Palate-Craniofacial Association completed online surveys to evaluate 20 presurgical photograph sets (frontal and basal views) of patients with UCLP (n = 10) and BCLP (n = 10) for severity of cleft deformity, quality of predicted surgical outcome, and likelihood of early surgical revision. Five patients in each group (UCLP and BCLP) received NAM, and 5 patients did not receive NAM. Surgeons were masked to patient group. Twenty-four percent (176/731) of surgeons with valid e-mail addresses responded to the survey. For patients with UCLP, surgeons reported that, for NAM-prepared patients, 53.3% had minimum severity clefts, 58.9% were anticipated to be among their best surgical outcomes, and 82.9% were unlikely to need revision surgery. For patients with BCLP, these percentages were 29.8%, 38.6%, and 59.9%, respectively. Comparing NAM-prepared with non-NAM-prepared patients showed statistically significant differences (P < 0.001), favoring NAM-prepared patients. This study suggests that cleft surgeons assess NAM-prepared patients as more likely to have less severe clefts, to be among the best of their surgical outcomes, and to be less likely to need revision surgery when compared with patients not prepared with NAM.

Living with Cleft Lip and Palate: The Treatment Journey

To better understand how individuals with cleft lip and palate (CLP) perceive and experience their treatment process and how these perceptions and experiences change over the life course. Qualitative in-depth semistructured interviews with 11 adults with nonsyndromal complete CLP. Individuals from three Canadian cities were recruited by convenience and theoretical sampling through AboutFace International. The number of participants was determined by the principle of theoretical saturation. The experience of individuals with CLP through the treatment process changes over the life course. In childhood and early adolescence, most individuals experience stigma, negative self-perception, and as a result were more prone to perceiving the treatment process not only as unbearably burdensome but also as fueling their feeling of "defectiveness." In adulthood, participants' self-perception improved, partly because of definitive surgical correction, leading them to realize treatment benefits and reappraise the treatment process as satisfactory rather than burdensome. Subsequently, some individuals pursued further surgeries hoping for additional psychological gains, in lieu of psychosocial interventions addressing the underpinnings of residual feelings of "defectiveness." This led to dissatisfaction and frustration when the procedures did not lead to the hoped-for psychological gains. The results emphasize the importance of self-perception in determining how participants perceive several important aspects of the treatment experience throughout the life course. Further studies should focus on how to incorporate self-perception as an important variable and outcome in the treatment process.

Advancement of maxillary anterior segment by distraction osteogenesis for severe maxillary retrusion in cleft lip and palate

Background Maxillary anterior segmental distraction osteogenesis (MASDO) is a recently used method for correction of severe maxillary retrusion in cleft lip and palate (CLP) patients. In this article, we evaluated the feasibility of MASDO using rigid external distraction (RED) and rapid orthodontic tooth movement to correct severe maxillary retrusion in CLP patients. Methods Fourteen male and five female complete CLP patients between the ages of 18 and 22 years (mean age 19.7 years) at the time of distraction, with severe maxillary retrusion, were treated with the rigid external distraction (RED) device after maxillary anterior osteotomy. Rapid orthodontic tooth movement was started one week after the MASDO. Standard profile photographic, cephalometric films were obtained preoperatively and after therapy. Sella-nasion-point A (SNA) and Sella-nasion-point B (SNB) angles were measured to reflect changes in maxillary and mandibular position, and the distance between anterior nasal spine and posterior nasal spine (ANS-PNS) was measured to represent the maxillary dental arch length. Results The SNA angle increased from an average of 74.6° (range 73.0°-78.0°), preoperatively, to 83.4° (range 78.6°-88.0°) after the RED was removed (P &lt;0.01). All cases of severe maxillary retrusion were improved. Nine patients' profiles became harmonious after therapy. One patient had a bimaxillary protrusion deformity and needed further surgery. The regenerate alveolar crest and edentulous space on both segments was almost completely eliminated after rapid orthodontic tooth movement. Conclusion MASDO with the RED system and rapid orthodontic tooth movement is a successful way of correcting severe maxillary retrusion in CLP patients.

Abnormalities of Maxillary Anterior Teeth in Chinese Children with Cleft Lip and Palate

To retrospectively study the anterior maxilla of southern Chinese children with complete cleft lip and palate (CLP) for the prevalence of different kinds of dental anomalies, position and rotation of the teeth, and the asymmetry of dental development. 195 southern Chinese children with CLP aged between 3 and 17 years. Dental records and study casts were studied as were the radiographs from which the dental development was determined. The tooth prevalence of cleft side permanent lateral incisor was 19.2% in unilateral CLP (UCLP) children and 20.5% in bilateral CLP (BCLP) children. The cleft side central incisors were rotated in 78.1% and 95.9% of the teeth in UCLP and BCLP children, respectively. Of the permanent canines, 43.4% were positioned mesially on the cleft side in UCLP children, while for BCLP children 69.7% of the teeth were in a normal position. In addition, the mesially positioned canines were often associated with an absence of the permanent lateral incisor while the distally positioned canines were always associated with the presence of supernumeraries in the cleft region. The permanent teeth on the cleft side showed significantly delayed development compared with their antimeres on the noncleft side; however, the delayed permanent lateral incisors did complete their formation normally. This group of Chinese children with CLP demonstrated statistically significant higher prevalences of hypodontia, microdontia, and delayed dental development on the cleft side than the noncleft side.