Complete Cleft Research Articles

Does the rehabilitation treatment predispose the patient with cleft to endodontic treatment?

Aim: to verify the relation between endodontic treatment of teeth adjacent to the cleft area and the rehabilitation of patients with unilateral cleft lip and palate, at the Hospital for Rehabilitation of Craniofacial Anomalies. Methods: the present split-mouth study was composed of 406 individuals with complete unilateral cleft lip and palate who had completed the rehabilitation process in a single tertiary cleft center (55.9% males). The information was collected from the dental history on the patients’ records and radiographs. The frequency of endodontic treatment in the upper incisors and canines was calculated for the cleft and non-cleft sides. The comparison between sides was performed by the chi-square test (p <0.05). Results: endodontic treatment was more frequent in teeth adjacent to the cleft than in contralateral teeth. The frequency of endodontic treatment in at least one tooth adjacent to the cleft was 18.97%, and 11.6% on the contralateral side. It was observed that endodontic treatment was necessary in 63.5% of patients who had been submitted to orthodontic treatment, 42.4% of those rehabilitated with fixed partial dentures and 12.0% of patients who underwent dental reshaping of teeth adjacent to the cleft. The treatments performed included vital pulp therapy (46.1%), non-vital pulp therapy (46.8%) and endodontic retreatment (7.1%). Conclusion: in individuals with complete cleft lip and palate, teeth close to the bone defect area and used for rehabilitation treatment presented greater need of endodontic intervention.

Median Cleft Lip.

Complete or partial lip clefts in the midline of the upper lip are defined as median clefts of the upper lip. In 1974, Tessier numbered the craniofacial clefts from 0 to 14 counterclockwise in a study involving 336 patients. Upper lip midline clefts are named Tessier 0 clefts. Despite the diversity in classifications, upper lip midline cleft is rare. Its incidence among cleft patients varies between 0.43% and 0.73%. If the more common forms of cleft lip and palate are not taken into account, the incidence of atypical cleft is estimated at 1/10 5 . A median upper lip cleft can be defined as a cleft that passes vertically through the midline of the upper lip. These clefts occur due to incomplete or complete nondevelopment of the medial nasal prominences. In this study, the authors shared a case diagnosed prenatally and referred to their clinic for cleft lip repair.

Rationale for white skin roll flap in unilateral cleft lip repair: A retrospective anthropometric measurement analysis

Although the "white skin roll" of the lip is often considered a line, it is better defined as the subunit between the vermilion border and the upper lip horizontal groove. In many unilateral cleft lip repair techniques, this structure is approximated between both sides of the cleft without restoration. This study aimed to analyze the white skin roll height in patients with unilateral cleft lip. This retrospective cohort study included 134 consecutive infants with unilateral cleft lip aged 3-6 months who underwent lip repair in a single institution between January 2019 and July 2021. White skin roll heights at the peak of the Cupid's bow on the non-cleft side (CPHIR), cleft medial element (CPHIL), and cleft lateral element (CPHIL') were measured, and differences in their averages were analyzed. The mean height was 1.70±0.30mm at CPHIR, 0.98±0.33mm at CPHIL, and 1.28±0.32mm at CPHIL.' The mean difference in height between CPHIR-CPHIL, CPHIR-CPHIL,' and CPHIL-CPHIL' groups was significant for each paired sample (p<0.01). No difference was found between the complete and incomplete clefts or left and right clefts (p>0.01). A significantly reduced mean height of the white skin roll was present more markedly on the cleft medial element than on the cleft lateral element. Therefore, we strongly support using a white skin roll flap on the cleft lateral element for unilateral cleft lip repair, embracing the concepts of subunits and lip contour lines.

Influence of the Number of Revision Surgeries and Nasal Symmetry After Final Rhinoplasty for Patients With Cleft Lip.

The effects of operative intervention on vertical nasal growth in patients with unilateral cleft lips (CLs) are well described. However, the factors influencing nasal symmetry have not been sufficiently evaluated. Therefore, this study aimed to study the factors that cause difficulties in obtaining nasal symmetry postoperatively in patients with CLs. We conducted a retrospective analysis using data from patients with CLs who underwent a series of treatments at Keio University Hospital from 1990 to 2000. We collected data on the patients' sex, cleft type, number and time of revision surgery, palatal fistula incidence, and history of the pharyngeal flap and orthognathic surgery. Nasal symmetry was analyzed as the symmetrical ratio after the final touch-up surgery, and multivariate analysis was conducted using binary logistic regression to determine the factors affecting nasal symmetry. This study included 89 patients with unilateral CL. Multivariate analysis revealed that complete cleft lip and palate ( P < 0.05, odds ratio = 4.37) and repeated revision surgery ( P < 0.05, odds ratio = 9.28) were significant predictors of the final nasal symmetry. Our study showed that cleft type and the number of revision surgeries were identified as important factors for obtaining nasal symmetry after final touch-up rhinoplasty. Revision surgery may be necessary to relieve patients' psychological stress due to nasal deformity, suggesting that this dilemma needs to be overcome.

Dynamic Molding of Cleft Nasal Cartilage in Unilateral Complete Cleft Lip and Palate Using Simple Segmented NAM.

Nasal morphology remodeling by nasoalveolar molding (NAM) before primary lip repair gives better post-surgery outcomes. However, traditional NAM has high technical sensitivity, a steep learning curve, frequent need for modifications, and interrupts lifting forces on the nasal cartilage during oral movements, thereby reducing overall efficacy of device. To eliminate interaction and interdependency of the nasal bulb with alveolar molding plate, we propose segmenting NAM (SNAM) into nasolabial complex molding (NCM) and alveolar complex molding (ACM). NCM addresses ala-septum, lip-premaxilla via lambda-nasal hook and lip taping. ACM addresses palate-alveolus via Yen-modified feeding plate. When the hook is suspended by elastic traction, nasal complex undergoes a natural rotation, where cleft-side ala lifts and septum medializes. Lip taping and feeding plate augment positive molding of cleft segments and maintain transverse relation. The current study outlines SNAM treatment strategy and assesses the effect on nasal deformity. Retrospective observational cohort study set in a comprehensive cleft care centre. Twenty patients with unilateral complete cleft lip and palate who underwent SNAM were selected. Retrospectively, standardized basilar views, pre-, and post-SNAM therapy were evaluated for nostril height, and nostril width, as a ratio of cleft to non-cleft side along with columellar deviation angle. SNAM resulted in significantly improved nostril symmetry with no complications observed. Nostril height ratio increased from 0.35 ± 0.10 to 0.78 ± 0.17. Nostril width ratio decreased from 3.14 ± 0.66 to 2.18 ± 0.42. Columellar deviation angle increased from 26.5 ± 6.30 to 58.5 ± 9.88 degrees. Dynamic correction of the nasal deformity in UCLP is possible through SNAM therapy.

Piriform Rim Asymmetry in Unilateral Cleft Lip and Palate Patients Before Orthognathic Surgery

Complete unilateral cleft lip and palate (UCLP) creates a continuity defect on the nasal floor, which contributes to nasal asymmetry. Traditionally, piriform rim symmetry has been evaluated by comparing cleft and noncleft sides. No study has compared the magnitude of perinasal asymmetry in UCLP patients with a control group of patients without clefts. To address the following question: In UCLP patients, whose alveolar clefts are reconstructed with alveolar bone grafts (ABGs), is the magnitude of remaining piriform rim asymmetry similar to that of patients without UCLP? This is a retrospective cohort study that used the CBCT of UCLP and non-UCLP patients to evaluate the piriform rim symmetry. The sample was derived from patients who presented for orthognathic surgery between January 2015 and December 2022. To be included, patients had to have a maxillary deficiency. The cleft group had ABG performed with symphyseal bone harvest and BMP application. Patients were excluded from the control group if they had clinical asymmetry and nasal septum deviation. Patients from the UCLP group were excluded if they failed the first attempt of ABG or had a syndrome. Preorthognathic CBCT was used to measure the distance from the inferior and lateral aspects of the piriform rim to reference lines. UCLP status grouped as present or absent (control). The magnitude of piriform rim asymmetry defined as the millimetric distance from the inferior and lateral aspects of the piriform rim to reference lines. The covariates were age, sex, tissue thickness at the level of the alar base, and turbinate size. Welch's two-sample t-test was utilized to compare means. A level of significance of 5% (P<.05) was used for all analyses. To analyze the reliability of the measurements intraexaminer and interexaminer errors were tested using the Weir method. A total of 60 patients were included, 30 in each group. The mean age of UCLP patients was 16.76 (range 13 to 25), and the control group was 17 (range 13 to 25), P=.71. The UCLP group had 12 girls, and the control had 18 girls (P=.12). In the UCLP group, the mean discrepancy between affected and unaffected sides at the inferior aspect of the piriform rim was 3.9mm (range 0.9 to 7mm, P<.01), and in the control group the discrepancy between right and left sides was 0.1mm (0-2.1mm, P=.87). The mean discrepancy between affected and unaffected sides at the lateral aspect of the piriform rim was 3.6mm (range 0.7 to 7.6mm, P<.01) in the UCLP group, and in the control group the discrepancy between right and left sides was 0.1mm (range 0.1 to 5.8mm, P=.78) in the control group. The mean alar base soft tissue thickness discrepancy was 3.1mm (range 0.9 to 7.9mm, P<.01) in the UCLP group and 0mm (range -1.8 to 1.9mm, P=.97) in the control group. The mean difference in the turbinate area in the UCLP group was 314mm2 (range 797 to 2,898) and in the control group 35mm2 (range 702 to 2,302) (P=.19). ABG with symphyseal bone and BMP was not able to provide the same level of piriform symmetry observed in patients without a cleft. Alar base tissue was thicker on the cleft side, and the turbinate size demonstrated greater variability in the UCLP patients.

"Strategic Application of Anatomical Subunit Approximation Technique for Correction of Complete Unilateral Cleft lip".

To discuss advantages, disadvantages and strategical application of anatomical subunit approximation technique in complete unilateral cleft lip repair. Analysis of consecutive 28 cases. A single surgeon experience at a university hospital. Among 77 patients who underwent cleft lip repair between May 5, 2019 and June 30, 2021, 28 patients with complete unilateral cleft lip who received cheiloplasty by author's technique. Surgical outcomes were assessed by frontal view medical photographs obtained postoperatively at follow-up visits. The average length difference between cleft and noncleft sides was <10% for transverse lip length and philtral height. Nostril sill height demonstrated about twenty percent of difference with much variable results. Although the one sample t-test revealed that differences exist between the cleft and noncleft side, they were within an acceptable range. Understanding the strengths and limitations of anatomical subunit approximation technique enabled strategic application in complete unilateral cleft lip repair. Satisfactory outcomes were achieved not only regarding the scar placement but also regarding the symmetry of the lips and augmentation of nasal sill.

The Implications of Laterality in Unilateral Cleft Lip Reconstruction: A Global Survey of Cleft Surgeons.

To explore the impact of directional laterality in complete Unilateral Cleft Lip (UCL) amongst the global cleft surgeon community. Cross-sectional survey study. Global distribution of online survey distributed in English and Spanish. Cleft surgeons from around the world. Survey participant perception of the impact of laterality on: (1) cleft presentation (2) surgical challenge and (3) surgical outcomes. Responses were received from 453 cleft surgeons located in 54 countries around the world. 221 (49%) had previously considered differences in patients presenting with a left- versus right-sided UCL. 95 (21%) considered right-sided clefts more difficult to reconstruct, 37 (8%) reported left-sided clefts to be more difficult and 321 (71%) reported no difference in difficulty between the cleft sides. Higher volume cleft surgeons, characterised by those reporting cleft as their principal area of practice and performing >20 cleft operations per year, were more likely to have both previously considered differences in laterality in cleft and to report right-sided unilateral cleft lip to be more difficult to primarily reconstruct. 395 (87%) did not consider surgical outcomes to be influenced by cleft laterality. This survey reports perceptions on cleft laterality from a large body of global surgeons and suggests a trend for increased difficulty in right-sided compared to left-sided cleft lip reconstruction, where such laterality-associated difficulty is perceived.

A Retrospective and Prospective Cohort Study Comparing Pediatric Patients With Cleft Lip and Palate From the United States and Guatemala.

Orofacial clefts (OFC) remain among the most prevalent congenital abnormalities worldwide. In the United States in 2010 to 2014, 16.2 of 10,000 live births are born with OFC compared with 23.6 of 10,000 in Alta Verapaz, Guatemala in 2012. Demographics and cleft severity scores were retrospectively gathered from 514 patients with isolated OFC at the Children's Hospital of Philadelphia scheduled for surgery from 2012 to 2019 and from 115 patients seen during surgical mission trips to Guatemala City from 2017 to 2020. Risk factors were also gathered prospectively from Guatemalan families. The Guatemalan cohort had a significantly lower prevalence of cleft palate only compared with the US cohort, which may be a result of greater cleft severity in the population or poor screening and subsequent increased mortality of untreated cleft palate. Of those with lip involvement, Guatemalan patients were significantly more likely to have complete cleft lip, associated cleft palate, and right-sided and bilateral clefts, demonstrating an increased severity of Guatemalan cleft phenotype. Primary palate and lip repair for the Guatemalan cohort occurred at a significantly older age than that of the US cohort, placing Guatemalan patients at increased risk for long-term complications such as communication difficulties. Potential OFC risk factors identified in the Guatemalan cohort included maternal cooking-fire and agricultural chemical exposure, poor prenatal vitamin intake, poverty, and risk factors related to primarily corn-based diets. OFC patients who primarily rely on surgical missions for cleft care would likely benefit from more comprehensive screening and investigation into risk factors for more severe OFC phenotypes.

Factors Contributing to Canine Impaction in Patients With Unilateral Cleft Lip and Palate Undergoing Alveolar Bone Grafts

Patients with unilateral cleft lip and palate (UCLP) undergo alveolar bone grafting (ABG) to unite the bony segments before eruption of the maxillary permanent canine. This study assessed the frequency of canine impaction after ABG in the UCLP patient population and identified associated demographic, anatomical, and operative factors. This retrospective cohort study included 257 patients with UCLP who received ABG surgery at a single craniofacial center. The variables were cleft characteristics, pre-ABG procedures, operative factors, and dental anomalies identified through electronic health records, radiographs, and intraoral photographs taken before ABG and at least 2years after ABG. The primary outcome variable was the presence of an impacted maxillary canine, defined as malposition of a fully developed canine following ABG with full eruption of the contralateral canine. The t tests, χ2 tests, and logistic regression analysis were used to evaluate frequency of canine impaction and test for associations with the predictor variables. Of 257 patients, 56% were male with a mean age of 9.2years at the time of ABG. The frequency of canine impaction was 27% (n=69, 95% confidence interval 22 to 33%). Significant associations were found for: complete clefts (30 vs 12%, P=.017), hypodivergent facial patterns (low angle: 46%; high angle: 29 vs 22% normal angle, P=.042), females (adjusted odds ratio [aOR]=2.1, P=.015), early grafting with less than 1/3 developed canine root (aOR=3.36, P=.024), pregraft extraction of primary canine (aOR=2.3, P=.009) and greater permanent canine angulation (odds ratio=1.1, P<.0001). No significant associations with pregraft orthodontic expansion or regrafting were detected. In this study, about one in four patients with UCLP had an impacted canine. Multiple factors including pregraft extraction of the primary canine and increased canine angulation were associated with impaction of the permanent canine.

Epidemiological study of patients with cleft lip and palate at Specialized National Hospital in Venezuela

ABSTRACT Aims: The aims of the study are to describe the epidemiological characteristics of the patients with cleft lip and palate (CLP) treated at Specialized National Hospital in Venezuela. Materials and Methods: This was a retrospective, epidemiological, and cross-sectional study. Sample involved medical records from patients with diagnosis of any CLP treated from 2011 to 2021. The variables analyzed were age, gender, origin, anatomical structures involved, syndromes, other associated conditions, and sequelae, which were collected and analyzed. A descriptive analysis of each variable was carried out. Results: Data from 641 patients were analyzed, with an average age of 1 year old (±3 months–9 years of age), showing an equitable distribution in relation to gender. Of the facial clefts, the most common was the complete bilateral alveolar cleft (16.2%), followed by the complete left cleft lip (10.5%). The study yielded few cases of patients with some syndrome or associated condition (3.7% for each one, respectively). Geographically, there was a distribution of cases in all the states of the Bolivarian Republic of Venezuela, with the largest number of cases being in the capital region. Conclusions: It was observed that the prevalence of CLP has increased in recent years; these epidemiological figures vary by region, age, and gender. However, greater knowledge from health professionals is necessary to understand the clinical and epidemiological aspects of the orofacial cleft, which is essential to improve the understanding of the pathogenesis, promote preventive strategies, and guide multidisciplinary clinical care.

Surgical technique to achieve postoperative alar base symmetry in complete bilateral cleft lip and alveolus repair – A prospective study

ABSTRACT Introduction: Children born with the bilateral cleft lip-cleft palate have a shortened columella and an elevated protruding premaxilla which results in an abnormal appearance of the nose. Materials and Methods: This study was conducted in the Baby MemorialHospital, Calicut, a Smile Train Center in India. After scrutiny, the eligible sample size amounted to30 cases. The patient’s age rangedfrom 4 to 7 months. The basic technique employed is “Veau three straight line repair” technique. This study analyses the importance of a geometrical incision, a back cut extending cephalically above the inferior turbinate at the mucocutaneous junction to elevate the nostril floor, to achieve the symmetry of the alar bases. Result: Preoperative and postoperative anthropometric studies were conducted on the asymmetry and symmetry of the alar bases. The p values for the right side preoperative and postoperative measurement is 0.007 which is highly significant and for the left side, it is &lt;0.001 which also denotes statistical significance of this technique. Conclusion: Further high volume multicentric studies may be suggested since bilateral cases amount for only 10% of the overall incidence of cleft lip cases and even high volume surgeons are privileged to treat only a few. Therefore, it is the obligation of every surgeon who undertakes the care of these children to learn from the past and to analyse results periodically, including comparison with other centres.

The Severity of Cleft Lip and Palate and Postsurgical Outcome in Non-syndromic Complete Unilateral Cleft Lip and Palate: A Pilot Study Based on Surgeon’s Perception

The Severity of Cleft Lip and Palate and Postsurgical Outcome in Non-syndromic Complete Unilateral Cleft Lip and Palate: A Pilot Study Based on Surgeon’s Perception

IMPACT OF NASOALVEOLAR MOLDING ON MAXILLARY ARCH DIMENSIONS AND MALOCCLUSION CHARACTERISTICS IN PEDIATRIC PATIENTS WITH CLEFT LIP AND PALATE DURING PRIMARY DENTITION

Unilateral complete cleft lip and palate (UCLP) are congenital disabilities when a baby's lip or mouth does not form properly during early pregnancy. This retrospective study investigated the long-term effects of passive alveolar molding (PAM) and nasoalveolar molding (NAM) on cleft width and maxillary growth parameters in children with UCLP. A retrospective study of children with UCLP was enrolled and divided into two groups: PAM and NAM. Cleft width measurements were obtained at baseline and regular intervals during the follow-up period. Maxillary growth parameters were also assessed, including arch width, dental occlusion, and facial symmetry. Data were analyzed using descriptive statistics, chi-square tests, and linear regression models. Data was collected from 52 patients according to the inclusion criteria. The NAM group consisted of 22 patients with UCLP (mean age of 3.98 ± 1.6 years) and 12 patients with BCLP mean age of 3.81 ± 1.9 years. Fourteen patients with UCLP (mean age 3.9 ± 1.9 years) and four patients with BCLP and mean age 4.4 ± 2.1 years were included in the non-NAM group. It is concluded that the results of our study suggest that passive alveolar molding (PAM) and nasoalveolar molding (NAM) have a significant impact on cleft width reduction and maxillary growth in unilateral cleft lip palate (UCLP).

Intraoral Scanning Evaluation of Maxillary Arch Changes after Modified Sommerlad Palatoplasty for around Three Years.

The purpose of this study was to investigate dental arch changes after modified Sommerlad palatoplasty in patients with cleft palate by intraoral scanning technique in children with early deciduous dentition. This study included 60 patients with nonsyndromic unilateral complete cleft lip with palate or cleft palate only treated by modified Sommerlad palatoplasty without relaxed excision before 18 months of age and 95 healthy controls without cleft. Three-dimensional images of the maxillary dental arches of all participants at age 3 to 4 years were obtained by intraoral scanning technique. Seven parameters (anterior dental arch width, middle dental arch width, posterior dental arch width, anterior palatal arch width, posterior palatal arch width, anterior dental arch length, and entire dental arch length) were measured. Compared with the male group, the posterior palatal arch width distance of controls in the female group decreased significantly ( P = 0.039), and the middle dental arch width, posterior dental arch width, and posterior palatal arch width distance of female patients decreased ( P = 0.013, P = 0.002, P = 0.005, respectively). The anterior dental arch length and entire dental arch length distance of children in the unilateral complete cleft lip with palate group was shorter than those of children with cleft palate only ( P < 0.0001, P < 0.0001, respectively). The patient group showed decreased distance of anterior dental arch width, anterior palatal arch width, anterior dental arch length, and entire dental arch length, and increased distance of posterior dental arch width and posterior palatal arch width compared with the control group ( P = 0.0002, P = 0.002, P < 0.0001, P < 0.0001, P = 0.007, P = 0.027, respectively). The results indicated that the modified palatoplasty group showed no growth inhibition in the middle or posterior dental arch width, or palatal arch width, but slight but significant inhibition in the length of the anterior and entire dental arch. Therapeutic, IV.

Outcomes of alveolar cleft repair in complete cleft lip and palate after tertiary gingivoperiosteoplasty and segmental Le Fort I osteotomy.

Gingivoperiosteoplasty is often used for reconstruction of alveolar defects in infants with cleft lip and palate. This study aimed to examine outcomes of tertiary gingivoperiosteoplasty, which has not previously been investigated. This prospective study included 11 adults with complete cleft lip and palate (n = 12 sites) who consecutively underwent segmental Le Fort I osteotomy and concomitant gingivoperiosteoplasty for correction of skeletal class III deformity, nasoalveolar fistula and alveolar cleft. Outcomes included clinical and radiographic evaluations of gingivoperiosteoplasty at the time of osteotomy (presence of nasoalveolar fistula, residual cleft defect and unsupported root ratio of cleft-adjacent teeth), and determination of influencing factors for the clinical success of alveolar cleft repair. Study variables included age, gender, pre-surgical orthodontic treatment and alveolar cleft width of cleft-adjacent canine and angulation between cleft-adjacent teeth before surgery and 1-week postsurgery. Posttreatment, no nasoalveolar fistula remained. The residual cleft defect decreased significantly (p < 0.01). The unsupported root ratio of cleft-adjacent teeth did not differ (p > 0.05); eight cleft sites reached Bergland I or II (67% success). One-week postsurgery, the minimal alveolar cleft width of cleft-adjacent canine was significantly less in the success group compared with the failed group (p = 0.01). Tertiary gingivoperiosteoplasty and segmental Le Fort I osteotomy decreased nasoalveolar fistulas and induced alveolar bone formation. The minimal alveolar cleft width immediately after surgery was the major influencing factor of clinical success. Segmental Le Fort I osteotomy with simultaneous gingivoperiosteoplasty efficaciously repairs adult alveolar clefts.

Presurgical Nasoalveolar Molding Modified Technique in Complete Bilateral Cleft Lip and Palate Infant: A Case Report

Through this research, we have presented a modified presurgical nasoalveolar molding (PNAM) device, protocol, and equipment of preoperative nasal alveolar formation techniques to improve lip, nose, alveolar, and palatal deformity in the Department of Orthodontics and Maxillo-Facial Department at the University of Prishtina. A two-week-old boy was brought to our Department of Orthodontics. The baby was diagnosed with non-syndrome bilateral complete cleft of the primary and secondary palate. After a complete examination and orthodontic therapeutic planning, precaution was taken for creating a PNAM appliance and sent to the laboratory. An intraoral molding plate was established on both sides of the separate segments of the maxilla and fixed with a mini screw to approximate the maxillary segments. Parts of the strings built in the front side activated (please check) and, together with the nasal stent, were added to correct the nose deformity. By using modified NAM to close the cleft segments, both the ones of the upper lip and the ones of the palate, we achieved the same results and reduced possible tissue damage by maintaining the conventional NAM apparatus. We used an alveolar formation plate with traction stainless steel to reduce the separate parts. Under this presurgical treatment, the cleft alveolus and palatal segments were reduced considerably. Also, the parts of the flatting nasals of the nose were set up. Through interdisciplinary work, we created a new modified NAM appliance to avoid the obstacles of the traditional NAM devices and to improve the presurgical treatment by using the benefits of the postnatal period of the child to have a more effective treatment. Despite the inability of previous studies to decide on the degree of efficacy of PNAM and the fact that scientific data is limited, we consider that our research can contribute to a better understanding of why it is essential to use PNAM and of the need to enhance the apparatus.

Effectiveness of iliac cancellous bone grafting in alveolar cleft repair and analysis of factors affecting it.

To review the effectiveness of secondary alveolar bone grafting using iliac cancellous bone in patients with unilateral complete alveolar cleft and to investigate the factors influencing it. A retrospective study of 160 patients with unilateral complete alveolar clefts who underwent iliac cancellous bone graft repair at the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, was conducted. Eighty patients in the young age group (6-12 years) and 80 in the old age group (≥13 years) were included. Bone bridge formation was determined using Mimics software, and the volume was measured to calculate the iliac implantation rate, residual bone filling rate, and resorption rate. The factors that affected bone grafting in both subgroups were investigated. Using bone bridge formation as the clinical success criterion, the success rate for the entire population was 71.25%, with a significant difference of 78.75% and 63.75% for the young and old age groups, respectively (P=0.036). The gap volume in the latter was significantly larger than that in the former (P<0.001). The factors that influenced bone grafting in the young group were the palatal bone wall (P=0.006) and history of cleft palate surgery (P=0.012), but only the palatal bone wall affected the outcome in the old age group (P=0.036). The results of alveolar bone grafting for the old age group were worse than those for the young age group. The palatal bone wall was an important factor that affected alveolar bone grafting, and alveolar bone grafting in the young patients was influenced by the history of cleft palate surgery.

The Effectiveness of Releasing the Lower Lateral Cartilage Through Intranasal Z-plasty Incision on the Vestibular Web During Secondary Correction of Nasal Deformities in Complete Unilateral Cleft Lip and Palate.

The primary goal in the secondary correction of unilateral cleft lip nose deformity is to achieve symmetry of the nose and nostril. This study aimed to investigate the efficacy of freeing the lower lateral cartilage from the pyriform ligament through an intranasal Z-plasty incision on the vestibular web in adult patients with complete unilateral cleft lip and palate. Thirty-six patients with complete unilateral cleft lip and palate, who underwent open rhinoplasty between August 2014 and December 2021, were identified retrospectively. Five parameters for nose form and nostril symmetry were measured on basal views through 2-dimensional photographic analysis. The patients were divided into subgroups with or without septoplasty. Cleft-to-non-cleft ratios between the Z (13 patients) and non-Z groups (23 patients) were compared using the Mann-Whitney U test. The mean follow-up was 12.9 months (6-31mo). In the Z group, there were significant differences between the preoperative and postoperative values for nostril angulation, regardless of septoplasty (all P <0.05). Despite septoplasty, significant differences in the postoperative changes in nostril angulation were found between the Z and non-Z groups (all P <0.05). Intranasal Z-plasty on the plica vestibularis is an effective technique for releasing the lower lateral cartilage, improving the nostril asymmetry in cleft lip nose deformity.

Three-Dimensional Evaluation of Nasolabial Morphology After Applying Presurgical Nasoalveolar Molding in Primary Unilateral Cheiloplasty Using the Modified Millard Technique.

To compare the soft tissue measurements of the upper lip and the nose on the cleft side and the noncleft side before surgery, immediately after cheiloplasty and two months after surgery. Descriptive clinical study with one group, prospective. Department of Odonto-Stomatology, Children's Hospital 1, at Ho Chi Minh City - Vietnam. 31 patients with a unilateral complete cleft lip participated in this study, 30 patients were evaluated at the time two months after surgery. Interventions include PNAM and cheiloplasty by modified Millard technique. Patients proceed to acquire 3D images of lips and nose, define landmarks and measure dimensions. There are 11 evaluators to be compared, p < 0.05 was considered statictical significance. After two months of surgery, on cleft side and noncleft side, the lengths of the upper lip were 10.87 ± 0.80 and 11.92 ± 0.78 (mm), the widths of the upper lip were 16.06 ± 1.10 and 16.40 ± 1.02 (mm), the heights of the nostril were 4.85 ± 0.44 and 5.93 ± 0.43 (mm), the lengths of columella were 4.08 ± 0.37 and 4.93 ± 0.38 (mm), and the widths of the nostril were 9.07 ± 0.37 and 8.37 ± 0.40 (mm). Cheiloplasty by modified Millard technique on the patients who used PNAM showed that after two months of surgery, the morphology of the upper lip and nose has a slight disproportion with the nasolabial measurements of the cleft side being smaller than on the noncleft side.