Complete Unilateral Cleft Lip Research Articles

Scar Outcome in Unilateral Complete Cleft Lip Repair: A Comparative Analysis of Vertical Lip Lengthening Strategies Using the Rotation-Advancement Concept.

To assess the differences in scar outcomes between modified rotation-advancement techniques proposed by Drs. Mohler and Noordhoff, designed to address issues such as inadequate vertical lip length and scarring on the upper third of the lip in the original rotation-advancement technique. Retrospective single-surgeon (RD) study. Consecutive non-syndromic children (n = 68) with unilateral complete cleft lip and palate. Modified Mohler (columellar backcut reconstructed with C flap; n = 34) and modified Noordhoff (lower, medially-created backcut reconstructed with laterally-based triangular skin flap; n = 34) repairs. Using 12-month postoperative frontal photographs, scar evaluations (overall and superior, middle, and inferior portions of the lip) were appraised by an assessment panel composed by independent professional and nonprofessional raters employing four validated qualitative scar assessment scales: Manchester Scar Scale, modified Scar-Rating Scale, Stony Brook Scar Evaluation Scale, and Visual Analog Scale. Quantitative computerized photogrammetric scar widths of the superior, middle, and inferior portions of the upper lip were also measured. The modified Noordhoff method showed significantly (all P < .001) better scar quality for the overall scar and superior portion of the scar in all four scales compared to the modified Mohler method, with no significant (all P > .05) difference for the middle and lower portions. No significant difference (all P > .05) was observed for photogrammetric scar width measurements. The modified Noordhoff technique provided better qualitative results for unilateral complete cleft lip-related scars compared to the modified Mohler technique.

Effect of maxillary distraction osteogenesis and LeFort-1 advancement orthognathic surgery on soft-tissue thickness and anterior soft-tissue to hard-tissue movement ratios among patients with complete unilateral cleft lip and palate

Objectives: The objective of this study was to compare the soft-tissue thickness and anterior soft-tissue to hard-tissue movement ratios in patients with unilateral cleft lip and/or palate (UCLP) following maxillary distraction osteogenesis using rigid external distractor device and maxillary advancement at LeFort I level using lateral cephalograms. Material and Methods: This retrospective study was conducted on 20 patients with UCLP who underwent either LeFort I maxillary advancement or maxillary distraction osteogenesis. Non-syndromic patients with complete UCLP anomalies and skeletal class III patterns due to maxillary hypoplasia were included in the study. The patients with a pre-surgical negative overjet of ≥5 mm were treated by maxillary distraction osteogenesis, while a negative overjet of &lt;5 mm was managed with maxillary advancement orthognathic surgery. The growth completion in all the patients was assessed using the cervical vertebrae maturation index (CS 6) on a lateral cephalogram. The lateral cephalograms taken before surgery at (T0) and after a minimum interval of six months (T1) of surgery were assessed for changes in soft-tissue thickness and hard-tissue to soft-tissue movement ratios among the two groups. Paired t-test was used to compare the mean values obtained within the same group at two different time intervals. Unpaired t-test was used to compare mean values between the Groups 1 and 2. Pearson’s correlation coefficient (r) test was used to assess the associations between the mean changes in hard- and soft-tissue variables. Results: Group 1 showed significantly greater maxillary advancement compared to Group 2 with a mean difference of 5.80 mm at Point A and 7.65 mm at the upper incisal edge. Soft-tissue thickness decreased significantly after advancement in Group 1 at subnasale (P &lt; 0.05), labrale superius, stomion, and labrale inferius (P &lt; 0.01) and at subnasale (P &lt; 0.05), stomion and labrale inferius (P &lt; 0.01) in Group 2. There was a significantly strong correlation between the hard- and soft-tissue movement in sagittal plane in both Group 1 and Group 2. In Groups 1 and 2, a statistical highly significant strong positive correlation was found between vertical change in dU1 to soft-tissue dLs and dStms. In Group 2, a statistical highly significant strong positive correlation was found between vertical change in dA to soft-tissue dC and dStms. Conclusion: The soft-tissue thickness reduced in patients with UCLP after maxillary advancement in both groups. The soft tissue followed the hard tissue in both groups. There was a greater downward movement of the maxillary base and soft-tissue lengthening in Group 1 compared to Group 2.

The influence of three different primary treatment protocols on 5-year-old maxillary growth in patients with complete unilateral cleft lip and palate

The study evaluated the effects of three different primary treatment protocols on maxillary growth in patients aged 5 years with complete unilateral cleft lip and palate (UCLP). The secondary objective was to assess the influence of initial cleft severity, family history of class III, and status of permanent lateral incisor on maxillary growth.In total, 54 patients with non-syndromic complete UCLP were included and grouped as follows: group An underwent lip adhesion, cheilorhinoplasty associated with tibial periosteal graft for hard palate repair, and finally veloplasty; group B underwent lip adhesion, then cheilorhinoplasty with intravelar veloplasty, and finally a hard-palate repair; group C underwent cheilorhinoplasty with intravelar veloplasty and then a hard-palate repair. Five-year maxillary growth was assessed on dental models, both clinically and digitally.No difference was found with GOSLON-Yardstick scoring. Five-year measurements showed that group C tended to have the best maxillary arch morphology (p = 0.012). Initial cleft severity did not impact maxillary growth, but status of permanent lateral incisor and family history of class III did (p = 0.019 and p = 0.004, respectively).In patients aged 5 years, the two-stage approach appeared to be the least detrimental to growth development. Predictive factors for growth retardation included the absence of lateral incisor and a family history of class III.

The Severity of Initial Unilateral Cleft Lip and Nasal Deformity Predicts Long-Term Postoperative Esthetic Outcome.

Infantile cleft lip and nasal severity influence the final esthetic result of the repair. Although various authors have described methods of cleft lip and nasal repair, there is a paucity of data that correlates cleft severity with esthetic outcomes. The aim of this study was to examine the correlation between presurgical severity of unilateral cleft deformity and long-term postoperative esthetic outcomes. This retrospective study, based at a single institution, investigated patients with complete unilateral cleft lip, with or without cleft palate, who underwent repair by a single surgeon, had preoperative infantile facial casts, and had postoperative facial photographs at 6 to 11 years of age (N=31). Preoperative nostril width ratio and columellar angle measurements were taken from facial casts. Postoperative, long-term nasolabial appearance was rated by 5 blinded observers used a modified Kuijpers-Jagtman scale. Linear regression was used to determine the relationship between preoperative cleft severity and postoperative ratings. Preoperative nostril width ratio directly correlated with postoperative nasal form score (r=0.40; P=0.026); likewise, preoperative columellar angle predicted postoperative nasal form score (r=0.37; P=0.040). Preoperative cleft severity was not significantly correlated with vermillion border appearance. Cronbach α values of 0.91 (nasal form) and 0.79 (vermillion border) indicated good inter-rater reliability. Kappa values of 0.87 (nasal form) and 0.70 (vermillion border) indicated good intrarater reliability. Preoperative unilateral cleft nose severity directly correlates with long-term postoperative nasal appearance in childhood. Outcome studies should present and control for preoperative severity to allow more accurate assessment of repair techniques.

Cleft Laterality Dental Arch Relationship Outcomes for Children with Unilateral Cleft Lip and Palate in New Zealand.

To investigate cleft laterality dental arch relationship outcomes of children with non-syndromic complete unilateral cleft lip and palate (UCLP) in New Zealand. A retrospective nationwide study. Virtual 3D orthodontic study models collected prior to undertaking secondary alveolar bone grafting. A total of 104 patients with UCLP (L = 80: R = 24). Four calibrated assessors used the GOSLON Yardstick and 100 mm Visual Analogue Scale (VAS) to score the randomised models on 2 separate assessment sessions. Weighted Kappa were used to determine the intra/inter-rater reliability for the GOSLON and correlations for the VAS. Intra-rater reliability ranged from 0.57-0.88 (GOSLON) and 0.45-0.93 (VAS). Inter-rater reliability ranged from 0.62-0.86 (GOSLON) and 0.64-0.93 (VAS).GOSLON scores for the left UCLP were 31.2% for good/very good; 26.3% for fair; 42.5% for poor/very poor while the right UCLP scored 8.3% for good/very good; 37.5% for fair; 54.2% for poor/very poor. The mean VAS for left and right UCLP were 53.4 (sd 22.5) and 44.6 (sd 17.1) respectively. Neither the GOSLON nor VAS differences reached statistical significance (both P = .08). From a clinical perspective right UCLP had worse dental arch relationship outcomes, however, these differences failed to reach statistical significance. Further studies using larger sample sizes are required to determine if cleft laterality is an important consideration when investigating UCLP dental arch outcomes.

The Influence of Sidedness in Unilateral Cleft Lip and Palate on Mid Facial Growth at Five Years of Age.

To determine whether facial growth at five years is different for children with a left versus right sided cleft lip and palate. Retrospective cohort study. Seven UK regional cleft centres. Patients born between 2000-2014 with a complete unilateral cleft lip and palate (UCLP). 5-Year-Old's Index scores. 378 children were included. 256 (68%) had a left sided UCLP and 122 (32%) had a right sided UCLP. 5-Year-Old's index scores ranged from 1 (good) to 5 (poor). There was a higher proportion of patients getting good scores (1 and 2) in left UCLP (43%) compared to right UCLP (37%) but there was weak evidence for a difference (Adjusted summary odds ratio 1.27, 95% CI 0.87 to 1.87; P = .22). Whilst maxillary growth may be different for left versus right sided UCLP, definitive analysis requires older growth indices and arch forms.

Dental Arch Relationships of Saudi Children with Unilateral Cleft Lip and Palate.

To determine dental arch relationships of Saudi children born with nonsyndromic complete unilateral cleft lip and palate (UCLP). This is a retrospective cohort study that comprised dental study models of 74 UCLP Saudi children aged 8-10 years who were recruited from 14 referral cleft centers. All participants had their cleft lip and palate repaired with no history of alveolar bone graft or any orthodontic treatment. Dental arch relationships of UCLP patients were assessed using the Great Ormond Street, London, and Oslo (GOSLON) Yardstick-a clinical tool that categorizes dental relationships of UCLP children into five discrete grades from I to V. The reliability of the rating was assessed with weighted kappa (κ) statistics. Three children (4.1%) had excellent surgical outcomes (grade I), 18 children (24.3%) filled into grade II (good outcome), 22 subjects (29.7%) had grade III (fair outcome), 27 children (36.5%) had grade IV (poor outcome), and 4 subjects (5.4%) were ranked as having very poor outcomes (grade V). The mean GOSLON score was 3.39. Intrarater and interrater agreements were high indicating good reproducibility. Based on the dental arch relationships, the treatment outcome of UCLP Saudi children was unsatisfactory, with a mean GOSLON score of 3.39. Delayed palate repair and the use of presurgical orthopedics may be considered in the future for cleft deformity management. To address the effect of particular cleft surgical protocol on dental arch relationships of UCLP patients. How to cite this article: Alforaidi S, Zreaqat M, Hassan R. Dental Arch Relationships of Saudi Children with Unilateral Cleft Lip and Palate. J Contemp Dent Pract 2023;24(12):987-990.

Mandibular canine development as an indicator of maxillary cleft site canine development

Objectives: The objective of this study was to determine if mandibular canine development is an indicator of maxillary cleft site canine development. Material and Methods: A cross-sectional chart review with analysis of cone-beam computed tomography (CBCT) imaging of patients aged 7–12 with a unilateral complete cleft lip and palate who received alveolar bone graft surgery from January 2009 to January 2019. Three-dimensional (3D) measurements of the cleft site canine and ipsilateral mandibular canine were taken. A two-dimensional image was created from the 3D CBCT to simulate a traditional panoramic radiograph. Descriptive statistics and multivariable linear regression analyses were conducted, adjusting for age and gender. Pearson and Spearman correlations were calculated. The main outcome measure was the mandibular canine crown-to-root ratio (C:RR) compared to that of the maxillary cleft site canine C:RR. Results: Five hundred and thirteen patients were reviewed, of which 78 met the inclusion criteria. Adjusting for age and gender, every unit change in mandibular canine C:RR corresponds to 0.69 (95% confidence interval [CI] = 0.42–0.95) change in maxillary canine C:RR, up to a mandibular canine C:RR of 3. Beyond a mandibular C:RR of 3, no change in the maxillary canine C:RR was observed (−0.02; 95%CI = −0.27–0.24). Pearson correlation coefficient was r = 0.65, and the Spearman correlation was P = 0.75. Conclusion: Mandibular canine C:RR is correlated to maxillary cleft site canine C:RR when the mandibular canine C:RR is ≤3.

Evaluation of facial pleasantness in patients with complete and unilateral cleft lip and palate rehabilitated and submitted to orofacial harmonization.

The objective of the present prospective case control study was to evaluate the facial pleasantness of patients with complete and unilateral cleft lip and palate at the end of interdisciplinary rehabilitation, submitted to facial fillers based on hyaluronic acid. The study group consisted of 18 individuals with complete unilateral cleft lip and palate, aged between 18 and 40 years (mean age 29 years) of both sexes. The patients presented a concave profile with mild to moderate maxillary deficiency, with completed orthodontic treatment and conducted by means of dentoalveolar compensations without orthognathic surgery. Participants underwent facial filling procedures with hyaluronic acid (HA) in the midface, inserted by a single operator. Standard photographs in frontal norm at rest, right profile at rest, and left profile at rest were obtained from each patient at the following operative times: (T1) pre-filler and (T2) and one-month post-filler. The photographs in T1 and T2 were randomly placed on a page of a virtual album. A 5-point Likert scale was used to assess facial pleasantness. The photographs were evaluated by two groups of evaluators consisting of 18 individuals with cleft lip and palate (CLPG=18) and 18 orthodontists with experience in the treatment of clefts (OG=18). For comparison between phases T1 and T2, and between evaluators with orofacial clefts and orthodontists, the Wilcoxon test was used (p<0,05). People with cleft lip and palate rated their face as more pleasant after the midface filling procedure. In the perception of the orthodontists, on the other hand, the facial pleasantness remained similar after the facial filling procedure. The filling of the middle third of the face in patients with cleft lip and palate treated without orthognathic surgery increased the pleasantness of the face in the opinion of laypeople with cleft lip and palate.

Complete unilateral cleft lip repair: A modification of the Mohler surgical technique

ABSTRACT Aims: Clefts manifested in cleft lip and palate are one of the most prevalent malformations in the craniofacial region. The objective of this study is to describe the surgical technique for the correction of unilateral cleft lip by means of a modification of the original Mohler technique with the same principle of rotation and advancement that allows us to obtain symmetry and balance on the cleft side. Patients and Methods: Two modifications were made to the original Mohler technique, one established in the preparation of two flaps for the conformation of the floor of the nostril, with which the mucocutaneous limit of the borders of the normal and cleft lip and the conformation of the vermilion were obtained. Using Z-plasty, clinical photographic records of the surgical technique and preoperative records as well as immediate, mediate, and late postoperative of the patients treated in our center were made. Results: In the patients who were treated under these modifications of the Mohler technique, the appropriate height was obtained on the cleft side compared to the healthy side, both 1 week and 1 month after surgery, it was discovered that the patients did not appear a discontinuity in the mucocutaneous line or at the vermilion level, the symmetry relationships at the vermilion level have significant differences in both height and thickness 1 week after surgery that improved at the control 1 month after surgery. Conclusions: The modifications made in the Mohler technique can be applicable and flexible for complete and incomplete clefts, obtaining favorable results in the functional and esthetic parts that allow following the patients with the stage of facial growth.

Impact of Unilateral Alveolar Bone Grafting on Nasal Volume and Nasolabial Surface: A 3D Analysis.

To determine possible effects of unilateral alveolar cleft closure on internal nasal volume and external nasolabial surface. Retrospective, single-arm, cohort study. Institutional, tertiary care. Patients with complete unilateral cleft lip, alveolus, and palate (CUCLAP), who underwent closure of the alveolar cleft with autologous bone graft (ABG) at the age of 9-11 years, with cone beam computed tomography (CBCT) and/or three-dimensional (3D) stereophotogrammetry images taken before and one year after the ABG procedure. ABG-pocedure in patients with CUCLAP. The influence of ABG on the internal and external nasal morphology. A total of 28 patients (21M/7F, 14R/14L) were divided into internal (CBCT) and external (3D-stereophotogrammetry) measurement subgroups. The external nasolabial surface showed a significant decrease of the angle alar curvature right-subnasale-alar curvature left (-1.99°; P = .02; 95% CI -2.61, -0.36) and an increase of the linear measurement between these points (+1.01 mm; P = .03; 95% CI: 0.11, 1.91). No significant differences were found when comparing the distance maps of the affected side with the non-affected side (P = .50, 95% CI: -0.20, 0.29). Closure of the alveolar cleft in CUCLAP patients with ABG did not affect the internal nasal volume, but significantly affected the external nasal surface. The procedure resulted in the nose becoming wider because both alar curvatures moved caudally and laterally relative to the subnasale.

Evaluation of a Novel Objective Method for The Assessment of Nasal Symmetry Among Patients with Unilateral Cleft Lip.

This is a cross sectional study aimed to asses novel semi objectve compter assisted method to asses the symmetry amog unilateral cleft lip patients. using Standard inferior view nose photos that were uploaded to Digimizer© Version 4.6.1 (2005-2016 MedCalc Software) Image Analysis, symmetry percentage was calculated and compared between cleft and non-cleft neonates. This method was compared to two subjective methods of rating symmetry. This a cross sectional pilot study performed in the Univresity Medical Center using standard inferior views of unilateral cleft patients which were compared to non-cleft neonates. Photographs of 71 neonates with unilateral complete and incomplete cleft lip and 30 neonates without facial cleft, which were born at the university medical center, Beer Sheba, Israel, were analyzed in a standard manner to determine nasal symmetry. the novel method proposed produced a nominal value for percentage of symmetry. Using Pearson's correlation test we found intra-rater reliability of 91.2% (p < 0.001) and Inter-rater reliability of 82.9% (p < 0.001). The analysis correlated with the surgeons subjective scores in both the numerical ranking method at 73% (p < 0.001) and 72.6% (p < 0.001) and the Ordinal ranking method at 87.6% (p < 0.001) and 77.7% (p < 0.001). The ability of the method to discriminate healthy from Cleft Lip patients overall was 92.3% With high sensitivity and specificity. This method accurately distinguishes healthy patients from cleft lip patients. We have achieved High levels of inter and intra-rater reliability. Significant correlations were found between our semiobjective method and the subjective scores.

Effectiveness of pre-alveolar bone graft orthodontics for patients with non-syndromic complete unilateral cleft lip, alveolus and palate: A systematic review and meta-analysis.

Non-syndromic complete unilateral cleft lip, alveolus and palate patients who have had ABG surgery. Orthodontics prior to ABG. Comparison: No orthodontic treatment prior to ABG. Successful eruption of permanent canines. All articles were screened for the title, abstract and full text independently and in duplicate by 2 reviewers. The quality assessment of RCT was performed using Cochrane's risk of bias tool and the CCT was assessed using ROBINS-I tool. Of the 904 studies retrieved in the search, one RCT and one CCT were included. Both studies were judged as high risk of bias. The results from one study showed a statistically significant increase in bone volume and decreased bone defect post-ABG in the orthodontic treatment group. However, there was no difference with respect to other variables. Both included studies were of low quality. There is not enough evidence to recommend orthodontic treatment pre-ABG for patients with complete unilateral cleft lip, alveolus and palate. Future high-quality studies are required to inform patients and clinicians about the effectiveness of pre-graft orthodontic treatment.

Retrospective study on primary rhinoplasty for unilateral complete cleft lip nasal deformity.

A retrospective study was conducted on the effect of primary rhinoplasty on infants with unilateral complete cleft lip nasal deformity. Infants with unilateral complete cleft lip in the Department of Cleft Lip and Palate Surgery, College of Stomatology, Xi'an Jiaotong University were selected. All infants underwent cheiloplasty and primary rhinoplasty. We reconstructed the nasal base and corrected the nasal septum and alar deformity at the same time. The nasal splint was worn 1 week after the surgery. The nasal morphology before surgery as well as 1 week and 1 year after surgery were analyzed. Significant differences were found on symmetry ratios including nasal base width, nostril height, alar angle and columella deviation angle between before and after operation (P<0.05). There were statistically significant differences in the symmetry ratio of nostril height and columella deviation angle between 1 year after surgery and 1 week after surgery (P<0.05). Infants with unilateral complete cleft lip nasal deformity can achieve satisfactory nasal morphology by primary rhinoplasty. Despite few cases of recurrence of nasal deformity, the nasal morphology can be well improved and maintained.

Treatment Modalities to Achieve Nasal Symmetry in Unilateral Cleft Lip/Nasal Deformity: An Objective and Comparative Evaluation.

Primary cleft lip repair techniques do not address the nasal deformity adequately resulting in nasal asymmetry. Maneuvers employed to minimize this have varying degrees of success. To assess the outcome of different treatment modalities employed to establish nasal symmetry in unilateral cleft lip. 100 patients with complete unilateral cleft lip/ palate operated for primary cheiloplasty with modified Millard's rotation advancement technique were divided into five groups. Group 1: lip repair alone, Group 2: NAM followed by lip repair, Group 3: lip repair followed by placement of conformers, Group 4: NAM followed by lip repair and placement of conformers, Group 5: lip repair with semi-open rhinoplasty. Objective assessment was done using measurable parameters after 12months post-operatively on a 1:1 standard photograph. Group 5 showed statistical significance in all parameters assessed. Progressive improvement in nasal symmetry was noted from Group 1 to Group V. In our study, group V, i.e., modified Millard's repair with semi-open rhinoplasty improved the results in terms of all the objective parameters assessed. The results of the other groups showed improvement though not consistent in all parameters. Naso-alveolar molding is an effective adjunct. Additionally, nasal conformers proved to be of great value in retaining the results obtained post-surgery.

The use of Korat-modified nasoalveolar molding devices in patients with unilateral complete cleft lip and palate with a 5-year follow-up

The nasoalveolar molding (NAM) appliance has been the appliance of choice for pre-surgical orthopedics to improve nasal and lip morphology, and optimally align the alveolar segments before cheiloplasty. However, the appliance has some limitations, including its complexity and long clinical chair time for appliance adjustments. In this case report, we present a patient treated for a right complete cleft lip and palate using three types of Korat modification for NAM with a 5-year follow-up. This study demonstrated that the Korat-NAM improved the aforementioned issues and was suitable for patients at different stages before and after lip and palate repair.

Establishment of a novel classification system for alveolar morphology in infants with unilateral complete cleft lip and palate

ObjectivesUnilateral complete cleft lip and palate (UCCLP) is one of the most severe clinical subtypes among cleft lip and palate (CLP), making repair surgery and subsequent orthodontic treatment particularly challenging. Presurgical nasoalveolar molding (PNAM) has shown conflicting and heterogeneous results in the treatment of UCCLP patients, raising questions about whether the diversity in alveolar anatomical morphology among these patients plays a role in the effectiveness of PNAM treatment.Materials and methodsWe collected 90 digital maxillary models of infants with UCCLP and performed mathematical clustering analysis, including principal component analysis (PCA), decision tree modeling, and area under the ROC Curve (AUC) analysis, to classify alveolar morphology and identify key measurements. We also conducted clinical evaluations to assess the association between the alveolar morphology and CLP treatment outcomes.ResultsUsing mathematical clustering analysis, we classified the alveolar morphology into three distinct types: average form, horizontal form, and longitudinal form. The decision tree model, AUC analysis, and comparison analysis revealed that four measurements (Trans ACG-ACL, ML length, MG length and Inc length) were essential for clustering the alveolar morphology of infants with UCCLP. Furthermore, the blinded clinical evaluation indicated that UCCLP patients with alveolar segments of horizontal form had the lowest treatment outcomes.ConclusionOverall, our findings establish a novel quantitative classification system for the morphology of alveolar bone in infants with UCCLP and suggest that this classification may be associated with the outcomes of CLP treatment.Clinical relevanceThe multidisciplinary CLP team should thoroughly evaluate and classify the specific alveolar morphology when administering PNAM to infants with UCCLP.

Longitudinal Three-Dimensional Stereophotogrammetric Growth Analysis in Infants with Unilateral Cleft Lip and Palate from 3 to 12 Months of Age.

This longitudinal study aimed to evaluate facial growth and soft tissue changes in infants with complete unilateral cleft lip, alveolus, and palate (CUCLAP) at ages 3, 9, and 12 months. Using 3D images of 22 CUCLAP infants, average faces and distance maps for the entire face and specific regions were created. Color-coded maps highlighted more significant soft tissue changes from 3 to 9 months than from 9 to 12 months. The first interval showed substantial growth in the entire face, particularly in the forehead, eyes, lower lip, chin, and cheeks (p < 0.001), while the second interval exhibited no significant growth. This study provides insights into facial soft tissue growth in CUCLAP infants during critical developmental stages, emphasizing substantial improvements between 3 and 9 months, mainly in the chin, lower lip, and forehead. However, uneven growth occurred in the upper lip, philtrum, and nostrils throughout both intervals, with an overall decline in growth from 9 to 12 months. These findings underscore the dynamic nature of soft tissue growth in CUCLAP patients, highlighting the need to consider these patterns in treatment planning. Future research should explore the underlying factors and develop customized treatment interventions for enhanced facial aesthetics and function in this population.

Mixed Dentition Period Follow-up of Primary Unilateral Cleft Nose Deformity Repair.

Recently, there has been an increased acceptance of the primary cleft rhinoplasty providing acceptable outcomes. Nose reconstruction, and specifically cleft nose deformity, should be addressed based on this philosophy. The purpose of this study was to evaluate surgical outcomes during the mixed dentition period after primary surgery to address unilateral cleft lip nose deformity based on the proposed technique. This is a retrospective cohort study. Thirty-two primary complete unilateral cleft lip patients were operated on by a single surgeon using the V-Y-Z cleft rhinoplasty. This method combines a composite V-Y advancement flap with lateral Z-plasty. Data collection was accomplished by evaluation of nasal symmetry through anthropometric measurements performed under general anesthesia during primary cleft palatoplasty and alveolar bone graft. The outcomes were evaluated through anthropometric measurements of the repaired nose during the mixed dentition period of follow-up, and no type of presurgical management was performed for any of the patients. Total nasal symmetry has been observed in 34.37% of patients at 7 years or more and 40.62% at 1-year follow-up. Nonstatistically significant differences were observed during follow-up, and major revision requirement (>3 mm of asymmetry in any of the nose measurements) was observed in 9.37% of patients. The proposed primary cleft rhinoplasty is a good approach to improve nasal appearance in patients with complete unilateral cleft lip and palate.

Growth-related nasal stability following unilateral complete cleft lip repair: A comparison of the standard and modified rotation-advancement technique

Growth-related nasal stability following unilateral complete cleft lip repair: A comparison of the standard and modified rotation-advancement technique