Complete Unilateral Cleft Research Articles

A new technique for perioral muscle reconstruction and lip lengthening in complete unilateral cleft lip

BackgroundAdequate skin lengthening and symmetry may not be consistently obtained in unilateral cleft lip repair, especially in patients with complete cleft. The purpose of this study was to present the model of muscle dissection and approximation to facilitate lip lengthening and symmetry. MethodsThe design followed the rotation-advancement (RA) method without skin measurement. A curvilinear skin incision was made from subnasale to the Cupid's bow peak (CBP). Muscle dissection was continued to the contralateral nostril floor beneath the columellar base to facilitate downward rotation in the medial lip. Wide muscle dissection was performed in the lateral lip segment from the nasal mucosa passing the alar base. The lateral lip muscle was advanced and sutured to the medial lip muscle in a Z-plasty fashion. A small skin backcut was made above the CBP. Primary nasal correction was performed. A series of 138 patients with complete unilateral cleft lip and palate were included in this study. Standard photographs were collected for measurement in the nasolabial region. ResultsAdequate lengthening and symmetry of the lip was obtained. The ratio of vertical philtral height was 0.99±0.05 between the cleft and noncleft sides. The C flap was used for supplementary skin lengthening in 58% of cases. Postoperative lip retraction requiring massage occurred in 13%. Overall nasolabial appearance was satisfactory. ConclusionThe new technique of perioral muscle reconstruction facilitated to obtain lip lengthening and symmetry in the repair of complete unilateral cleft lip.

Range and timing of surgery, and surgical sequences used, in primary repair of complete unilateral cleft lip and palate: The Cleft Care UK study.

To describe the range of surgery used to repair the lip and palate in the UK with specific interest in the sequence/timing used in complete unilateral cleft lip and palate (cUCLP). The Cleft Care UK study, a cross-sectional study of 268 5-year-olds, born from 2005 to 2007, with complete unilateral cleft lip and palate. Information on surgery was extracted from medical notes by surgeons during research clinics and transcribed onto a standardized questionnaire. Surgical data were available for 251 (94%) children from all cleft centres in the UK (n=18). Over a two-year period, 32 surgeons used 10 different surgical sequences in primary repair of the cleft lip and palate. The most frequently used sequence was repair of cleft lip and anterior hard palate followed by repair of posterior hard palate and soft palate (70%). Four surgical sequences were used only once. Most surgeons had a preferred sequence, but 38% (11/29) used more than one sequence during the study period. The timing of repair of the lip, the hard palate and the soft palate varied with surgical sequence, and also between surgeons, even adjusting for the different sequences used. Despite centralization of cleft services in the UK, there remains considerable variation in both the sequence and timing of surgical repair of cleft lip and palate in infancy. Further work is required to understand whether these factors are associated with differences in outcome.

Early outcomes of cleft and palatal width following anterior palate repair (vomerine flap) in infants with wide cleft lip and palate.

BackgroundAnterior palatal repair performed during cleft lip repair using a vomerine flap may assist in recruiting additional soft tissue for subsequent completion of palatoplasty, especially in patients with a wide cleft. We present our early results in the hope of triggering a re-evaluation of this technique regarding its advantages for maxillary growth through further studies of patients with a wide cleft.MethodsA retrospective analysis of patients with complete unilateral and bilateral cleft lip and palate was performed, including cleft and palatal measurements taken during initial surgery (lip repair together with anterior palate repair) and upon completion of palatoplasty.ResultsIn total, 14 patients were included in this study, of whom nine (63.3%) had unilateral cleft lip and palate and five (37.5%) had bilateral cleft. All patients had a wide cleft palate. Lip and anterior palate repair was done at a median age of 3 months, while completion of palatoplasty was done at a median age of 10.5 months. Measurements taken upon completion of palatoplasty showed significant cleft width reduction in the mid-palate and intertubercle regions; however, the palatal arch distances at nearby landmarks showed non-significant marginal changes.ConclusionsAnterior palate repair using a vomerine flap significantly reduced the remaining cleft width, while the palatal width remained. Further research is warranted to explore the long-term effects of this technique in wide cleft patients in terms of facial growth.

Analysis of Dental Arch in Children With Oral Cleft Before and After the Primary Surgeries.

This study aimed to evaluate longitudinally the alteration of the dental arch dimensions of children with different oral cleft types, before and after the primary surgeries. Three-dimensional images of the maxillary dental casts of children with unilateral complete cleft lip (G1), unilateral complete cleft lip and palate (G2), and cleft palate (G3). The children were evaluated at pre-cheiloplasty (T1), pre-palatoplasty (T2), and 1 year after palatoplasty (T3). The measurements obtained: intercanine (C-C') and intertuberosity (T-T') distances, anterior (I-CC') and total (I-TT') arch lengths. To analyze the intraexaminer error, paired t-test was applied and Dahlbergh formula. The intragroups comparisons were applied: paired t-test, ANOVA followed by Tukey, Wilcoxon test, and Kruskal-Wallis test followed by Dunn test. The intergroup comparisons were performed by independent t-test and Mann-Whitney test. In G1, the C-C', T-T', and the I-TT' distances revealed a significant increase of the maxilla. In G2, the C-C' distance statistically decreased from T1 to T3, T-T' distance showed statistical increase from T1 to T3. The I-TT' length increased with statistically significant differences between T1 and T3, T2 and T3. In G3, the C-C', T-T', and I-TT' distance increased was statistically significant. The longitudinal evaluation of the changes occurred in the dental arches with different oral cleft types showed that cheiloplasty and palatoplasty caused the most alterations in the development of the maxillary dimensions of children with complete cleft lip and palate.

Is PRP Effective in Reducing the Scar Width of Primary Cleft Lip Repair? A Randomized Controlled Clinical Study.

To evaluate and analyze the effect of platelet-rich plasma (PRP) injection on the scar formed after unilateral complete cleft lip scar repair using a modified Millard technique. An unavoidable cheiloplasty scar is a result of the wound healing process that not only influences patient self-esteem for life but also affects muscle function. Blind, randomized, controlled clinical trial. From December 2016 to February 2018, 24 patients with unilateral complete cleft lip undergoing primary cheiloplasties were equally assigned to study and control groups. All patients were treated by modified Millard cheiloplasty. In the study group, PRP was injected into the muscle and skin layers immediately after wound closure, while the control group patients were treated with no PRP injection. Scar width was assessed after 6 months through the muscle using ultrasonography and at the skin surface via photographs. Scar width showed a significant improvement in the study group. Injection of autologous PRP provides effective improvement of cutaneous and muscular wound healing and decreases scar tissue formation.

Association between MSX1 rs12532 polymorphism with nonsyndromic unilateral complete cleft lip and palate and tooth agenesis

ObjectivesTo investigate the association of MSX1 rs12532 polymorphism with the risk of nonsyndromic unilateral complete cleft lip and palate (NSCLP) and tooth agenesis. Materials and methodsThe study is comprised of 384 individuals divided into 4 groups: group 1, patients with unilateral complete NSCLP and premolar agenesis (n = 57); group 2, patients with unilateral NSCLP without tooth agenesis (n = 117); group 3, patients with premolar agenesis without oral cleft (n = 53) and group 4 (n = 157), a control group with individuals without tooth agenesis and oral cleft. Genotyping of rs12532 was carried out with Taqman chemistry, and associations were investigated using logistic regression analyses. ResultsOverall rs12532 allele and genotype distributions revealed no significant differences between the groups of NSCLP or tooth agenesis. ConclusionAlthough our results are consistent with a lack of association of MSX1 rs12532 and the risk of unilateral NSCLP and tooth agenesis, further studies with additional SNPs and a more diverse ethnic cohort are warranted.

Apical root resorption after orthodontic treatment in patients with unilateral cleft lip and palate.

The aims of this retrospective longitudinal study were to present the incidence of external apical root resorption (EARR) in the maxillary anterior teeth of patients with complete unilateral cleft lip and palate (CUCLP) and to evaluate the influence of orthodontic treatment variables on the development of EARR. Forty-one patients with CUCLP participated in the study. Orthopantomograms (OPGs), taken before (T2) treatment with multiband orthodontic appliances (MBA), and periapical radiographs (PAs) of the maxillary anterior teeth taken at the end (T3) of orthodontic treatment (OT) were assessed for EARR. The incidence of EARR at T3 (97.6%) was considerably higher than at T2 (51.2%). Central incisors and canines on the cleft side showed a significantly higher score (p < 0.01, p < 0.05 respectively) of EARR in comparison to the same group of teeth on the non-cleft side. Preexisting EARR and abnormal root morphology were identified as predisposing factors for EARR. Patients with CUCLP treated with MBA have higher incidence of EARR on the maxillary anterior teeth of the cleft side. Severe EARR is rather rare but more often seen on central incisors of the cleft side. As most of the patients with cleft lip and palate undergo a challenging and long-term OT with MBA, it is of importance to identify the predisposing factors related to the special anatomical features of the bone and teeth located in the cleft area, as well as the special OT needs of these patients.

Long-term Results of Unilateral Cleft Lip Repair With Multiple Infantile Hemangiomas Including the Cleft Side of the Upper Lip

PURPOSE: Cleft lip and infantile hemangioma are relatively common congenital diseases. However, infantile hemangiomas on the cleft side, in the operative field of cleft lip, are extremely rare, and no clear guidelines have been established for their treatment. We experienced a case in which a patient with a cleft lip had infantile hemangioma on the cleft side. We performed cleft lip repair on a patient with infantile hemangioma on the cleft side of the cleft lip at 3 months after birth and have been following-up on the patient for the past 18 years. We report the results of 18-year follow-up after the surgery of this rare patient. METHODS: The male patient was diagnosed with a left unilateral complete cleft lip with alveolar cleft and a submucous cleft palate. There were multiple infantile hemangiomas throughout his body, with no notable abnormalities in the chromosomal analysis. In particular, the patient had infantile hemangiomas on the upper lip and lower lip, right ear helix, back, and left shoulder. The hemangioma on the upper lip was on the lateral segment of the cleft side. As per the general treatment guidelines, cleft repair was performed at 3 months after birth. Millard’s rotation advancement technique was used for the repair, which uses the lower small triangular flap. The patient was followed up for 18 years after surgery. RESULTS: There was no excessive bleeding during the surgery, and blood transfusion was not needed. The excised tissue was confirmed to be infantile hemangioma in the histopathologic examination. The patient did not show any abnormalities during recovery, and there was some residue of infantile hemangioma in the repair site in the upper lip vermilion. The residual infantile hemangioma in the repair site of the upper lip vermilion was involuted by 5 years old, and there was only a normal degree of scarring after cleft lip repair of the upper lip vermilion. At the same time, the infantile hemangiomas in the right ear helix, back, and left shoulder were completely involuted without any scarring. The patient has been followed up until now, and at 18 years, he has no particular problems other than the red scar on the lower lip. CONCLUSION: Infantile hemangiomas requiring lip repair for unilateral complete cleft lip are extremely rare, and there are no established surgical guidelines for this condition. In such cases, delaying lip repair until the infantile hemangioma is involuted may not be desirable for obtaining the best esthetic outcome, and it is also not desirable because it may induce psychosocial impairment in patients and caregivers. Therefore, we believe that general cleft lip repair produces good outcomes even in cases involving hemangiomas on the cleft side.

Early Cleft Repair Versus Nasoalveolar Molding: Comparing Preoperative Severity and Postoperative Results Utilizing a Computer Engineered AI System

BACKGROUND: Early cleft lip repair (ECLR) can be performed safely and effectively. One persistent question is whether ECLR may be offered to wide unilateral complete clefts who historically would have received nasoalveolar molding (NAM). This study aims to compare the preoperative cleft severity of ECLR patients to those who underwent NAM pretreatment and compare postoperative outcomes. METHODS: Unilateral CL patients (January 1, 2005, to September 11, 2018) were retrospectively reviewed and divided into 2 groups: ECLR (age <3 months) and presurgical NAM with CL repair (age 3–6 months). Pretreatment CL severity was assessed using an AI computer engineered system that calculated cleft width ratios (CWRs, pretreatment cleft width divided by commissure width). For further analysis, a second subset of wide complete cleft lip patients undergoing ECLR (excluding incomplete clefts) was created to compare to the NAM group. RESULTS: Seventy-four ECLR patients and 25 NAM patients (average age at repair 32.24 and 117.56 days, respectively) met inclusion criteria. Mean CWR was 0.456 for ECLR patients and 0.501 for NAM patients (P = 0.165). The ECLR subgroup considering only patients with complete cleft lips had a mean CWR of 0.520, suggesting that this group had more severe clefts. The ECLR subgroup’s average lip length, frontal nasal breadth, commissure length, nostril breadth, nostril width, and nasal angle symmetry ratios were compared to the NAM group’s postoperatively. The average lip length, frontal nasal breadth, and commissure length symmetry ratios for the ECLR subgroup of 27 complete clefts were 0.88, 1.05, and 0.92, respectively, compared to 0.93, 1.08, and 0.89 for the NAM group (P = 0.181, P = 0.526, P = 0.378). The average nostril breadth, nostril width, and nasal angle ratios among the ECLR subgroup were 1.09, 1.17, and 1.12, respectively, compared to 1.12, 1.19, and 1.14 in the NAM group (P = 0.480, P = 0.613, P = 0.640). CONCLUSION: ECLR provides patients with severe cleft lips an alternative option to NAM with at least equivalent results. With increased experience, long-term data, and increased awareness, we feel that ECLR has the potential to be a paradigm shift in the treatment of the cleft lip/nasal deformity.

Effects of Different Timing of Alveolar Bone Graft on Craniofacial Morphology in Unilateral Cleft Lip and Palate.

To evaluate the effect of the timing of secondary alveolar bone graft (SABG) on craniofacial morphology in patients with complete unilateral cleft lip and palate (UCLP). Single-center retrospective assessment of consecutively treated nonsyndromic patients with complete UCLP. One hundred sixty-seven patients (108 males, 59 females) with complete UCLP in whom the cleft was repaired with 1-stage method at approximately 8 months of age. The age of 128 patients at SABG varied from 1.4 to 11.5 years (SABG group), while 39 patients still awaited SABG at the moment of cephalometric evaluation (no-SABG group). Craniofacial morphology was assessed on lateral cephalograms taken at 10 years of age (standard deviation = 0.8; range: 7.5-12.3) using linear and angular measurements. T tests and regression models were made to analyze data. Regression models demonstrated that the effect of SABG on the craniofacial morphology was limited-cephalometric variables which were statistically significantly different between SABG and no-SABG groups showed no association with the timing of SABG when (1) age of primary repair of the cleft, (2) age of cephalometric evaluation, (3) cleft side, (4) gender, and (5) operator were controlled for. Only the length of the maxilla (Condylion-point A) was affected-1-year delay of SABG corresponded with an increase in Co-point A distance by 0.52 mm. However, adjusted R2 of the model was 0.11. Our findings cautiously indicate that SABG performed before 8 years of age can have limited negative effect on craniofacial morphology. Nevertheless, our results should be confirmed by cleft centers practicing alternative surgical repairs of the cleft.

Three-dimensional facial development of children with unilateral cleft lip and palate during the first year of life in comparison with normative average faces.

BackgroundStereophotogrammetry can be used to study facial morphology in both healthy individuals as well as subjects with orofacial clefts because it shows good reliability, ability to capture images rapidly, archival capabilities, and high resolution, and does not require ionizing radiation. This study aimed to compare the three-dimensional (3D) facial morphology of infants born with unilateral cleft lip and palate (UCLP) with an age-matched normative 3D average face before and after primary closure of the lip and soft palate.MethodsThirty infants with a non-syndromic complete unilateral cleft lip, alveolus, and palate participated in the study. Three-dimensional images were acquired at 3, 6, 9, and 12 months of age. All subjects were treated according to the primary surgical protocol consisting of surgical closure of the lip and the soft palate at 6 months of age. Three-dimensional images of UCLP patients at 3, 6 (pre-treatment), 9, and 12 months of age were superimposed on normative datasets of average facial morphology using the children’s reference frame. Distance maps of the complete 3D facial surface and the nose, upper lip, chin, forehead, and cheek regions were developed.ResultsAssessments of the facial morphology of UCLP and control subjects by using color-distance maps showed large differences in the upper lip region at the location of the cleft defect and an asymmetry at the nostrils at 3 and 6 months of age. At 9 months of age, the labial symmetry was completely restored although the tip of the nose towards the unaffected side showed some remnant asymmetry. At 12 months of age, the symmetry of the nose improved, with only some remnant asymmetry noted on both sides of the nasal tip. At all ages, the mandibular and chin regions of the UCLP patients were 2.5–5 mm posterior to those in the average controls.ConclusionIn patients with UCLP deviations from the normative average 3D facial morphology of age-matched control subjects existed for the upper lip, nose, and even the forehead before lip and soft palate closure was performed. Compared to the controls symmetry in the upper lip was restored, and the shape of the upper lip showed less variation after primary lip and soft palate closure. At this early age, retrusion of the soft-tissue mandible and chin, however, seems to be developing already.

Efficacy of morpho-functional repair in management of different morphological variants of unilateral complete cleft lip

BackgroundTo study the surgical outcome in various morphological variants of unilateral complete cleft lip in our high volume centre over a period of 4 years, using Morpho-Functional technique in all cases by indirect two dimensional photographic analysis. MethodsIn this prospective cohort study, 749 patients with Unilateral Cleft Lip with palate were included over a period of 4 years from January 2010 to December 2014. All Subjects underwent surgery before the age of 1 year with the follow-up two dimensional photographs taken at 4 years post-operatively. Eight measurements were performed on the photographs. All parameters were measured on both Cleft & Non cleft sides and the ratio was considered with the normal side as the base line. Shapiro–Wilk and Kolmogrov–Smirnoff tests were used to confirm that the data was normally distributed. One way ANOVA was done to find out if there were any significant differences amongst the different groups along various parameters, respectively. Further Tukey post hoc analysis was done to confirm where the differences occurred between groups. ResultsNone of the groups showed any statistical differences on any parameters. There were minor variations between the different groups due to the ranging morphology of the defect but overall satisfactory to good results were seen on all measured parameters evaluated. ConclusionThis shows that the Morphofunctional technique, with its combinations & modifications of various school of thought, is versatile enough to achieve good surgical outcomes despite the wide variations seen in size and type of defects in unilateral cleft lip. This comes about because of the comprehensive nature of the technique & the balance that it creates among the affected structures.

Closer to the Truth on National Fistula Prevalence After Unilateral Complete Cleft Lip and Palate Repair? The Cleft Care UK Study.

To (1) determine the prevalence of nonperialveolar palatal fistula up to age 5 following repair of unilateral cleft lip and palate (UCLP) in the United Kingdom, (2) examine the association of palatoplasty techniques with fistula occurrence, and (3) describe the frequency of fistula repairs and their success. Cross-sectional study. All 11 centralized regional cleft centers in the United Kingdom. Two hundred sixty-eight children born between 2005 and 2007 recruited by Cleft Care UK, a nationwide cross-sectional study of all 5-year-old children born with nonsyndromic UCLP. Nonperialveolar palatal fistula prevalence up to age 5. Fistulas were found in 72 children (31.3%, 95% confidence interval: 25.4%-37.7%) and had no significant association with palate repair sequences. Twenty-four fistulas were repaired by age 5, 12 of which had data showing 10 (83.3%) successful repairs. The prevalence of nonperialveolar fistulas following primary palatoplasty of UCLP in the United Kingdom was higher than previously reported. This information should be part of the preoperative discussion with families. Prospective collection of the presence of fistulas will be necessary before we can associate the occurrence of fistulas with a surgeon, institution, surgical technique, or protocol of care.

Primary Repair of Unilateral Complete Cleft Lip and Nose Deformities

Primary Repair of Unilateral Complete Cleft Lip and Nose Deformities

Two-stage cleft palate closure by our treatment algorithm in complete unilateral Cleft Lip and Palate: results of velopharyngeal function

Background: It has been reported that two-stage palatoplasty is excellent in terms of maxillary growth but poor in terms of speech outcomes.

Association between cervical vertebral maturation stages and dental calcification stages in patients with unilateral complete cleft lip and palate

The purpose of the study is to investigate the relationship between dental calcification stages (DCS) and cervical vertebral maturation stages (CVMS) in patients with unilateral complete cleft lips and palates (UCLP) and to provide a theoretical basis for the treatment time selection of cleft lip and palate (CLP) patients. A total of 123 UCLP patients and 215 non-CLP subjects were selected. The DCS of the left mandibular canine, premolar, and second molar in non-CLP subjects and on both cleft sides of UCLP patients were assessed utilizing the Demirjian method. CVMS was observed utilizing the Baccetti method. The results were analyzed by Spearman rank correlation, and the correlation coefficients were compared. There was a correlation between the CVMS and the DCS of the left mandibular canine, the first premolar, the second premolar, and the second molar in the non-CLP subjects and on both cleft sides of the UCLP patients (r=0.762-0.864, P<0.05; r=0.809-0.914, P<0.05, respectively). The correlation between the CVMS and the DCS of the mandibular first premolar was highest among the UCLP patients. Except for the first and the second premolars of UCLP females, the correlation between the DCS and the CVMS of the other teeth did not differ among the non-CLP subjects (P>0.05). DCS can be utilized as a biological index to determine the growth development statuses. The correlation between the CVMS and the DCS of the mandibular first premolar was the highest.

Beware the Alar Base Optical Illusion in Assessment of Unilateral Cleft Lip Nasal Deformity

After repair of unilateral cleft lip, lateral drift of the alar base is expected and may require revision. Although the alar base appears wider than on the noncleft side, by measurement it could be symmetric or narrow. Is this an optical illusion? This is a retrospective photographic evaluation of children who underwent repair of unilateral complete cleft lip and palate. On submental standardized photographs, raters judged whether the alar base position was wider, equal to, or narrower than on the noncleft side. The true alar base position was measured by photogrammetry and the frequency of alar base misjudgment was assessed. On control photographs, the cleft side alar base was wider than the noncleft side. On test photographs, the cleft side alar base was narrower than the noncleft side. Possible association between misjudgment and nasal features was also evaluated. Data were analyzed using the Fisher's exact test. Three raters assessed 61 patients aged 6 to 9 years and treated between 1995 and 2015. In 77 percent of control photographs, raters correctly judged the cleft side alar base as wider. In 65 percent of test photographs, raters incorrectly judged the alar base position as wider on the cleft side. Asymmetry of nostril outline and a transverse nostril axis were associated with misjudged photographs (p < 0.05). Alar base assessment can be altered by an optical illusion. Simple anthropometry counters this misperception. Measurement should be repeated after correction of the deviated anterocaudal septum and elevation of the lower lateral cartilage. Thereafter, a decision is made on altering the alar base position. Diagnostic, II.

Enamel defects in permanent teeth of patients with cleft lip and palate: a cross-sectional study.

ObjectiveThis study investigated the prevalence, type, and location of enamel defects in the permanent teeth of patients with complete unilateral or bilateral cleft lip and palate (CLP), and compared the prevalence and characteristics of defects between CLP patients and non-CLP individuals.MethodsWe examined completely erupted permanent dentition, except for third molars, of CLP patients and non-CLP individuals of both sexes, 9–36 years of age, and analyzed corresponding panoramic radiographs. Two independent examiners performed clinical examinations in accordance with the Modified Developmental Defects of Enamel index.ResultsA total of 210 (87.9%) CLP patients and 194 (41.4%) non-CLP individuals had at least one enamel defect; these were more prevalent in the CLP group than in the non-CLP group. Upper teeth were primarily affected by enamel defects associated with the cleft; defects were most prevalent on the cleft side in CLP patients, followed by the non-cleft side in CLP patients, and then by non-CLP individuals.ConclusionEnamel defects were more common in CLP patients than in non-CLP individuals. Among CLP patients, enamel defects were more prevalent in the cleft side of the maxilla; the central incisor was the most commonly affected tooth in this quadrant.

Bone-anchored maxillary protraction in unilateral cleft lip and palate: a cephalometric appraisal.

The aim of this study was to evaluate the cephalometric outcome of bone-anchored maxillary protraction (BAMP) in individuals with unilateral complete cleft lip and palate (UCLP). The experimental group (EG) comprised 23 individuals (17 males and 6 females) with UCLP and a mean age of 11.7 years. At least 6 months after secondary alveolar bone grafting, Bollard miniplates were installed in the posterior region of the maxilla and in the anterior region of the mandible. Class III elastics were recommended to be worn for 24 hours/day for a mean time of 18 months. Cone beam computed tomography (CBCT) was obtained before (T1) and after treatment (T2). The control group (CG) consisted of 23 individuals with UCLP matched by initial age and gender with the EG and without any orthopaedic or surgical intervention performed between T1 and T2. The interval between T1 and T2 observations was 18 months for both groups. Twenty-one cephalometric variables were analysed. Intra- and intergroup comparisons were performed using paired and independent t-tests, respectively (P < 0.05). BAMP caused a greater maxillary protrusion (SNA) and a greater decrease of Class III maxillomandibular discrepancy (ANB and Wits appraisal) compared with the CG. BAMP also caused a counterclockwise rotation of the occlusal plane (Occ Plane to FH) and an improvement in the molar relationship compared with controls. BAMP therapy demonstrated a significant orthopaedic maxillary protraction and an improvement in the Class III skeletal pattern in UCLP.

Evaluation of the Effects of Cheiloplasty on Maxillary Arch in UCLP Infants Using Three-Dimensional Digital Models.

To analyze and identify changes in the maxillary dental arch before and after cheiloplasty in a group of unilateral complete cleft lip and palate (UCLP) infants. This is a cohort study. Study models from 16 infants with nonsyndromic UCLP, who were treated at Khon Kaen University, were taken before (T1) and after cheiloplasty (T2). The dental models underwent a process of scanning through a 3D scanner, from which 9 linear and 2 angular landmarks were evaluated. Paired t test was used to compare the measurement statistically between T1 and T2. Alveolar cleft gap (G-L), anterior basal angle (∠GC-CC'), and anterior arch curvature angle on greater segment (∠GIC) were significantly decreased (P < .05). Contrarily, anterior ridge length of greater segment (C-I), anterior ridge length of lesser segment (L-C'), and posterior arch width (T-T') were significantly increased (P < .05) after cheiloplasty. While, anterior portion of greater segment (I-G), anterior arch width (C-C'), anterior arch depth (I⊥CC'), arch length (G⊥TT'), and arch circumference (T-C-I-G-L-C'-T') showed no significant difference. The measurements were tested using the Intraclass correlation coefficient. The coefficients indicated high reliability. Cleft gap significantly decreased after lip repair, and the anterior part of maxillary dental arch was also bent palatally after cheiloplasty without any other intervention except cheiloplasty. More studies are needed to assess the amount of lip pressure. If any convincing force is presented, an appliance to prevent undesirable pressure is indicated.