Cleft Lip Management Research Articles

Knowledge and awareness of pediatricians about early interventions performed by pediatric dentists in the management of cleft lip and palate – A questionnaire-based study

ABSTRACT Background and Introduction: Cleft lip and palate (CL/P) is one of the most common congenital anomalies which require multidisciplinary care. Patients with CL/P require appropriate corrective treatment to improve health, function, and esthetics. Knowledge about the various treatment procedures available and the timing of the procedures among pediatricians is vital for them to refer the patient at the correct stage to the appropriate specialist for the best possible rehabilitation. Aim: The aim of this study was to evaluate the knowledge and awareness of pediatricians about early interventions performed by pediatric dentists in the management of CL/P. Materials and Methods: A closed-ended questionnaire that included questions regarding the knowledge and awareness of obturators, lip taping, and nasoalveolar moldings was formulated. A questionnaire with 20 questions was circulated among the pediatricians through a web-based portal. Their knowledge and awareness about early interventions performed by pediatric dentists in the management of CL/P were assessed. Results: Results showed that out of 323 pediatricians who participated in the survey, 99.4% had heard of obturators. Awareness about lip taping was 78.3% while that of nasoalveolar molding was 55.1%. The benefits of the procedure and appliance were not well known. Conclusion: To improve the health, psychological, and social support of patients with CL/P, more awareness needs to be created among pediatricians regarding the management to provide better and timely oral rehabilitation.

Application of 3D Printing in Cleft Lip and Palate Repair.

This manuscript reviews the transformative impact of 3-dimensional (3D) printing technologies in the treatment and management of cleft lip and palate (CLP), highlighting its application across presurgical planning, surgical training, implantable scaffolds, and postoperative care. By integrating patient-specific data through computer-aided design and manufacturing, 3D printing offers tailored solutions that improve surgical outcomes, reduce operation times, and enhance patient care. The review synthesizes current research findings, technical advancements, and clinical applications, illustrating the potential of 3D printing to revolutionize CLP treatment. Further, it discusses the future directions of combining 3D printing with other innovative technologies like artificial intelligence, 4D printing, and in situ bioprinting for more comprehensive care strategies. This paper underscores the necessity for multidisciplinary collaboration and further research to overcome existing challenges and fully utilize the capabilities of 3D printing in CLP repair.

Epidemiology of cleft lip and palate charity mission surgery at Bandung Cleft Lip and Palate Center, Indonesia: a 14-year institutional review.

The management of cleft lip and palate aims at improving the patient's aesthetic and functional outcomes. Delaying primary repair can disrupt the patient's functional status. Long-term follow-up is essential to evaluate the need for secondary repair or revision surgery. This article presents the epidemiology of cleft lip and palate, including comprehensive patient characteristics, the extent of delay, and secondary repair at our institutional center, the Bandung Cleft Lip and Palate Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia. This retrospective study aimed to determine the epidemiology and recurrence rates of cleft lip and palate at the Bandung Cleft Lip and Palate Center, Indonesia, from January 2007 to December 2021. The inclusion criteria were patients diagnosed with cleft lip and/or palate. Procedures such as labioplasty, palatoplasty, secondary lip and nasal repair, and alveolar bone grafting were performed, and data on recurrence were available. In total, there were 3,618 patients with cleft lip and palate, with an age range of 12 months to 67 years. The mean age was 4.33 years, and the median age was 1.35 years. Males predominated over females in all cleft types (60.4%), and the cleft lip was on the left side in 1,677 patients (46.4%). Most cases were unilateral (2,531; 70.0%) and complete (2,349; 64.9%), and involved a diagnosis of cleft lip and palate (1,981; 54.8%). Delayed primary labioplasty can affect daily functioning. Primary repair for patients with cleft lip and palate may be postponed due to limited awareness, socioeconomic factors, inadequate facilities, and varying adherence to treatment guidelines. Despite variations in the timing of primary cleft lip repair (not adhering to the recommended protocol), only 10% of these patients undergo reoperation. Healthcare providers should prioritize the importance of the ideal timing for primary repair in order to optimize physiological function without compromising the aesthetic results.

Sociodemographic Factors Associated with Knowledge About Management of Cleft Lip and Palate Patients in Peruvian Dental Students: A Logistic Regression Analysis.

Cleft lip and palate are relatively frequent craniofacial alterations caused by the lack of union of the frontonasal processes with the maxillary processes during the first weeks of intrauterine life. This study evaluated the sociodemographic factors associated with the level of knowledge about management of cleft lip and palate (CLP) patients in Peruvian dental students. This analytical, observational, cross-sectional and prospective study evaluated 191 dental students belonging to two branches of a private Peruvian university (one branch in the capital city and the other in a province), from September to November 2022. A validated questionnaire of 14 closed multiple-choice questions was used. A logit model was used to evaluate the influence of the variables: sex, age, academic year of study, marital status, relationship with CLP persons, place of origin and area of residence, on the level of knowledge of the students considering a significance level of p<0.05. Of the total, 77%, 22.5% and 0.5% presented a poor, fair and good level of knowledge, respectively, on the dental management of the patient with cleft lip and palate. In addition, those who lived in urban areas were 2.8 times more likely to have poor knowledge about the dental management of patients with CLP, compared to those who lived in non-urban areas (OR = 2.83; 95% CI: 1.26-6.33). Finally, sex, age, marital status, place of origin, academic year of studies and relationship with CLP persons were not considered influential factors (p>0.05). Most of the students showed a poor level of knowledge about the dental management of patients with cleft lip and palate, a risk factor being that the students live in an urban area. It is recommended that educational authorities include selected topics on CLP in subjects related to infant, child and adolescent care.

Evidence Mapping and Quality Analysis of Systematic Reviews on Various Aspects Related to Cleft Lip and Palate.

Management of cleft lip and palate is interdisciplinary. An evidence-mapping approach was envisaged to highlight the existing gaps in this field, using only the highest level of evidence. To conduct evidence mapping and quality analysis of systematic reviews and meta-analyses related to any aspect of cleft lip and palate. The cleft lip and palate field was divided into 9 domains and 50 subdomains and a method of categorization of systematic reviews was established. A comprehensive search strategy was carried out in seven databases along with the search of gray literature and references of included articles. Systematic reviews related to any aspect of cleft lip and palate, conducted by a minimum of two reviewers, with a comprehensive search strategy and adequate quality analysis were included. A self-designed, pre-piloted data-extraction sheet was used to collect information that was analyzed through an expert group discussion. Quality analysis was performed using ROBIS-I, AMSTAR 2, and the PRISMA checklist. A total of 144 systematic reviews published between 2008 and 2022 were included. The largest number of these could be categorized in the therapeutic domain (n = 58). A total of 27% of the studies were categorized as inconclusive, 40% as partially conclusive, and 33% as conclusive. As per ROBIS-I, 77% of reviews had high risk of bias while 58% were graded as critically low in quality as per AMSTAR 2. The majority of systematic reviews showed low reporting errors. The majority of systematic reviews related to cleft lip and palate relate to therapeutic and prognostic domains and show high risk of bias and critically low quality regardless of the source journal. The results of this paper might serve as a starting point encouraging authors to carry out high-quality research where evidence is lacking. A multidisciplinary expert-group formulated an a priori protocol, registered in Open Science Framework (DOI 10.17605/OSF.IO/NQDV2).

Inter-Disciplinary Dental Care and Management of Cleft Lip And Palate: A Case Series

Inter-Disciplinary Dental Care and Management of Cleft Lip And Palate: A Case Series

Single visit feeding plate for infant: A case report.

A child born with cleft lip and palate may experience difficulties while feeding. It is the most common congenital craniofacial malformations. Feeding difficulties should be assessed and intervened as early as possible, as they are an important aspect of the multidisciplinary team approach in the management of cleft lip and palate. Feeding obturators improve feeding thereby contributing to weight gain and a thriving state of health, a prerequisite for surgical repair of the defects. A successful prosthesis should meet the physiological, psychological and aesthetic needs of the patient. This article describes the procedure for rehabilitation of cleft palate patient with feeding plate.

Orofacial Clefts: Genetics of Cleft Lip and Palate.

Orofacial clefting is considered one of the commonest birth defects worldwide. It presents as cleft lip only, isolated cleft palate or cleft lip and palate. The condition has a diverse genetic background influenced by gene-gene and gene-environment interaction, resulting in two main types, syndromic and nonsyndromic orofacial clefts. Orofacial clefts lead to significant physiological difficulties that affect feeding, speech and language development and other developmental aspects, which results in an increased social and financial burden on the affected individuals and their families. The management of cleft lip and palate is solely based on following a multidisciplinary team approach. In this narrative review article, we briefly summarize the different genetic causes of orofacial clefts and discuss some of the common syndromes and the approach to the management of orofacial clefts.

Comprehensive care of children with cleft lip and palate

Cleft lip and palate (CLP) is a common congenital abnormality that demands multidisciplinary treatment. It affects 1 in 1,000 live births on average, and isolated cleft palate affects 1 in 2,000 live births. According to several epidemiological studies, if one parent has a cleft, their kid has a 3.2% probability of developing CLP and a 6.8% chance of developing an isolated cleft palate. A child born with a cleft lip or palate, or other craniofacial anomaly has several challenges, such as early feeding and nutritional issues, middle ear illness, hearing loss, speech and resonance irregularities, etc. This article gives an overview of interdisciplinary approach in management of cleft lip and palate and explains the significant role of a Pediatric dentist in management of CLP.

Effects of Nasoalveolar Molding on Maxillary Arch Dimensions and Malocclusion Characteristics of Deciduous Dentition Patients with Cleft Lip and Palate.

To evaluate the effects of nasoalveolar molding (NAM) therapy on maxillary arch dimensions and malocclusion characteristics in patients with unilateral (UCLP) and bilateral cleft lip and palate (BCLP). Patients in deciduous dentition were referred to the institutional department of orthodontics. The NAM group consisted of 21 patients with UCLP (mean age 4.7±0.7 years) and 12 patients with BCLP (mean age 4.8±0.7 years). Sixteen patients with UCLP (mean age 4.9±0.9 years) and 5 patients with BCLP (mean age 5.4±1.1 years) were included in the non-NAM group. The plaster models of all patients were digitized. Dental arch dimensions and malocclusion characteristics were analyzed via digital software. One-way ANOVA with Bonferroni correction was used for statistical analysis. Intercanine and intermolar widths showed statistically significant differences according to the cleft type (P<.01). There was no statistically significant effect of NAM therapy on maxillary arch parameters and malocclusion characteristics (P>.05). The prevalence of anterior crossbite was 12.1% in the NAM group, and 23.8% in the non-NAM group. NAM therapy did not affect the maxillary arch dimensions and malocclusion characteristics in patients with UCLP and BCLP. The cleft type was the main factor, leading to a significant difference in maxillary widths.

Management of Cleft Lip and Palate: A Narrative Review

Cleft of lip and palate are the most common serial congenital anomalies to affect the orofacial region. Its occurrence can be isolated or together in various combination and/or along with other congenital deformities. In addition to aesthetic disfigurement, a child with cleft lip and/or palate suffers functional morbidity such as restricted maxillofacial growth, speech anomalies, swallowing and feeding difficulties, hearing loss and/or recurrent ear infections. Although not generally life-threatening, living with a cleft evoke a significant health burden. The management of patients with cleft lip and cleft palate is very complex and requires a multidisciplinary team with several treatment interventions This article aims to review the primary care physicians in literature knowledge about cleft lip and palate.

Presurgical Nasoalveolar Molding—Efficacy and Biomechanics in Management of Cleft Lip and Palate: A Review of the Literature

AbstractPresurgical infant orthopaedics (PSIO) appliances are used in the management of cleft lip and palate. Frequently, among all PSIO appliances utilized is presurgical nasoalveolar molding (NAM) appliance. In this review, we looked for the application of the NAM appliance, its efficacy, and biomechanics. A comprehensive search strategy was performed in two databases (Google Scholar and PubMed) for articles using NAM in the treatment plan of patients with cleft lip and palate. Six articles were included in this study with one randomized control trial, two retrospective, and three case reports studies. The studies reveal the NAM is efficient as a presurgical modality treatment for complete cleft lip and palate with multiple benefits, including reducing surgical scars and alveolar gap, used as feeding plate, improve nasal contour, and decreased the number of rectifying surgical procedure.

Updated Evidence in Management of Cleft Lip and Palate: Simple Review Article

The most common oro-facial congenital deformity reported in live newborns is a cleft of the lip, palate, or both. The objective of this study was to&nbsp;the&nbsp;updates in management, and outcomes of cases of cleft lip and/or palate. PubMed and EBSCO Information Services&nbsp;will be&nbsp;chosen as the search databases for the publications used within the study. Topics concerning&nbsp;the&nbsp;updates in management, and outcomes of cases of cleft lip and/or palate, published in English around

Protocols in the management of cleft lip and palate: A systematic review

AimTo identify clinical decisions on surgical as well as non-surgical modalities for the treatment of CLP patients based on randomized controlled trials (RCTs). Materials and methodsPubMed, Ebscohost, and Cochrane Library were searched and 20 articles based on RCTs conducted on cleft patient management were identified. ResultsThe topics explored were infant orthopedics, lip and palate repair, alveolar bone grafting, and management of cleft maxillary hypoplasia. Nasoalveolar molding (NAM) was found to have great benefits when carried out within one month of birth. Fisher and Mohler's lip repair technique and use of recombinant human bone morphogenetic protein-2 (rh-BMP2) for alveolar bone grafting showed promising results. rh-BMP2 for alveolar bone grafting appears to be a promising alternative to autografts. ConclusionEarly commencement of NAM in neonatal life is of great benefit to cleft patients. There is a need for more multicentre collaborations, mainly to identify the ideal surgical technique to reduce the variability in treatment and to ensure that the patient receives appropriate evidence-based treatment.

Adult Cleft Patients: An Exploration of Functional Needs and Treatment Barriers.

Management of cleft lip and palate has been well characterized in pediatric patients, but limited data exist regarding the long-term functional outcomes of cleft patients once they reach adulthood. An institutional, cross-sectional survey of adult patients with a history of cleft lip and/or palate was performed. The survey recorded patient characteristics, concerns, and barriers to care. Patient-reported outcome measures were assessed using the Nasal Obstruction Symptom Evaluation Scale, Epworth Sleepiness Scale, Mandibular Function Impairment Questionnaire, and the CLEFT-Q Speech Modules. A total of 63 patients (18.2%) participated in the survey. The mean patient age was 43.7 years (median: 41y, range: 19-93y), and the most common diagnosis was cleft lip and palate (51%) followed by isolated cleft palate (35%) and isolated cleft lip (14%). A subset of patients scored with moderate to severe dysfunction on each outcome measure including the Nasal Obstruction Symptom Evaluation Instrument (59%), Epworth Sleepiness Scale (7%), and Mandibular Function Impairment Questionnaire (13%). Respondent scores on the CLEFT-Q Speech modules demonstrated a bimodal distribution with lower scores in a significant subset of patients with cleft palate and cleft lip and palate. Many respondents (41%) were interested in clinical evaluation but cited barriers to seeking treatment including financial barriers (35%) or lack awareness of clinical options (27%). Many cleft patients have persistent needs or concerns in adulthood, especially regarding speech and nasal breathing. Systemic barriers pose challenges to these patients undergoing clinical evaluation.

The Contemporary Management of Cleft Lip and Palate and the Role of Artificial Intelligence: A Review

Introduction: Cleft management is an exhaustive process for the patient, the orthodontist, and the caregiver. In recent decades, a wide number of challenges have been addressed with the inclusion of various dental specialties for the detection, diagnosis, and treatment of orofacial clefts. The orthodontist plays a very pivotal role during the overall management of children with cleft lip and palate as they need to make critical decisions for when to intervene orthodontically and at what stage to set priorities for individual treatment goals. Objectives: The objectives of this study were to provide an in-depth review of the evolving role of various disciplines focusing on orthodontics in the management of cleft cases. Methods: A general search was carried out to identify the published data on cleft lip and cleft palate management on PubMed and Scopus until the 1st of June 2021 using keywords such as cleft lip, cleft palate, cleft orthodontics, naso-alveolar molding, and surgical cleft orthodontics. The related literature was then reviewed and analyzed. Results: With improvements in 3D modeling, CT scans of patients can be used to construct precise 3D models, and these can be utilized to demonstrate various clinical issues related to clefts. The orthodontist has a major role in the various stages and steps, follow-up, treatment care, and outcome assessment. With the advent of technological advancements and artificial intelligence, the role is only going to evolve and expand further in the management of the cleft lip and palate. Diagnostic techniques utilizing artificial intelligence to detect cleft during the prenatal period have also been tested and have been shown to have a high rate of accuracy. The evolution of distraction osteogenesis came into the limelight as a revolutionary modality for cleft treatment. Computer-assisted orthognathic surgery is a widely used modality for reshaping the osseous defects of the maxilla in patients with congenital clefts. With the development of additional modalities such as aligners, patients that need to undergo complex orthognathic surgeries can also be treated with aligners without compromising the outcomes. Conclusion: The cleft lip and palate can be managed by a multi-disciplinary team. Orthodontics has an important role in the overall management of a cleft affected individual as they must make critical decisions regarding orthodontic interventions as well as set priorities for each treatment goal. With the advent of technological advancements and artificial intelligence, the diagnosis and management of the cleft lip and palate have become simplified.

Nutritional needs of cleft lip and palate child

Children with cleft lip and palate often suffer from nutritional deficiencies and subsequent growth problems, both of which are largely attributed to feeding difficulties due to the structural defect as well as the numerous surgical procedures that they undergo. The aim of this review article is to assess the nutritional needs of such children and to emphasize the role of nutrition in their long-term growth and development along with parental education on nutrition and various alternative feeding practices as an important aspect in the management of cleft lip and palate which may otherwise be overlooked. For this review, various articles on cleft lip and palate from plastic surgery to dental surgery journals were studied and more articles were based on subsequent bibliographic reviews of the above. It was concluded that to achieve optimal health in these children, the dietary changes required per day were minuscule. Rather, it is the delivery method of breast milk or formula which often needs to be changed to reduce effort and resultant caloric loss by the newborn, indirectly boosting the caloric intake and resultant weight gain and growth.

Knowledge of Cleft Lip and Cleft Palate among Medical Students of a Tertiary Care Hospital in South India

Background: Sufficient knowledge and awareness of cleft lip and palate deformity is required to identify and manage at the condition at the earliest.&#x0D; Objectives: This study was conducted to assess the awareness and knowledge of medical students on cleft lip and palate. To assess the understanding of the possible causative factors of cleft lip and palate among the same population.&#x0D; Materials and Methods: A cross sectional study was carried out among 128 medical students attending a tertiary care hospital in south India. This was performed through a researcher administered questionnaire which contained queries regarding risk factors and management.&#x0D; Results: A total of 89.1% of the subjects were aware of the term cleft lip and palate with the majority being females. Though they were not well informed regarding the treatment procedures, and timings. The results were then interpreted in table formats for better understanding of the level of education on the topic.&#x0D; Conclusion: There is a general lacking of experience in the diagnosis and management of cleft lip and palate among medical students which should be addressed to ensure timely cure and quality of life of the patients.

Prosthetic management of cleft lip and palate

Cleft lip and palate is the most frequent congenital oral dysmophosis (1/600 births). They can be associated with polyformative syndromes. The aetiology is most often unknown, but heredity is still a predominant factor. These clefts result from an absence or insufficient fusion of the different facial buds occurring from the fifth to the 7th week of intrauterine life. They can have several forms. The treatment of cleft lip and palate requires multidisciplinary management. When orthodontics is lacking, the prosthesis takes over. Combined with maxillofacial surgery, the results are spectacular.

RECONSTRUCTION OF CLEFT LIP AND PALATE AND STANDARDIZATION OF THEIR CLINICAL RECORD FROM INFANCY THROUGH ADOLESCENCE

INTRODUCTION: Orthodontics and dentofacial orthopaedics play an important role in reconstruction of child with cleft lip and palate (CLP). In layman term, cleft palate can be dened breach in continuity of the palate. DISCUSSION: Generally, midfacial irregularity and maxillary retrusion are the commonly seen problem after the surgical correction of CLP patients, which occurs mainly because of intrinsic factors, functional or adaptive factors inuencing the position and growth of normal and abnormal part and iatrogenic factors due to effect of treatment procedures. The principle of NAM is “negative sculpturing” and “passive molding” of the alveolus and the soft tissues. Orthodontic techniques are used to mold the maxillary, alveolar, and nasal tissues of an infant with CLP. Despite all the hard work that goes into every case, one aspect seems to be missing among many dentists across the globe is proper documentation of their cases. A proper documentation has many advantages. From start of the treatment planning in diagnosis to follow-up and for patient satisfaction point of view, standardization of clinical record play vital role in management of cleft lip and palate patents. CONCLUSION: The orthodontist play an important role in reconstruction of cleft lip and palate patient from birth to adulthood and provides both esthetic and functional treatment. knowing proper documentation not only improves diagnosis and treatment planning for orthodontist but also improve their future clinical practice