Palate Cases Research Articles

Columellar lengthening with V-Y advancement flap in aesthetic rhinoplasty

Achieving a harmonious nasal shape requires balance from the frontal, lateral, and basal views. A short columella can lead to inadequate tip projection and drooping. While various methods have been used to lengthen a short columella in cleft lip and palate cases, adapting these techniques for aesthetic surgery presents challenges. This report outlines the design and surgical considerations for this issue. Ten patients with a short columella at risk of skin resistance or retraction were evaluated. The V-Y flap technique was employed, featuring a V-shaped design starting at the midpoint between the columellar footplate and the lowest point of the nostril sill. Standard techniques included a columellar graft to prevent narrowing. The rhomboid flap was trimmed and sutured in place. Results showed that the V-Y flap provided adequate tip projection, reduced columellar flaring, and improved nostril shape. Scarring was comparable to an inverted-V incision, with improvements in the columellar base and philtrum and high patient satisfaction. The technique effectively addressed tip projection challenges in patients with short columella.

The Efficacy of Naso-Alveolar Molding on Premaxilla Pushback and Dentoalveolar Changes in Patients With Bilateral Cleft Lip and Palate.

To evaluate the extent of naso-alveolar molding (NAM) in pushing the premaxilla posteriorly in patients with bilateral cleft lip and palate (BCLP). Naso-alveolar molding application in cleft lip and palate cases bridges the cleft gap and increases nasal tip projection. In BCLP, NAM potentially mobilizes the premaxilla posteriorly to allow tension-free primary lip closure. However, some patients with BCLP with NAM history still necessitate osteotomy during labioplasty, questioning the efficacy of NAM for BCLP management. This single-center retrospective study was conducted using medical records of nonsyndromic patients with BCLP. Twenty-six patients with BCLP were enrolled over a 5-year period with a history of NAM application before primary labioplasty. The changes in premaxilla width (P), anterior arch width (A), posterior arch width (R), and anteroposterior projection of the premaxilla (P'-A') were statistically analyzed at 2 time points: (1) at the start of NAM application (T1) and (2) after completion of NAM before surgery (T2). The average age at NAM initiation was 46.2 ± 40.4 days, and the average duration of NAM usage was 125.14 ± 62.94 days. A and P-A showed significant differences between T1 and T2 (P < 0.0001), whereas the rest did not show significant differences in value following NAM application (P > 0.05). Naso-alveolar molding successfully pushed back the premaxilla portion about 4.68 ± 2.83mm on average. Naso-alveolar molding can push back the premaxillary protrusion up to 5mm, which can serve as a cutoff point for the consideration of combined modalities. Prenatal diagnosis, counseling, and cleft education should be the benchmark in cleft centers to improve overall patient outcomes.

A Cleft Lip and Palate Case with Oligodontia

A Cleft Lip and Palate Case with Oligodontia

Cleft Palate Induced by Augmented Fibroblast Growth Factor-9 Signaling in Cranial Neural Crest Cells in Mice.

Although enhanced fibroblast growth factor (FGF) signaling has been demonstrated to be crucial in many cases of syndromic cleft palate caused by tongue malposition in humans, animal models that recapitulate this phenotype are limited, and the precise mechanisms remain elusive. Mutations in FGF9 with the effect of either loss- or gain-of-function effects have been identified to be associated with cleft palate in humans. Here, we generated a mouse model with a transgenic Fgf9 allele specifically activated in cranial neural crest cells, aiming to elucidate the gain-of-function effects of Fgf9 in palatogenesis. We observed cleft palate with 100% penetrance in mutant mice. Further analysis demonstrated that no inherent defects in the morphogenic competence of palatal shelves could be found, but a passively lifted tongue prevented the elevation of palatal shelves, leading to the cleft palate. This tongue malposition was induced by posterior spatial confinement that was exerted by temporomandibular joint (TMJ) dysplasia characterized by a reduction in Sox9+ progenitors within the condyle and a structural decrease in the posterior dimension of the lower jaw. Our findings highlight the critical role of excessive FGF signaling in disrupting spatial coordination during palate development and suggest a potential association between palatal shelf elevation and early TMJ development.

High incidence and geographic distribution of cleft palate cases in Finland are associated with a regulatory variant in IRF6.

In Finland the frequency of isolated cleft palate (CP) is higher than that of isolated cleft lip with or without cleft palate (CL/P). This trend contrasts to that in other European countries but its genetic underpinnings are unknown. We performed a genome-wide association study for orofacial clefts, which include CL/P and CP, in the Finnish population. We identified rs570516915, a single nucleotide polymorphism that is highly enriched in Finns and Estonians, as being strongly associated with CP ( P = 5.25 × 10 -34 , OR = 8.65, 95% CI 6.11-12.25), but not with CL/P ( P = 7.2 × 10 -5 ), with genome-wide significance. The risk allele frequency of rs570516915 parallels the regional variation of CP prevalence in Finland, and the association was replicated in independent cohorts of CP cases from Finland ( P = 8.82 × 10 -28 ) and Estonia ( P = 1.25 × 10 -5 ). The risk allele of rs570516915 disrupts a conserved binding site for the transcription factor IRF6 within a previously characterized enhancer upstream of the IRF6 gene. Through reporter assay experiments we found that the risk allele of rs570516915 diminishes the enhancer activity. Oral epithelial cells derived from CRISPR-Cas9 edited induced pluripotent stem cells demonstrate that the CP-associated allele of rs570516915 concomitantly decreases the binding of IRF6 and the expression level of IRF6 , suggesting impaired IRF6 autoregulation as a molecular mechanism underlying the risk for CP.

Effect of Slow Maxillary Expansion and Alternative Rapid Maxillary Expansion Protocols on Airway Volume in Cleft Palate Cases: A Cone Beam Computed Tomography Based Study.

A total of 22 patients with cleft palate aged 8 to 12 years were selected and categorized into two groups: the first group was treated with alternate rapid maxillary expansion and constriction (Alt-RAMEC) using an expander with differential opening (EDO) and facemask, while the second group was treated using slow maxillary expansion (SME) using an EDO. Finally, the pharyngeal airway volume in the two groups was compared using cone beam computed tomography (CBCT). CBCT scans were performed before expansion and six months following the expansion. Alveolar crest level, maxillary breadth, nasal cavity width, arch width, inclination of the molar teeth, buccal and palatal alveolar bone thickness, and maxillary alveolar width were all assessed. Paired t-tests (p=0.05) were applied to compare interphase data. The two groups showed a non-significant difference in terms of nasopharyngeal volume (cm3), oropharyngeal volume (cm3), and overall pre- and post-treatment results (p>0.005). Results of comparison of pre- and post-treatment periods in the Alt-RAMEC group revealed a significantly higher cleft volume (cm3) (p=0.001). Results of comparison of pre- and post-treatment periods in the SME group revealed a substantial rise in cleft volume (cm3) (p=0.003).Results from a comparison of the cleft volume (cm3) between the two study groups pre- and post-intervention revealed a non-significant difference (p=0.200 and 0.054, respectively).

Missing Puzzle Pieces: Cleft Lip and Palate

Facial differences can arise while a baby is still growing inside the mother. Two common examples include cleft lip and cleft palate. Most of the body’s cells contain DNA, which serves as the instructions for creating all the features of the body, such as the parts of the face. Cells use DNA’s instructions to form the face from five big “puzzle pieces” called prominences. Sometimes the DNA instructions get changed or steps are skipped, which can change how the puzzle pieces, or prominences, connect. This results in facial differences like cleft lip, in which there is a gap in the lip and cleft palate, in which there is a gap in the roof of the mouth. Most cases of cleft lip and cleft palate can be fixed with surgery, and children go on to live long, healthy lives.

Prevalence of Dental Anomalies in Patients with Non-syndromic Cleft Lip with or without Cleft Palate

This study aimed to assess the prevalence and distribution pattern of dental anomalies in the permanent teeth of patients with non-syndromic cleft lip with or without cleft palate. Additionally, it aimed to compare differences in dental anomalies between cleft and non-cleft areas, considering gender and cleft phenotype. Panoramic radiographs of 164 patients diagnosed with non-syndromic orofacial clefts were retrospectively analyzed by a single examiner to confirm dental anomalies. The dental anomalies investigated included tooth agenesis, supernumerary teeth, microdontia, rotation, ectopic eruption, and enamel hypoplasia. Cleft phenotypes were categorized into 7 types based on medical and dental records. A significantly higher prevalence of supernumerary teeth was observed in males than females within non-cleft areas (&lt;i&gt;p&lt;/i&gt; = 0.017), with no significant differences in other dental anomalies. In non-cleft area, patients with cleft palate exhibited a high prevalence of tooth agenesis (&lt;i&gt;p&lt;/i&gt; &lt; 0.0001) and microdontia (&lt;i&gt;p&lt;/i&gt; = 0.012) compared to other cleft phenotypes. Maxillary incisor rotation was closely associated with adjacent tooth agenesis in unilateral cleft lip and palate cases (&lt;i&gt;p&lt;/i&gt; = 0.034). This study suggests that the additional subphenotype based on dental anomalies in patients with orofacial cleft may serve as applicable clinical markers.

A retro-prospective study\' of cleft palatal fistulas: An analy\'sis of prevalence, cause and location in C) perated cleft lip and palate cases

One of the expected outcomes of palate repair is to achieve complete partition between nasal and oral cavity in addition to good speech. Any failure of achieving complete structural integrity of palate is labelled as an oronasal (palatal) fistula with persistent passage between oral and nasal cavity, it can occur at the anterior, posterior or mid palatal region The aim of the study is to assess prevalence of palatal fistula, cause of palatal fistula, location of palatal fistula and to derive a more relevant surgical technique. A retro-prospective study was conducted in operated cleft patients who showed presence of palatal fistula between the age group of 9 months to 7 years. The data collected included age, sex and type of cleft defecttype, width of cleft palatetype of surgery performed, size of fistula, location of fistula, duration of fistula formationpostoperatively 8 palatal fistula were included. The fistula was located mostly at the anterior palatal region (50%) and secondly at the mid palatal region (38%). The occurrence of fistula in operated cleft lip and palate cases was noted mostly after V-Y pushback palatoplasty followed by Von Langenbeck Among the surgical techniques used for palatoplasty, the Von Langenbeck is proven to be superior than V-Y pushback palatoplasty in accordance with the occurrence of palatal fistula. The anterior palate fistulas were the most common type in the study.

Orofacial clefts patients epidemiology in Hermina Hospital during 2008-2017

Background: Malformation of lip and palate closure that occurs during embryology time in the mother's womb will affect the shape of mouth and face. This congenital malformation is often referred to orofacial clefts including cleft lip, cleft palate, cleft lip and palate. Orofacial clefts cases are still commonly found in Indonesia. This study aims to present orofacial clefts patients epidemiology in Hermina Hospital during 2008-2017. Methods: Retrospective studies were conducted on 230 orofacial clefts patients at Hermina Podomoro and Hermina Kemayoran Hospital from 2008 until 2017. The variables include the distribution of age, gender, residency area, diagnosis, and type of operations. Results: From 230 patients, there were 169 patients (73.5%) in age group of 0-4 years with an average 2.1 years old. 125 patients were male (54.34%). 103 patients from Jakarta (44.8%) and 127 patients from outside Jakarta (55.2%). There were 116 cases of cleft lip (50.5%), 99 cases of cleft palate (43%), and 15 cases of cleft lip and palate (6.5%). There were 137 labiaplasty operations (59.57%) and 93 palatoplasty operations (40.43%). Palatoplasty including primary and secondary palatoplasty. Conclusion: Orofacials cleft patients from Hermina Kemayoran and Hermina Podomoro Hospital from 2008-2017 average age 2.1 years old. Most of the patients are male and came from outside Jakarta. The most common diagnosis is cleft lip with labiaplasty operation handling.

Epidemiological Profile of Cleft Lip and Palate Cases in A Libyan Neonatal Unit at Al Wahda Teaching Hospital, Derna: A Comprehensive Analysis

Aim. This study aims to assess the prevalence and associated risk factors of Cleft lip and palate (CLP) among neonates in Derna, Libya, over a six-year period from 2016 to 2021. Methods. This retrospective observational study analysed data from the neonatal unit registry at Al Wahda teaching hospital in Derna, Libya. The study population comprised neonates admitted to the hospital from 2016 to 2021. Inclusion criteria specified Libyan neonates diagnosed with CLP, while exclusion criteria excluded stillbirths and non-Libyan neonates. Data analysis involved calculating incidence rates, descriptive statistics, and subgroup analyses to identify demographic characteristics and associated risk factors. Results. Out of 2,887 neonatal records reviewed, 10 cases of cleft lip ± palate (CL±P) were identified, yielding an overall incidence rate of 0.6 cases per 1000 live births. The majority of cases (50%) presented with both cleft lip and palate, followed by cleft palate only (40%) and cleft lip only (10%). Demographic analysis revealed a higher prevalence among females (60%), full-term neonates (80%), neonates from larger families of more than 6 children (50%), and those with birth weights between 2.5 and 4 kg (70%). Left-sided clefts were more common (90%) than right-sided clefts (10%). Potential risk factors included maternal history of abortion (20%), irregular pregnancy follow-up (90%), and gestational diabetes (10%). Conclusion. This study provides insights into the prevalence and associated risk factors of cleft lip ± palate (CL±P) among neonates in Derna, Libya. The findings underscore the importance of comprehensive prenatal care and public health interventions to address modifiable risk factors and reduce the incidence of cleft lip ± palate in affected populations. Further research is needed to explore additional factors contributing to cleft anomaly occurrence and outcomes.

Bias analyses to investigate the impact of differential participation: Application to a birth defects case-control study.

Certain associations observed in the National Birth Defects Prevention Study (NBDPS) contrasted with other research or were from areas with mixed findings, including no decrease in odds of spina bifida with periconceptional folic acid supplementation, moderately increased cleft palate odds with ondansetron use and reduced hypospadias odds with maternal smoking. To investigate the plausibility and extent of differential participation to produce effect estimates observed in NBDPS. We searched the literature for factors related to these exposures and participation and conducted deterministic quantitative bias analyses. We estimated case-control participation and expected exposure prevalence based on internal and external reports, respectively. For the folic acid-spina bifida and ondansetron-cleft palate analyses, we hypothesized the true odds ratio (OR) based on prior studies and quantified the degree of exposure over- (or under-) representation to produce the crude OR (cOR) in NBDPS. For the smoking-hypospadias analysis, we estimated the extent of selection bias needed to nullify the association as well as the maximum potential harmful OR. Under our assumptions (participation, exposure prevalence, true OR), there was overrepresentation of folic acid use and underrepresentation of ondansetron use and smoking among participants. Folic acid-exposed spina bifida cases would need to have been ≥1.2× more likely to participate than exposed controls to yield the observed null cOR. Ondansetron-exposed cleft palate cases would need to have been 1.6× more likely to participate than exposed controls if the true OR is null. Smoking-exposed hypospadias cases would need to have been ≥1.2 times less likely to participate than exposed controls for the association to falsely appear protective (upper bound of selection bias adjusted smoking-hypospadias OR = 2.02). Differential participation could partly explain certain associations observed in NBDPS, but questions remain about why. Potential impacts of other systematic errors (e.g. exposure misclassification) could be informed by additional research.

Analysis of risk factors affecting poor wound healing after primary cleft palate surgery.

To study the risk factors of poor wound healing after primary cleft palate surgery. In this study, 980 cases of congenital cleft palate treated by Sommerlad-Furlow in the Department of Cleft Lip and Palate Surgery of Sichuan University from 2017 to 2021 were continuously analyzed. Indicators included patient's age, gender, body weight, cleft palate type, width of the widest fistula, cleft palate index (width of the widest fistula/width at the posterior edge of the maxillary tubercle plane), preoperative white blood cell count, preoperative hemoglobin level, preoperative antibiotic use, doctor's seniority, use of relaxation incision, operation time, postoperative upper respiratory tract infection, and postoperative wound healing. The postoperative wound healing was divided into normal healing, delayed healing, and palatal fistula. Both delayed healing and palatal fistula were classified as poor healing. The factors that may affect the healing outcome of the palatal wound after primary cleft palate repair were analyzed using SPSS 26.0 software. A total of 825 patients (84.2%) had normal healing, 112 patients (11.4%) had delayed hea-ling, and 43 patients (4.4%) had palatal fistula. Doctor's seniority, width of the widest fissure, cleft palate index, and operation time influenced the wound healing effect after cleft palate surgery (P<0.05). Doctors with low seniority, wide width of the widest fistula, large cleft palate index, and long operation time were the risk factors of poor wound healing. Doctor's seniority, width of the widest fissure, cleft palate index, and operation time are related to the effect of healing effect after cleft palate surgery.

Interim use of Hyrax Screw Assembly for Single-Step Closure of Small Alveolar Cleft before Anterior Maxillary Distraction Osteogenesis

Anterior maxillary distraction osteogenesis (AMDO) is often used for the correction of maxillary retrognathia in select cleft lip and palate cases. The restoration of alveolar arch continuity is desirable before the initiation of AMDO in these cleft maxillary deformities; however, AMDO is technically difficult in a patient with coexisting alveolar cleft where there is a discontinuity of the defect that presents a challenge in terms of adequate vector control of the movement of the anterior segment and the potential risk of tipping of teeth, which already have compromised anchorage/bone support on the cleft side. The treatment becomes more challenging when ongoing management is compounded by failed previous alveolar cleft grafting procedures, along with the patient’s reluctance to undergo further grafting of alveolar clefts. This technical note demonstrates a novel application of the modification of the Hyrax screw where an initially fully opened Hyrax screw was utilised as an interim assembly for accomplishing the single-step closure of a small alveolar cleft before the commencement of anterior maxillary distraction osteogenesis. This technique may prove to be feasible for patients presenting with alveolar cleft defects of smaller widths of up to 5 mm and relatively well-aligned upper arches. Keywords: Distraction Osteogenesis; Cleft Palate; Cleft Alveolar; Maxillary Osteotomy; India.

Evaluation of the Change in Halitosis with the Improvement in Oral Health in Cleft Lip and Palate Patients.

This study aimed to assess the effects of hygiene education on periodontal health and mouth/nasal halitosis in patients with cleft. 39 patients with cleft who were accepted for orthodontic treatment divided into two groups as with (Group1; n = 24) and without braces (Group2; n = 15). Plaque Index (PI), Gingival Index (GI), and Tongue coating Index (TCI) values were recorded. The BANA test microbiological kit, was used to determine the amount of anaerobic bacteria. Values of volatile sulfur components (VSC) for the measurement of oral and nasal halitosis were measured with a Halimeter device. After the initial measurements, oral hygiene instructions were given to eliminate the plaque production on teeth, periodontal structure, tongue and palate. All measurements were repeated 4 weeks after the hygiene instructions. Wilcoxon and Mann-Whitney U test were used for statistical analysis. In both groups, the PI, GI, values were significantly decreased (P < .05). Tongue coating area, thickness and TCI were significantly reduced (P < .05). Oral halitosis values decreased significantly (P < .05). The PI values decreased significantly more in the Group 1 (P < .05). Non significant difference was detected in nasal halitosis in both groups. In unilateral cleft lip and palate cases cases (n = 23), no significant difference was found in nasal halitosis values between the cleft and the healthy sides (P > 0.05). In patients with clet cases, periodontal health was improved and oral halitosis was reduced by the given hygiene education; brushing the teeth, especially the tongue and palate. However, hygiene education did not have a significant effect on nasal halitosis. Key Words: Cleft lip and palate, Halitosis, BANA test, Periodontal index.

Management of impinging “Nickel titanium palatal expander” in cleft palate cases by “Soft flow” (temporary mucosal protector)

The temperature-activated Arndt nickel titanium palatal expander has been a good choice for cleft palate applications because it creates transverse maxillary expansion, uprights and rotates the maxillary molars, and allows a smooth transition to fixed retention with no requirement for patient compliance and little manipulation by the clinician. But the clinical problem sometimes encountered is the impinging of “Nickel-Titanium” metal component of the Nickel titanium palatal expander on the soft palate. “Soft Flow” is a Temporary Mucosal Protector introduced recently in the orthodontic market which prevents the impinging of micro- implants or hooks of the molar buccal tubes. The following article highlights the clinical problem encountered after placement of Nickel Titanium Palatal Expander and how “Soft Flow” helps to overcome it.

Cleft palate in Pierre Robin syndrome: A Review of 7 cases

IntroductionPierre Robin syndrome is a malformative sequence associating retrognathism, glossoptosis and a median cleft palate which is usually large. This poses the problem of its therapeutic management. PurposeTo show the approach of the Stomatology and Maxillofacial Surgery Department of the Mohammed VI University Hospital in the management of cleft palate in Pierre Robin syndrome.This was a retrospective study, covering 5 years, which allowed us to include 7 cases of cleft palate in Pierre Robin syndrome. Our study parameters were epidemiological, clinical, therapeutic and evolutionary. ResultsThe average age of our patients, at the time of the 1st consultation, was 4 months. There was a slight male predominance with a sex ratio = 1.3. The patients presented a U-shaped cleft in 57.1% of cases, and a V-shaped cleft in 42.9% of cases. Three patients underwent a one-stage closure by velopalatoplasty using the Von Langenbeck technique. Four patients underwent a 2-stage closure, i.e., intravascular veloplasty in the first stage, followed by closure of the residual cleft palate in the second stage. The results were satisfactory. A palatal fistula was noted in 42.8% of cases, which was managed secondarily. ConclusionThe management of cleft palate in Pierre Robin syndrome is a real challenge for the maxillofacial surgeon.

Ultrasound Detection of Fetal Palate Development in the Early Stages of the Second Trimester and Its Clinical Application.

To establish normal values of palatal bone growth in fetuses at different gestational weeks in the early stages of the second trimester and to explore the clinical application value of the four-step ultrasound screening method for fetal cleft lip and palate. A prospective study of prenatal ultrasound screening. Secondary maternal and child health institutions. 300 fetuses of 12 to 20 +6 weeks gestation without cleft lip and/or palate; 8538 fetuses at high risk of cleft lip and palate with malformations or karyotypic abnormalities. None. palatomandibular diameter (PMD) and transverse palatal diameter was measured and establish their typical values. (1) There is a typical "superimposed line" sign in the median sagittal section of the typically developing fetal face from 12 to 20+6 weeks of gestation. (2) The PMD and hard palate transverse diameter of fetuses from 12 to 20+6 weeks of gestation increased linearly with time. (3) Among 8538 high-risk fetuses, 21 cases of cleft lip and palate were diagnosed by the four-step ultrasound screening method in the early stages of the second trimester. The median sagittal section of the typically developing fetal face in the early stages of the second trimester presents a typical "superimposed line" sign, and the PMD and transverse palatal diameter increase with time. The four-step ultrasound screening method for fetal cleft lip and palate in the early stages of the second trimester has high clinical application value.

Applications of Artificial Intelligence in the field of therapies focused on orofacial cleft repair and rehabilitation

&lt;p&gt;Orofacial clefts are common congenital malformations with genetic and environmental risk factors. The management of cleft lip and palate spreads over the course of the child’s development into adulthood. Currently Artificial Intelligence (AI) has gained much popularity in the dental field. AI is of much help in the multidisciplinary management of cleft lip and cleft palate repair starting right from the prenatal period itself. This review focuses on the available documentation in the literature that has thrown light on the recent applications of AI in cleft lip and palate cases.&lt;/p&gt;

Rare variants found in clinical gene panels illuminate the genetic and allelic architecture of orofacial clefting

PurposeOrofacial clefts (OFCs) are common birth defects including cleft lip, cleft lip and palate, and cleft palate. OFCs have heterogeneous etiologies, complicating clinical diagnostics because it is not always apparent if the cause is Mendelian, environmental, or multifactorial. Sequencing is not currently performed for isolated or sporadic OFCs; therefore, we estimated the diagnostic yield for 418 genes in 841 cases and 294 controls. MethodsWe evaluated 418 genes using genome sequencing and curated variants to assess their pathogenicity using American College of Medical Genetics criteria. Results9.04% of cases and 1.02% of controls had “likely pathogenic” variants (P < .0001), which was almost exclusively driven by heterozygous variants in autosomal genes. Cleft palate (17.6%) and cleft lip and palate (9.09%) cases had the highest yield, whereas cleft lip cases had a 2.80% yield. Out of 39 genes with likely pathogenic variants, 9 genes, including CTNND1 and IRF6, accounted for more than half of the yield (4.64% of cases). Most variants (61.8%) were “variants of uncertain significance”, occurring more frequently in cases (P = .004), but no individual gene showed a significant excess of variants of uncertain significance. ConclusionThese results underscore the etiological heterogeneity of OFCs and suggest sequencing could reduce the diagnostic gap in OFCs.