Palate Cases Research Articles

The use of direct metal laser sintering technology in the management of acquired maxillofacial defects due to malignant neoplasm

Rehabilitation of maxillary defects presents a significant challenge in terms of restoration of near normal functions following the healing of large surgical wound. The obturator prostheses as a part of prosthetic management are used for the separation of oral and nasal cavities to allow adequate deglutition and articulation and support for the soft tissue to restore the midfacial contour in palatal defect cases. This clinical report describes a prosthetic approach to the rehabilitation of an acquired palatomaxillary defect with definitive obturator prosthesis as well as guide flange prosthesis for the management of mandibular deviation.

Orthodontists and Orthodontic Residents’ Education: Effect on Professional Attitudes and Behavior

IntroductionDental education aims at shaping the future professional behavior of their students, thus contributing to reduce oral health disparities and increasing care for the society.ObjectiveThe objective of this study was to access the perception of the quality classroom-, clinic-, and community-based orthodontic postgraduate education devoted to the management of cleft lip palate cases, surgical orthodontic cases, and growth modification casesNull HypothesisNo relationship exists between the quality of postgraduate dental education and professional attitude and behavior in providing care to cleft lip palate cases, surgical orthodontic cases, and growth modification cases.Materials and Methods:A total of 200 active members were involved. The first group included approximately 100 residents of Central India and the second group consisted of approximately 100 active orthodontists of Central India. The questionnaire was given to each group about the different clinical condition. Answers were given on 5-point scale to access the professional attitude and behavior.ConclusionsThe finding of this study challenges administrators about the postgraduate dental program in the specialty of orthodontics and reflects the degree to which this education contributes to the orthodontic health of the society.

Surgery for advanced oropharyngeal cancer

The study objectiveis to assess the results of this approach and identifications of factors that may influence the effectiveness of such an approach.Materials and methods. Since 2009 through 2016 72 patients with stage III and IV aged between 42 and 77 years underwent upfront surgery.Anatomical sites included 34 (46 %) tonsil, 24 (33 %) base of tongue and 14 (21 %) soft palate cases. Transcervical sparing the mandible,mandibulectomy and transoral approaches were used in 42 (58 %), 11 (15 %) and 7 (10 %) patient, respectively. Total glossectomy was performed in 4 (5.5 %) cases. Tumor extension necessitated extended laryngectomy in 8 patients (11.5 %). Primary closure of the pharyngeal wound was possible in 30 patients (42 %). Reconstruction with distant flaps was performed in the remaining 42 patients. Both free (anterolateral thigh – 19, radial forearm flap – 10) and flaps with axial blood supply (pectoralis major – 9, supraclavicular flap – 4) were used. There were 6 T1, 12 T2, 28 T3 and 20 T4 tumors; 62 patients were N-positive: N1 – 10 cases, N2 – 51, N3 – 1. Positive surgical margins were diagnosed in 13 cases (18 %) including 3 cases of R2 resection. Adjuvant radiation therapy with or without chemotherapy was completed in 45 patients (63.4 %). Survival was calculated according to Kaplan–Mayer method.Results.There was 1 death in early postoperative period. Mean follow-up for the remaining patients (n = 71) was 27 months (1–94). Median survival was 27 months (95 % CI 11.5–42.5); 3-year overall survival was 44 %; 33 out of 34 still alive patients are capable to take food orally. Only 1 (2.9 %) patient is gastrostomy tube dependent. Univariate analysis revealed that positive margins (p <0.0001) and completeness of combined treatment (p <0.01) are the main factors that have statistically significan impact on prognosis.Conclusion.Combined approach with upfront surgery is one of the main treatment modalities for advanced oropharyngeal cancer. Modern reconstructive options and strict adherence to a proper surgical technique give a high chance for a valuable rehabilitation for the vast majority of patients. Scrupulous planning of the resection of the primary tumor based on modern imaging techniques and encouraging patients to complete all prescribed treatments are the main physician-related factors that influence survival outcome.

The Clinical Application of Recombinant Human Bone Morphogenetic Protein 7 for Reconstruction of Alveolar Cleft: 10 Years' Follow-Up

The purpose of this study was to report on a 10-year assessment after the application of recombinant human bone morphogenetic protein 7 (rhBMP-7) for the reconstruction of alveolar clefts. This study was conducted as a prospective phase II clinical trial on 9 unilateral and 2 bilateral alveolar clefts that received rhBMP-7 (Osigraft; Stryker Biotech, UK). The mean age of thepatients at surgery was 10.4years. At 6months postoperatively, occlusal radiographs were taken to evaluate bone formation at the cleft site. Patients were followed within the routine cleft care pathway for 10years to monitor the impact of bone morphogenetic protein 7 on orthodontic treatments and maxillary growth. Radiographs were taken according to the standard cleft care protocol. The radiographic assessment of the unilateral cleft lip and palate cases suggested good bone formation with a Kindelan score of grade 1 or 2. The bilateral alveolar cleft cases had a score of grade 3 or 4, indicating failure or partial failure. The children with successful grafts underwent a routine orthodontic follow-up without incident. The maxillary growth appeared to be similar to that in cases grafted with autogenous bone. No long-term complications and no abnormal pattern of bone formation were detected. The study provides unique evidence on the long-term safety of rhBMP-7 when applied at the area of skeletal immaturity for the reconstruction of alveolar clefts in children.

A retrospective analysis of incidence and management of palatal fistula.

Background:Cleft palate repair may be compromised by a number of complications, most commonly the development of a fistula. Fistulas may cause hypernasal speech, articulation problems and food or liquid regurgitation from the nose.Objective:The study determines the incidence and management of cleft palatal fistulas in a series of primary cleft palate repair surgeries. It is a retrospective analysis of total 185 palatal fistula cases operated at our hospital from the year 2004 to 2016.Subjects and Methods:Of 185 palatal fistulas, 132 cases had been operated at our institute for primary palatoplasty, and the rest 53 were the outside-operated cases. The patients with bilateral as well as unilateral cleft lip and palate were included. Isolated cleft palate patients were also included in the study. Palatal fistulas were subdivided into three types depending on their size. Anterior palatal fistulas were mostly treated by using tongue flap (65.57%), followed by local flaps (34.43%). Middle and posterior palatal fistulas were mostly treated by von Langenbeck Palatoplasty. One patient (>5 mm fistula) was treated using free radial forearm flap.Results:Anterior palatal fistulas (65.57%) were most commonly reported, followed by middle (24.86%) and posterior (9.18%). Most commonly, the size of the fistulas ranged from 2 mm to 5 mm. The complication rate was reported to be 3.75% in case of tongue flap and 11.9% complications were reported in case of local flaps.Conclusion:Tongue flap remains the flap of choice for managing very difficult and challenging anterior palatal fistulas compared to local flaps.

TGFα/HinfI Polymorphisms Contribute to Nonsyndromic Cleft Lip and Palate in Turkish Patients.

Nonsyndromic cleft lip with/without cleft palate (nsCL ± P) is one of the most common birth defects of complex etiology, occurring in ∼1/700 live births worldwide. A series of epidemiological studies were conducted to investigate the association between a transforming growth factor alpha (TGFα) polymorphism and nsCL ± P risk. The aim of this study was to investigate the association between the TGFα/HinfI polymorphisms and nsCL ± P in Turkish patients. One hundred fifty-five Turkish subjects were enrolled: 70 nsCL ± P patients and 85 unrelated control individuals. Genomic DNA was isolated from peripheral blood leukocytes, and molecular analysis of gene polymorphisms was carried out using polymerase chain reaction and restriction enzyme digestions. We found significant difference between the TGFα gene HinfI allele frequencies of the controls and: 1) the occurrence of nonsyndromic cleft lip (p = 0.029,); 2) the occurrence of nonsyndromic cleft lip and palate (nsCL + P) cases (p = 0.024; and 3) the occurrence of both nsCL ± nsCLP cases (p = 0.0365). The association between age of parents, gender, maternal exposures, socioeconomic status and clefts was assessed in each group separately. Our study indicates that the TGFα HinfI gene polymorphism might be associated with nsCL ± P susceptibility, thus contributing to the occurrence of nsCL ± P in Turkish patients. The relatively small sample size of our study is one limitation of our study, and future research with larger specimen sets from different ethnicities will be required to validate our findings.

Whistle deformity evaluation after Cronin labioplasty in unilateral cleft lip and palate cases from an anthropometry aspect

Whistle deformity of the lip usually occurs after labioplasty. We compared the height of Cupid’s bow on the normal side, midline, and cleft side after Cronin labioplasty in patients with unilateral cleft lip and palate (UCLP) in lip function and resting positions to determine the presence of whistle deformity. We evaluated whistle deformity according to an anthropometry scale from a profile photograph, including the height of Cupid’s bow on the normal side, midline, and cleft side in 24 patients with UCLP after Cronin labioplasty, while the lips in function and resting positions. Based on statistics, the results showed significant differences (P < 0.05) in the height of Cupid’s bow at midline in normal children and those with whistle deformity while the lips were at rest. On the other hand, significant differences also were found in the height of Cupid’s bow on the normal and cleft sides; on the normal side, cleft side, and midline in patients with whistle deformity in lip function and resting positions; on the right and left sides in normal children in lip function and resting positions; and in normal children and those with whistle deformity in the lip function position (P > 0.05). There was no significant difference between the height of Cupid’s bow on the normal and cleft sides; on the normal side, cleft side, and midline in patients with whistle deformity in lip function and resting positions; on the right and left sides in normal children in lip function and resting positions; and in normal children and those with whistle deformity in the lip function position. On the other hand, there was a significant difference between the height at midline in normal children and between normal children and those with whistle deformity while the lips were at rest.

Evaluation of the fetal palate at 11 to 13 (+6) weeks of gestation based on an analysis of static ultrasound images using modern IT techniques.

To describe a new computer-based technique to isolate the shape of the fetal palate visible in the midsagittal plane from static ultrasound images routinely used to measure nuchal translucency. This is a retrospective interpretation of images of the midsagittal view of the fetal face at 11 to 13 (+6)weeks of gestation in 7 cases of cleft lip and palate (CLP) and 7 normal controls. The images were subjected to pattern analysis. Proprietary software was applied and for each CLP case, and palatine bones with different forms from those of fetuses in the control group were recorded. In 4 cases, an image of a continuous palatine bone was observed at a threshold of 180, whereas the remaining 3 images were obtained at 128. A continuous palatine bone structure was not observed in any fetus from the CLP group, even at a level of 128, when the surrounding structures were visible. The application of pattern analysis to a 2D frozen image is a new approach for prenatal diagnostics. This technique may be a helpful tool for physicians and could assist in the diagnosis of cleft palate.

Assessment of regional asymmetry of the face before and after surgical correction of unilateral cleft lip

This study was carried out on 26 unilateral cleft lip and palate (UCLP) cases with mean age 3.6 ± 0.7 months.3D facial images were captured for each infant 2–3 days before the repair of cleft lip and at 4 months following surgery at a mean age of 8.2 ± 1.8 months, using a stereophotogrammetry imaging system. An iterative closest point (ICP) algorithm was used to superimpose the 3D facial model to its mirror image using VRMesh software. After the superimposition, the face model was divided into seven anatomical regions. Asymmetry of the entire face and of the anatomical regions was calculated by measuring the absolute distances between the 3D facial surface model and its mirror image. Colour maps were used to illustrate the patterns and magnitude of the facial asymmetry before and after surgery. There were significant decreases in the asymmetry scores for the nose, upper lip and the cheeks as a result of the surgical repair of cleft lips. Surgery did not change the magnitude of the asymmetry scores for the lower lip and chin. Residual nasolabial asymmetries were detected.The main outcome of the findings of this innovative study is to inform the required surgical refinement of primary repair of cleft lip in order to minimise facial asymmetry. We have presented a sensitive tool that could be used for comparative analysis of lip repair at various cleft centres and to guide secondary corrective surgery when required.

Incidence of Cleft Lip and Palate in Erbil City

Aims: This study was conducted to assess the epidemiology and some of the possiblerisk factors causing cleft lip and palate in Erbil city.Materials and Methods: the data were obtained from the records of Raparinpaediatric and maternity hospital in the center of Erbil city. The file records oflive births during a period from January 2000 to January 2008 were reviewed forthe occurrence of cleft lip and palate. The cleft cases were evaluated for site andtype of cleft and sex of the infant. and some risk factors.Results: 121 cleft lip and/or palate cases out of 60418 live births were registered. Theoverall incidence was 2:1000 live births. The percentage of cleft lip and palate,cleft palate only, cleft lip only was 55%, 30%, and 15% respectively. The ratioswith respect of left or right or bilateral cleft was approximately 4.5:2:1.The infantsex and site of family residence showed no significant influence on the incidenceof clefting. Maternal age of more than 30 years, maternal smoking, and positivefamily history of clefts, consanguineous marriage and low infant birth weightsignificantly increased the incidence of cleft lip and palate. About 7.4% of cleftcases were associated with other congenital anomalies, most frequentlycongenital heart disease.Conclusion: The incidence of cleft lip and/or cleft palate is 2:1000 births. Theincidence of cleft lip and palate is two times greater than cleft palate alone, andthree times than cleft lip alone. Cleft lip was two times greater on the left sidethan on the right side. The incidence of clefts was greater in males than females.

A novel non-coding RNA within an intron of CDH2 and association of its SNP with non-syndromic cleft lip and palate

BackgroundGenome-wide linkage analysis and whole genome sequencing in a Van der Woude syndrome (VWS) family revealed that the SNP, rs539075, within intron 2 of the cadherin 2 gene (CDH2) co-segregated with the disease phenotype. ResultsA study with nonsyndromic cleft lip with or without cleft palate (NSCL ± P) cases (N = 292) and controls (N = 287) established association of this SNP with NSCL ± P as a risk factor. RT-PCR based expression analysis of the SNP-harbouring region of intron 2 of CDH2 in the clefted lip and/or palate tissues of 16 patients revealed that the mutant allele expressed in all those individuals having it (hetero-/homozygous), whereas the wild type allele expressed in <50% of the samples in which it was present. The intronic transcript was also present in the prospective lip and palate region of 13.5 dpc mouse embryo, detected by RNA in situ hybridization and RT-PCR. ConclusionsThese results including the in silico, characterization of the ~200 nt-intronic transcript showed that conformationally it fits best with noncoding small RNA, possibly a precursor of miRNA. Its function in the orofacial organogenesis remains to be elucidated which will enable us to define the role of this mutant ncRNA in the clefting of lip and palate.

Prevalence of orofacial clefts and risks for nonsyndromic cleft lip with or without cleft palate in newborns at a university hospital from West Mexico.

We determined the overall prevalence of typical orofacial clefts and the potential risks for nonsyndromic cleft lip with or without cleft palate in a university hospital from West México. For the prevalence, 227 liveborn infants with typical orofacial clefts were included from a total of 81,193 births occurred during the period 2009-2016 at the "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara (Guadalajara, Jalisco, Mexico). To evaluate potential risks, a case-control study was conducted among 420 newborns, including only those 105 patients with nonsyndromic cleft lip with or without cleft palate (cases), and 315 infants without birth defects (controls). Data were analyzed using multivariable logistic regression analysis expressed as adjusted odds ratio with 95% confidence intervals . The overall prevalence for typical orofacial clefts was 28 per 10,000 (95% confidence interval: 24.3-31.6), or 1 per 358 live births. The mean values for the prepregnancy weight, antepartum weight, and pre-pregnancy body mass index were statistically higher among the mothers of cases. Infants with nonsyndromic cleft lip with or without cleft palate had a significantly higher risk for previous history of any type of congenital anomaly (adjusted odds ratio: 2.7; 95% confidence interval: 1.4-5.1), history of a relative with cleft lip with or without cleft palate (adjusted odds ratio: 19.6; 95% confidence interval: 8.2-47.1), and first-trimester exposures to progestogens (adjusted odds ratio: 6.8; 95% CI 1.8-25.3), hyperthermia (adjusted odds ratio: 3.4; 95% confidence interval: 1.1-10.6), and common cold (adjusted odds ratio: 3.6; 95% confidence interval: 1.1-11.9). These risks could have contributed to explain the high prevalence of orofacial clefts in our region of Mexico, emphasizing that except for history of relatives with cleft lip with or without cleft palate, most are susceptible of modification.

Alterations in DNA methyltransferases and methyl-CpG binding domain proteins during cleft palate formation as induced by 2,3,7,8-tetrachlorodibenzo-p-dioxin in mice

Maternal exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) induces cleft palate formation in mice. This TCDD treatment, which may be considered an environmental factor in cleft palate formation, is associated with alterations in DNA methylation. However, the underlying molecular mechanisms of DNA methylation produced by TCDD in mouse embryos are poorly understood. DNA methyltransferases (DNMTs) and methyl‑CpG binding domain proteins (MBDs) are thought to be closely associated with the actions of DNA methylation. Therefore, the present study tested the hypothesis that this cleft palate inducing effect of TCDD will alter the expression levels of DNMTs and various MBDs in palate tissue of fetal mice. Pregnant C57BL/6Jmice were treated with either TCDD (64µg/kg) or corn oil (control) at embryonic day10.5 (E10.5) and fetal palates were harvested for structural and molecular analyses at E13.5, E14.5, E15.5 and E17.5. Expression levels of DNMTs and MBDs were assayed using reverse transcription‑quantitative polymerase chain reaction and western blotting. The incidence of cleft palates in the TCDD group was 98.24%, whereas no cases of cleft palate were observed in the control group. Expression levels of DNMTs and MBDs were significantly increased in the TCDD group compared with the control. The results demonstrate clear alterations in DNMTs and MBDs, as induced by TCDD, and suggest that such alterations are important in cleft palate formation in fetal mice.

Identification of Isthmin 1 as a Novel Clefting and Craniofacial Patterning Gene in Humans.

Orofacial clefts are one of the most common birth defects, affecting 1-2 per 1000 births, and have a complex etiology. High-resolution array-based comparative genomic hybridization has increased the ability to detect copy number variants (CNVs) that can be causative for complex diseases such as cleft lip and/or palate. Utilizing this technique on 97 nonsyndromic cleft lip and palate cases and 43 cases with cleft palate only, we identified a heterozygous deletion of Isthmin 1 in one affected case, as well as a deletion in a second case that removes putative 3' regulatory information. Isthmin 1 is a strong candidate for clefting, as it is expressed in orofacial structures derived from the first branchial arch and is also in the same "synexpression group" as fibroblast growth factor 8 and sprouty RTK signaling antagonist 1a and 2, all of which have been associated with clefting. CNVs affecting Isthmin 1 are exceedingly rare in control populations, and Isthmin 1 scores as a likely haploinsufficiency locus. Confirming its role in craniofacial development, knockdown or clustered randomly interspaced short palindromic repeats/Cas9-generated mutation of isthmin 1 in Xenopus laevis resulted in mild to severe craniofacial dysmorphologies, with several individuals presenting with median clefts. Moreover, knockdown of isthmin 1 produced decreased expression of LIM homeobox 8, itself a gene associated with clefting, in regions of the face that pattern the maxilla. Our study demonstrates a successful pipeline from CNV identification of a candidate gene to functional validation in a vertebrate model system, and reveals Isthmin 1 as both a new human clefting locus as well as a key craniofacial patterning gene.

A novel method of obtaining impression from three-dimensionally printed skull and incorporating medical grade silicone elastomer in fabricating silicone palatal feeding obturators for cleft lip and palate cases

This report aims to depict a novel method in impression taking and feeding obturator fabrication for cleft lip and palate patients, utilizing three-dimensionally printed base of the skull from presurgical computerized tomography scan data. This technique uses soft and biocompatible medical grade room temperature vulcanizing silicone elastomer as the material of choice for fabrication procedure and reviews a representative patient case of a 10-month-old female child with bilateral cleft lip and palate deformity. Before final insertion, a strap was attached to the obturator as a safety precaution in case of accidental swallowing. The use of this unique technique satisfies all benefits of conventional feeding obturator with the added benefits of reducing most of its discomfort and difficulties of direct impression taking from the infant and fabricating process.

Demographic distribution and pattern of orofacial clefts in a Nigerian Urban Hospital

Introduction: Clefts lip and palate are the most common deformities in the head-and-neck region. They vary in the severity of presentation from small notches in the lip to clefts that extend through the alveolar ridge in the mouth and involve the floor of the nostrils/palate. They may either occur in isolation (asyndromic) or in association with other congenital anomalies as part of a syndrome as observed. Patients and Methods: This is a retrospective clinic-based study of records of patients seen with orofacial clefts from 2009 to 2014, at the Army Dental Clinic, Bonny Cantonment, Lagos, Nigeria. Results: A total of 43 cases of cleft lip and palate of varying degrees were seen over the study period. There were slightly more males (n = 23, 53.5%) than that of females (n = 20, 46.5%). The age at presentation ranged from 4 days old to 46 years and the median age was 3 years. In terms of age distribution, patients aged 3 years and below (n = 23; 53%) were the most predominant group. This was followed by the 4–7 years (n = 6; 13.9%) age bracket. Patients aged 8–11 years, 12–15 years, and 28–31 years were equally distributed with 3 (6.9%) each. Conclusion: A significant minority of orofacial clefts patients still present in adulthood possibly due to ignorance about treatment options and poverty to access surgical treatment.

Case report: optical biopsy in HPV6 lesion

The optical biopsy is a noninvasive diagnostic procedure that performs an analysis of the tissue with an optical system that allows reaching a result without extracting the sample (excisional biopsy) from the body tissue. Particularly, we are making spectrofluorometry (SFM) observations in loci lesions and healthy surrounding areas. The tissue is accessed through the body surface, including the analysis of the skin itself or mucosal surface, or by endoscope into any cavity. We have found spectral similarities in the detection of infectious diseases of their natural spectral fluorescence. Specifically, in the analyzed cases of DNA-HPV+ patients, we observed in all of their fluorescence spectra the same type of relevant peaks. So, we present here the SFM observation of HPV6 infected hard palate case. In addition, we show in this case the positive reaction images after the topication with 3-5% acetic acid as it occurs in the cervix uterine lesion.

Use of Bauru Yardstick in Patients With Complete Bilateral Cleft Lip and Palate at an Indian Center.

To evaluate dental arch relationship in treated bilateral cleft lip and palate (BCLP) cases at an Indian cleft center using the Bauru yardstick. Digital photographs of the dental cast of 50 consecutively treated patients (28 males and 22 females) with nonsyndromic BCLP at an Indian cleft center were rated by 2 examiners as per the Bauru yardstick for the 12-year-old age group. The average age group was 12 ± 0.62 years. All cases were treated with same surgical protocol. The inter-examiner agreement between the 3 examiners was found to be very high, with weighted kappa values ranging from 0.894 to 0.951. The intraexaminer agreement between the 2 examinations for all the examiners was also found to be very high, with weighted kappa values ranging from 0.894 to 0.931. Seventy-eight percent of patients were rated with a Bauru yardstick score of 1+2. In addition, 10% of patients were rated with a score of 3, 8% as 4, and 4% as 5. The overall Bauru yardstick score for the center was 2.36. The protocol followed for the repair of BCLP cases by the center was found to be a good regimen in regard to the Bauru yardstick score.

Assessment of facial asymmetry before and after the surgical repair of cleft lip in unilateral cleft lip and palate cases

This study was performed to assess facial asymmetry in patients with unilateral cleft lip and palate (UCLP) before and after primary lip repair. Three-dimensional facial images of 30 UCLP cases (mean age 3.7±0.8months) captured 1–2days before surgery and 4 months after surgery using stereophotogrammetry were analysed. A generic mesh – a mathematical facial mask consisting of thousands of points (vertices) – was conformed on the three-dimensional images. Average preoperative and postoperative conformed facial meshes were obtained and mirrored by reflecting on the lateral plane. Facial asymmetry was assessed by measuring the distances between the corresponding vertices of the superimposed facial meshes. Asymmetries were further examined in three directions: horizontal, vertical, and anteroposterior. Preoperatively, the philtrum and bridge of the nose were deviated towards the non-cleft side. The maximum vertical asymmetry was at the upper lip. The greatest anteroposterior asymmetry was at the alar base and in the paranasal area. The overall facial asymmetry improved markedly after surgery. Residual anteroposterior asymmetry was noted at the alar base, upper lip, and cheek on the cleft slide. In conclusion, dense correspondence analysis provided an insight into the anatomical reasons for the residual dysmorphology following the surgical repair of cleft lip for future surgical consideration.

Clinico-statistical Study of the Cases of Cleft Lip and/or Palate in the Past 10 Years at Our Department

Clinico-statistical Study of the Cases of Cleft Lip and/or Palate in the Past 10 Years at Our Department