Palate Infants Research Articles

Nasoalveolar Molding in Lately Presented Moderate to Severe Unilateral Cleft Lip and Palate Infants: Does it Add?

Alignment of the alveolar segments with early nasal cartilage tackling is the foundation upon which excellent surgical results are dependent. The purpose is to evaluate the short-term effect of triple combination of passive alveolar molding with early nasal molding augmented by controlled corrective power of lip tapping in lately presented moderate to severe unilateral complete cleft lip and palate infants. A prospective case series study was conducted in Plastic and Maxillofacial Surgery Department, Ain Shams University in collaboration with Orthodontics Department, from January 2021 till June 2023, 15 infants elder than 2 months till 6 months were enrolled in the study. Eight nasal anthropometric measurements ratios through 2-dimension assessment and 4 maxillary arch measurements ratios through 3-dimension assessment were recorded. Extraoral results revealed clinically and statistically decrease of nasal width, alar base width, alar base height ratios, and columellar angle, while increase of nasal height, nasal dome height, columellar length, and alar projection length ratios. Intraoral results revealed clinically and statistically decrease in cleft width with maintained posterior arch width and intercanine width. In conclusion, this triple combination helped in presurgical lessening the alveolar and nasal deformity of such elder infants in a shorter time in comparison with other conventional methods with lesser number of appointments decreasing burden of care to their families improving their compliance.

Some oral microbiota in complete cleft infants in comparison with normal infants.

To compare caries-related microorganisms and candida in complete cleft infants with normal palate infants. The case-control study was conducted from April 2021 to January 2022 at the College of Dentistry, University of Baghdad, Baghdad, Iraq, and comprised infants with age ranging from 1 day to 4 months. They were divided into complete cleft group A and control group B. Group A was subdivided into those with class III Veau's palatal classification, and the rest with class IV Veau's palatal classification. Samples were taken using oral swab which were subjected to colony morphology, gram staining and biochemical testing. Data was analysed using SPSS 21. Of the 52 subjects, 26(50%) were in each of the 2 groups. The subgroups of group A had 13(50%) patients each. The counting and colonisation of streptococcus mutans, lactobacilli and candida albicans were significantly higher in group A than in group B (p<0.05). The difference between the subgroups of group A was not significant (p>0.05). Infants with cleft palate were more susceptible to dental caries and oral infection than those with normal palate.

Model analysis through two-dimensional evaluation of alveolar changes of untreated unilateral cleft lip and palate infants

The primary objective of therapeutic interventions for unilateral cleft lip and palate (UCLP) is to reestablish typical role and anatomy. The efficacy of nasoalveolar molding relies on the age at which it is initiated, thus early initiation is recommended. Evaluating the success of presurgical orthopedics involves assessing the after-treatment maxillary arch form and proportions in UCLP infants and comparing them to age-matched infants without clefts. Untreated UCLP cases exhibit various changes in the transverse and angular dimensions of the alveolar segment. Utilizing digital analysis of UCLP plaster casts through Photoshop software (version 24.0.0) can serve as an alternative method to predict changes in cleft width, arch width, and angular measurements in untreated cases.

Post-cheilorhinoplasty esthetic evaluation of unilateral cleft lip and palate infants treated with and without pre-surgical nasoalveolar molding

Objectives: Unilateral cleft lip and palate sets many challenges both functional and esthetic. Cleft patients are at an elevated risk for developing psychosocial problems. The objective of this study was to assess any difference in esthetics post-cheilorhinoplasty in unilateral cleft lip and palate (UCLP) infants treated with and without nasoalveolar molding. Materials and Methods: Esthetic evaluation of nasolabial appearance and comparative analysis of photographic records collected post-cheilorhinoplasty for presurgical nasoalveolar molding (PNAM), lip-tape (LPTP), no pre-treatment (NoPreTx), and control (CTRL) groups were done using 5 point scale. There were six evaluators, two orthodontists, and one maxillofacial surgeon each from the two participating institutions. Paired “t”-test for nasolabial score comparison between groups, Cronbach’s alpha for reliability analysis, and Fleiss Kappa for interevaluator agreement were used for statistics. All statistical analysis was done at confidence level of 95% and 0.05 as level of significance. Results: Significant difference was found between nasolabial esthetic scores for PNAM group when compared to LPTP (P = 0.000) and NoPreTx (P = 0.001) groups. Infants who underwent PNAM had better nasolabial esthetic scores in all categories compared to infants who underwent LPTP or NoPreTx. The scale of measurement and the nasolabial esthetic evaluation scores were coherent and reliable as shown by Crohnbach’s alpha (&lt;0.9) both for individual components and for overall score. Conclusion: UCLP infants who were brought by their parents to the craniofacial center early within 1 month of their birth and who underwent nasoalveolar molding therapy before cheilorhinoplasty had significantly better nasolabial esthetics post-surgery.

Case Study in Infants with Cleft Lip and Palate Who Attended the Fundación Operación Sonrisa Consultation in The Period 2015-2019

Cleft lips and palate are considered congenital craniofacial malformations originating in the early stage of embryo development, due to an incomplete fusion of the medial nasal processes and maxillary processes. A multidisciplinary team is required to carry out the ideal treatment for these childhood patients. Aims: The objective of this study was meant to describe the casuistry of patients with cleft lip and palate in infants who attended the Operation Smile Venezuela Foundation in the period from 2015 to 2019. Subjects and Method: This was a non-experimental and descriptive field research. The sample included medical records from patients with cleft lip and palate that were attended since 2015 to 2019, having in account exclusion and inclusion criteria. A questionnaire was used as an instrument through the Google Form application with 34 closed questions of dichotomous answers. The variables studied were epidemiological characteristics such as: age, gender and origin, also we analyzed types of clefts lip and palate and whether they obtained surgical resolution or not, which were collected and evaluated according to our type of research and the objectives. Results: 618 medical records were analyzed, with an average of showing a prevalence in preschool age ( 40%) , followed by minor infants ( 29%) and the age with less prevalence was newborns (1%). In terms of gender there was an almost equal distribution, males (58%) and females (42%). Geographically there was a predominance in the Capital District (20%), Miranda (15%), Aragua (13%) and Monagas (12%) during the period studied. But states such as Amazonas, Barinas, Cojedes, Delta Amacuro, Lara and Nueva Esparta had the lowest percentage (0%). Of the cleft lip the most prevalent was the Complete left Unilateral, followed by the Incomplete Left Unilateral and the Complete Bilateral cleft lip. The Complete Bilateral and the Hard and Soft Posterior Palate Cleft were the most common. Conclusions: It is essential to determine the epidemiological variants, as well as to know the etiology of the cleft lip alveolus palatal and how to prevent them. Likewise, through this work, the activity that Operation Smile Venezuela Foundation carried out day by day is made known.

Assessment of Incidence of Aspiration Pneumonia in Infants with Cleft Palate

Background: A cleft lip (CP) is characterized by a split in upper lip, which may extend into the nose. These abnormal fissures can cause difficulties with nutrition, hearing, speaking and recurrent respiratory and ear infections. Objectives: The study assessed the complications associated with the cleft palate in infants and the incidence of aspiration pneumonia. Methods: The study was conducted in tertiary care hospitals and pediatric clinics at District Dera Ismail Khan, from February 2021 to September 2022, comprising 141 CP patients. Results: The incidence of CP was seen 7.90% in District Dera Ismail Khan, which was higher in males (68.08%) than in females (31.91%). The mean age of the study group was 4.35+3.12, with birth weight and weight at the time of assessment being 3.85+1.78 and 23.78+15.19, respectively. Their mean maternal age and weight at the time of delivery were 32.91+9.07 and 61.65+21.56, respectively. A significant proportion (p&lt;0.05) suffered from aspiration pneumonia (64.53%), while 19.85% of the patients had complained of recurrent pneumonia due to CP. Other complications included chest infection (43.26%), ear infection (8.51%), nasal obstruction (31.91%), vomiting during feeding (26.95%) and regurgitation of milk and other food materials (12.05%). Ten CP patients died (7.09%) due to the complications associated with this disorder. Practical implications: For infants with orofacial clefts, the incidence of LRTIs is potentially high, thus accumulated breastfeeding length might mediate the connections of CP. Conclusion: It was concluded that CP was significantly associated with pulmonary defects and caused fatal LRTIs in the affected population, especially in breastfeeding infants. Keywords: Cleft palate; Ear infections; Fetal defects; Genetic Disorders; Pulmonary infections.

Presurgical techniques for the treatment of cleft lip and palate in infants – a review of the literature

Presurgical techniques for the treatment of cleft lip and palate in infants – a review of the literature

Clinical Application of Hyperdry Amniotic Membrane in Cleft Palate Repair.

To examine the safety and efficacy of hyperdry amniotic membrane (HDAM) for wound closure after palatoplasty in cleft palate patients. HDAMs were prepared by washing and drying under infrared rays and microwaves at temperatures less than 60°C using a hyperdrying device. A total of 16 cleft palate patients (8 males, 8 females), aged 1 to 3 years (mean age 1 year 9 months), received one-stage pushback palatoplasty. The remaining raw wound after surgery was covered by an HDAM and a plastic cover plate. The cover plate was removed 1 week after surgery and parameters including temperature, feeding, allergic reactions, postoperative bleeding, re-epithelialization, wound dehiscence, and infection were monitored during the follow-up period of 31.2 months. All patients could adequately ingest at 5 days postoperation and after removal of the cover plate. None of the patients had a persistent fever or allergic reactions. Ingestion was feasible immediately in all patients, and no postoperative bleeding was observed during ingestion. No secondary hemorrhages were observed during follow-up. No postoperative wound dehiscence on the midline of the palate was observed. No infections were observed after the removal of the cover plate. No patients suffered from severe scar formation or contracture of the wound in the follow-up period. Hemorrhage, undue epithelialization, and scar contracture did not occur in any patient. The mean evaluation score was 7.75 points. HDAM can be used safely and effectively for wound closure following palatoplasty in cleft palate infants. Future studies testing the safety of patient's own amnion for palatoplasty, are required.

Cleft Lip and/or Palate in Infants Prenatally Exposed to Opioids.

To determine the prevalence and odds ratios for cleft lip and/or palate (CL/P) among infants prenatally exposed to opioids with or without neonatal opioid withdrawal syndrome (NOWS). This study represents an exploratory, retrospective cohort study design of newborn medical health records from 2011 to 2016. Records were drawn from a regional health system located in South Central Appalachia. The original population yielded 3 cohorts of infants: (1) infants with opioid exposure (OE) but not requiring pharmacological intervention (OE; N = 168); (2) infants with NOWS requiring pharmacological intervention (N = 294); and (3) infants with no opioid exposure (NOE; N = 16 090), the primary comparison group. Infants in the NOWS and OE groups showed significantly increased prevalence and odds ratios for CL/P when compared to those in the NOE group. Prevalence rates per 1000 live births for infants with OE (35.71) and infants with NOWS (6.80) were significantly higher than those for infants with NOE (1.37). Comparison of infants with OE to the NOE group revealed significantly increased odds for CL/P, isolated cleft palate (CP), cleft lip (CL), and cleft lip and palate (CLP) (27.05, 41.81, 19.26, 19.37, respectively; all Ps < .008). The odds ratios for infants with NOWS compared to the NOE group were significantly higher for CL/P and CP (5.00 and 10.98, respectively; Ps < .03) but not for CL and CLP. The results provide additional evidence that prenatal OE should be considered among the critical environmental risk factors that can contribute to CL/P.

Cleft Lip and Palate in Infants With Prenatal Opioid Exposure.

This study examines phenotypic presentation and perioperative outcomes of cleft-related procedures for infants with cleft lip and/or palate (CL/P) and prenatal opioid exposure. This is a retrospective review of infants with prenatal opioid exposure treated for CL/P from 2008 to 2018. Patients cared for at a tertiary center from 2008 to 2018. Eighteen patients with documented prenatal opioid exposure and CL/P had primary repairs in our unit. The phenotypes of CL/P were characterized. Demographic data regarding additional exposures, as well as associated medical and social comorbidities were recorded. Outcome variables included operative delays, perioperative complications, and loss of follow-up. Isolated cleft palate (CP; 67%) was overrepresented among patients with prenatal opioid exposure and CL/P, as was Robin sequence (50% in isolated CP). Fifty-six percent had exposure to additional substances. A majority (67%) had other medical conditions or anomalies, and 17% had known genetic syndromes. Seventy-two percent were in state custody. Thirty-nine percent of exposed patients had delays in their planned operative dates due to medical and/or social factors. There were no postoperative readmissions following cleft procedures. Lack of follow-up was noted in 33% of patients. Infants with CL/P who have prenatal opioid exposure are likely to have additional medical conditions and complex social challenges.

Presurgical nasoalveolar molding therapy in cleft lip palate infant: A successful case report

Nasoalveolar molding (NAM) is a recent infant orthopedic appliance constructed in cleft lip and palate patients below 3–4 months of age because the moldability of primary cartilage is very high due to high estrogen content in infants below 4 months of age. We started NAM therapy in this case at 3 weeks of age and continued till 4 months of age, the cleft lip gap decreased from 19 mm to 9 mm and palate (alveolar) gap reduced from 9 mm to 3 mm, there was also improvement in nasal anatomy. This is an important case report in which we have successfully completed NAM therapy and also followed the case after lip surgery for 6 months which resulted in better surgical outcome in terms of function and esthetics. In conclusion, we suggest that presurgical NAM improves esthetics, decreases cleft deformities, and prepares the patients for less surgical procedures with better results.

Assisted Nursing: A Case Study of an Infant With a Complete Unilateral Cleft Lip and Palate.

This case presents a mother's feeding experience of an infant born with a complete unilateral cleft lip and palate from birth until both were repaired. She fed him directly at the breast with assistance, controlling the delivery of the mother's own milk. The infant received only his mother's own milk, no bottles, and the excess expressed milk was donated to a milk bank. The Cleft Team supported the mother's wish to breastfeed but expressed realism that cleft lip and palate infants could not create suction. Success had never been observed in the unit. Instead, the team suggested expressing to deliver as much of the mother's own milk. The mother had previously breastfed her three children and was keen on finding innovative ways to breastfeed. Several techniques were trialed with the help of an International Board Certified Lactation Consultant. The most sustainable and successful was the use of a nipple shield applied to the maternal nipple areola complex to cover the lip palate. Underneath, a nasogastric tube connected to a syringe delivered the mother's own milk. Exclusive expressing protected maternal supply, the infant's nutrition and growth were monitored carefully and this technique reinforced mother-infant bonding. Feeding with the modifications was challenging at times. However, maternal satisfaction was high because the mother had achieved her goal of breastfeeding without assistance post cheiloplasty and palatoplasty. This case adds to the limited body of research about feeding infants with cleft lips and palates directly at the breast.

Orofacial clefts: treatment based on a multidisciplinary approach

Orofacial clefts: treatment based on a multidisciplinary approach

Effectiveness of a Novel 3D-Printed Nasoalveolar Molding Appliance (D-NAM) on Improving the Maxillary Arch Dimensions in Unilateral Cleft Lip and Palate Infants: A Randomized Controlled Trial.

The aim of the current study was to introduce and measure the effectiveness of a new 3D-printed nasoalveolar molding (D-NAM) appliance on improving the maxillary arch dimensions (MADs) in infants with unilateral complete cleft lip and palate (UCLP) before surgical lip repair. A prospective, balanced, randomized, parallel groups, single-blinded, controlled trial. All the steps of the current study were carried in the Department of Orthodontics, Cairo University in Egypt. Thirty-four, nonsyndromic infants with UCLP. The eligible infants were randomly assigned into either no-treatment (control) or to the new D-NAM groups. In D-NAM group, the maxillary models were 3D scanned into virtual models onto which segmentation and alveolar segments approximation were performed. Approximation movements were divided into 3 models representing 3 activation steps. On each of these models, virtual appliance construction was performed followed by 3D printing of the appliance. Nasal stent was added manually to the appliances of the second and third steps. Horizontal tapes were applied to infants in the D-NAM group only. A Blinded assessors carried all the MADs measurements virtually on digital models collected at the beginning (T1) and after (T2) treatment. Clinically and/or statistically significant improvements in all the measured MADs were recorded in D-NAM group at T2 before surgical lip repair in comparison to control group. The introduced D-NAM/3D-printed appliance is a simple and efficient technique to improve the MADs in infants with UCLP before surgical lip repair.

The Effect of Immediate Versus Delayed Addition of the Nasal Stent to the Nasoalveolar Molding Plate on Nostrils Shape and Cleft Width in Infants With Unilateral Cleft Lip and Palate

The main aim of this study was to evaluate the effect of immediate versus delayed addition of the nasal stent to the nasoalveolar molding plate on the nose shape and alveolar cleft area in unilateral cleft lip and palate infants. Twenty nonsyndromic newborn infants with unilateral cleft lip and palate were scanned 3 dimensionally using Proface software. In the experimental group, the nasal stent was added on the day the molding plate arrived, and in the control group when the alveolar gap reached 5 mm. Two months after adding nasal stents in each group patients' faces were scanned again and some parameters were measured. In addition, immediately after treatment, 1 month later and at the end of investigation, impressions were taken, and stone casts were scanned by cone-beam computed tomography and the alveolar gap was measured. Fisher exact test, paired t test, and ANOVA were used for data analyses. P < 0.05 was considered as significant. In this study, changes in the parameters showed significant differences between the case and controls for the columellar angle, nostril width on the cleft side, nostril height on the cleft side, soft tissue cleft width, and nasal surface area. However, the nostril's width and height in the noncleft side, intercommissural distance, nasal surface area on the noncleft side, nostril area between the cleft and noncleft side after treatment, and the alveolar gap did not show significant differences between the groups (P > 0.05). Early use of nasal stents showed more desirable results in decreasing the width of the nostrils and increasing its height and correcting the angle of the columella without any adverse effects on the nostrils after treatment.

Parents’ Acceptance to Alveolar and Nasoalveolar Molding Appliances during Early Cleft Lip and Palate Care: A Call for High-Quality Research

AIM: Acceptance and compliance of the parents are an essential pillar in the success of pre-surgical infant orthopedic (PSIO) treatment. The aim of this systematic review is to evaluate the burden of care associated with the alveolar molding (AM) and nasoalveolar molding (NAM) appliances as experienced by the parents with unilateral complete cleft lip and palate (UCLP) infants.&#x0D; METHODS: An electronic search was carried on by two reviewers in eight search engines, as well as a manual search till July 2019. Randomized controlled trials (RCTs) comparing AM/NAM appliances to controls in infants with UCLP were selected. Risk of bias was evaluated using Cochrane risk of bias assessment tool for RCTs.&#x0D; RESULTS: One RCT was included in the qualitative analysis. Non-significant differences were found in the amount of mothers’ satisfaction between the intervention and control groups.&#x0D; CONCLUSIONS: Insufficient low-quality evidence is available regarding the effects of AM and NAM on parents’ satisfaction and burden of care. No conclusions can be withdrawn from the existing studies. High-quality research is needed to elucidate the degree of parents’ acceptance to the molding appliances.&#x0D; PROSPERO registration number: CRD42016043174.

Presurgical orthopedic treatment of children with unilateral cleft lip and palate with a sequential splints method: indications and long-term results

To justify the use of the Sequential Splints Method of presurgical orthopedic treatment for children with unilateral cleft lip and palate depending on extent of initial deformation and to estimate long-term results. The method was applied in 17 unilateral cleft lip and palate infants who received treatment at the age from 4 days to 3 months. There was a control group of 28 cleft lip and palate patients operated with no early orthodontics. Average age in both groups at the time of research was 3.8±0.9 years. Comparative assessment was conducted before the beginning of the post-operative orthodontic treatment for the following parameters: residual width of the alveolar process cleft, presence of lateral incisor's bud, the extent of the nose deformation on the cleft side. It was found that residual width of the alveolar process cleft was, on average, 5.95 mm in the main group and 12.6 mm in the control group. The percentage of the lateral incisor adentia was 28% in the main group and 66% in the control group. The mean score of alar nose deformation was 3.9 and 3.1 points, correspondingly. According to obtained results patients who did not receive the presurgical orthopedic treatment were more likely to have residual deformations and larger residual width of the alveolar process cleft. There was higher risk of teeth germs loss in the control group. The Sequential Splints Method of presurgical orthopedic treatment is recommended as a necessary part of the treatment for the unilateral cleft lip and palate.

Do Infant Cleft Dimensions Have an Influence on Occlusal Relations? A Subgroup Analysis Within an RCT of Primary Surgery in Patients With Unilateral Cleft Lip and Palate.

To investigate whether infant cleft dimensions, in a surgical protocol with early or delayed hard palate closure, influence occlusion before orthodontics. Subgroup analysis within a randomized trial of primary surgery (Scandcleft). Tertiary health care. One surgical centre. A total of 122 unilateral cleft lip and palate infants received primary cheilo-rhinoplasty and soft palate closure at age 4 months and were randomized for hard palate closure at age 12 versus 36 months. A novel 3D analysis of cleft size and morphology was performed on digitized presurgical models. Occlusion was scored on 8-year models using the modified Huddarth-Bodenham (MHB) Index and the Goslon Yardstick. Differences in MHB and Goslon scores among the 2 surgical groups adjusted for cleft size. The crude analysis showed no difference between the 2 surgical groups in Goslon scores but a better MHB (P = .006) for the group who received delayed hard palate closure. When adjusting for the ratio between cleft surface and palatal surface (3D Infant Cleft Severity Ratio) and for posterior cleft dimensions at tuberosity level, the delayed hard palate closure group received 3.65 points better for MHB (confidence interval: 1.81; 5.48; P < .001) and showed a trend for reduced risk of receiving a Goslon of 4 or 5 (P = .052). For posterior clefts larger than 9 mm, the Goslon score was better in the delayed hard palate closure group (P = .033). Seen from an orthodontic perspective, when the soft palate is closed first, and the cleft is large, the timing of hard palate closure should be planned in relation to posterior cleft size.

MALNUTRITION IN CHILDREN WITH UNREPAIRED OROFACIAL CLEFT: A SYSTEMATIC REVIEW

Background: The anatomical defect of the oral cavity in children with orofacial clefts presents them with feeding challenges which increase their risk of becoming malnourished. The objective of this review was to investigate the extent of malnutrition among children under 5 years with unrepaired cleft of the lip and/ or palate. Materials and Methods: A systematic literature search of published articles that assessed malnutrition in children with unrepaired cleft lip and/or palate was conducted. Pubmed Central, Cochrane library, Pubmed (MEDLINE) and Google Scholar databases were searched. Result: A total of 4,489 papers were found of which 8 were included in the review after meeting the inclusion criteria. Malnutrition was found to be higher in isolated cleft palate and cleft lip and palate infants than in isolated cleft lip infants who had nutritional status close to that of non-cleft infants. Syndromic cleft infants were highly malnourished compared to non-syndromic infants. Weight-for-age was the most assessed anthropometric indicator of nutritional status. Average prevalence of underweight (low weight-for-age) was 21.5%. Conclusion: Malnutrition is high especially within the first year of life in infants with unrepaired cleft lip and/or palate. Keywords: Cleft lip and palate, malnutrition, growth impairment, failure to thrive

A novel one stage technique used for fabrication of a single visit feeding appliance for cleft palate infants.

A novel one stage technique used for fabrication of a single visit feeding appliance for cleft palate infants.