Palate Infants Research Articles

口唇口蓋裂児における吸啜機能の発達 －口唇形成術前後および３か月後の口腔周囲筋活動の変化－

口唇口蓋裂児における吸啜機能の発達 －口唇形成術前後および３か月後の口腔周囲筋活動の変化－

Nursing habits in cleft lip and palate children

Cleft lip and palate anomalies are malformations that affect patients causing some alterations. These alterations can compromise maternal nursing and lead to early introduction of bottle feeding and sugar in the diet of cleft lip and palate infants, compromising their oral health and the surgical/rehabilitation process. Objective: The purpose of this study was to evaluate the nursing habits and the use of baby bottles in a group of cleft lip and palate infants. Material and methods: Two hundred and twenty nine mothers of cleft lip and palate infants in the age range from 6 to 36 months enrolled in the Hospital for Rehabilitation of Craniofacial Anomalies – USP/Bauru were interviewed. It was obtained data on family socioeconomic characteristics as well as mother educational level using the patient’s file. Using a pre-structured questionnaire accomplished always by the same interviewer, information on natural and artificial nursing pattern was obtained. Results: Only 21.4% of the mothers accomplished breastfed their babies. 98.25% of mothers used bottle feeding with milk and other sucrose liquids at one to ten times frequency. Nocturnal nursing habit was verified in 59.38% of total sample. Conclusion: Cleft lip and palate infants presented inadequate nursing habits in relation to both the content and the frequency ingestion, suggesting the need of a multidisciplinary guidance and following-up of infants during this age range.

Supporting the Drive to Thrive in Cleft Lip and Palate Infant- A Case Report

In infants with cleft lip and palate, failure to thrive (FTT) condition has largely been attributed to early feeding difficulties. Presurgical Nasoalveolar Molding (PNAM) forms an integral part of treatment modality for cleft infants in such conditions, by providing a myriad of benefits.It balances several aspects of treatment such as growth, aesthetics and function in cleft infants and also provides psychological reassurance to the parents. This clinical report describes the presurgical management of an infant with complete unilateral cleft lip and palate who was in failure to thrive condition.

Natal and neonatal teeth among cleft lip and palate infants

Objective:Natal/neonatal teeth are reported to be more common among clefts and congenital anomalies. Data exclusively among clefts is sparse. The aim was to evaluate prevalence of natal teeth among cleft lip and palate neonates and review the causes, presentation, associated anomalies, complications and management.Materials and Methods:Out of 641operated patients, records of 151 infants with cleft lip and palate with less than three months of age presented to the department of plastic and reconstructive surgery from 2005 to 2011 were reviewed. Out of which 107 were unilateral complete lip and palate (ULCP), 15 bilateral cleft lip and isolated cleft palate constituted 29.Results:Three patients among the studied records showed neonatal teeth. Two had paired central mandibular incisor teeth along with associated other anomalies and one had a single maxillary neonatal tooth. All were present in unilateral cleft lip and none of the bilateral or isolated cleft palate infants showed neonatal teeth. The overall incidence of neonatal teeth was 1.98% and 2.8% in unilateral Cleft lip.Conclusion:Our study supports the incidence of 2% natal teeth among UCLP. Involvement of mandibular central incisors in contrast to the notion that maxillary alveolus is more commonly affected suggest that it is not only the anatomical disturbance but also all those possible common multifactorial etiological factors contributing to the congenital anomalies as such. Natal/neonatal teeth are rather under-diagnosed and reported than a rare phenomenon and the prevalence is higher in certain population. Riga-Fede disease unlikely to be seen in clefts with neonatal teeth due to anatomical factors. The extraction of non mobile tooth if necessary can be done during the primary surgery for the cleft lip.

Evaluation of pre- and post-treatment changes in the alveolus of infants with cleft lip and palate using nasoalveolar molding

Objectives: The purpose of this study was to evaluate the changes in maxillary alveolar morphology in unilateral and bilateral cleft lip palate infants treated with presurgical nasoalveolar molding (PNAM). Materials and Methods: In this retrospective study, 10 infants, less than 6 months of age, with cleft lip and palate (CLP) treated with PNAM prior to surgical repair, were evaluated. Pre-PNAM (T1) and Post-PNAM (T2) study models were analyzed. Critical linear dimensions like inter-canine width, inter-tuberosity width, and arch length were measured and compared at the T1 and T2 stages using a grid comparison system. Results: The width of the alveolar cleft, arch length, and arch width showed a significant decrease in infants treated with PNAM. The inter-tuberosity width and arch perimeter showed a statistically significant increase with PNAM. Conclusion: PNAM was effective in reducing the severity of the initial cleft deformity mainly at the anterior portion of the maxillary arch.

Maxillary arch dimensions in cleft infants in Northern Finland

Objective. The aim of this study was to examine the maxillary arch dimensions in cleft lip and/or palate infants in Northern Finland before surgery. Materials and methods. The subjects consisted of 70 Finnish cleft patients born between 1997–2004 in Northern Ostrobothnia Hospital District in Finland. The study casts were obtained before surgery at the mean age of 5.6 months (SD = 2.2). There were 42 children with cleft palate (CP) (26 girls/16 boys), 13 with unilateral cleft lip and palate (UCLP) (eight girls/five boys), eight children with cleft lip (CL)(two girls/six boys) and seven with bilateral cleft lip and palate (BCLP) (two girls/five boys). Conventionally-used landmarks were marked on study casts and cleft width, arch circumference, anterior and posterior arch width and arch length were measured with a digital sliding calliper. The statistical method was ANOVA. Results. The prevalence of CP in this study, 60% of all clefts, is higher than the average standards. There were statistically significant differences in cleft width, posterior and anterior arch width, arch length and arch circumference, when different cleft groups were compared. When differences between girls and boys were compared, boys had larger cleft size and arch dimensions generally, but the results were not statistically significant. Conclusions. The results show the large variation in the severity of cleft lip and/or palate deformity at birth and in maxillary arch dimensions between different cleft types. It also demonstrates the effect of phenotypic variability within the groups of cleft lip and/or palate.

Presurgical Orthopaedic Nasoalveolar Molding in Cleft Lip and Palate Infants: A Comparative Evaluation of Cases Done With and Without Nasal Stents

Addressing the craniofacial anomaly of cleft lip and palate presurgically has been done since more than 50years now, with a constant improvisation of the treatment protocols from time to time. The present study deals with a modification of the technique devised 16years ago. The effect of nasal stents attached to a pre-surgical naso-alveolar molding (PNAM) appliance on the nasal morphology achieved prior to primary surgical correction of the cleft lip was to be evaluated. Twenty subjects, infants with cleft lip and palate, less than 2months of age were selected for presurgical nasoalveolar molding treatment. Impressions were recorded, casts made and PNAM appliance fabricated. Ten infants were given the appliance without nasal stents and to the other ten appliances nasal stents were added. The patients were recalled every 2-3weeks and a series of 9 measurements were recorded every visit along with adjustments made to the appliance for desirable effects on the lip, alveolus and nose. This was carried out till the patient was taken up for lip repair. The final measurements obtained at the end of the presurgical treatment were recorded. Mann-Whitney test, between study and control group showed that the increase in the columella length was statistically significant (p=0.0001 and p=0.033) in the study group as compared to the control group. Also the increase of the nasal tip projection (mean=1.30mm) in the study group was found to be statistically significant (p=0.006) as compared to the control group. We concluded that nasal stents attached to the alveolar molding appliance, yield significant improvement of the nasal morphology and better nasal aesthetics presurgically.

Nipple trauma in infants? Bednar aphthae

IntroductionBednar aphthae are infected wounds caused by trauma, localized to the hard palate in infants. They do not require specific treatment because they regress spontaneously in a few days. They often remain undiagnosed; other times, because of the pain they caused, they may worsen the nursing. Case reportWe describe the clinical case of a healthy infant of 2 months, fed with formula, who has 2 aphthous lesions in the oral cavity associated with irritability and inconsolable crying during feeding. We excluded the influence of infectious factors or underlying diseases. The hypothesis of a traumatic factor was supported by the anatomical features of aphthae and then confirmed by the gradual resolution of lesions after some advices on breastfeeding. ConclusionsOur intent is to provide a photographic record of Bednar aphthae, which are quite common but often misdiagnosed also because of lacking of photographic material. Improved knowledge of this condition helps physicians in the differential diagnosis of a traumatic condition that is not as unusual as it seems in newborns.

Use of folic acid supplements and risk of cleft lip and palate in infants: a population-based cohort study

Orofacial clefts occur when the lips or the roof of the mouth do not fuse properly during the early weeks of pregnancy. There is strong evidence that periconceptional use of folic acid can prevent neural tube defects but its effect on oral clefts has generated debate. To identify factors associated with suboptimal periconceptional use of folic acid and its potential effect on oral clefts. The population-based infant cohort of the national Growing Up in Ireland study, which consists of 11 134 9-month-old infants. Data collection comprised questionnaires conducted by interviewers with parents in parents' homes. Characteristics of mothers who did or did not take folic acid before and during pregnancy, as well as the effect of folic acid use on the prevalence of cleft lip and palate were recorded. The prevalence of cleft lip and palate was 1.98 (95% confidence interval [CI] = 1.31 to 2.99) per 1000 9-month-olds. The odds ratio for cleft lip was 4.36-fold higher (95% CI = 1.55 to 12.30, P = 0.005) for infants of mothers who did not take folic acid during the first 3 months of pregnancy, when compared with those who did have a folate intake during the first trimester. Folic acid use was suboptimal in 36.3% (95% CI = 35.4 to 37.2) of the sample. These findings support the hypothesis that taking folic acid may partially prevent cleft lip and palate. They are particularly relevant for GPs, because they are usually the first port of call for women before and during early pregnancy.

おしゃぶりを利用した哺乳装置で早期に経口摂取が可能となったTreacher Collins症候群とPierre Robin症候群を合併した口蓋裂児の1例

おしゃぶりを利用した哺乳装置で早期に経口摂取が可能となったTreacher Collins症候群とPierre Robin症候群を合併した口蓋裂児の1例

Otitis Media with Effusion and Hearing Loss in Chinese Children with Cleft Lip and Palate

To determine the incidence of otitis media with effusion and the associated hearing loss, the rate of ventilation tube insertion, and complications of ventilation tube insertion in Chinese cleft palate patients. Retrospective review in a tertiary care hospital in Hong Kong. A total of 104 consecutive patients with cleft lip and/or cleft palate who were born between January 1996 and January 2006. The incidence of otitis media with effusion in Chinese cleft palate patients for the first 2 years after birth was 76.1%. Of these patients, 16.9% had otitis media with effusion associated with a moderate hearing loss (>40 decibels hearing level [dBHL]). Approximately half (53.2%) of our patients had ventilation tube insertion. Complications including retraction, tympanosclerosis, and perforation of the tympanic membrane were found in 15.7% of all ears with otitis media with effusion and ventilation tube insertion. The high incidence of otitis media with effusion in cleft palate infants found in this study is consistent with that reported in the Western literature. A small but significant proportion of otitis media with effusion was associated with moderate hearing loss that truly required surgical treatment. Cleft palate children are much more likely to develop otitis media with effusion than normal children, and they develop the condition at an earlier age. A protocol for the treatment of otitis media with effusion in cleft palate patients and further prospective studies are warranted.

A comparison of results using nasoalveolar moulding in cleft infants treated within 1 month of life versus those treated after this period: development of a new protocol

The objectives of this study were to: evaluate the effects of nasoalveolar moulding (NAM) in complete unilateral cleft lip and palate infants presenting for treatment at different ages; propose a new NAM protocol in these patients; improve the predictability of NAM. Study groups comprised: group I ( n = 15) treated with NAM within 1 month of age; group II ( n = 15) treated with NAM between 1 and 5 months of age. Control: group III ( n = 15) comprised of non-cleft 18-month old children. A standard protocol was followed. Patients were evaluated before initiation of NAM, before cheiloplasty and at 18 months. 7 linear anthropometric measurements were compared using dento-facial models. Statistical analysis before and after NAM revealed that group I patients demonstrated 81%, 198%, 69% and 145% improvement in intersegment distance, nasal height, nasal dome height and columella height respectively; whilst group II patients demonstrated 51%, 33%, 21% and 38% improvement for the same. At 18 months, group I patients closely resembled group III patients. This study concluded that the effects of NAM were most significant in group I. Group II patients also benefited from NAM, although to a lesser extent. This study validates the use of NAM in infants presenting late for treatment.

Risk Factors for Hyperketonemia in Cleft Lip and Palate Infants During General Anesthesia

The purpose of the present study was to investigate the risk factors for hyperketonemia with respect to patient age, the starting time of anesthesia (morning or afternoon), and the preoperative liquid intake when glucose was administered to infants before and during general anesthesia to avoid the hyperketonemia resulting from lipid catabolism. The subjects were 147 healthy infants, including 55 infants 2 to 6 months old (cleft lip group) and 92 who were 10 to 24 months old (cleft palate [CP] group). For preoperative liquid intake, the infants were allowed to drink formula or breast milk for ≤ 5 hours before entering the operating room and 6.7% glucose solution for ≤ 2 hours before entering the operating room. As an intraoperative infusion, 195 mg/kg/hour of glucose was constantly administered. The levels of blood ketone bodies and glucose were measured at anesthesia induction and 2 hours after induction. Blood ketone body (β-hydroxybutyrate) concentrations of ≥ 1.0 mmol/L were considered abnormally high. The ketone body concentrations were abnormally high in 34 infants and normal in 113 infants. Significant differences were present in relation to age (P = .001) and age group (CP group, P < .001), and starting time of anesthesia (afternoon cases, P = .003). However, no difference in preoperative liquid intake was seen between groups. Logistic regression analysis suggested age group (CP group) and starting time of anesthesia (afternoon cases) as factors associated with elevated blood ketone body concentrations. The risk factors for abnormally high ketone body concentrations were age group (CP group) and starting time of anesthesia (afternoon cases).

Effect of improved feeding methods on cleft lip and cleft palate newborns

Objective To discuss the effects of improved feeding methods on reducing feeding complication of cleft lip and cleft palate newborns.Methods 40 cleft lip and cleft palate infants were randomly divided into control and treatment group, 20 patients in the control group using conventional ordinary spoon feeding and routine nursing, and treatment group was with improved feeding method and the conventional methods of nursing.Results Satisfaction on the nursing of children's parents was better than the control group (P<0.05), complications of the three results are significantly better than the control group (P<0.05).Conclusions Reasonable nursing and feeding of cleft lip and cleft palate can reduce the complication rate and improve the satisfaction of parents, obtain the good follow-up results, and worthy to be popularized. Key words: Cleft lip; Cleft palate; Infant,newborn; Nursing; Feeding methods

Rates and Risks of Gastrostomy Tubes in Infants With Cleft Palate

To review data on a cohort of infants with cleft palate to (1) determine rates of gastrostomy (G)-tube placement, (2) identify contributing comorbidities, and (3) use relative risk analyses to improve management of cleft palate in infants with feeding difficulty. Retrospective medical record review. Tertiary care children's hospital. Infants with cleft palate born between January 1, 2000, and December 31, 2008, without G-tubes prior to referral were included. Comorbidities were analyzed, including syndromes and chromosomopathies (syn/chrom) and cardiac, respiratory, neurologic, and gastrointestinal diagnoses. These comorbidities were analyzed independently. Gastrostomy-tube placement. Of 214 infants with cleft palate, 34 required G-tubes. Of these, 19 had syn/chrom. Independent of these diagnoses, 17 infants had 1 system comorbidity and 12 had multisystem comorbidities. Of the 180 patients without G-tubes, 20 had syn/chrom. Independent of these diagnoses, 10 infants had 1 system comorbidity and 2 had multisystem comorbidities. Rates of G-tube placement ranged from 3% in infants without any comorbidity to 94% in infants with respiratory comorbidity. Relative risks of G-tube placement with syn/chrom, 1 system comorbidity, and multisystem comorbidities were 5.68 (95% confidence interval, 3.18-10.16), 21.79 (8.76-54.17), and 29.66 (12.18-72.21), respectively. Diagnosis of syn/chrom or major comorbidity significantly increases risk of G-tube placement. Regardless of syn/chrom association, problems affecting the heart, respiratory system, central nervous system, and lower esophageal sphincter are the most significant risk factors, implying that particular comorbidities are more influential than a simple diagnosis of syn/chrom. These data should help identify children at greatest risk for G-tubes and those expected to overcome feeding difficulties, leading to more persistent use of nonsurgical therapy before resorting to G-tubes.

Changes in Maxillary Alveolar Morphology with Nasoalveolar Molding

To evaluate the changes in maxillary alveolar morphology in unilateral cleft lip palate infants treated with nasoalveolar molding (NAM). Study was carried out in the orthodontic department associated with a operating cleft unit in a rural region of central India. Ten UCLP (unilateral cleft lip palate) infants less than 6 weeks of age were treated with NAM prior to surgical repair. Pre NAM and Post NAMstudy models of the UCLP infants were analyzed. Critical linear dimensions including inter- canine width, inter-tuberosity width, arch length and midline deviation were recorded at the different stages using a digital vernier caliper and compared. Statistical analysis were performed using SPSS 13.00 statistical software. Results from this study showed that the width of the alveolar cleft showed a significant decrease with NAM. The arch length and width of the arch in the anterior region also showed a reduction with NAM. The intertuberosity width showed a statistically significant increase during treatment. The arch perimeter showed a significant increase with NAM. NAM was effective in reducing the severity of the initial cleft deformity mainly at the anterior portion of the maxillary arch.

Finite Element Analysis of Eustachian Tube Function in Cleft Palate Infants Based on Histological Reconstructions

The prevalence of otitis media with effusion approaches 100% in infants with cleft palate (CP), and disease pathogenesis is believed to be caused by eustachian tube (ET) dysfunction. Quantify the functional consequences of ET anatomy in infant CP specimens, and identify the relative importance of various tissue biomechanical properties on ET function in infants with CP. Finite element models of ET anatomy and physiology were developed by using image analysis and three-dimensional (3D) reconstruction techniques. Models were developed using histological images of ET structures obtained from five infant CP specimens. The models were parameterized, and the effects of varying model parameters, which included tensor veli palatini and levator veli palatini force, ET cartilage, periluminal mucosal compliance, and hamular position on resistance to airflow through the tubal lumen, were determined. Of the evaluated parameters, only applied tensor veli palatini muscle force and compliance of the periluminal mucosa and cartilage tissues were significant predictors of resistance to airflow through the ET during muscle-assisted opening. Finite element models of ET function in the CP infant identified tensor veli palatini muscle force as a direct predictor and mucosal/cartilage compliance as an indirect predictor of ET opening during muscle-assisted lumen dilations. Hamular position and levator veli palatini force were not found to have an effect on ET function in CP infants.

Presurgical Nasoalveolar Molding Assisted Primary Reconstruction in Complete Unilateral Cleft Lip Palate Infants

Various methods have been described for the primary surgical reconstruction of the unilateral cleft lip and palate deformity (UCLP) in infants. There have been several attempts at restoring the normal anatomy of the nose at the time of lip repair in the affected individuals with varying degrees of success. Presurgical nasoalveolar molding (PNAM) is a presurgical infant orthopedic procedure that attempts to target the nasal deformity leading to a more esthetic surgical repair. At our center we aimed to use PNAM to help in providing the surgical team with a better foundation for an easier and more esthetic single stage repair at the level of nose in addition to the lip and alveolus. The infant nasal cartilages are amenable to correction in the first few weeks of life when they retain their plasticity. Three infants with complete unilateral cleft lip palate (CUCLP) were operated upon after a course of PNAM. No nasal stents were use after repair to retain the results. PNAM reduced the extent of the cleft deformity and improved the anatomic relationship between the affected structures. Postoperative recovery was uneventful. Subjective evaluation immediate post surgery and at the time of palate repair reveals adequate nasolabial esthetics. Long-term results of PNAM assisted repair are to be ascertained. The use of PNAM enables in reducing the severity of the deformity the surgical team has to tackle thereby enabling in a better and esthetic primary repair.

Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy

Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy

Caring for cleft lip and palate infants: Impression procedures and appliances in use

The treatment goal for cleft lip and palate (CLP) patients is to restore the normal anatomy of the affected structures. Many surgical procedures and infant maxillary orthopedic appliances have been described to achieve these goals. A variety of appliances have been described for maxillary orthopedics in infants. Prior to the fabrication of any of these appliances, we are faced with the challenge of the impression procedure in the CLP infant. This article attempts to briefly describe the appliances in use for infant maxillary orthopedics and the impression procedures followed prior to their fabrication.