Treatment Of Cleft Palate Patients Research Articles

Velopharyngeal Insufficiency Treatment in Cleft Palate Patients: Umbrella Review.

Velopharyngeal insufficiency may occur as a result of an anatomical or structural defect and may be present in patients with cleft lip and palate. The treatment options presented in the literature are varied, covering invasive and non-invasive methods. However, although these approaches have been employed and their outcomes reviewed, no conclusions have been made about which approach is the gold-standard. This umbrella review aimed to synthesize the current literature regarding velopharyngeal insufficiency treatments in cleft lip and palate patients, evaluating their effectiveness based on systematic reviews. A standardized search was carried out in several electronic databases, namely PubMed via Medline, Web of Science, Cochrane Library, and Embase. The quality of the included studies was evaluated using AMSTAR2 and degree of overlap was analyzed using Corrected Covered Area. Thirteen articles were included in the qualitative review, with only 1 in the non-invasive method category, and 12 in the invasive method category. All reviewed articles were judged to be of low quality. In symptomatic patients, treatment did not solely comprise speech therapy, as surgical intervention was often necessary. Although there was no surgical technique considered to be the gold standard for the correction of velopharyngeal insufficiency, the Furlow Z-plasty technique and minimal incision palatopharyngoplasty were the best among reported techniques.

Retention protocol following post-orthodontic treatment in cleft palate patients – A review

To evaluate and compare the available literature on efficiency of different retention appliances in maintaining the results achieved after orthodontic treatment in cleft palate patients. On comparing the literature available on different retention appliances currently available, it was found that the cast metal retainers offered a more stable and rigid design to maintain the post treatment arch width and also provided the aesthetic replacement of the missing teeth in the cleft region by incorporating a pontic. The cleft lip and palate patients should be informed and motivated for a long term or indefinite retention phase irrespective of the type of retention appliance used. Presently, very few studies are available comparing the effectiveness of different retention protocols in cleft lip and palate patients. Hence, there is need to conduct evidence based high quality longitudinal studies to compare the effectiveness of different retention appliances.

Temporal muscle flap (TMF) as an alternative to the treatment in cleft palate patients: a case report

Background: The temporal muscle flap (TMF) is a type of soft tissue flap technique used to reconstruct defects in the cranium and face. In 1963, Bakamjian published the first case of the use of this flap for the reconstruction of palate defects, being considered a versaltile alternative. The technique to be pediculated has great reliability and vascularization, due to irrigation through the posterior and anterior deep temporal arteries.

A Survey on Orthodontic Treatment for Cleft Palate Patients in Chiba Hospital of Tokyo Dental College

A Survey on Orthodontic Treatment for Cleft Palate Patients in Chiba Hospital of Tokyo Dental College

New biomaterials versus traditional techniques: advances in cleft palate reconstruction.

Cleft lip and palate still remains one of the most common congenital anomalies, and consequently surgical correction of these anomalies is still commonplace. Despite numerous existing surgical techniques having good outcomes, it is still recognized that the morbidity of certain surgical procedures and success rates regarding outcomes can be improved. The purpose of this review is to evaluate new literature and techniques compared with the time tested procedures that are commonly used. As technology continues to advance, the understanding of details regarding biochemical pathways responsible for the development of cleft defects and also the efficacy of biomaterials that can be used in their correction are being discovered and better understood. Many studies have been conducted in both animal and human study participants that further the understanding of these questions. The efficacy and benefit of newly devised biomaterials seems to indicate that these biomaterials are a viable adjunct and often an alternative in the treatment of cleft palate patients. In this review of recent literature, the discussion begins with a review of the more traditional and widely accepted iliac crest bone grafting and then evolves into a discussion of several animal and human studies to delineate the progress being made in this field. The literature exploring the details regarding biochemical pathways and cellular mediators that are involved in cleft formation, as well as biomaterials used in surgical repair are evaluated. The findings in the literature suggest that there is a bright future in better understanding the cause of cleft formation on a molecular level and associated attempts that can be made in altering some of these factors along with discovering new biomaterials that can be a useful adjunct to existing techniques.

Isolation and Characterization of Satellite Cells from Rat Head Branchiomeric Muscles

Fibrosis and defective muscle regeneration can hamper the functional recovery of the soft palate muscles after cleft palate repair. This causes persistent problems in speech, swallowing, and sucking. In vitro culture systems that allow the study of satellite cells (myogenic stem cells) from head muscles are crucial to develop new therapies based on tissue engineering to promote muscle regeneration after surgery. These systems will offer new perspectives for the treatment of cleft palate patients. A protocol for the isolation, culture and differentiation of satellite cells from head muscles is presented. The isolation is based on enzymatic digestion and trituration to release the satellite cells. In addition, this protocol comprises an innovative method using extracellular matrix gel coatings of millimeter size, which requires only low numbers of satellite cells for differentiation assays.

Isolation and Characterization of Satellite Cells from Rat Head Branchiomeric Muscles.

Fibrosis and defective muscle regeneration can hamper the functional recovery of the soft palate muscles after cleft palate repair. This causes persistent problems in speech, swallowing, and sucking. In vitro culture systems that allow the study of satellite cells (myogenic stem cells) from head muscles are crucial to develop new therapies based on tissue engineering to promote muscle regeneration after surgery. These systems will offer new perspectives for the treatment of cleft palate patients. A protocol for the isolation, culture and differentiation of satellite cells from head muscles is presented. The isolation is based on enzymatic digestion and trituration to release the satellite cells. In addition, this protocol comprises an innovative method using extracellular matrix gel coatings of millimeter size, which requires only low numbers of satellite cells for differentiation assays.

Postoperative evaluation of the folded pharyngeal flap operation for cleft palate patients with velopharyngeal insufficiency.

Background:Velopharyngeal function is very important for patients with cleft palate to acquire good speech. For patients with velopharyngeal insufficiency, prosthetic speech appliances and speech therapy are applied first, and then pharyngeal flap surgery to improve velopharyngeal function is performed in our hospital. The folded pharyngeal flap operation was first reported by Isshiki and Morimoto in 1975. We usually use a modification of the original method.Purpose:The purpose of this research was to introduce our method of the folded pharyngeal flap operation and report the results.Materials and Methods:The folded pharyngeal flap operation was performed for 110 patients with velopharyngeal insufficiency from 1982 to 2010. Of these, the 97 whose postoperative speech function was evaluated are reported. The cases included 61 males and 36 females, ranging in age from 7 to 50 years. The time from surgery to speech assessment ranged from 5 months to 6 years. In order to evaluate preoperative velopharyngeal function, assessment of speech by a trained speech pathologist, nasopharyngoscopy, and cephalometric radiography with contrast media were performed before surgery, and then the appropriate surgery was selected and performed. Postoperative velopharyngeal function was assessed by a trained speech pathologist.Results:Of the 97 patients who underwent the folded pharyngeal flap operation, 85 (87.6%) showed velopharyngeal competence, 8 (8.2%) showed marginal velopharyngeal incompetence, and only 2 (2.1%) showed velopharyngeal incompetence; in 2 cases (2.1%), hyponasality was present. Approximately 95% of patients showed improved velopharyngeal function.Conclusions:The folded pharyngeal flap operation based on appropriate preoperative assessment has been shown to be an effective method for the treatment of cleft palate patients with velopharyngeal insufficiency.

Characterization of Phosphate Glass/Hydroxyapatite Scaffold for Palate Repair

Bone grafting is the standard treatment for cleft palate patients. However, a downside to this method is that it requires multiple surgeries to fill the gap in the mouth. Bone tissue engineering can be employed as a solution to this problem to fabricate artificial bone based on synthetic biomaterials. The objectives of this study focus on preparing phosphate glass and hydroxyapatite (HA) as well as developing appropriate forming conditions for scaffold based on the polymeric replication method. Various glass compositions and sintering temperatures were examined in order to investigate scaffold structure, compressive strength, and biodegradability. Amounts of CaO and sintering temperatures were varied in order to explore their impacts on scaffold properties. Results from XRD clearly show that phosphate glass and HA can be successfully synthesized using natural materials. It was also found that polymeric foam replication can be successfully used for scaffold fabrication and the scaffold microstructure revealed that the appropriate pore size for bone tissue engineering is in the 240 360 μm range. Results indicate that biodegradability can be regulated by the amount of CaO used. For example, specimens with the highest level of biodegradability were obtained from 30 mol% of CaO composition. The highest compressive strength (6.54 MPa) was obtained from scaffold containing 40 mol% of CaO, sintered at 750 °C.

Prospective study of the sagittal growth of the maxilla in patients with maxillary unilateral complete cleft lip and palate operated at 6 months of age under a functional technique

Introduction: One of the common consequences of the surgical treatment of cleft palate patients is the excessive maxillary retrusion, which has not only aesthetic consequences but can also cause a psychological problem affecting their insertion in the social and work environment. The aim of this study was to determine whether the functional surgical repair of the lip in a same group of patients with maxillary unilateral complete cleft lip and palate, operated at 6 months of age, allows a normal sagittal development of the maxilla, both in the stage of mixed and permanent dentition, with a 8 year-long monitoring of this group of patients, and comparing the sagittal maxillary growth between these two periods.

Long-term stability of alveolar bone grafts in cleft palate patients

Many authors have examined the surgical bone treatment of cleft palate patients, but no study has emphasized the role of orthodontic therapy. The aims of this study were to evaluate the long-term stability of bone grafts when using an orthodontic-surgical protocol, to determine the success of bone grafts in minor vs severe clefts, and to develop a qualitative method for assessing the success of bone grafting. Forty-nine patients were included in this study. Occlusal x-rays were taken before (T0), immediately after (T1), and at least 1 year after bone grafting (T2). Two radiographic parameters were analyzed adjacent to the cleft side: the vertical bone level (Bergland scale) and the horizontal bone level (Witherow-derived scale). The bone graft success at T2 was 91.84% (95% confidence interval, 84.55-96.41). The severity of the cleft before grafting was not statistically correlated with success at T2 (P <0.05). The concordance rate between Bergland and Witherow values was 87.07% (95% confidence interval, 82.69-90.69). The variables analyzed (sex, age, type of cleft, lateral incisor agenesis) were not statistically correlated (P <0.05) with the stability of bone graft. Based on the results, the only factor involved in the stability of the graft seems to be dental age at the time of bone grafting and the orthodontic therapy before and after grafting. It seems appropriate to recommend early application of a surgical-orthodontic protocol to treat cleft lip and palate patients, prevent postoperative bone resorption, and guarantee correct positioning of the teeth.

Distraction Osteogenesis in the Treatment of Dentofacial Deformities

Distraction osteogenesis (DO) is a major surgical technique that promotes new bone formation. It was first developed in the long bones and has now been applied to the facial bones. McCarthy et al. were the first to apply the procedure to the human mandible. The early uses in craniofacial surgery and orthognathic surgery were with extraoral appliances and therefore had limited appeal to many patients other than those with severe craniofacial anomalies, such as hemifacial microsomia. This changed with the introduction of intraoral appliances. Since that time, the use of DO has expanded to applications beyond those in jaw and craniofacial abnormalities to include its use in the treatment of cleft palate patients, condylar regeneration, discontinuity defects of the mandible, and for ridge augmentation before the placement of implants. Moreover, as experience in treating severe dentofacial deformities increased, surgeons were encouraged to intercede at an earlier age to minimize the extent of the deformity and to minimize relapse after surgery. This article describes some of the newer concepts in using DO to treat maxillary and mandibular deformities and growth discrepancies that are not amenable to routine orthognathic surgery.

P.295 Temporary tracheostomy and MMA as a treatment of cleft palate patient with pharyngofixation and OSAS

P.295 Temporary tracheostomy and MMA as a treatment of cleft palate patient with pharyngofixation and OSAS

Application of Osseointegrated Implant for Overlaydenture and Prosthetic Treatment in Cleft Palate Patients

Application of Osseointegrated Implant for Overlaydenture and Prosthetic Treatment in Cleft Palate Patients

Repair of the cleft palate without lateral release incisions: results concerning 124 cases

The authors report their experience in the treatment of cleft palate patients, with or without cleft lip, carried out without lateral release incisions. The surgical approach was as follows: the cleft palate only was closed in one step at the age of 10 to 12 months, while the cleft of lip and palate was closed in two steps: at 6 months of age the soft palate together with lip and nose repair and at 18 to 24 months the hard palate with gingivo-alveoloplasty. Out of the 147 patients treated from 1984 until 1992, 124 (73 cleft palate, 51 cleft lip and palate) were treated without lateral release incisions, allowing first intention healing in 122 cases. The failures observed involved 2 cases: in the first (a bilateral case with a wide cleft) an almost total dehiscence of the suture at the level of the hard palate occurred, while in the second (a cleft palate case) a small oronasal fistula developed (healed spontaneously in 2 weeks). Our results confirm that by performing the described surgical technique without lateral release incisions, a 98% success rate for closure of a cleft palate could be obtained. Of course, in very large clefts the lateral release incision should be considered however.

Trends in Prosthodontic Treatment of Cleft Palate Patients at One Institution: A Twenty-One Year Review

This 21-year retrospective study evaluated the trends observed in the prosthodontic treatment of 269 patients. The patients were divided into three groups. The speech aid group consisted of 203 patients and showed a significant decrease in numbers over time. The maxillary obturator group consisted of 24 patients and did not show a significant change. The infant feeding prosthesis group consisted of 42 patients and showed a significant increase in numbers. Possible reasons for the trends observed are discussed.

Trends in prosthodontic treatment of cleft palate patients at one institution: a twenty-one year review.

This 21-year retrospective study evaluated the trends observed in the prosthodontic treatment of 269 patients. The patients were divided into three groups. The speech aid group consisted of 203 patients and showed a significant decrease in numbers over time. The maxillary obturator group consisted of 24 patients and did not show a significant change. The infant feeding prosthesis group consisted of 42 patients and showed a significant increase in numbers. Possible reasons for the trends observed are discussed.

Use of overdentures in the treatment of cleft palate patients

Special programmes have been written to register the The changes as a result of surgery showed that the soft scans using 18 points over the face. These points are tissues of the midface had improved on average by then used to register the scans and average the points 335 mm and that the face height had been reduced on on the face and construct an average face for each average by 7-9 mm. When comparing the clefts with group of patients pre and post operatively and for the the normals the unilateral clefts had longer faces and normals. The average faces were then registered using after surgery the clefts did not resemble the normals. 1.5 points over the eyes and forehead which were considered to show least change following surgery.

Behandlung von Kindern mit Lippen-Kiefer-Gaumen-Spalten-ein Beitrag zur psychosozialen Rehabilitation

The long-term treatment of cleft palate patients starts immediately after birth and is pursued in orderly fashion [correction of persecuted orderly] to adolescence. The results of anonymous survey of the opinion of parents of cleft palate children who undergo or underwent early treatment procedures, up to seven years of age, are presented. Questions concerned mother's or parent's experience of birth, first medical information, early orthopedic care and treatment, and psychosocial adjustment of the children as well. This study suggests that objective findings in children and subjective conditions of parents do not correlate in the beginning, as is to be seen in cleft palate versus cleft lip palate group. One other conclusion indicates the existence of a small quantity of parents able to accept their affected child without additional problems arising from the cleft.

Functional regulator therapy for cleft palate patients

Nine cleft lip and palate children exhibitng collapse of maxillary segments and cross-bite were treated orthodontically with the functional regulator (FR) for periods ranging from 6 to 18 months. The purpose of this investigation was to evaluate quantitatively treatment of cleft palate patients with the functional regulator and to evaluate the effect of the appliance on their speech. Cleft palate patients typically have speech, nose, and lip defects which make patient cooperation and appliance acceptance more difficult. However, patient cooperation was considered good with an average mean of 12.7 hours per day of appliance wear and a range of 5.6 to 18.2 hours. Change in interimplant dimension was measured on frontal radiographs, and dental changes were measured of serial dental casts. The resulting data indicated no significant change in maxillary width or cross-bite relationship. The functional regulator was not clinically useful in this sample when the treatment objective was primary expansion of collapsed maxillary segments in the cleft palate patient. Good speech-production skills prior to treatment will minimize the adverse effect that the FR has on speech intelligibility. A significant amount of accommodation to the appliance occurs within 1 week after insertion, but maximum improvement in speech intelligibility occurs with full-time wear of the appliance for as many hours per day as possible.