Unilateral Cleft Lip And Palate Patients Research Articles

Bridging the Gap: Sella Turcica in Unilateral Cleft Lip and Palate Patients.

The aims of this study were to analyze the prevalence of sella turcica bridging and to measure the size of the sella turcica on profile cephalograms in a homogenous group of surgically repaired unilateral cleft lip and palate (UCLP) patients. Tertiary care center. Retrospective cross-sectional study. Preorthodontic lateral cephalometric radiographs of 64 UCLP individuals between the ages of 16 and 29 years along with an equal number of age- and sex-matched skeletal Class I controls. The extent of calcification of the interclinoid ligament was quantified (completely calcified, partially calcified, no calcification) and mean values compared. Length, depth, and diameter of the sella turcica were also measured. The results were statistically analyzed using paired t test and Wilcoxon signed ranks test. Complete sella bridging of both type A (4.6%) and type B (21.7%) was significantly higher in UCLP patients. This has not been reported previously. Partial sella bridging was also higher in cleft patients as evaluated by two methods (42.18%, 39.06%). This study demonstrated a statistically significant decrease in all dimensions of sella turcica in UCLP patients. The UCLP patients apparently had higher predilection for sella turcica bridging. The dimensions of sella turcica were also seen to be significantly smaller than the control group. Defective proliferation and deviated pathways of neural crest cell migration as well as premature rupture of contact between neuroepithelium and oral ectoderm as postulated causes are discussed.

Characteristics of Maxillary Morphology in Unilateral Cleft Lip and Palate Patients Compared to Normal Subjects and Skeletal Class III Patients

This study is to investigate the anatomical features of maxillae in unilateral cleft lip and palate (UCLP) patients with maxillary retrusion. Additionally, the dissimilarities of retruded maxillae between the UCLP patients and the skeletal class III patients were compared. Craniofacial measurements were carried out among 32 UCLP adult patients with maxillary retrusion (GC), 24 adult patients in class III (SNA < 80°, ANB < 0°) patients (GIII), and 32 normal controls (GN). The authors measured the width and length of the maxillae, as well as their relative positions to the coronal plane passing through basion. The independent sample group t test was performed, and P < 0.05 was regarded as statistically significant. In the GC group, the anterior and posterior maxillary length (A1-P3M⊥CP and P3M-P6M⊥CP) and overall maxillary length (A1-P6M⊥CP) at the dental level, the interdental widths of the maxillae, the maxillary volume (GM), and the volume consisting of maxilla and maxillary sinus (GT) significantly reduced compared with the GN group (P < 0.05). The distances from the points on the maxillae to the coronal plane (A1⊥CP, P3M⊥CP, and P6M⊥CP) in the GC and GIII groups were smaller than those in the GN group (P < 0.05). In summary, for the UCLP patients, the decreased prominence of maxillary complex could be mainly caused by the shortened maxillary length; meanwhile, posterior position of the maxillary body may have some influence on the maxillary protrusion. While for the class III patients, maxillary retrusion was resulted from malposition and malmorphology on an equal basis.

Airway Obstruction and the Unilateral Cleft Lip and Palate Deformity

Patients with unilateral cleft lip and palate (CLP) deformities commonly develop nasal airway obstruction, necessitating septoplasty at the time of definitive rhinoplasty. We assessed the contribution of the bony septum to airway obstruction using computed tomography (CT) and cone beam CT (CBCT). A 2-year retrospective review of all subjects with unilateral CLP who underwent CBCT imaging (n = 22) and age-matched controls (n = 9) who underwent CT imaging was conducted. Control CT scans were used to determine the segment of nasal septum comprised almost entirely of bone. The CBCT of the nasal airway was assessed using Dolphin software to determine the contribution of the bony septum to septal deviation and airway obstruction. The nasal septum posterior to the midpoint between anterior and posterior nasal spine is comprised of 96% bone. The nasal airway associated with this posterior bony segment was 43.1% (P < 0.001) larger by volume on the non-cleft side in patients with unilateral CLP. The average septal deviation within the posterior bony segment was 5.4 mm, accounting for 74.4% of the maximal deviation within the nasal airway. The average airway stenosis within the posterior bony nasal airway was 0.45 mm (0-2.2 mm). In patients with unilateral CLP, the bony nasal septum can demonstrate significant deviation and airway stenosis. Surgeons should consider a bony septoplasty in their treatment algorithm in unilateral CLP patients who have reached skeletal maturity.

Three-dimensional analysis of maxillary development in patients with unilateral cleft lip and palate during the first six years of life.

The purpose of this work was to analyse early upper-jaw development in patients with unilateral cleft lip and palate (UCLP) treated using two different concepts and to compare shape and size developments between these two groups and a group of noncleft patients. A total of 204 maxillary casts available for this study from 50 UCLP patients were analyzed for upper-jaw development based on three-dimensional measurements performed with a Reflex Microscope from birth up to 71 months of age. Thirty-five of these 50 patients were part of an early treatment group (two-stage cleft closure with single-stage palatoplasty at an age of 10-14 months) and 15 were part of a late treatment group (two-stage cleft closure with palatoplasty at an age of 4-7years). The control group included 39 casts of 17 noncleft patients. Analysis of shape and size between the patients in the three groups yielded statistically significant differences between the cleft and the noncleft patients. In both treatment groups, we made observations typically associated with cleft formation like lateralization, asymmetry of the greater and lesser cleft segments, and pronounced vertical deviations of the segments. Viewed in all dimensions, however, the patients in the early treatment group approached the control group more closely, although a statistically significant difference was still observed. Our results suggest that the timing of hard-palate closure is not a decisive factor for upper-jaw development. Intrinsic factors (initial cleft width, presence of tooth buds) and the surgeon's skills appear to have a much more defining role.

A comparative cephalometric study for adult operated cleft palate and unoperated cleft palate patients

ObjectiveTo determine the effects of a cleft deformity unilateral cleft lip and palate (UCLP) and the subsequent surgical interventions on maxillary growth. Materials and methodsThis retrospective study evaluated the lateral cephalograms of 3 groups of individuals: 40 adult patients with ULCP who underwent surgery for both lip and palate; 40 adult patients with ULCP who underwent surgery for lip only; and 40 age- and gender-matched noncleft controls. Differences in jaw morphology among them were analyzed statistically. ResultsAdult UCLP patients in both groups showed maxillary hypoplasia in anteroposterior and vertical directions compared with noncleft control adults. Significant differences (p ≤ 0.01) in the ANB (subspinale–nasion–supramentale angle), NA-FH (the angle formed between Frankfort horizontal plane and the plane from nasion to subspinale), MP-FH (the angle formed between mandibular plane and Frankfort horizontal plane), and GoMe/SN (the ratio between length of mandibular body and length of anterior cranial base) were found between the two UCLP patient groups. Although maxillary growth in the two UCLP groups was less than that in the noncleft control group, the anteroposterior growth in the UCLP patients with palatoplasty was even less than that in the UCLP patients with unoperated palate. ConclusionsThere may be an intrinsic deficiency of maxillary anteroposterior and vertical development in UCLP patients compared with the noncleft controls. Palatoplasty can further limit the anteroposterior growth of maxilla but has no detrimental effect on maxillary vertical development. The mandible is rotated clockwise after palatoplasty in UCLP patients.

Effects of nasoalveolar molding therapy on alveolar morphology in unilateral cleft lip and palate using two different approaches

Objective: The objective of this study was to evaluate the effects of presurgical nasoalveolar molding (PNAM) therapy by standard Grayson technique (G1) and Yen Modification single step NAM technique (G2) on alveolar tissues in patients with unilateral cleft lip and palate (UCLP) using three-dimensional digital models. Materials and Methods: Totally, 10 patients with a mean age of 20 ± 16.07 days, having complete UCLP, were included in this prospective study. The maxillary plaster models were scanned. The study sample was divided into two group of 5 UCLP patients (G1 treated by standard Grayson technique and G2 treated by Yen Modification) for linear, angular, and area measurements before and after PNAM therapy. The distances between the identified landmarks were measured on the maxillary casts, and the distance and area measurements were performed using software Poly works (IIT Delhi). All subjects had undergone PNAM therapy for 3 months, the alveolar segments should have been approximated (≤5 mm), and the cleft width after PNAM should be reduced. Results: The decrease of the cleft width and arch length on the cleft side were significantly altered on the affected side (P < 0.005). No significant changes were observed when comparing both the groups using standard Grayson technique and Yen Modification single step NAM technique (G1 and G2). Conclusion: PNAM therapy effects mainly in the anterior alveolar segment and reduction of palatal and alveolar cleft width in patients with unilateral clefts of lip, alveolus, and palate in both Grayson and Yen Modification single step NAM technique. Both the Groups G1 and G2 suggested same treatment outcome in term of alveolar molding, but single step technique reduces patient's visits.

Area and volume of the pharyngeal airway in surgically treated unilateral cleft lip and palate patient: A cone beam computed tomography study

Background: Area and volume of the pharyngeal airway in surgically treated unilateral cleft lip and palate (UCLP) patient: A cone beam computed tomography (CBCT) study. Context: Surgical repair of cleft causes restriction of maxillary growth and mid face but the effect of this reduced growth on volume of the pharyngeal airway has not been investigated thoroughly. Aims: The aim of the study was to assess the area, volume and smallest cross-sectional area of the pharyngeal airway in individuals with UCLP using CBCT and compare with age and sex matched noncleft controls. Settings and Design: Retrospective study. Materials and Methods: The study was carried out on 20 surgically treated UCLP patients and compared with 40 normal non cleft subjects with Class I skeletal relation within age group of 7-14 years. CBCT image processing and analysis were performed using Dolphin Imaging software (11.7 version premium; Dolphin Imaging and Management Solutions, Chatsworth, Calif) and volumetric rendering was done for airway analysis. Statistical Analysis Used: All statistical analyses were performed with SPSS software (version 15.0J for Windows; SPSS, Inc., Chicago, IL). An independent sample t-test was used to determine the significance of the difference between the means. Results: No significant difference was found in the area and volume of nasopharynx, oropharynx, hypopharynx, total pharyngeal volume (P = 0.86) and minimum axial area (P = 0.69) of the pharynx between the groups. Conclusions: Using CBCT, this study found that there was no significant difference in the pharyngeal area and volume between UCLP and noncleft groups. Further investigations are necessary to clarify the relationship between pharyngeal structure and airway function in patients with CLP.

Longitudinal analysis of palatal volume in unilateral cleft lip and palate children

Cleft lip and/or palate are among the most frequent congenital craniofacial defects, which every year affect one in 500-700 newborn worldwide (1,2). The aim of this study was to analyze the effect of orthopaedic and surgical treatments on the palatal size and shape of patients with unilateral cleft lip and palate (UCLP). Ninetysix palatal casts from 32 neonatal patients, attending the Fundacion Clinica de Noel (Colombia) were analyzed through a stereophotogrammetric system. The analysis was carried out before (mean age 10.5 days, SD 4.8) and after (mean age 83.3 days, SD 6.6) orthopaedic treatment (performed with acrylic plates) and after cheiloplasty (mean age 317.1 days, SD 44.2). Volumes of the greater and the minor alveolar segments were evaluated through a new measurement protocol. Intra and inter operator repeatability was evaluated using paired Student’s t test. In order to investigate differences between alveolar segments and time, volume measurements were compared with a repeated two-way analysis of variance (ANOVA). No significant differences between repetitions, both intra and inter operator, were found (p>0.05). Random errors explained 3.7% of the sample variance. On the other hand, significant differences in volume measurements were found both in alveolar segment and time (p<0.01). Before orthopaedic treatment, the smaller palatal segment had a mean volume of 0.52 cm3 (SD 0.23), and the greater of 0.9 cm3 (SD 0.40); after orthopaedic treatment, the mean volumes were 0.58 cm3 (SD 0.25), and 1.09 cm3 (SD 0.43). After surgery, mean values of 0.73 cm3 (SD 0.28) and 1.31 cm3 (SD 0.52) were measured. Results suggest that a three-dimensional stereophotogrammetric system is a repeatable and reliable method to evaluate palatal casts of patients with UCLP. Obtained data offer a preliminary quantitative information about the changes occurring in maxillary arches of UCLP patients after orthopaedic treatment and surgery. Further investigation is required to increase the frequency of evaluations and the number of patients.

Pattern of dental anomalies in nonsyndromic clefts and its relationship to neural crest developmental fields

Objectives: To correlate dental anomalies in different cleft groups with that of the neural crest developmental fields. Materials and Methods: The study was performed at the Department of Orthodontics, Tamil Nadu Government Dental College and Hospital, Chennai on 60 subjects with cleft of lip, palate in the age group of 12-25 years of both genders. Subjects were divided into two major groups. Group A consisted of 30 subjects with unilateral cleft lip and palate (UCLP) and Group B comprised of 30 subjects with bilateral cleft lip and palate (BCLP). For assessment purpose both right and left side UCLP patients were grouped together. The subjects were classified by cleft type into one of three groups as unilateral left cleft lip and palate, unilateral right cleft lip and palate, BCLP. Results: Statistical analysis using Chi-square test yielded significant differences in agenesis of tooth (P < 0.001), ectopic eruption (P < 0.001), rotated tooth (P < 0.001), and impacted tooth (P < 0.001). The other dental anomalies did not yield any significant differences. Conclusion: Agenesis of the lateral incisor was the most common dental anomaly in the frontonasal field area. The ectopic eruption was the prevalent dental anomaly in the maxillary field area and agenesis of second premolar in the palatine field area.

Bridging the Gap: Sella Turcica in Unilateral Cleft Lip and Palate Patients.

Objectives : The aims of this study were to analyze the prevalence of sella turcica bridging and to measure the size of the sella turcica on profile cephalograms in a homogenous group of surgically repaired unilateral cleft lip and palate (UCLP) patients. Setting : Tertiary care center. Design : Retrospective cross-sectional study. Patients : Preorthodontic lateral cephalometric radiographs of 64 UCLP individuals between the ages of 16 and 29 years along with an equal number of age- and sex-matched skeletal Class I controls. Main Outcome Measures : The extent of calcification of the interclinoid ligament was quantified (completely calcified, partially calcified, no calcification) and mean values compared. Length, depth, and diameter of the sella turcica were also measured. The results were statistically analyzed using paired t test and Wilcoxon signed ranks test. Results : Complete sella bridging of both type A (4.6%) and type B (21.7%) was significantly higher in UCLP patients. This has not been reported previously. Partial sella bridging was also higher in cleft patients as evaluated by two methods (42.18%, 39.06%). This study demonstrated a statistically significant decrease in all dimensions of sella turcica in UCLP patients. Conclusions : The UCLP patients apparently had higher predilection for sella turcica bridging. The dimensions of sella turcica were also seen to be significantly smaller than the control group. Defective proliferation and deviated pathways of neural crest cell migration as well as premature rupture of contact between neuroepithelium and oral ectoderm as postulated causes are discussed.

Maxillary Protraction in Patients with Cleft Lip and Palate in Mixed Dentition: Cephalometric Evaluation after Completion of Growth

Objective : To clarify the short- and long-term effects of maxillary protraction (MP) in mixed dentition in patients with unilateral cleft lip and palate (UCLP). Design : Retrospective study. Setting : University of Tokyo Hospital. Patients and Intervention : Eleven Japanese patients with UCLP in mixed dentition were treated with MP and followed up until the completion of growth. Multibracket treatment had been performed after MP treatment in all patients. Main Outcome Measure : Lateral cephalograms taken before and after MP and after completion of growth were used. Posterior and anterior vertical reference lines (PV, AV) were used to measure the horizontal movements of point A, pogonion, and maxillary first molar (U6). SNA, SNB, ANB, maxillary and mandibular length, mandibular plane angle, Wits value, upper incisor inclination, overjet, and overbite were also measured. Results : Large variation was found in the effects of MP, and five patients eventually required orthognathic surgery. In average change with MP, the maxilla showed favorable forward growth. Point A had moved forward from PV but not AV. The mandible rotated backward. However, ANB and the Wits value did not improve. U6 moved forward, and the overjet improved. After MP, the skeletal Class III relationship became severe. Conclusions : MP was effective as an early treatment for UCLP patients. However, its effects showed large variation and were in conflict with facial growth. Conscientious explanation of the expected effects and associated problems should be given to the patients/parents before its application.

The effects of palatoplasty and pre-surgical infant orthopedic treatment on occlusion in unilateral cleft lip and palate patients

PurposeThe aim of this study was to evaluate the effect of pre-surgical infant orthopedic treatment (Hotz plate) and type of palatoplasty on the dental arch relationship and the dental arch morphology of unilateral cleft lip and palate (UCLP) patients. Materials and methodsSeventy-four children with UCLP were divided into three groups. One group had undergone one-stage palatoplasty without Hotz plate (OSP w/o H), the second had undergone one-stage palatoplasty with Hotz plate (OSP w/H), and the third had undergone two-stage palatoplasty with Hotz plate (TSP w/H). We evaluated the dental models which were taken during initial examination at our orthodontic clinic, using the Goslon Yardstick, the 5-year-old index, and dental model analysis. ResultsRegarding both indices, there were no significant differences among the three groups. However, the dental arch width between maxillary deciduous canines in OSP w/H and TSP w/H was significantly greater than that of OSP w/o H. The dental arch width at the maxillary deciduous second molars in TSP w/H was significantly greater than in OSP w/H and OSP w/o H. ConclusionDental arch relationship in UCLP patients was not influenced by the type of palatoplasty and the use of pre-surgical infant orthopedic treatment. Our results suggest that pre-surgical infant orthopedic treatment results in the increase of anterior dental width, whereas two-stage palatoplasty is significantly effective for increasing posterior dental width in UCLP patients.

New Neonatal Classification of Unilateral Cleft Lip and Palate—Part 1: To Predict Primary Lateral Incisor Agenesis and Inherent Tissue Hypoplasia

To bring a neonatal classification system of unilateral cleft lip and palate (UCLP) and to correlate this classification with the distribution of the primary lateral incisor. Retrospective with longitudinal follow-up. Setting : Tertiary. Patients : One hundred twenty-one patients with treated UCLP. Thirteen plaster casts were used as controls. The UCLP patients were classified anatomically into four categories: class 1 corresponds to a maxillary arch with a narrow alveolar cleft, class 2 corresponds to a balanced form, class 3 corresponds to a wide cleft and short maxilla, and class 4 corresponds to a wide cleft and long maxilla. Clinical validity was evaluated with a concordance analysis (intra- and interexaminer). This anatomical classification was also corroborated with an automatic classification determined by morphometric parameters measured on neonatal maxillary plaster casts. The class was finally correlated with the distribution of the primary lateral incisor. Clinical classification of UCLP found 12 cases of class 1 (9.9%), 36 cases of class 2 (29.8%), 47 cases of class 3 (38.8%), and 26 cases of class 4 (21.5%). The clinical classification was validated with a good intra- and interexaminer concordance analysis (κ > .6). The automatic classification was close to the clinical classification in 84%. The correlation was ideal in class 1 (100%), almost perfect in class 4 (92%), but lower for class 2 (74%) and class 3 (70%). The primary lateral incisor was usually duplicated in class 1, whereas class 2 and class 4 were correlated with a primary lateral incisor located on the lateral palatal segment. Class 3 was associated with an agenesis of the primary lateral incisor (P < .001). UCLP can be classified into four different classes at birth, which can all give information about the inherent tissue hypoplasia and the distribution of the primary lateral incisor.

The Assessment of Digital Study Models Using the GOSLON Yardstick Index

Objective : To investigate the reproducibility and repeatability of digital models of patients with a unilateral cleft lip and palate (UCLP) using the GOSLON yardstick. Design : Reproducibility and repeatability study. Method : Two examiners used the GOSLON yardstick to assess the intermaxillary dentoalveolar relationship of 30 consecutive UCLP patients by analyzing their 9-year (±3 months) dental study casts and digital study models. The records were rated 1 week apart to avoid bias. The process was repeated 1 month later as a measure of reproducibility. Reliability was assessed by comparing the GOSLON score achieved between the two modalities. Patient dental study casts were sent to 3M Unitek Australia to be scanned using the 3M Unitek Lava(TM) system to produce digital study models. The accuracy of the dental study cast occlusal registration was assessed by both raters prior to sending the study models for scanning. Statistical analysis : The Linear Weighted Kappa statistic and Kendall's Coefficient of Concordance statistic were used to determine the levels of agreement within and between raters. Results : The linear weighted Kappa statistic for intrarater repeatability of digital study models scores were very high (0.89 and 0.97). This compared favorably to the intrarater repeatability of study model casts scores (0.86 and 0.97). There was very good agreement for interrater digital study model scores (0.80 and 0.87) and also for the interrater study model casts scores (0.80 and 0.90). Kendall's Coefficient of Concordance statistic (0.99) and Correlation Coefficient (0.86) support the weighted Kappa results of the digital study model scores. Conclusion : Digital models can be used for GOSLON scoring with a high degree of reproducibility and repeatability.

Late Maxillary Protraction in Patients with Unilateral Cleft Lip and Palate: A Retrospective Study

This retrospective study assessed the dentoskeletal effect of late maxillary protraction (LMP; reverse-pull headgear, Class III elastics, and maxillary sutural loosening) in unilateral cleft lip and palate (UCLP) patients versus a control group of untreated UCLP patients. Cephalograms taken at age 13 to 14 years (T1) and 17 to 18 years (T2) were used for this study. The study group comprised 18 patients (10 male and 8 female, mean age at start of LMP therapy = 13.4 [0.45] years). A control groups of 17 patients (8 male and 9 female, mean age = 13.5 [0.44] years) was used for comparison. The repeated-measures analysis of variance showed statistically significant changes across time between groups for the following variables (mean difference [T2-T1] in the study group, 95% confidence interval): SNA (°) (1.95, 0.75 to 3.15), A ⊥ Na Perp (mm) (1.82, 0.86 to 2.77), CoA (mm) (2.92, 1.53 to 4.31), ANB (°) (3.13, 2.02 to 4.24), Wits (mm) (7.82, 5.01 to 10.54), Mx-Md Diff (mm) (0.62, -1.58 to 2.83), Occl P-SN (°) (-3.98, -5.99 to -1.98), overjet (mm) (8.82, 5.90 to 11.74), FMIA (°) (4.05, -0.05 to 8.15), and IMPA (°) (-5.77, -9.74 to -1.80). Late maxillary protraction created a slight open bite (0.66 mm). Trends for overeruption of mandibular incisors and an increase in lower face height (P = .07 for both) were noted in the study group. Late maxillary protraction produced a combination of skeletal changes (protraction of maxilla, improvement in the maxillo-mandibular skeletal relationship) and dental compensations (counterclockwise rotation of occlusal plane, retroclination of mandibular incisors) in patients with UCLP. Late maxillary protraction was also associated with some unwanted tooth movements (open bite tendency, mandibular incisors overeruption).

Study of Dental Cast and Cephalometric in Unoperated Adult UCLP Patients

Background: Early operated patients with orofacial clefts often develop a retrusive maxilla. It is not clear whether this growth disturbance is attributed to the congenital malformation itself or to the cleft surgery or both. Objective: to evaluate transversal and anterio-posterior maxillary development in unoperated adult patients with unilateral cleft lip and palate (UCLP). Methods: 68 dental casts of unoperated adult UCLP patients were compared to 24 adult controls. The casts were analyzed three dimensionally using an industrial coordinate measuring machine (=CMM) (Zeiss Numerex; Carl Zeiss Stutgart, Germany). 12 cephalograms of unoperated UCLP patients and 24 controls were available and measured for the following variables: Maxillary length, SNA, SNB, Gonial angle and SN-FH angle. The data obtained was analysed by paired t-test, level of significance was set at p<0,05. Results: measured on dental casts, the transversal distance at the level of the second molars was significantly smaller compared to the control group. Cephalometrically there were no significant difference for the 5 cephalometic measurements. Conclusion: the presence of a cleft influences the development of the maxilla: the more extensive the cleft, the more extensive the effect on the dental arch, but the compression of the maxillary arch is limited to the anterior regio. Measured cephalometrically the cleft has no influence on the development of the maxilla. However, the sample size for the cephalometric study was small. DOI: 10.14693/jdi.v16i3.105

3D asymmetry of operated children with oral clefts

To explore three-dimensional (3D) facial asymmetry differences in operated children with oral clefts and to compare the results with a control group. The sample comprised one hundred and three 8- to 12-year-old children: 40 with unilateral cleft lip and palate (UCLP); 23 with unilateral cleft lip and alveolus (UCLA); 19 with bilateral cleft lip and palate (BCLP); 21 with cleft palate (CP) and 80 sex- and age-matched controls living in the North East of England. 3D stereophotogrammetric facial scans were recorded for each participant at rest. Thirty-nine landmarks were recorded for each scan. The x, y and z coordinates for each landmark were extracted. Kruskal-Wallis and Mann-Whitney tests were conducted to identify 3D landmark asymmetry differences between the groups. Statistically significant differences were observed between all the groups. The UCLP and UCLA patients displayed the greatest asymmetry, followed by the BCLP group. The CP group was the least asymmetric among the cleft groups. Asymmetry was present to a lesser extent in the control group. Shape analysis indicates the possible differences in the aetiology and growth pattern of the CP group compared to UCLA or UCLP and BCLP groups.

Biomechanical Effects on Maxillary Protraction of the Craniofacial Skeleton With Cleft Lip and Palate After Alveolar Bone Graft

To explore the biomechanical effects of maxillary protraction on the craniofacial skeleton in patients with unilateral cleft lip and palate (UCLP) after alveolar bone graft (ABG) and resorption of ABG, thus to provide theoretical basis for the clinical application of maxillary protraction, which can improve the facial deformity of the UCLP patients. A finite element model of a UCLP patient's skull was generated using data from spiral computed tomographic (CT) scans. Based on this finite element model, another 6 ABG finite element models were constructed to simulate ABG and resorption of ABG, respectively (nonresorption model, upper one-third resorption of the grafted bone model, upper two-thirds resorption of the grafted bone model, lower one-third resorption of the grafted bone model, lower two-thirds resorption of the grafted bone model, upper one-third and lower one-third resorption of the grafted bone model). Two additional models were developed to simulate maxillary protraction with expansion and maxillary protraction alone. All models were loaded with orthopedic force (30 degrees downward and forward to the occlusal plane, 500 g per side) on the region of alveolar of maxillary canine. Before ABG, the cleft side showed larger displacement than the noncleft side, when it came to the stress distribution in the craniofacial suture, it showed an asymmetric pattern as well. After ABG, the displacement difference between the cleft side and the noncleft side decreased, and the stress distribution in the craniofacial suture showed more symmetric than that before ABG. The pterygopalatine suture obtained the largest value, followed by zygomaticotemporal, zygomaticomaxillary, and zygomaticofrontal sutures among the observed sutures. Higher stresses and pronounced forward displacement were generated in the craniofacial sutures after maxillary protraction with expansion. Maxillary protraction after ABG performed a more favorable outcome. Among the ABG models, nonresorption model showed the best effect after loading maxillary protraction force, and resorption in the lower region of the grafted bone showed a better effect than resorption in the upper region of the grafted bone. Maxillary expansion could effectively facilitate the orthopedic of the maxillary protraction presumably.

Nasal asymmetry in unilateral cleft lip and palate

Comparison of nasal asymmetry between unilateral cleft lip and palate (UCLP) patients with and without nasal correction at primary repair. Assessment of the value of Symnose as a routine research tool. 75 ten-year-old UCLP patients who underwent primary lip repair by one of two techniques: classical Millard with primary nasal correction (n=30) or modified Millard without nasal correction (n=45). Control group of ten-year-old school children (n=45). Nasal asymmetry of participants was measured from facial photographs taken in two views: frontal and basal. The Symnose computer program was used to calculate asymmetry for three parameters: front perimeter (FP), base perimeter (BP) and nostrils (N). Total asymmetry was also calculated. Each image was traced on three separate occasions and a mean of the three measurements was calculated. BP, N and total asymmetry were significantly greater in UCLP patients without nasal correction compared to both controls and patients with correction (BP=12.73% v 4.90% v 6.75%, N=47.73% v 15.83% v 30.75%, total=81.87% v 46.43% v 54.68%, p≤0.001). FP asymmetry was significantly greater in controls than all UCLP patients (22.87% v. 18.18% and 15.07%, p=0.001 and p=0.008). BP measurements have a higher degree of repeatability than FP and N (Coefficient of repeatability=5.99, 17.02 and 16.47, respectively). Primary nasal correction produces greater nasal symmetry during childhood from the basal view. Symnose is a simple method of objectively measuring asymmetry in UCLP, however improvements are required before it can be considered a useful research tool.

Nasal Changes after Presurgical Nasoalveolar Molding (PNAM) in the Unilateral Cleft Lip Nose

Nasal reconstruction for patients with unilateral cleft lip and palate (UCLP) is a challenge for the reconstructive surgeon. Presurgical nasoalveolar molding (PNAM) was introduced to reshape the cleft nasal structures prior to lip repair. This study analyzed two-dimensional nasal changes before and after PNAM in patients with complete UCLP. Thirty UCLP patients (19 males; 11 females) who received PNAM before lip repair were included in this study. PNAM was applied for 100 days. Nasal casts were obtained before and after PNAM. Frontal and 45° standardized digital photographs were taken from all casts, and a photogrammetric analysis (16 linear, six angular, and two area measurements) was performed. Paired Student's t tests were used to search for differences by time, and time versus side (cleft versus noncleft). Significant reduction of cleft columella deviation with an increase in columella length, nostril height, and axial inclination on the cleft side were recorded. This resulted in an increase in the projection of the nasal tip. The noncleft measurements remained without significant changes. The cleft nostril area increased significantly more than the noncleft side by 90% with PNAM treatment. Significant normal growth changes were observed in nasal width and nasal height. A favorable reshaping of the nose after PNAM was achieved, resulting in an improvement in form before lip surgery. These changes lead to improved nasal symmetry before primary lip and nasal reconstruction in UCLP patients.