Unilateral Cleft Lip And Palate Research Articles

Three-dimensional Analysis of Maxillary Morphology in Infants with Unilateral Cleft Lip and Palate.

To three-dimensionally (3D) analyze the maxillary morphology of infants with unilateral cleft lip and palate (UCLP) and preliminarily classify the alveolar arch to assist in personalization of sequence therapy. Retrospective study. Patients with UCLP referred to outpatients' clinic. 84 nonsyndromic infants with complete UCLP were recruited (58 boys, 26 girls, mean age 29.48 days). Morphometric analysis was conducted on 3D maxillary models. Principal component analysis (PCA) and cluster analysis were combined to classify maxillary phenotypes preliminarily. The Wilcoxon Signed Rank test and the Kruskal-Wallis test were used to compare differences between variables. A P value less than .05 was considered statistically significant. The maxilla was divided into three types: narrow, homogenous and broad, accounting for 9.52%, 23.81% and 66.67% respectively. The alveolar cleft site (median value) was located in 61% of the total length of the alveolar arch. In the comparison of anterior and total alveolar lengths, the non-cleft side had longer alveolar bone than the affected side, a difference of approximately 2 mm. Pairwise comparisons of variables describing alveolar symmetry revealed significant differences in all subjects; whereas type C had poorer arch symmetry than types A and B, mainly in terms of anterior and overall symmetry. In infants with UCLP, the maxillary alveolar arch was inherently asymmetrical with partially bone missing (about 2 mm). Significant differences in alveolar bone morphology and symmetry exist between different types of infants, with individuals with broad clefts (type C, the largest proportion) having the worst maxillary development.

Correlation between Cleft Width and Adjacent Teeth Inclination in Patients with Unilateral Cleft Lip and Palate Using CBCT: A Retrospective Study.

To evaluate buccolingual and mesiodistal inclination of cleft-adjacent maxillary permanent central incisors (U1) and canines (U3) in patients with unilateral cleft lip and palate (UCLP) in the late mixed dentition and to investigate the correlation between the alveolar cleft width and cleft-adjacent teeth inclination using cone beam computed tomography (CBCT). Observational cross-sectional retrospective study. Department of Orthodontics, Hama University Dental School. 32 patients with UCLP (22 boys, 10 girls; mean age = 10.53 ± 1.51 years). Buccolingual and mesiodistal inclination of maxillary central incisors and canines were measured on both sides. Then, the cleft and non-cleft sides were compared using the Wilcoxon signed-rank test. Pearson's correlation was used to explore the association between the alveolar cleft width and cleft-adjacent U1 and U3 buccolingual and mesiodistal inclination. The cleft-adjacent central incisors were significantly inclined lingually and distally compared with their non-cleft antimeres (P = .003, P < .001, respectively). The cleft-adjacent canines were significantly inclined buccally and mesially compared with their non-cleft antimeres (P < .001, for both). A positive correlation was found between the buccolingual inclination of cleft-adjacent U1 and the alveolar cleft width (r = 0.49, P = .004). Patients with UCLP demonstrated a significant lingual and distal inclination of cleft-adjacent U1 and a significant buccal and mesial inclination of cleft-adjacent U3. The buccolingual inclination of cleft-adjacent U1 tends to increase with increasing the alveolar cleft width; however, the correlation was weak.

Cleft Laterality Dental Arch Relationship Outcomes for Children with Unilateral Cleft Lip and Palate in New Zealand.

To investigate cleft laterality dental arch relationship outcomes of children with non-syndromic complete unilateral cleft lip and palate (UCLP) in New Zealand. A retrospective nationwide study. Virtual 3D orthodontic study models collected prior to undertaking secondary alveolar bone grafting. A total of 104 patients with UCLP (L = 80: R = 24). Four calibrated assessors used the GOSLON Yardstick and 100 mm Visual Analogue Scale (VAS) to score the randomised models on 2 separate assessment sessions. Weighted Kappa were used to determine the intra/inter-rater reliability for the GOSLON and correlations for the VAS. Intra-rater reliability ranged from 0.57-0.88 (GOSLON) and 0.45-0.93 (VAS). Inter-rater reliability ranged from 0.62-0.86 (GOSLON) and 0.64-0.93 (VAS).GOSLON scores for the left UCLP were 31.2% for good/very good; 26.3% for fair; 42.5% for poor/very poor while the right UCLP scored 8.3% for good/very good; 37.5% for fair; 54.2% for poor/very poor. The mean VAS for left and right UCLP were 53.4 (sd 22.5) and 44.6 (sd 17.1) respectively. Neither the GOSLON nor VAS differences reached statistical significance (both P = .08). From a clinical perspective right UCLP had worse dental arch relationship outcomes, however, these differences failed to reach statistical significance. Further studies using larger sample sizes are required to determine if cleft laterality is an important consideration when investigating UCLP dental arch outcomes.

Longitudinal Speech Outcome at 5 and 10 Years in UCLP: Influence of Speech Therapy and Secondary Velopharyngeal Surgery.

To investigate speech development of children aged 5 and 10 years with repaired unilateral cleft lip and palate (UCLP) and identify speech characteristics when speech proficiency is not at 'peer level' at 10 years. Estimate how the number of speech therapy visits are related to speech proficiency at 10 years, and what factors are predictive of whether a child's speech proficiency at 10 years is at 'peer level' or not. Longitudinal complete datasets from the Scandcleft project. 320 children from nine cleft palate teams in five countries, operated on with one out of four surgical methods. Secondary velopharyngeal surgery (VP-surgery) and number of speech therapy visits (ST-visits), a proxy for speech intervention. 'Peer level' of percentage of consonants correct (PCC, > 91%) and the composite score of velopharyngeal competence (VPC-Sum, 0-1). Speech proficiency improved, with only 23% of the participants at 'peer level' at 5 years, compared to 56% at 10 years. A poorer PCC score was the most sensitive marker for the 44% below 'peer level' at 10-year-of-age. The best predictor of 'peer level' speech proficiency at 10 years was speech proficiency at 5 years. A high number of ST-visits received did not improve the probability of achieving 'peer level' speech, and many children seemed to have received excessive amounts of ST-visits without substantial improvement. It is important to strive for speech at 'peer level' before age 5. Criteria for speech therapy intervention and for methods used needs to be evidence-based.

Cleft Treatment: Obturpaedics, Orthopaeddontics, Orthodontics-Important Concepts

Cleft patients present with a wide clinical spectrum. Deciding on the precise techniques is of utmost importance. There are various surgical procedural treatments, what is critical, is the technique used in the course of the application of Obturpaedic, Orthopaeddontic and Orthodontic treatments. The reason for its importance is that it impacts on the lifelong outcome for the cleft patient and the goal is to obtain the optimal result. Deciding on the most suitable treatment plan is often challenging, especially for patients born with unilateral and bilateral cleft lip, cleft alveolus, cleft hard and soft palate (CLAP) (±41%) and those with a hard and soft palate cleft (hPsP) (±17%), including infants born as a Pierre Robin sequence (±6%) for their survival. Additional cleft anomalies, such as isolated Cleft Lip (CL) (6%), Cleft Lip with Cleft Alveolus (CLA) (±14%) and isolated Soft Palate Cleft (sP) (18%), presents less of a challenge with the application of Obturpaedic, Orthopaeddontic and Orthodontic treatments.

Facial Analysis of Patients with Unilateral or Bilateral Cleft Lip and Palate Using 3D Stereophotogrammetry.

To evaluate the quantitative values of linear and angular facial anthropometrics in patients with unilateral cleft lip and palate (UCLP) and compare them with those of patients with bilateral cleft lip and palate (BCLP) using three-dimensional (3D) facial imaging. Retrospective, observational, and cross-sectional study. Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP). In total, 61 non-syndromic patients with CLP who underwent multidisciplinary treatment and rehabilitated with a prosthesis were enrolled and divided into those with UCLP (G1; n = 31) and those with BCLP (G2; n = 30). Facial images were captured using a 3D camera after landmarks were marked on each patient's face. The software evaluated linear and angular parameters. Statistical tests were applied. Significance was determined as P < 0.05. Overall, 22 linear and 13 angular measurements were evaluated. The nasal length (P = 0.08), middle third of the face (P = 0.06), base nose width (P < 0.001), nasal root width (P < 0.001), nasal tip angle (P = 0.018), philtrum width (P < 0.001), lower face width (P = 0.039) and midfacial depth (P = 0.040) were significantly higher in G2; the upper cutaneous lip height was significantly higher in G1. Sexual dimorphism was observed except for linear measurements (linear distance between the labiale superius and labiale inferius landmarks, nasal root width, and upper cutaneous lip length) and angular measurements. G2 had a greater length and width of nose and nasal root, nasal tip angle, philtrum width, and lower face width, midfacial depth, and midface third than G1. These findings also revealed the presence of sexual dimorphism.

The Influence of Sidedness in Unilateral Cleft Lip and Palate on Mid Facial Growth at Five Years of Age.

To determine whether facial growth at five years is different for children with a left versus right sided cleft lip and palate. Retrospective cohort study. Seven UK regional cleft centres. Patients born between 2000-2014 with a complete unilateral cleft lip and palate (UCLP). 5-Year-Old's Index scores. 378 children were included. 256 (68%) had a left sided UCLP and 122 (32%) had a right sided UCLP. 5-Year-Old's index scores ranged from 1 (good) to 5 (poor). There was a higher proportion of patients getting good scores (1 and 2) in left UCLP (43%) compared to right UCLP (37%) but there was weak evidence for a difference (Adjusted summary odds ratio 1.27, 95% CI 0.87 to 1.87; P = .22). Whilst maxillary growth may be different for left versus right sided UCLP, definitive analysis requires older growth indices and arch forms.

Dental Arch Relationships of Saudi Children with Unilateral Cleft Lip and Palate.

To determine dental arch relationships of Saudi children born with nonsyndromic complete unilateral cleft lip and palate (UCLP). This is a retrospective cohort study that comprised dental study models of 74 UCLP Saudi children aged 8-10 years who were recruited from 14 referral cleft centers. All participants had their cleft lip and palate repaired with no history of alveolar bone graft or any orthodontic treatment. Dental arch relationships of UCLP patients were assessed using the Great Ormond Street, London, and Oslo (GOSLON) Yardstick-a clinical tool that categorizes dental relationships of UCLP children into five discrete grades from I to V. The reliability of the rating was assessed with weighted kappa (κ) statistics. Three children (4.1%) had excellent surgical outcomes (grade I), 18 children (24.3%) filled into grade II (good outcome), 22 subjects (29.7%) had grade III (fair outcome), 27 children (36.5%) had grade IV (poor outcome), and 4 subjects (5.4%) were ranked as having very poor outcomes (grade V). The mean GOSLON score was 3.39. Intrarater and interrater agreements were high indicating good reproducibility. Based on the dental arch relationships, the treatment outcome of UCLP Saudi children was unsatisfactory, with a mean GOSLON score of 3.39. Delayed palate repair and the use of presurgical orthopedics may be considered in the future for cleft deformity management. To address the effect of particular cleft surgical protocol on dental arch relationships of UCLP patients. How to cite this article: Alforaidi S, Zreaqat M, Hassan R. Dental Arch Relationships of Saudi Children with Unilateral Cleft Lip and Palate. J Contemp Dent Pract 2023;24(12):987-990.

Cortical Bone Thickness and Morphology at the Infrazygomatic Crest Area in Growing Thai Patients with UCLP: A CBCT Study.

To determine and compare buccal cortical bone thickness and morphology (in terms of shape and height) at the infrazygomatic (IZ) crest in growing Thai patients with unilateral cleft lip and palate (UCLP) using cone-beam computed tomography (CBCT) with the ultimate goal of identifying potential sites that are suitable for the placement of miniplates. Prospective study. Institutional research. Twenty-four Thai patients with non-syndromic complete UCLP with Class III skeletal discrepancy aged 10-14 years. A total of 48 CBCT images captured the IZ crest. Five horizontal and six vertical reference planes were established in the IZ crest area. The mean buccal cortical bone thickness of the cleft and non-cleft sides were 1.13 ± 0.45 mm and 1.15 ± 0.46 mm, respectively. The most frequently observed shape for the IZ crest was the external concave contour. There were no statistically significant differences in cortical bone thickness and shape distribution between the cleft and non-cleft sides. (P > .05). The thickness of the buccal cortical bone increased anteriorly and superiorly from V + 0 and H + 0. The average height of IZ crest on the cleft side was 16.20 ± 1.59 mm and 16.78 ± 1.84 mm on the non-cleft side. Notably, significant differences were detected in terms of height between the cleft and non-cleft side and cortical bone thickness by gender (P < .05). The IZ crest was found to provide sufficient support for the insertion of a miniplate, particularly in the superior and anterior regions, ensuring primary stability in growing Thai patients with UCLP.

Validity of the Cleft Aesthetic Rating Scale Does Not Improve with Inclusion of Fixed Scores for Atypical Outcomes.

The Cleft Aesthetic Rating Scale (CARS) is a valid tool to assess the aesthetic outcome after unilateral cleft lip and palate (UCLP) repair. The goal of this study was to investigate whether the reliability of CARS increases by including fixed rates for atypical outcomes such as a smaller nostril, lower vermillion border or whistling deformity. 197 patients with UCLP who underwent cleft repair were included. Three cleft experts rated the post-operative photos using the original CARS, followed by a second assessment employing the modified CARS. Medisch Centrum Leeuwarden, Universitair Medisch Centrum Groningen, Radboud Universitair Medisch Centrum and Amsterdam University Medical Center. Photographs of 16- to 25-year-old patients with repaired UCLP. Two separate assessments using the original and modified CARS. The Intraclass Correlation Coefficient (ICC) was used to test inter-rater reliability of the original and modified version of the CARS. The reported ICC for the nose scored by means of the original and modified CARS were 0.68 (95% CI 0.62-0.74) and 0.66 (95% CI 0.59-0.72) respectively. The reported ICC for the lip assessed with the original and modified CARS were 0.53 (95% CI 0.33-0.67) and 0.57 (95% CI 0.34-0.72) respectively. No significant difference was found between the original and modified ICC of the nose and lip. The implementation of the fixed rates did not result in an increased reliability of the CARS. Therefore, we recommend the utilization of the original CARS.

Should left- and right-sided unilateral cleft lip and palate patients be grouped together when reporting the outcomes?

Investigate associations between cleft laterality in patients with non-syndromic unilateral cleft lip and palate (UCLP) and oral-health, dental-arch, speech, audiological, psychological and nasolabial-aesthetic outcomes. Secondary data analysis of the outcomes of 5-year-old children with non-syndromic complete UCLP identified from three studies: Cleft Collective (n = 155), Cleft Care UK (CCUK) (n = 266) and Clinical Standards Advisory Group (CSAG) study (n = 238). Outcome measures included occlusal assessment using the 5-year-old's index score, speech intelligibility rating using the CAPS-A Audit tool, audiological assessment using pure tone audiometry, nasolabial aesthetic assessment using the Asher-McDade tool, oral-health assessment using decayed, missing, filled teeth scores and parent-reported outcomes. Logistic regression with adjustment for age, sex and index-of-multiple-deprivation scores were performed. No differences were found in patient-reported outcomes between the left and right clefts in the Cleft Collective study. From the CCUK study, right clefts had poorer speech (n = 236; 95% CI 1.09, 3.42; and P = .03) and hearing outcomes (n = 211; 95% CI 1.03, 3.43; P = .04). In the CSAG study, patients with left clefts were more likely to be teased (n = 213; 95% CI 0.26, 0.85; and P = .01). Weak associations between cleft laterality, speech, hearing and psychological outcomes were found, however the findings were inconsistent across the studies. This study contributes to evidence of associations between laterality and outcomes in children born with UCLP.

Enhanced antimicrobial efficacy of chlorhexidine-encapsulated halloysite nanotubes incorporated in presurgical orthopedic appliances: an in vitro, controlled study.

Presurgical infant's orthopedic appliances (PSIOs) play an increasingly crucial role in the interdisciplinary management of neonatal CLP, aiming to improve and maintain adequate nasolabial aesthetics, followed by primary lip/nasal surgery in both unilateral and bilateral CLP cases. The use of PSIOs in cleft lip and palate patients can lead to contamination with oral microflora, acting as a potential reservoir for infectious microorganisms. Acrylic surfaces might provide retention niches for microorganisms to adhere, and inhabit, which is difficult to control in immunocompromised patients, thus predisposing them to increased infection risks. The objective of this multi-assay in vitro study was to investigate the effects of incorporating chlorhexidine-loaded halloysite nanotubes (CHX-HNTs) fillers on the morphological, cytotoxic, release, and antimicrobial characteristics of self-cured acrylic polymethyl methacrylate (PMMA) material used in pre-surgical orthopedic appliances. Disk-shaped PMMA specimens were prepared with varying proportions of CHX-HNTs. A control group without any addition served as a reference, and four experimental samples contained a range of different concentrations of CHX-HNTs (1.0, 1.5, 3, and 4.5 wt%). The antimicrobial efficacy was assessed using an agar diffusion test against common reference microorganisms: Candida albicans, Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus agalactiae. Cytotoxicity was examined using the L929 cell line (mouse fibroblasts) through a (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide, MTT) cell viability assay. The release kinetics of CHX were monitored using UV-spectral measurements. The statistical analysis used a one-way ANOVA followed by Tukey's post hoc test. The integration of CHX-HNTs in PMMA exhibited a substantial dose-dependent antifungal and antibacterial effect against microorganisms at tested mass fractions (1.0 to 4.5 wt%). CHX release was sustained for up to 60 days, supporting prolonged antimicrobial activity. Furthermore, no significant cytotoxicity was determined in the L929 fibroblast cell line (control), indicating the biocompatibility of the CHX-HNTs-enhanced PMMA. Incorporating CHX-HNTs in PMMA successfully enhanced its antimicrobial properties, providing sustained CHX release and superior antimicrobial efficacy. These findings demonstrate the potential of antimicrobial nanoparticles in dental therapies to improve therapeutic outcomes. However, rigorous further clinical trials and observational studies are warranted to validate the practical application, safety, and efficacy. This study has the potential to make a major impact on the health of infants born with cleft lip and palate by helping to reduce the prevalence of infectious illnesses. The incorporation of CHX-HNTs into PMMA-based appliances is a novel promising preventive approach to reduce microbial infections.

Dental and skeletal maturation of Chinese male children with unilateral cleft lip and palate.

The aim of this study was to determine whether the relationship between dental age (DA), cervical stage (CS) and chronological age (CA) in Chinese male children with unilateral cleft lip and palate (UCLP) is similar to that of children without clefts. Panoramic and cephalometric radiographs of 105 male UCLP patients, aged from 8 to 16 years, were collected and compared to 210 age-matched healthy control males. The Demirjian and cervical vertebral maturation (CVM) methods were used to visually examine the radiographs and Spearman's correlation analysis was used to identify differences between the two groups with regards to CS, DA and CA. There was a significant positive correlation between DA and CA in both groups and the mean CA-DA difference was significantly higher in children with UCLP when compared to controls (0.319 vs. 0.003, p < 0.05). A significant delay in tooth development was detected in UCLP children from 10 to 12 years-of-age. Both the UCLP and control groups showed high correlations between CS and DA. Calcification stage D appeared only before CS3; however, from CS5 to 6, all teeth have almost completed their maturation phase. Chinese male UCLP patients are likely to experience delayed tooth development compared to healthy controls, especially during the fast-growing period. Evaluating the stages of tooth mineralization could represent a rapid method to assess growth potential.

Differences in velopharyngeal pressures during speech sound production in patients with unilateral cleft lip and palate (UCLP) and healthy individuals.

During articulation the velopharynx needs to be opened and closed rapidly and a tight closure is needed. Based on the hypothesis that patients with cleft lip and palate (CLP) produce lower pressures in the velopharynx than healthy individuals, this study compared pressure profiles of the velopharyngeal closure during articulation of different sounds between healthy participants and patients with surgically closed unilateral CLP (UCLP) using high resolution manometry (HRM). Ten healthy adult volunteers (group 1: 20-25.5 years) and ten patients with a non-syndromic surgically reconstructed UCLP (group 2: 19.1-26.9 years) were included in this study. Pressure profiles during the articulation of four sounds (/i:/, /s/, /ʃ/ and /n/) were measured by HRM. Maximum, minimum and average pressures, time intervals as well as detection of a previously described 3-phase-model were compared. Both groups presented with similar pressure curves for each phoneme with regards to the phases described and pressure peaks, but differed in total pressures. An exception was noted for the sound /i:/, where a 3-phase-model could not be seen for most patients with UCLP. Differences in velopharynx pressures of 50% and more were found between the two groups. Maximum and average pressures in the production of the alveolar fricative reached statistical significance. It can be concluded that velopharyngeal pressures of patients with UCLP are not sufficient to eliminate nasal resonance or turbulence during articulation, especially for more complex sounds. These results support a general understanding of hypernasality during speech implying a (relative) velopharyngeal insufficiency.

Evaluation of Cervical Spine Curvature and its Relation with Cranial Base in Class I, Cleft and Class III Malocclusion Individuals: A Cross-sectional Analysis

Introduction: According to the literature, an existing correlation is said to be present between craniocervical and craniofacial morphology. Recent studies have revealed that there are certain variations among the different forms of craniofacial patterns with respect to the morphology of the vertebrae. Since there are very few studies comparing the curvature of the cervical column in relation to the cranial base in Cleft, Class-I and ClassIII individuals, this study was carried out. Aim: To provide a comprehensive comparative analysis of the curvature of the cervical vertebral column and its relationship with the cranial base in Class-I, cleft, and Class-III individuals within the Central Indian population. Materials and Methods: In this cross-sectional study conducted at the Department of Orthodontics and Dentofacial Orthopaedics at Sharad Pawar Dental College and Hospital, Sawangi (M).Wardha, Maharashtra, India, patients with skeletal Class-I, Class-III, and Unilateral Cleft Lip and Palate (UCLP) or Bilateral Cleft Lip and Palate (BCLP) in the Central India region were included. The study duration was eight months, from April 2022 to January 2023. The research involves a meticulous examination of 90 individuals, divided into three groups: Class-I individuals (n=30), cleft individuals (n=30), and ClassIII individuals (n=30). A comprehensive set of radiographic and cephalometric measurements will be employed to assess cervical vertebral curvature. One-way Analysis of Variance (ANOVA) test was used for analysis. Results: With the exception of Sella-Nasion to Gonion Gnathion (SA-Go-Gn), where the p-value was 0.13, a statistically significant difference between Class-I and Class-III was seen for all angles. For Class-III cases with clefts, every angle revealed a statistically significant difference. Except for SN-Go-Gn (p=0.65), all of the angles revealed a statistically significant difference when compared to Class-I with Cleft, with a p-value &lt;0.05. Conclusion: The modified curvature angle utilised in the present study facilitated the assessment of cervical curvature in Cleft, Class-I, and Class-III malocclusions, revealing differences in skeletal sagittal jaw relations, particularly in their cervical positions, as indicated by the study findings. Participants in skeletal Class-III had significantly straighter cervical columns than participants in skeletal Class-I. A significant difference between the maxillary base, mandibular base, and the midsection of the spinal column was seen between all three groups.

The Effect of Cleft Width on Maxillary Morphology in Newborn with Unilateral Cleft Lip and Palate

Objective: This study aims to investigate the impact of cleft width on maxillary morphology in newborns with unilateral cleft lip and palate (UCLP). Materials and Methods: Plaster models from 35 newborns with unilateral cleft lip and palate (UCLP) (17 boys, 18 girls) and 35 newborns with isolated soft palate cleft (CP) (16 boys, 19 girls) were examined. The measured parameters included C-C' , T-T', arch circumference, arch length, G-L, a-a', and b-b'. Statistical analyses were conducted using an independent samples t-test and Mann–Whitney U test for normally and non-normally distributed data, respectively. Pearson Correlation assessed the correlation between G-L and other measurements. The analysis was performed at a significance level of 0.05 using R software, version 4.0.5. Results: Statistically significant differences were found in C-C' (p &lt; 0.001) and T-T' (p &lt; 0.05) between the two groups. UCLP newborns showed a significant increase in arch length (28.4 ± 2.9 mm) compared to CP (25.0 ± 2.6 mm, p &lt; 0.001). Both (a-a') and (b-b') demonstrated a significant increase in UCLP (p &lt; 0.001). A significant correlation was observed between (G-L) and (C-C') and (a-a') (p &lt; 0.01), and between (T-T') and (a-a') and (b-b') (p &lt; 0.01). The correlation between arch circumference and (b-b') was significant at the 0.05 level. Conclusion: In UCLP newborns with increased anterior cleft width, the anterior alveolar arch width increases, affecting maxillary morphology. While early orthopedic and surgical interventions prove effective in managing severe clefts, the initial severity of the cleft width significantly influences dental arch relationships and treatment outcomes. Consequently, initiating maxillary expansion and protraction interventions during the early primary dentition period becomes crucial.

Assessment of Multiple Dimensions of Psychological Well-Being in Swiss Youth Born with a Unilateral Cleft Lip and Palate

Objective This study examines the psychological well-being of Swiss youths born with a unilateral cleft lip and palate (UCLP), in a multi-dimensional and clinical perspective. Design Retrospective cross-sectional study. Setting Self-report questionnaires completed by youths born with UCLP, followed at a specialized cleft clinic in Switzerland, and by peers without UCLP, recruited in schools of the Vaud county, Switzerland. Participants Youths aged 7.5 to 16, born with UCLP (clinical group, n = 41, 29.2% female) or without UCLP (control group, n = 56, 49.0% female). Outcome measures Adverse life events (ALE; Adverse Life Events), behavioral and emotional symptoms ( Strengths and Difficulties Questionnaire and Post-Traumatic Checklist Scale), bodily self-esteem ( Body Esteem Scale), quality of life ( Kidscreen-27), emotion regulation ( Cognitive Emotion Regulation Questionnaire), social support ( Sarason's Social Support Questionnaire). Results Most outcomes showed no significant group-difference. Compared to matched peers, youths with UCLP reported lower psychological quality of life and social support satisfaction, along with positive factors of fewer ALE and lower non-adaptive emotion regulation. In youths with UCLP, higher scores for ALE were associated with higher total scores for behavioral and emotional symptoms. Higher scores for bodily self-esteem were associated with higher scores for satisfaction of social support and adaptive emotion regulation. Conclusions Youths with UCLP show globally similar psychological well-being as matched peers. We observed some vulnerabilities but also protective factors, which support the need for psychological perspective within multidisciplinary care. The relationships between dimensions suggest specific targets that may have an impact in context of intervention.

Bone-Anchored Maxillary Protraction for Adolescents with Cleft Palate and Class III Malocclusion: A Case Series

To describe the long-term treatment course of bone-anchored maxillary protraction (BAMP) and evaluate orthognathic surgical indications after BAMP Retrospective case series Craniofacial/Cleft Palate Program at the Orthopaedic Institute for Children in Los Angeles, CA Twelve male patients with cleft palate (CP), unilateral cleft lip and palate (UCLP), or bilateral cleft lip and palate (BCLP) and Class III malocclusion treated with BAMP (mean age: 11.4 ± 2.6 years) were included. BAMP treatment was performed by placement of bone-anchored maxillary and mandibular plates connected with intraoral Class III dental elastics or maxillary plates connected to a facemask. We retrospectively assessed BAMP treatment variables, including age at surgery, revision surgeries, and treatment duration. The primary goal was correction to class I occlusion. Twelve patients underwent BAMP treatment for an average of 4.4 ± 2.4 years. Two patients were corrected to class I occlusion at the time of this report. Le Fort I advancement was no longer required in two patients (16.7%), it was required for nine patients (75.0%) and was completed for one patient following BAMP treatment (8.3%). This preliminary report demonstrated that BAMP treatment may be associated with a minimal reduction in the requirement for Le Fort I advancement at skeletal maturity. Future studies with larger sample sizes are necessary to confirm this association.

Evaluation of nasolacrimal canal morphology in different facial skeletal relationships

BackgroundAbnormal morphological variations of nasolacrimal canal (NLC) and its lack of understanding contributes to acquired injuries during craniomaxillofacial surgical procedures which leads untoward postoperative complications like nasolacrimal obstruction (NLO) and epiphora. PurposeThe purpose of this study was to determine dimensional and volumetric morphological variations of nasolacrimal canal in various facial skeletal relationships which aid in performing a precise and safe surgery. Materials and methodsThis retrospective cohort study involved dimensional and volumetric analysis of nasolacrimal canal procured from computed tomography scans of 47 individuals grouped as ClassI, Class II and Class III, and unilateral cleft lip and palate (UCLP) groups. The outcome variables included length of NLC, volume of NLC, distance between the inferior orifice of the NLC to nasal floor, distance between inferior orifice of NLC to canine apex and distance between inferior orifice of NLC to central incisor apex. The objectives were to analyse morphological variation of NLC in different facial skeletal relationships and to evaluate the variation with change in facial sides and its relationship with surrounding structures. ResultsVolume of the NLC was found significant in Class I and UCLP population (p < 0.05) with the greatest volume in the UCLP group. The mean linear and volumetric measurements between the right and left sides were found insignificant among all groups. Inferior orifice of NLC from canine apex were farthest in Class III and nearest in the UCLP group (p < 0.05). There was no significant association between outcome variables and skeletal base configuration. ConclusionNLC demonstrates dimensional and anthropometric variations between different skeletal relationships and this study is inevitable in understanding the probability of NLC injury during maxillofacial surgeries.

THE INFLUENCE OF CLEFT LIP AND PALATE SEVERITY ON SURGICAL OUTCOMES

Highlights: The severity of unilateral CLP was assessed by categorizing preoperative photo data based on the severity of the cleft, and this severity was then correlated with the surgical outcomes. The way wounds heal is influenced by the width of the gap and suture tension, which are crucial factors in determining surgical outcomes. Abstract: Introduction: An orofacial cleft is a congenital abnormality in which an abnormal opening or cleft of the lips and/or palate. Data in 2017 showed that the most encountered characters are patients with cleft lip and palate. The distribution of the incidence of cleft lip and palate at Cleft Lip and Palate (CLP) Center Faculty of Medicine University of Muhammadiyah Malang was dominated by the complete unilateral type, which was 45.22%. Generally, the severity of cleft lip and/or palate is influenced by the severity of the preoperative cleft. Methods: This study used a retrospective cohort design taken from 40 medical records at Cleft Lip and Palate (CLP) Center Faculty of Medicine University of Muhammadiyah Malang. The preoperative photo data were categorized according to the severity of the cleft, then postoperative photos were assessed according to the Visual Rating Chart (VRC) indicator. Results: The intraclass correlation coefficient (ICC) reliability test between evaluators has a strength of &gt; 0.8 on the outcome of lip and nose surgery and also &gt; 0.9 on the outcome of the palate, indicating that there was no perception gap between evaluators. The Mann-Whitney non-parametric test had a significance of p &lt; 0.05, indicating that there was a positive correlation between the severity of unilateral cleft lip and palate and the outcome of surgery. Conclusion: There is a correlation between the severity of the unilateral cleft lip and palate and the surgical outcome.