Complete Unilateral Cleft Lip Research Articles

The Implications of Laterality in Unilateral Cleft Lip Reconstruction: A Global Survey of Cleft Surgeons.

To explore the impact of directional laterality in complete Unilateral Cleft Lip (UCL) amongst the global cleft surgeon community. Cross-sectional survey study. Global distribution of online survey distributed in English and Spanish. Cleft surgeons from around the world. Survey participant perception of the impact of laterality on: (1) cleft presentation (2) surgical challenge and (3) surgical outcomes. Responses were received from 453 cleft surgeons located in 54 countries around the world. 221 (49%) had previously considered differences in patients presenting with a left- versus right-sided UCL. 95 (21%) considered right-sided clefts more difficult to reconstruct, 37 (8%) reported left-sided clefts to be more difficult and 321 (71%) reported no difference in difficulty between the cleft sides. Higher volume cleft surgeons, characterised by those reporting cleft as their principal area of practice and performing >20 cleft operations per year, were more likely to have both previously considered differences in laterality in cleft and to report right-sided unilateral cleft lip to be more difficult to primarily reconstruct. 395 (87%) did not consider surgical outcomes to be influenced by cleft laterality. This survey reports perceptions on cleft laterality from a large body of global surgeons and suggests a trend for increased difficulty in right-sided compared to left-sided cleft lip reconstruction, where such laterality-associated difficulty is perceived.

The Severity of Cleft Lip and Palate and Postsurgical Outcome in Non-syndromic Complete Unilateral Cleft Lip and Palate: A Pilot Study Based on Surgeon’s Perception

The Severity of Cleft Lip and Palate and Postsurgical Outcome in Non-syndromic Complete Unilateral Cleft Lip and Palate: A Pilot Study Based on Surgeon’s Perception

IMPACT OF NASOALVEOLAR MOLDING ON MAXILLARY ARCH DIMENSIONS AND MALOCCLUSION CHARACTERISTICS IN PEDIATRIC PATIENTS WITH CLEFT LIP AND PALATE DURING PRIMARY DENTITION

Unilateral complete cleft lip and palate (UCLP) are congenital disabilities when a baby's lip or mouth does not form properly during early pregnancy. This retrospective study investigated the long-term effects of passive alveolar molding (PAM) and nasoalveolar molding (NAM) on cleft width and maxillary growth parameters in children with UCLP. A retrospective study of children with UCLP was enrolled and divided into two groups: PAM and NAM. Cleft width measurements were obtained at baseline and regular intervals during the follow-up period. Maxillary growth parameters were also assessed, including arch width, dental occlusion, and facial symmetry. Data were analyzed using descriptive statistics, chi-square tests, and linear regression models. Data was collected from 52 patients according to the inclusion criteria. The NAM group consisted of 22 patients with UCLP (mean age of 3.98 ± 1.6 years) and 12 patients with BCLP mean age of 3.81 ± 1.9 years. Fourteen patients with UCLP (mean age 3.9 ± 1.9 years) and four patients with BCLP and mean age 4.4 ± 2.1 years were included in the non-NAM group. It is concluded that the results of our study suggest that passive alveolar molding (PAM) and nasoalveolar molding (NAM) have a significant impact on cleft width reduction and maxillary growth in unilateral cleft lip palate (UCLP).

Intraoral Scanning Evaluation of Maxillary Arch Changes after Modified Sommerlad Palatoplasty for around Three Years.

The purpose of this study was to investigate dental arch changes after modified Sommerlad palatoplasty in patients with cleft palate by intraoral scanning technique in children with early deciduous dentition. This study included 60 patients with nonsyndromic unilateral complete cleft lip with palate or cleft palate only treated by modified Sommerlad palatoplasty without relaxed excision before 18 months of age and 95 healthy controls without cleft. Three-dimensional images of the maxillary dental arches of all participants at age 3 to 4 years were obtained by intraoral scanning technique. Seven parameters (anterior dental arch width, middle dental arch width, posterior dental arch width, anterior palatal arch width, posterior palatal arch width, anterior dental arch length, and entire dental arch length) were measured. Compared with the male group, the posterior palatal arch width distance of controls in the female group decreased significantly ( P = 0.039), and the middle dental arch width, posterior dental arch width, and posterior palatal arch width distance of female patients decreased ( P = 0.013, P = 0.002, P = 0.005, respectively). The anterior dental arch length and entire dental arch length distance of children in the unilateral complete cleft lip with palate group was shorter than those of children with cleft palate only ( P < 0.0001, P < 0.0001, respectively). The patient group showed decreased distance of anterior dental arch width, anterior palatal arch width, anterior dental arch length, and entire dental arch length, and increased distance of posterior dental arch width and posterior palatal arch width compared with the control group ( P = 0.0002, P = 0.002, P < 0.0001, P < 0.0001, P = 0.007, P = 0.027, respectively). The results indicated that the modified palatoplasty group showed no growth inhibition in the middle or posterior dental arch width, or palatal arch width, but slight but significant inhibition in the length of the anterior and entire dental arch. Therapeutic, IV.

The Effectiveness of Releasing the Lower Lateral Cartilage Through Intranasal Z-plasty Incision on the Vestibular Web During Secondary Correction of Nasal Deformities in Complete Unilateral Cleft Lip and Palate.

The primary goal in the secondary correction of unilateral cleft lip nose deformity is to achieve symmetry of the nose and nostril. This study aimed to investigate the efficacy of freeing the lower lateral cartilage from the pyriform ligament through an intranasal Z-plasty incision on the vestibular web in adult patients with complete unilateral cleft lip and palate. Thirty-six patients with complete unilateral cleft lip and palate, who underwent open rhinoplasty between August 2014 and December 2021, were identified retrospectively. Five parameters for nose form and nostril symmetry were measured on basal views through 2-dimensional photographic analysis. The patients were divided into subgroups with or without septoplasty. Cleft-to-non-cleft ratios between the Z (13 patients) and non-Z groups (23 patients) were compared using the Mann-Whitney U test. The mean follow-up was 12.9 months (6-31mo). In the Z group, there were significant differences between the preoperative and postoperative values for nostril angulation, regardless of septoplasty (all P <0.05). Despite septoplasty, significant differences in the postoperative changes in nostril angulation were found between the Z and non-Z groups (all P <0.05). Intranasal Z-plasty on the plica vestibularis is an effective technique for releasing the lower lateral cartilage, improving the nostril asymmetry in cleft lip nose deformity.

Three-Dimensional Evaluation of Nasolabial Morphology After Applying Presurgical Nasoalveolar Molding in Primary Unilateral Cheiloplasty Using the Modified Millard Technique.

To compare the soft tissue measurements of the upper lip and the nose on the cleft side and the noncleft side before surgery, immediately after cheiloplasty and two months after surgery. Descriptive clinical study with one group, prospective. Department of Odonto-Stomatology, Children's Hospital 1, at Ho Chi Minh City - Vietnam. 31 patients with a unilateral complete cleft lip participated in this study, 30 patients were evaluated at the time two months after surgery. Interventions include PNAM and cheiloplasty by modified Millard technique. Patients proceed to acquire 3D images of lips and nose, define landmarks and measure dimensions. There are 11 evaluators to be compared, p < 0.05 was considered statictical significance. After two months of surgery, on cleft side and noncleft side, the lengths of the upper lip were 10.87 ± 0.80 and 11.92 ± 0.78 (mm), the widths of the upper lip were 16.06 ± 1.10 and 16.40 ± 1.02 (mm), the heights of the nostril were 4.85 ± 0.44 and 5.93 ± 0.43 (mm), the lengths of columella were 4.08 ± 0.37 and 4.93 ± 0.38 (mm), and the widths of the nostril were 9.07 ± 0.37 and 8.37 ± 0.40 (mm). Cheiloplasty by modified Millard technique on the patients who used PNAM showed that after two months of surgery, the morphology of the upper lip and nose has a slight disproportion with the nasolabial measurements of the cleft side being smaller than on the noncleft side.

Differences of temporomandibular joint symmetry in patients with unilateral complete cleft lip and palate at different developmental stages.

Currently, the research results regarding the bilateral temporomandibular joint symmetry in patients at different ages with unilateral complete cleft lip and palate (UCLP) are still controversial. In this study, the position of condyle in the articular fossa and morphology of condyle in UCLP patients at different developmental stages was measured and analyzed to explore the asymmetry difference, which can provide a new theoretical basis for the sequential therapy. A total of 90 patients with UCLP were divided into a mixed dentition group (31 cases), a young permanent dentition group (31 cases) and an old permanent dentition group (28 cases) according to age and dentition development. Cone beam computed tomography (CBCT) images were imported into Invivo5 software for 3D reconstruction, and the joint space, anteroposterior diameter, medio-lateral diameter, and height of condylar were measured, and its asymmetry index was calculated. The asymmetry index of condylar height and anteroposterior diameter among the 3 groups, from small to large, was the mixed dentition group<the young permanent dentition group<the old permanent dentition group (both P<0.05). There was no significant difference in condylar anteroposterior diameter and asymmetry index between the mixed dentition group and the young permanent dentition group (both P>0.05), all of them were lower than those in the old permanent dentition group (both P<0.05). Compared with the normal side, the height of fracture condyle was smaller among the 3 groups (all P<0.05), and the anterior joint space was smaller (P<0.05) and the posterior joint space was larger (P<0.05) in the mixed dentition group. In patients with UCLP, the asymmetry of condylar morphology increases with age, but the condylar position tends to normal. These results suggest that early treatment has important clinical significance for the morphologic development of temporomandibular joint in UCLP patients.

Design of Unilateral Complete Presurgical Nasoalveolar Molding (PNAM) Corrector Based on Feature Points Extraction of Complex 3D Surface

Cleft lip and palate is a congenital maxillofacial deformity. Unilateral complete cleft lip and palate is one of the most common clinical types. Nasal alveolar molding (PNAM) is a recognized strategy for the treatment of cleft lip and palate. However, the current design of PNAM devices mainly relies on the subjective experience of doctors. The purpose of this paper is to describe the design and manufacture of a new computer-aided design appliance, which can be applied to the presurgical nasoalveolar molding of unilateral complete cleft lip and palate, eliminate individual differences, and improve production efficiency. In this paper, seven feature points on the healthy side and the affected side are extracted by the method of Gaussian curvature and ridge line extraction, and the healthy side rotation and built-in model are designed by using these seven feature points, which can quickly generate eight treatment stages of PNAM. The correction effects of the PNAM appliance designed in this paper were compared with the original maxillary model and the clinical PNAM appliance (hand-made by subjective experience) from the aspects of alveolar fissure width and symmetry. The PNAM appliance designed in this paper can effectively improve the symmetry of patients with unilateral complete cleft lip and palate (morphological similarity: t = 3.250, p ≤ 0.01; length similarity: t = 1.559, p = 0.150) and reduce the width of alveolar cleft (t = 8.330, p &lt; 0.01). This can fully achieve the therapeutic effect of PNAM appliances prepared by experienced doctors and is more efficient. The method based on complex 3D surface feature point extraction can provide the basis for the design and evaluation of a unilateral complete PNAM correction model, improve the design and production efficiency of unilateral complete cleft lip and palate appliance, eliminate the design problems caused by individual differences, and reduce the burden of doctors.

Comparative evaluation of nasolabial appearance of unilateral cleft lip and palate patients by professional, patient and layperson using 2 aesthetic scoring systems: A cross sectional study.

To compare the perspective of healthcare providers (orthodontists), cleft patients and laypersons in judging nasolabial aesthetics in patients with complete unilateral cleft lip, with or without cleft palate (UCL ± P) using 2 scoring systems. This cross-sectional study was conducted in a tertiary care government hospital. Photographic records of 100 patients with complete UCL ± P from the age group of 5-18 years (mean age-12.2 ± 3.93 years) were included in this study. Photographic records of 100 patients with complete UCL ± P from the age group of 5-18 years were included. A panel of 3 orthodontists, 3 laypersons and 3 cleft patients rated nasolabial aesthetics using 2 scoring systems i.e. Asher-McDade index (AMAI) and Cleft Aesthetic Rating Scale (CARS). Spearman's split-half reliability, Intra-class correlation coefficient and Cronbach's alpha were computed to measure internal consistency and reliability. Inter-panel agreement between pair of groups was determined by means of Spearman correlation coefficient. Estimated reliability of CARS for 3 raters in each panel was in moderate agreement for orthodontists and cleft patients (0.849 and 0.810). Good repeatability and agreement were recorded with moderate to high intra-panel reliability for all parameters of both AMAI and CARS. Overall inter-panel agreement was moderate for both AMAI and CARS. Pair-wise inter-panel agreement showed a moderately positive correlation in both scales (AMAI and CARS) by cleft patients and professionals. CARS index can be reliably used for assessment of nasolabial aesthetics by cleft patients, professionals and lay persons on 2D facial photographs. Patients were more critical than clinicians and laypersons using both indices (CARS and AMAI) as they are more self-aware and conscious. Thus, a clear communication between clinician and patient regarding expectations, perception and satisfaction with surgical results is strongly recommended.

Comparison of Facial Growth Between Two Nasoalveolar Molding Techniques in Unilateral Complete Cleft Lip Patients: A Randomized, Prospective, Single-blind Trial.

Nasoalveolar molding (NAM) has become standard treatment in our Craniofacial Center. Two types of pre-surgical NAM, Grayson technique and Figueroa technique, co-exist. We previously found no differences in number of clinic visits, cost and 6 months post-operative outcome between the two techniques. Since Figueroa's method involves passive, whilst Grayson's method involves active, alveolar molding, we extended the previous study to evaluate facial growth between these two groups. This randomized, prospective, single-blind study, conducted between May 2010 and March 2013, recruited 30 patients with unilateral complete cleft lip and palate patients and randomized them for Grayson or Figueroa pre-surgical NAM. Their standard lateral cephalometric measurements at 5 years were used to determine facial growth. Twenty-nine patients completed 5 years of follow-up. There were no statistical differences in facial cephalometric measurements between the two groups. Pre-surgical NAM using either passive or active NAM technique produced similar facial growth patterns after unilateral cleft lip and palate repair.

Cupid's Bow Leveling and Preservation of Lip Height and Width: A Modified Rotation-Advancement Technique.

Several methods for cleft lip repair have been developed over time, with no clear method considered the standard. In the authors' department, the use of a modified rotation-advancement technique rather than the traditional rotation-advancement technique in unilateral complete cleft lip repair has increased over the past decade. This study aimed to determine which technique provides better outcomes. This retrospective study was conducted by analyzing the preoperative and postoperative aesthetic nasal and labial anthropometric measurements of the frontal and basal views of 213 consecutive patients treated between October of 2013 and June of 2019. A total of 141 participants were treated with the traditional rotation-advancement technique, and 72 with the modified rotation-advancement technique. The inclusion criteria were nonsyndromic unilateral complete cleft lip repair with high-resolution, good-quality photographs; no presurgical nasoalveolar molding; no revision in the lip or nose areas; and at least 1 year of follow-up. Patients who received the modified rotation-advancement technique had significantly improved Cupid's bow position and orientation ( P < 0.02 and P < 0.01, respectively) and enhanced vertical lip height symmetry ( P < 0.01) while preserving the lip width. The columellar length ( P < 0.03) and angulation ( P < 0.045) were also significantly improved, with enhanced nostril inclination in this group ( P < 0.06). According to the findings of the current study, modified rotation-advancement technique assisted surgeons in improving symmetrical leveling of the Cupid's bow and significantly aided in correcting lip height without compromising lip width. Moreover, the modified rotation-advancement technique resulted in better aesthetic nasal outcomes. Therapeutic, III.

Influence of presurgical nasoalveolar molding (PNAM) treatment in maxillary dental arch width and nasolabial symmetry in patients with unilateral complete cleft lip and palate.

Unilateral complete cleft lip and palate (UCCLP) is one of the most severe clinical subphenotypes among nonsyndromic cleft lip and/or palate (NSCL/P), that complicates surgical repair operations. Presurgical nasoalveolar molding (PNAM) is a technique used to reshape the nose, lip and alveolar bone of infants with UCCLP before surgery (the modified Mohler rotation advancement cheiloplasty and two flap palatoplasty), with the potential to facilitate surgical repair. However, the effectiveness of PNAM treatment is still a matter of debate. In this paper, the 3Shape scanning system and 3dMD stereophotography were used to assess the short-term and long-term effects of PNAM treatment on the dental arch morphology and nasolabial features of patients with UCCLP, respectively. The findings indicated that PNAM treatment negatively affects both short-term and long-term dental arch shape compared to the treatment without PNAM, particularly in terms of limiting the transverse width of the maxillary canine-to-midline. Regarding the nasal and labial symmetry, PNAM improves the symmetry of the nasal alae in patients over 7 years old and the symmetry of the lip in patients under 7 years old. Moreover, UCCLP patients who received PNAM treatment exhibited a shorter and wider shape of the nostril on the cleft side compared to those without PNAM treatment. In clinical practice, the multidisciplinary team should carefully consider the advantages and disadvantages of the outcomes of PNAM treatment when treating infants with cleft lip and palate.

Outcomes of permanent canines on the cleft side after secondary alveolar grafting using different materials in complete unilateral cleft lip and palate.

The prevalence of impaction of the permanent canine on the cleft side (PCCS) ranges from 12-35% after alveolar bone grafting (ABG). PCCSs usually develop above other permanent teeth in the alveolar process, gradually becoming vertical until they reach the occlusal plane. The type of cleft, hypodontia of lateral incisor on the cleft side, slower PCCS root development, and genetic factors are predictors of impaction and/or its ectopic eruption. To compare the behavior of PCCS in individuals with complete unilateral cleft lip and palate (UCLP) subjected to secondary alveolar grafting (SAG) with different materials. This retrospective longitudinal study analyzed 120 individuals undergoing SAG with iliac crest bone, rhBMP-2, and mandibular symphysis. The individuals were selected at a single center and equally divided into three groups. Panoramic radiographs were analyzed by the Dolphin Imaging 11.95 software to measure PCCS angulation and PCCS height from the occlusal plane at two different timepoints. No statistical significance was found between grafting materials (P=0.416). At T1, the PCCS height from the occlusal plane was greater for rhBMP-2 and mandibular symphysis compared to iliac crest bone. The lateral incisor on the cleft side was not related to success or lack of eruption of PCCS (P=0.870). Impaction rates of PCCS were similar for the materials studied. Absence of the lateral incisor on the cleft side did not prevent spontaneous eruption of PCCSs.

Short-term surgical outcomes in patients with unilateral complete cleft lip and palate after presurgical nasoalveolar molding therapy: A three-dimensional anthropometric study.

This brief research report aimed to evaluate the short-term efficacy of presurgical nasoalveolar molding (PNAM) therapy on the nasolabial morphology three dimensionally in patients with non-syndromic complete unilateral cleft lip and palate (UCLP). Thirty-six patients with non-syndromic complete unilateral complete cleft lip and palate were enrolled retrospectively and categorized into 2 groups: 18 patients who had received PNAM treatment (PNAM group) and 18 age-matched patients who have not receive PNAM treatment (no PNAM group) from 2017 to 2021. The average starting age for PNAM therapy was 18.33 days, and the average PNAM treatment duration was 99.08 days. Twelve nasolabial parameters were measured to compare the postsurgical outcomes of two groups. In PNAM groups, cleft width, vertical distance between double Crista philtri and columellar deviation were reduced compared to that in no PNAM group. And nostril height was larger than that in no PNAM group. The differences between two groups were statistically significant (p < .05). There were no statistical differences in columellar length, nostril width and bi-alar width between two groups. However, the nostril width on cleft side in PNAM group was decreased by an average of 1.1 mm. Our result indicated that PNAM therapy decreased cleft width and vertical distance between Crista philtri. It also increased nasal symmetry by decreasing columellar deviation, increasing nostril height.

Comparative 3D study of dental arches in children with microcephaly associated with congenital Zika syndrome, orofacial cleft, and without craniofacial anomalies.

The dentist participates in the treatment protocol for craniofacial anomalies in individuals from the first months of life. to compare in a retrospective cohort study the morphometry of the edentulous palate of children microcephaly associated with congenital Zika syndrome (CZS), unilateral complete cleft lip and alveolus (UCL), and without craniofacial anomalies. Forty-five digitized dental molds composed the sample divided into three groups: CZS; UCL; and without craniofacial anomalies (control group). The following measurements were evaluated: intercanine and intertuberosity distances; dental arch length, area, volume, and mismatch superimposition. Parametric and non-parametric tests were applied (α = 5%). CZS group showed the smallest means of intercanine distance and area than those of the other groups (p = .001 and p = .010, respectively). The dental arch length was greater in the CZS group than in the control group (p = .020). The evaluation of the mismatch superimposition showed that the CZS group had the lowest means of maximum distance and root mean square than that of the UCL group (p = .025 and p = .005, respectively). CZS participants tended to palatal narrowing, while UCL individuals had parameters similar to those of the control group, despite the alveolus defect.

Novel Reconstruction of Orbicularis Oris in Unilateral Complete Cleft Lip Repair.

Background: Orbicularis oris muscle repair is key to successful unilateral cleft lip repair. Objective: To measure the lip symmetry after repair of the lip muscles in the midline compared with traditional repair on the cleft side. Methods: A retrospective review and photographic analysis of patients with complete cleft lip treated with the modified approach were carried out. Anthropometric analysis was done at pre-, immediate, and 1-year postoperatively, and at 1-year follow-up. Four upper lip and six nostril landmarks were measured. Results: Fourteen patients met inclusion criteria. Immediate postoperatively, the horizontal lip length on the cleft side was shorter than that on the noncleft side, but the discrepancy decreased as facial development progressed over the course of a year. Lip measurements at the 1-year follow-up were approximately symmetrical in vertical lip height, philtral height, and lateral lip height. Small changes in the nasal correction occurred at 1 year. Conclusion: A modified technique in the unilateral complete cleft lip repair seeks to balance the perinasal and perioral muscles and improve symmetric outcomes.

Assessment of Self-Esteem and Quality of Life in Patients with Complete Unilateral Cleft Lip and Palate Undergoing Orthodontic Treatment.

To assess the self-esteem and quality of life (QOL) in patients with complete unilateral cleft lip and palate (UCLP) who were undergoing orthodontic treatment. This cross-sectional study was conducted on a total sample of 300 individuals consisted of 150 patients with UCLP (Group I) and 150 normal controls (Group II) with an age range of 10-25 years, who were undergoing comprehensive orthodontic treatment from December 2016 to December 2018. The Self Esteem and QOL were assessed using the Rosenberg Self Esteem scale (RSE) and Modified Paediatric QOL Inventory Scale (M-PQOL), respectively, in Group I and II. The comparison of overall mean scores of responses to RSE questionnaires showed nonsignificant differences for all the responses and was significant only for RSE 6 and RSE 8 in the age group of 10-15 years and 21-25 years, respectively, and nonsignificant for all other questions in all the age groups. The comparison of overall mean scores of M-PQOL for the total sample showed nonsignificant differences in Group I and II for physical functioning, emotional functioning, and school functioning domain, and were highly significant differences (P ≤ 0.001) in the social functioning domain and M-PQOL 12 and M-PQOL 21. This study demands a definite need of a psychologist/psychiatrist among the cleft care team to counsel the patients with cleft during orthodontic treatment for motivating them to gain self-respect and acceptance in the society as certain aspects, particularly social functioning domain made them feel different from normal children because of the functional and aesthetic problems.

Primary correction of the nasal deformity on patients with unilateral cleft lip

Introduction. Orofacial clefts, is a group of conditions that includes cleft lip, cleft palate, and both together. Symmetry of the face can be obtained with primary nose reconstruction. The goal: Analysis of patients with unilateral complete cleft lip patients treated with or without a primary nasal correction at the time of cleft lip repair were compared to evaluate the relevance of early surgical correction of the nose Material and method. The 5 unilateral cleft subjects were operated on in 2022 by a technique of primary cleft nose correction (PCR), and 5 were operated without primary nose reconstruction (NNC). The anteroposterior and inferior facial appearances of each of the cases have been evaluated. A computer-based method of measuring nasal asymmetry was used to objectively analyze the results and compare them between children with and without primary nasal reconstruction. Measuring was done before and after the surgery and include qualitative and quantitative measurements. Results: The results support the observation that nasal shape become symmetric in children that support primary nasal reconstruction and asymmetric in children without primary nasal reconstruction. Conclusion: Primary nose reconstruction result in better cosmetic outcomes.

Surgical sequence, timing and volume, and variation in dento-facial outcome, speech and secondary surgery in children with unilateral cleft lip and palate: The Cleft Care UK Study.

To estimate both the association of surgical variables in complete unilateral cleft lip and palate (cUCLP) in the UK with outcomes at age 5 years, and the association of secondary speech surgery, volume of surgery, and surgeon with the same outcomes. The Cleft Care UK study, a cross-sectional study of 268 5-year-olds, born from 2005 to 2007, with cUCLP. Information on surgical variables was extracted from a standardized questionnaire. Dento-facial outcomes were derived from dental study casts of dental arch relationships. Three speech outcomes - intelligibility, structure and articulation - were derived using the Cleft Audit Protocol for Speech-Augmented tool. Surgical and outcome data were available for 211 (79%) children from all cleft centres in the UK. Later soft palate surgery was associated with a 17% increased chance of a poor intelligibility score (P=.02), and high volume surgery with a 249% increased chance of a good articulation score (P=.01). There were no between surgeon effects identified. No association between the surgical variables examined and dento-facial outcome, or secondary speech surgery by the age of 5 years were found. This study found associations between surgical variables and speech outcomes at 5 years of age, but not between surgical variables and dento-facial outcome, nor between surgical variables and secondary speech surgery. High surgical volume should be maintained, and any changes towards later surgery monitored for changes in speech outcome.

Maxillary Development and Dental Arch Relationships Following Early Two-Stage Palatoplasty: A Comparative Study.

To examine skeletal morphology and dental arch relationships at 8 years of age following early 2-stage palatoplasty, which consists of soft palate plasty at 1 year of age and hard palate closure at 1.5 years of age, and to compare the results with those of conventional pushback palatoplasty. Retrospective. Single institutional study. Eighty-six patients with nonsyndromic complete unilateral cleft lip and palate (UCLP) were selected. The subjects were divided into 2 groups according to the palatoplasty protocols, as follows: 45 patients, who underwent early 2-stage palatoplasty (ETS group), and 41 patients, who underwent 1-stage pushback palatoplasty (PB group). Skeletal morphology was assessed using lateral cephalometric analysis, and dental arch relationships were examined using the GOSLON yardstick. Cephalometric analysis revealed that the anterior-posterior length of the maxilla, measured by PTM-A and PTM-ANS, both projected to the nasal floor (NF) plane, was longer in the ETS group than in the PB group (PTM-A/NF, p = .04; PTM-ANS/NF, p = .03, unpaired t-test), although no significant difference was observed in SNA (p = .09, unpaired t-test). Upper posterior facial height was shorter in the ETS group than in the PB group (p = .02, unpaired t). Assessments with the GOSLON yardstick showed that the ETS group presented better dental arch relationships than the PB group (p = 0.04, Mann-Whitney's U-test). The present results suggested that the ETS protocol reduced the negative effects of palatal surgery on facial development and dental arch relationships in patients with complete UCLP at 8 years of age.