Unilateral Complete Cleft Of Lip Research Articles

Modified Mucosal Reconstruction in Unilateral Complete Cleft of Lip and Primary Palate: Surgical Technique and Practical Strategies.

The nasal floor and intraoral lining reconstruction of unilateral complete cleft of lip and primary palate has sparsely been reported. Solution: This article combines the previously-described C-flap mucosal flap and inferior turbinate flap with the newly-described lateral nasal mucosal flap for the mucosal repair of this uncommon subtype of deformity. Valuable practical strategies are offered to optimize the surgical execution within a limited pediatric intranasal surgical access, targeting to minimize tissue trauma and bleeding.

Orofacial clefts: treatment based on a multidisciplinary approach

Orofacial clefts: treatment based on a multidisciplinary approach

Primary Repair in Patients With Unilateral Complete Cleft of Lip and Primary Palate: Assessment of Outcomes.

Asymmetry of median facial structures is a major concern for patients with unilateral cleft lip and palate, and the principal goal of its treatment is to restore symmetry. Unilateral complete cleft of lip and primary palate (UCCLPP) is an uncommon subgroup and rarely reported. Patients with UCCLPP have protruding and deviating premaxilla, rendering a primary repair difficult. This study evaluated consecutive patients with UCCLPP and presented their treatment outcome. We assessed 36 patients with UCCLPP and collected clinical information. Surgical repair was performed at 3 months of age by using a modified rotation-advancement method and primary nasal reconstruction. A single surgeon performed all surgical procedures. A postoperative nasal stent was used for 6 months. Follow-up standardized photographs were collected. Landmarks were identified, and nose and lip dimensions measured. The ratios of the corresponding parameters (cleft vs noncleft side) were obtained for evaluating nose and lip symmetry. No surgical complication was noted in any patient. The overall lip and nose outcome after the primary repair were adequate, and all ratios were close to 1. The nostril width was slightly wider on the cleft side, but the alar width and height were acceptable. The lip heights were balanced between the 2 sides. Patients who received presurgical nasoalveolar molding did not show more favorable lip and nose dimensions, except for the medial philtral height. Even in the presence of protruding and deviating premaxilla, our patients with UCCLPP obtained adequate lip and nose outcome after undergoing primary lip repair and nasal reconstruction.

Long-term follow-up study of patients with a unilateral complete cleft of lip, alveolus, and palate following the Utrecht treatment protocol: Dental arch relationships

ObjectiveThis study sought to evaluate long-term dental arch relationships in adults with a unilateral complete cleft lip and palate (UCLP) treated by the Utrecht protocol and to compare results with the centers from the Eurocleft study. Materials and methodsRetrospective analysis of UCLP patients age 17 or older, treated by two-stage palate closure at the Wilhelmina Children's Hospital, a tertiary center for cleft surgery in Utrecht, the Netherlands. Patients were invited to the clinic for a long-term evaluation. Casts were obtained on the day of follow-up and assessed by the modified Goslon Yardstick for permanent dentition. Dental casts were scored twice by 3 different examiners. ResultsIntra-rater agreement varied from 0.743 to 0.844, the inter-rater agreement from 0.552 to 0.718. The mean Goslon Yardstick score was 3.3. Thirty-three percent of the patients had a Goslon score of 1 or 2, 45% had a score of 4 or 5. ConclusionsThe present study found unfavourable results regarding dental arch relationships after delayed hard palate closure at 3 years old. The mean Goslon Yardstick score was 3.3 (SD 1.4) and 45% of the casts were allocated to group 4 or 5 despite extensive orthodontic treatment. We observed a high number of secondary surgical interventions but no evident benefit regarding dental occlusion following the Utrecht treatment protocol, which includes a two-stage palatoplasty. Other factors than the timing of palate closure are likely of influence.

Long-term mid-facial growth of patients with a unilateral complete cleft of lip, alveolus and palate treated by two-stage palatoplasty: cephalometric analysis

ObjectivesThe aim of this study is to evaluate long-term facial growth in adults previously treated for an isolated unilateral complete cleft lip, alveolus and palate by two-stage palatoplasty.Materials and methodsUnilateral cleft lip and palate (UCLP) patients of 17 years and older treated by two-stage palatoplasty were invited for long-term follow-up. During follow-up, lateral cephalograms were obtained (n = 52). Medical history was acquired from their medical files. Outcome was compared to previously published normal values and the Eurocleft study.ResultsSoft and hard palate closure were performed at the age of 8 (SD 5.9) months and 3 (SD 2.2) years, respectively. The mean maxillary and mandibular angle (SNA, SNB) were 74.9° (SD 4.2) and 75.8° (SD 3.8). Maxillary and maxillomandibular relationships (SNA, ANB) were comparable to all Eurocleft Centres, except for Centre D. We observed a significantly steeper upper interincisor angle compared to the Eurocleft Centres.ConclusionsThis study describes the long-term craniofacial morphology in adults treated for a UCLP with hard palate closure at a mean age of 3 years. The mean maxillary angle SNA and mandibular angle SNPg were comparable to previous studies both applying early and delayed hard palate closure. The observed upper incisor proclination is likely caused by orthodontic overcorrection in response to the unfavourable jaw relationships. No clear growth benefit of this protocol could be demonstrated.Clinical relevanceThe present study shows the long-term craniofacial morphology of UCLP adults after the Utrecht treatment protocol which includes two-stage palate closure.

Use of combination of Millard and Pfeifer incision technique for treatment of unilateral complete cleft of lip: A report of two cases

Cleft lip and palate is one of the most common congenital deformities of the head and neck region. The prevalence of cleft lip and palate depends on racial, ethnic, geographic origin, and socioeconomic status. It is estimated that isolated cleft lip occurs in 20–30%, cleft lip along with palate occur in 35.50% and isolated palate in 30–45% of cases. It affects the psychological, social, and mental well-being. It is considered as a social stigma and has poor acceptance with a negative perception. These patients require a multidisciplinary approach and aged specific treatment plan. Early repair of cleft lip is advocated for making the child acceptable to the parents and relatives as well as to the society. It also helps in the feeding of the child. There are various techniques for repair of the complete unilateral cleft lip. Almost all techniques continue to leave behind some amount of dissatisfaction. Even today most of the surgeons like to use Millard's technique or its modifications. Here, we present two cases of a newly developed technique utilizing both Millard and Pfeifer incision. For assessment of the success of the technique, we evaluated the vermilion match, lip length, nasal symmetry, white roll match, and postoperative scar after 6 months of primary lip closure. At 6 th month follow-up, we found the overall result was average for both the cases. (minor deformities which can be corrected by lip revision procedure). As this technique is based on the principle of rotation and elongation, we found that this technique allowed tension free closure of the cleft lip even when both the patients had a wide cleft of the lip. This technique addresses the overall anatomy of cleft lip including nasal region. The incision marking is such that rhinoseptoplasty and alar cinch suturing can be done without making any new incision.

Normal palatal sutures in newborns and fetuses: a critical fact for successful palatal distraction.

Distraction osteogenesis (DO) has recently been applied to the palate. Successful posterior lengthening and medial advancement of the palates was continuously reported. Based on these studies, it is obvious that DO will play a major role in the management of problems related to palatal defects in the near future. Although the results are appealing, they may not be applicable for humans due to anatomic differences. All experimental studies used normal palatal sutures of young dogs for size expansion. Therefore, it is necessary to know normal palatal sutures in infants before one can clinically apply this new technique. With consent, palates of fetuses and neonates who died of various causes were examined. Eight fresh cadavers were available for the dissection, with two being skeletonized using the boiling process. There were three fetal deaths in utero (33-41 weeks of gestational age) and five postnatal deaths (aged between 5 hours and 6 months). All specimens were grossly normal in shape and size except for one with a unilateral complete cleft of lip and palate. A midline palatal suture was found in every noncleft specimen, while premaxillary and transverse palatomaxillary sutures were present in every specimen. Laterally, there was no true suture except for the most posterior portion, which was contiguous with the greater palatine foramen. The palatal sutures of third-trimester fetuses and neonates are not different from adult ones. There is no lateral suture that will allow distraction in the medial direction. It is only the posterior hard palate (palatine bones) that can potentially be moved medially and posteriorly by sutural expansion with DO.

Growth defects in unrepaired unilateral cleft lip and palate

The positional relationships of the dentoalveolar segments in ten subjects with unrepaired unilateral complete clefts of lip and palate were studied in order to assess the effects of the cleft malformation on dentoalveolar growth. The findings suggest that there are localized growth defects, particularly in lateral and vertical growth at the region of the alveolar cleft, which cannot be accounted for by operative trauma. The position and shape of the central incisor nearest the cleft was also found to be defective in some subjects.