Unrepaired Unilateral Cleft Lip Research Articles

"The Septum and Nasomaxillary Vault Associated with Unrepaired Unilateral Cleft Lip and Palate: A Data-Driven 3D Model".

Defining the nature of the unilateral cleft lip and palate nasal deformity (uCLND) and its optimal surgical correction continues to be a challenge. The purpose of this study was to develop a data-driven model of the primary unrepaired osseocartilaginous skeleton of the nasomaxillary complex. CT scans of nineteen 3-month-old infants with unrepaired unilateral cleft lip and palate and nineteen age- and race-matched controls were analyzed. Osseous landmark deviation in subjects with clefts was compared to controls. Segmentation of the osseocartilaginous septum was performed, and deformational differences were calculated between cleft and non-cleft cohorts. Compared to controls, the rhinion, non-cleft nasomaxillary junction, and cleft nasomaxillary junction deviated towards the non-cleft side. The piriform margins each diverge away from midline with the non-cleft side deviating lateral and superior, and the cleft side deviating lateral and posterior. These alterations result in a bony torsion with sigmoidal configuration of the cleft side aperture, vertical shortening of the central midface, and de-projection of the nasal pyramid. Segmentation of the septum revealed anterior deviation toward the non-cleft side with a single convexity toward the cleft. This three-dimensional data-driven model contradicts prior models and confirms a collapsing twist of the cleft side aperture and medialization of the bony margin of the nasal airway with deviation of the nasal bone complex toward the non-cleft side. This analysis defines the critical anatomic characteristics of the cleft nasal deformity and informs the goals of nasal correction at the time of primary repair.

Revisiting the unrepaired unilateral cleft lip and nasal deformity using 3D surface image analysis: A data-driven model and its implications

Current descriptions of the unilateral cleft lip and nasal deformity (uCLND) are based upon limited sample sets and subjective observations. While those descriptions are inconsistent and contradictory, theoretical models, including Hogan's "tilted tripod" and Fisher's "nasal arch forms", have never been tested. Given that favorable outcomes of treatment remain elusive, detailed study of the deformity is critical in devising better treatments. The purpose of this study was to develop a data-driven three-dimensional (3D) model of uCLND that spans the spectrum of presentation and involves a pervasive underlying mechanism. We studied 3D images of 100 infants with unrepaired cleft lip at 6 months of age. Objective assessment included the landmark positions, anthropometric dimensions, and shape-based measures. Cleft severity was stratified by the lateral displacement of subnasale, so that a model could be developed using linear regression. With progressive deviation of subnasale, the non-cleft alar base moved lateral, the cleft alar base was left posterior, and the nasal dorsum followed the caudal septum (deviating towards the non-cleft side). The "twist" resulted in opposing cleft alar dome collapse, non-cleft alar ring constriction (the non-cleft nasal sill narrowed, lateral genu rose, and alar-cheek junction became more acute), and displacement of the philtrum from midline. Our study not only supports theoretical models of uCLND but also clarifies vectors of change and reveals significant non-cleft side alterations. On the basis of our findings, the objectives of treatment should involve centralization of the columella and philtrum and rebalancing the nose by untwisting the orthogonal displacement of the alar bases.

Evaluation of bite force in patients with cleft lip and palate and its comparison with normal patients

Aim and Objectives: This in vivo cross-sectional study aimed to measure and correlate the average and maximum bite forces between cleft and noncleft individuals. Materials and Methods: The study was conducted on thirty cleft and thirty noncleft lip and palate patients who were belonging to the age group of 14–30 years with unrepaired unilateral cleft lip and palate under treatment at the Craniofacial Center, Yenepoya Dental College, Mangalore, and G. S. R Craniofacial Center, Hyderabad, India. Dental Prescale® sheet was used to record the bite force of the patients and the test sheet was scanned with an Epson v330 color HD photo scanner, and the bite force was evaluated by an FDP 8010 analyzing system. The data were analyzed statistically by the Student's data t-test. Results: The control group had a statistically significantly higher mean pressed area on the left side (P = 0.034), maximum pressure on the left side (P < 0.001), mean maximum pressure on the right side (P = 0.024), and mean average pressure on the left side (P = 0.038). There was no statistically significant difference in the mean pressed area on the right side (P = 0.569) and average pressure on the right side of the control and study groups (P = 0.358). Conclusions: There was a statistically significant difference in the mean maximum pressure (P = 0.001) and average pressure (P = 0.039) among cleft lip and palate patients when compared with that of the control group. There was no significant difference between male and female subjects of both the groups.

Reliability of Measurements on Plaster and Digital Models of Patients with a Cleft Lip and Palate.

The purpose of this study was to determine (1) the more and less reliable measurements/methods and (2) the influence of knowledge and skill on the inter-examiner, intra-examiner, and inter-method reliability of nasolabial measurements on plaster casts and three dimensional (3D) stereophotogrammetric images of casts in infants with an unrepaired unilateral cleft lip and palate (UUCLP). Preoperative extraoral plaster casts from 42 patients with UUCLP were measured with a digital caliper, and the image acquisition of casts was performed with the 3dMDface stereophotogrammetry system (3dMD, Atlanta, GA). Two examiners (one postgraduate student, one lecturer) evaluated 19 nasolabial measurements in two separate sessions. Intra-rater, inter-rater, and inter-method reliability was lower in measurements of nasal, philtral, and nasal floor width. Almost all of the interclass correlation coefficients (ICC) for measurements performed by the lecturer were above 0.75, whereas the intra-examiner reliability of some measurements performed by the postgraduate student showed low ICC (<0.75). Measurements of curving slopes, such as nasal width, of small dimensions, such as nostril floor width, and deformity-affected anatomic parts, such as philtrum width, presented a low reliability. Measurements on 3D images showed a higher reliability compared to plaster model measurements performed by the postgraduate student. Therefore, it may be recommended to use 3D digital images of infants with CLP for nasolabial measurements especially if performed in postgraduate settings.

Measuring Symmetry in Children With Cleft Lip. Part 2: Quantification of Nasolabial Symmetry Before and After Cleft Lip Repair.

The first part of this study validated an automated computer-based method of identifying the three-dimensional midfacial plane in children with unrepaired cleft lip. The purpose of this second part is to develop computer-based methods to quantify symmetry and to determine the correlation of these measures to clinical expectations. A total of 35 infants with unrepaired unilateral cleft lip and 14 infant controls. Six computer-based methods of quantifying symmetry were developed and applied to the three-dimensional images of infants with unilateral cleft lip before and after cleft lip repair and to those of controls. Symmetry scores for cleft type, changes with surgery, and individual subjects ranked according to cleft severity were assessed. Significant differences in symmetry scores were found between cleft types and found before and after surgery. Symmetry scores for infants with unilateral cleft lip approached those of controls after surgery, and there was a strong correlation with ranked cleft severity. Our computer-based three-dimensional analysis of nasolabial symmetry correlated with clinical expectations. Automated processing made measurement convenient. Use of these measures may help to objectively measure cleft severity and treatment outcome.

Adult Cleft Lip Repair under Local Anaesthesia: The Ghana Experience

Background: Unlike developed countries where adult primary cleft lip and palate cases are barely nonexistent, developing countries still have a backlog of adults with unrepaired cleft lip and palate. Method: A retrospective review of adult/adolescent cleft lip repair under local anesthesia was performed between 2012 and 2015. Results: Fifty six (56) adolescent and adults were seen comprising 35 females and 21 males. Forty two patients presented with unrepaired unilateral cleft lip of which only 6 were complete; 4 were unrepaired bilateral cleft lip and 10 were revisions. The lowest age was 13 years (two patients) and the highest age was 66 years (one patient). The mean weight was 54 kg. The mean anaesthetic time including waiting time was 12.94 minutes and mean operation time was 56.52 minutes. Majority of the patients were discharged same day except for five who needed to stay overnight because of distance from their home. There were no reported early postoperative complications and wound healing was uneventful for all the patients. Conclusion: Cleft lip repair in adults under local anesthesia is safe, effective and less expensive. A modification in technique with minimal dissection and efficiency is essential in such cases.

Reliability of Nasolabial Anthropometric Measures Using Three-Dimensional Stereophotogrammetry in Infants with Unrepaired Unilateral Cleft Lip

Surgical and orthodontic treatment of unilateral cleft lip +/- palate can produce dramatic changes in nasolabial form; however, the lack of ideal methods with which to objectively document three-dimensional form limits the ability to assess treatment outcomes. The purpose of this study was to determine the reliability of three-dimensional stereophotogrammetry for anthropometric assessment of the unilateral cleft lip +/- palate deformity in infants before cleft lip repair. Preoperative three-dimensional images were acquired from 26 consecutive patients with unrepaired unilateral cleft lip +/- palate. Three raters performed indirect anthropometry on each image on two separate occasions, with at least 1 week between rating sessions. One rater performed direct measurements on participants before surgery while in the operating room. Twenty-six linear and angular measurements were considered, and intrarater, interrater, and intermethod reliability were assessed. Regarding intrarater and interrater reliability, most measurements had Pearson coefficients greater than 0.75, mean differences less than 0.8 mm, and mean proportional differences less than 0.1. For measurements involving vermilion height, nostril remnants, or Cupid's bow width, Pearson coefficients ranged from 0.3 to 0.75, mean differences ranged from 0.4 to 0.9 mm, and mean proportional differences ranged from 0.1 to 0.3. Regarding intermethod reliability, correlation coefficients ranged from 0.4 to 0.75 for most measurements. The mean differences for nose and lip measurements were less than 1 mm and between 0.8 and 1.3 mm, respectively. Three-dimensional stereophotogrammetry provides a reliable method for many anthropometric measurements of nasolabial form in infants with unrepaired unilateral cleft lip +/- palate. Diagnostic, II.

Quantification of Negative Aesthetic Ratings in Primary Unrepaired Unilateral Cleft Lip Infants by Modified Paired Comparison Method

To quantify negative aesthetic ratings in primary unrepaired cleft lip infants by further refining our previously reported paired comparison method. The Thurstone paired comparison method was used to quantify negative aesthetic ratings of plaster facial models selected and ordered according to a table of paired random numbers. A total of 30 facial models of unrepaired incomplete unilateral cleft lip infants were used in this study. Raters comprised 20 oral surgeons and anesthesiologists. Quantification of aesthetic ratings for the 30 face models of unrepaired incomplete unilateral cleft lip infants was obtained. The ratings ranged from 0 to 5.08. Quantification of the aesthetic ratings for the 30 face models will be used as objective variables in a multivariate analysis in the third stage of this ongoing study.

110 infants with unrepaired unilateral cleft lip: An anthropometric analysis of the lip and nasal deformities

The aim of this retrospective study was to correlate the width of the cleft lip with the severity of the nasal deformity in unilateral cleft lip and palate (UCLP) patients before primary lip repair. Preoperative impression casts were made. Measurements were taken of the width of the cleft lip (CW), nose (NW), and nasal floor (NFW), alar base height (ABH), columella length (CL), nasal length (NL) and nasal tip protrusion (NTP). The ratio of the non-cleft side (NFW) to the cleft side (NFWR), the ratio of the non-cleft side (ABH) to the cleft side (ABHR), and the ratio of the cleft side (CL) to the non-cleft side (CLR) were calculated. The average NW, NL and CW were higher in the group with complete clefts. There was a negative linear relationship between CW and NFWR, and a positive linear relationship between CW and ABHR in the complete group. In the incomplete group, negative correlations were obtained between CW and NFWR and between CW and ABHR. These findings show that there are correlations between CW and the transverse and vertical imbalance of nose in both groups but not between CW and anteroposterior imbalance of nose.

Growth defects in unrepaired unilateral cleft lip and palate

Growth defects in unrepaired unilateral cleft lip and palate

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.