Dental arches in six-year-old children with operated and unoperated submucous cleft palate and isolated cleft palate

The sizes of dental arches in 129 children with cleft palate were evaluated retrospectively from dental casts taken at the mean age 6.2 years (range 5.2-7.5). The material included 61 children with submucous cleft palate (SMCP) and 68 children with isolated cleft palate (ICP). Twenty of the children with SMCP were not operated on, while 41 had had surgical treatment, either palatal repair (n = 16, mean age at operation: 1.6 years, range 0.8-3.9) or pharyngeal flap (VPP) surgery (n = 25, mean age at operation: 4.5 years, range 2.6-6.2). In children with ICP, one-stage hard-palate and soft-palate closure had been done at the mean age of 1.5 years (range 1.0-2.1). Decreased maxillary intermolar widths were seen in children with SMCP after VPP, and especially after palatal repair. The children with ICP had the smallest maxillary dental arch widths. No significant differences were observed in the maxillary arch length or mandibular intermolar arch dimensions in children with SMCP or ICP. Surgery is associated with decreased maxillary intermolar arch widths in children with SMCP. Children with ICP had smaller maxillary dental arch widths than children SMCP.     

Dental arches in submucous cleft palate: comparison of six-year-old boys with unoperated submucous cleft palate, with operated cleft of the soft palate, and without a cleft

OBJECTIVE: To evaluate the dental arch dimensions in 6-year-old boys with unoperated submucous cleft palate (SMCP), and to compare their dental arch dimensions with those of boys without clefts and boys with clefts of the soft palate (CP). MATERIAL AND METHODS: The sizes of dental arches in 97 boys were compared retrospectively from dental casts taken at a mean age of 6.4 years (range 5.2-8.4). The material included 34 boys without clefts, 30 with unoperated SMCP, and 33 with CP. In children with CP, palatal closure had been done by the pushback technique at a mean age of 1.5 years. RESULTS: The dental arch dimensions of the boys with SMCP were similar to those of boys without clefts, except for a decreased maxillary arch length. There was no difference in maxillary arch length between the boys with SMCP and those with CP. The boys with CP had smaller maxillary and mandibular dental arch widths than the boys without clefts and with SMCP. There were no differences in the number of boys with permanent incisors between the three groups. CONCLUSION: Six-year-old boys with unoperated SMCP have similar dental arch dimensions as boys without clefts, except for a decreased maxillary arch length.     

Endoscopic partial adenoidectomy for children with submucous cleft palate.

OBJECTIVE: Children with submucous cleft palate who suffer from chronic nasal obstruction because of hypertrophic adenoids usually are not subjected to adenoidectomy because of the fear of postoperative velopharyngeal insufficiency. These patients present a therapeutic challenge because we are aware more than ever of the importance of normal nasal breathing and nocturnal respiration, especially during childhood. Our hypothesis was that transnasal endoscopic horizontal limited adenoidectomy may relieve nasal obstruction while preserving the function of the velopharyngeal valve. The objective of this study was to evaluate the efficacy of transnasal endoscopic horizontal partial adenoidectomy in patients with submucous cleft palate and adenoidal hypertrophy. SETTING: Patients were either referred to the outpatient clinic of the Palate Surgery Unit (seven patients) or were patients referred to the senior author's (Y.F.) private clinic. All the patients had been operated on by this senior author (Y.F.). PATIENTS: Ten children aged 3.5 to 13 years (six girls and four boys) with submucous cleft palate and hypertrophic adenoids were included in the study. All the patients were hyponasal and suffered nasal obstruction, loud snoring, and episodes of apnea. INTERVENTIONS: Endoscopic partial adenoidectomy was accomplished to open the lower third of the choanae. Nasal breathing was achieved in all the patients, and only mild snoring remained in two patients. The hyponasality disappeared and speech intelligibility normalized. Mild hypernasality developed in two patients but was still perceived as an overall improvement in speech. CONCLUSIONS: Transnasal endoscopic horizontal partial adenoidectomy may be an effective surgical method for relief of nasal obstruction while preserving velopharyngeal valve function in patients with submucous cleft palate who suffer from obstructive adenoids.     

Craniofacial cephalometric morphology in six-year-old girls with submucous cleft palate and isolated cleft palate

Ninety-three girls with cleft palate (53 submucous cleft palate (SMCP) and 40 isolated cleft palate (ICP)), mean age 6.2 years (range 5.5-7.5), were compared retrospectively from lateral cephalograms. Forty-three patients with SMCP had had surgical treatment at the mean age of 3.4 years (range 0.9-6.8), 10 of the SMCP patients were unoperated. Twenty-six patients with ICP had clefts of the hard and soft palate, and 14 had clefts of the soft palate only. Palatal closure of ICP had been done at the mean age of 1.5 years (range 1.0-2.1). The skeletal craniofacial morphology was similar in SMCP and ICP. The maxilla and mandible were well related to each other but slightly retrusive in relation to the cranial base. The slight skeletal retrusion was significantly more masked by soft tissue in patients with SMCP. The patients with SMCP showed higher values for soft tissue maxillary and mandibular prominence.     

唇腭裂患者前牙区恒牙的发育异常

唇腭裂是口腔颌面部最常见的先天畸形,常伴发各种恒牙发育异常,尤其是靠近裂隙的前牙区.相较国外,目前国内对此的研究缺乏,本文对调查唇腭裂患者中切牙、侧切牙和尖牙区的形态、数目、萌出异常和牙根发育等各类发育异常的文献作回顾性概述,为临床医师早期酌情涉入治疗和适当降低序列治疗的难度和复杂性提供依据.     

Three-dimensional morphology of the palate in subjects with isolated cleft palate at the stage of permanent dentition.

OBJECTIVE: Three-dimensional analysis of palate size and shape in patients with isolated cleft palate at the stage of permanent dentition. DESIGN: Cross-sectional study using Fourier transform profilometry.Subjects: Twenty-nine randomly selected dental casts of approximately 15-year-old boys with isolated cleft palate and 28 dental casts of normal boys of the same age.Interventions: All patients were operated on by the same method (pushback and pharyngeal flap surgery) at a mean age of 4.5 years. MAIN OUTCOME MEASURES: Data on the palate height in 210 defined locations (pixels). RESULTS: The palate in isolated clefts is narrower throughout its whole extent and lower from the level of the first premolars. The difference, as compared with controls, increases in a posterior direction. At the level of the first molars, palatal height is reduced by one-quarter, the area of the transversal section by more than one-third. The shaping of the palate vault is, on average, symmetrical with a marked interindividual variability. Palatal height does not depend on the width of the dentoalveolar arch, and the height of the primary palate is not reduced. CONCLUSION: The smaller width and reduced height from the level of the first premolars posteriorly confirm the substantially reduced space available for the tongue in patients with isolated cleft palate. Deviations are on the average symmetrical, and the anterior part of the palate is not shallower.     

Dental development of Chinese children with cleft lip and palate.

OBJECTIVE: To compare the dental development and rate of tooth development between children with and without cleft lip and palate. Patients: Age- and gender-matched pairs (231 in all) of southern Chinese children ages 3 to 12 years, with and without cleft lip and palate. METHODS: Dental histories and radiographs were studied. From these, dental development was determined. RESULTS: Of 2946 tooth pairs in the children with cleft lip and palate, 252 (8.6%) were found to be asymmetric, significantly (p < .001) more than the 63 of 3179 (2.0%) tooth pairs observed in the children without cleft lip and palate. The teeth with the highest frequency of asymmetry were the maxillary lateral incisors (38.1%). Differences in dental development on the cleft versus noncleft sides of children with unilateral cleft lip and palate were significant for both maxillary and mandibular teeth (p < .001 and p = .039, respectively). The mean delay in tooth formation of the children with cleft lip and palate was 4.4 months relative to the children without cleft lip and palate. The majority of the teeth in the cleft lip and palate group were delayed by one developmental stage. This happened in 40.0% of the maxillary teeth and 30.1% of the mandibular teeth. The delay in tooth formation increased as the number of missing teeth increased in the children with cleft lip and palate, although not significantly. CONCLUSIONS: This group of southern Chinese children with cleft lip and palate demonstrated a higher prevalence of asymmetric and delayed dental development than did their counterparts who did not have cleft lip and palate.     

Dental caries of primary incisors in children with cleft lip and palate

Visual dental examinations were performed on 64 children ages 18 months through 4 years presenting at a Craniofacial Defects Team charged with diagnostic and referral services. Of the 41 children with cleft lip and/or cleft palate, 13 (32%) had dental caries of one or more maxillary primary incisors. One of the remaining 23 children examined experienced caries of the maxillary primary incisors. In incisors of children having clefts of the alveolus, caries tended to correspond to sites of enamel deficiency in caries-free children with alveolar clefts. Caries patterns in children with clefts involving only the palate resembled "nursing carries". Children with clefts are at significant risk for caries of the primary incisors; a dental prevention program is to be emphasized in referring these children for care.     

Clinical grading system for submucous cleft palate

Submucous cleft palate is a structural abnormality of the palate. The clinical features vary, as does the functional impairment, which ranges from none to severe. Although there is a poor correlation between the presenting clinical signs and the severity of velopharyngeal insufficiency during speech, a clinical grading system could assist surgical management and allow more meaningful comparisons to be made between outcome studies. The grading system described is based on clinical examination alone and reflects the likely degree of structural abnormality of the musculature of the soft palate.     

非综合征性单侧完全性唇腭裂恒牙发育异常的研究

目的 经回顾性研究了解非综合征性单侧完全性唇腭裂患者恒牙发育异常的情况.方法 收集244例植骨期非综合征性单侧完全性唇腭裂患者的影像学资料,记录和统计分析恒牙发育异常.结果 在本研究中各种恒牙异常的发生率为:先天缺失163例(269颗)(163/244,66.8%),最常累及的牙位是上颌侧切牙;畸形牙82例(85颗)(82/244,33.6%),绝大多数为上颌侧切牙的小牙畸形;额外牙12例(12颗)(12/244,4.9%),多发生于裂区,表现为畸形小牙.牙位发育异常的性别比较发现,非裂侧上颌仅侧切牙缺失,男性高于女性(P<0.05).裂侧的先天缺牙、额外牙和畸形牙的发生率均高于非裂侧,差异有统计学意义(P<0.01),上下颌均有相同发现.结论 非综合征性单侧完全性唇腭裂患者各类牙齿发育异常的患病率均高于健康人群.裂侧的牙齿发育异常较非裂侧更为多见.

Abstract：

Objective To investigate the prevalence of dentM anomalies in Chinese children with complete unilateral cleft lip and palate(UCLP).Methods Dental histories and radiographs of 244 Chinese children with UCLP were collected.The diagnosis of dental anomalies waft based on panoramic radiographs before alveolar bone grafting.All patients were over 8 years old.Results In the UCLP group,66.8% of the patients was presented with hypodontia.The maxillary lateral incisors were the most common teeth affected,followed by maxillary second premolars,mandibular incisors and mandibulax second premolars.A total of 33.6%the patients Was presented with dental malformation,most were mierodontic laterel incisors.A total of 4.9% the patients was presented with hyperdontim The supernumerary teeth were more frequently found in the cleft region.The prevalence of missing maxillary lateral incisor in the noneleft side was statistically different between genders,which was higher in male(P<0.050).This group of Chinese children with UCLP demonstrated significantly higher prevalence of hypodontia,hyperdontia,and malformation on the cleft side than on the noncleft side(P<0.01).Conclusions Hypodontia is the most common type of dental anomalies.The prevalence of dental anomalies is higher in the UCLP patients than in the normal population.Dental anomalies occur more frequently on the cleft side than on the nonclefi side.     

Malformation of the vomer in submucous cleft palate

Background: Several criteria are described in the literature to diagnose a submucous cleft palate. Commonly the differences in the extent of the submucous cleft will not be as overt as in open clefts. Nevertheless, complete submucous cleft palate may cause imperfect palato-pharyngeal closure so that the affected person needs to undergo speech training and surgical treatment. Patients: We investigated 30 patients who underwent palatal repair to correct this disorder. They were evaluated according to the Koch's documentation system. Results: In all patients an additional malformation of the inner nose was found: The vomer was not fused with the palatal shelves. There were with different degrees of severity of this malformation and they were not necessarily correlated with the extent of the palatal cleft. Conclusion: In our opinion, this malformation of the vomer should be seen as a typical symptom of classical submucous cleft palate. Discussion is needed on how the vomerine malformation should be incorporated into the surgical procedure. Since we know from septal surgery that a basal septal perforation will lead to disturbances of nasal breathing. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.     

Cephalometric analysis in submucous cleft palate: comparison of cephalometric data obtained from submucous cleft palate patients with velopharyngeal competence and incompetence.

OBJECTIVE: The purpose of this study was to investigate the relationship between craniofacial and nasopharyngeal morphology and velopharyngeal function in submucous cleft palate. DESIGN AND PATIENTS: Fifty-two lateral cephalometric radiographs of 46 submucous cleft palate (SMCP) patients with velopharyngeal competence (24 patients) and incompetence (22 patients) at 4 and 7 years of age were studied. The patients had not received any surgical or orthodontic treatment prior to cephalography being performed. RESULTS: Significant differences were found between cephalometric variables (N-Ba, N-S-Ba angle) in children with velopharyngeal competence and incompetence. However, the results of our study showed that cephalometric data alone are not useful for predicting velopharyngeal function and can not serve as an absolute prognostic indicator. CONCLUSION;There are many factors that can influence velopharyngeal function in SMCP patients. Cephalometric data did not demonstrate a strong relationship to velopharyngeal function.     

Three-dimensional morphology of the palate in subjects with unilateral complete cleft lip and palate at the stage of permanent dentition.

OBJECTIVE: Three-dimensional analysis of palate size and shape in patients with complete unilateral cleft lip and palate (UCLP) at the stage of permanent dentition. SUBJECTS: Thirty randomly selected dental casts of boys approximately 15 years old with complete UCLP and 28 dental casts of normal boys of the same age. INTERVENTIONS: All patients underwent lip repair according to Tennison with primary periosteoplasty (mean age 8.5 months) and palate repair by pushback and pharyngeal flap surgery (mean age 4.9 years). MAIN OUTCOME MEASURES: Data on the palate height in 210 defined locations. RESULTS: The palate in patients with UCLP was narrower throughout its whole extent, more anteriorly than posteriorly. From the canines posteriorly, it was also lower, and the difference as compared with controls increased in a posterior direction up to the level of second premolars (up to 30%) and then slightly diminished (to 21% between the first molars). The reduction of area of transverse sections reached 45% between premolars and 39% between first molars. The palate in the anterior portion was highest on the cleft side and in a posterior direction the maximum height of the palate shifted toward the midline and even beyond that line toward the noncleft side. Palatal height did not depend on dentoalveolar arch width. CONCLUSION: The smaller width and height of the palate confirm the substantially reduced space for the tongue in patients with UCLP. The reduction is only slightly larger than in previously examined patients with isolated cleft palate. Palatal vault is asymmetrical, highest anteriorly on the cleft side and posteriorly on the noncleft side.     

Dental arch relationships in Yorkshire children with unilateral cleft lip and palate.

OBJECTIVE: To assess the dental arch relationships of children with a complete unilateral cleft lip and palate (UCLP), born consecutively between 1983 and 1987, who had undergone primary cleft repair in the West Yorkshire region of the United Kingdom. The treatment outcome of this UCLP sample was then compared with the results of a previously published intercenter European study. DESIGN: A retrospective study with standardized record collection and blind assessment. SETTING: Regional dental hospital providing secondary and tertiary health care to the local population. PATIENTS: 35 UCLP patients whose primary repair had been performed within West Yorkshire. INTERVENTIONS: Dental casts obtained for each subject within 12 months of their 10th birthday. MAIN OUTCOME MEASURES: The West Yorkshire models were randomly mixed with an anonymous sample of 115 UCLP cases from other cleft centers in the U.K. The dental arch relationships of the 10-year-old models were assessed by applying the Goslon Yardstick. RESULTS: One-third of the West Yorkshire cleft sample were rated as belonging to Goslon group 2 (good result), another third to group 3 (fair result), and the remaining third to groups 4 and 5 (poor/very poor result). Numerically, the results were of a slightly higher standard than that previously published for other U.K. and European cleft centers but were inferior to the treatment outcome of two European centers. No statistically significant differences were found between the outcome results of the West Yorkshire group and the other cleft centers. CONCLUSIONS: These results provide useful baseline data against which progress in achieving improved treatment outcome for West Yorkshire UCLP children can be determined by future research.