Facial appearance in adults who had cleft lip and palate treated in childhood

Sixty-eight adults (44 men and 24 women) with treated total cleft lip and palate were compared with a group of 66 adults (49 men and 17 women) without clefts, matched by sex and age. The outcome measures included a self-report questionnaire about body image, quality of life in general, health-related quality of life, somatisation, and depression. The group with clefts were also asked if they had further need of treatment. They reported significantly more dissatisfaction with their facial appearance (nose, lips, mouth, profile, and overall facial appearance) than the group without clefts. Satisfaction with facial appearance was significantly correlated with a better quality of life in both groups, and significantly correlated with a better health-related quality of life and a lower grade of somatisation in the group with clefts. Dissatisfaction with facial appearance was the most significant predictor of depression in both groups. A panel of four professionals from a cleft lip and palate treatment team judged the outcome of treatment in 64 of the subjects on colour slides. The professionals and the subjects with clefts were generally not very satisfied with the results of the surgical outcome. Thirty of the subjects with clefts (47%) wished to have more operations. The professional group recommended further operations in 38 of the cases (59%), in particular, rhinoplasties. We conclude that the subjects with treated clefts were not satisfied with their facial appearance, although they seem to be psychosocially well-adjusted to their disability.     

Psychosocial Adjustment in Norwegian Adults who Had Undergone Standardised Treatment of Complete Cleft Lip and Palate II. Self-reported problems and concerns with appearance

Aspects of social and psychological adjustment were investigated in a sample of 233 Norwegian adults 20–35 years old with repaired complete cleft lip and palate (CLP); in 126 the cleft was on the left, in 45 on the right, and in 62 it was bilateral. All subjects received a standardised regimen of care from the Oslo cleft palate team. The study, based on response to a questionnaire, partly copied a national survey of social and economic life in the Norwegian population. Adults with complete clefts were compared with a large control sample of the same age. The purpose of this paper is to describe the occurrence of common psychological problems among subjects with CLP. Anxiety, depression, and palpitations were reported about twice as often by subjects with CLP compared with controls, and these psychological problems were strongly associated with concerns about appearance, dentition, speech, and desire for further treatment. These findings suggest that there is an impaired level of psychological wellbeing among subgroups of subjects with clefts.     

Clefts with associated anomalies and syndromes in Finland.

Probands with clefts born during an 11-year period, 1975-85, were evaluated; 1,586 probands were found of whom 345 (171 males and 174 females, 21.8%) had an associated anomaly. More male patients had cleft lips, with or without cleft palate (CL(P)) and more female patients had cleft palates (CP). The anomalies were subdivided according to anatomical site, and the biggest category was that of the extremities (29.7%) followed by cardiovascular (14.8%) and other facial anomalies (13.0%). The smallest category was chromosomal anomalies (2.7%) followed by miscellaneous anomalies (4.1%). A total of 560 malformations were found. Most anomalies per proband with clefts were found in the bilateral cleft lip and palate subgroup (mean 1.04). The lowest (0.14) was found in the subgroup with the least severe cleft deformity, the cleft lip with or without cleft alveolus. In the CP groups a similar trend was found with 0.21 in the subgroup of submucous cleft palate and 0.33 for the subgroup cleft palate, submucous clefts excluded. A total of 133 probands with 39 different recognised syndromes was delineated, 25 in the CL(P) group and 108 in the CP group (8.4% of the total 1,586 patients with clefts). There was no difference in parental age between probands with an associated anomaly and those with a solitary cleft. Anomalies were more than three times as frequent among probands with clefts as among the general population.     

Social adjustment in French adults from who had undergone standardised treatment of complete unilateral cleft lip and palate

France has a population of about 60 million peoples and each ten years data about the standard of living are collected by the central bureau of statistics, we considered the collection of data on 5000 households in 1999 in our geographical area would afford a unique opportunity to compare the equivalent status of French adults with repaired cleft of the lip and palate (CLP). Aspects of social adjustment were investigated in a sample of 82 French adults 18-35 years old with repaired complete unilateral cleft of the lip and palate (CLP). All subjects received a standardized regimen of care from the Burgundy cleft palate team of Dijon. The investigation, based on response to a questionnaire, partly replicated a national survey of social and economic life in the population (Standard of living survey Burgundy, INSEE France 1999), so that adults with complete clefts could be compared with a large control sample of the same age. The control group was constituted by subjects between 18 and 35 years in the standard of living survey Burgundy 1999, INSEE France, they were taken from a regional probability sample of households. This report covers education, employment, and marriage. The significant difference between groups was assessed by: Student's t-test or analysis of variance for continuous variables and chi2 test for categorical variables. The results demonstrated that there are significant differences in educational attainment and employment between adults with cleft of the lip and palate and other people. Fewer with cleft of the lip and palate marry, and when they marry they do so later in life, scholarship history showed significant delay in the cleft of the lip and palate group, independence regarding housing was lower in the cleft of the lip and palate group. If cleft of the lip and palate adults functioned within normal limits with regard to employment. However, levels of income were substantively lower than control groups. It would appear that cleft subjects experience some limitation in their ability to secure vocational and economic rewards from society. As a conclusion we can say regarding our results that the cleft of the lip and palate group, even with the smallest degree of malformation (unilateral without associated malformation), showed a significant delay in the independence process.     

271例婴幼儿完全性唇腭裂一期修复及初步观察

目的 探索婴幼儿完全性唇腭裂一期修复的可行性，并对其效果进行初步观察。方法 对3－12个月婴儿安全性唇腭裂进行了一期修复，同时对24例裂隙宽大的患儿进行术前腭部矫治，对术后1－4年的116例患儿唇的外形及事音进行了初步评价。结果 271例婴幼儿完全性唇腭裂修复手术，术后除2例发生呼吸困难，6例腭部瘘孔形成及5例作品渗血外，全部愈合良好。研究发现19例单侧完全性唇腭裂术前腭部矫治后，齿槽部裂隙左右距离轿治前平均缩小6．1mm；前后距离轿较矫治前平均缩小6．6mm；唇外菜评价优良率达93．1％，语音评价优良率达94．8％。结论 婴幼儿完全性唇腭裂一期是完全的、可行的。术前腭部桥治可明显缩小齿槽部的裂隙，有利于宽大裂隙的修复。婴幼儿完全性唇腭裂一期修复可获良好唇外形及语音功能恢复。     

Primary,Early Bone Grafting in Complete Clefts of the Lip and Palate: A Follow-up Study of 53 Cases

Fifty-three patients with complete unilateral and bilateral cleft lip and palate between the ages of 5 1/2 and 13 1/2 years have been followed up. Following preoperative jaw orthopedic treatment, when indicated, these cases were operated with lip closure and bone grafting with four mucoperiosteal flaps as described by Nordin (1960) and Bäckdahl & Nordin (1961). In the 14 bilateral cases this operation was done in two stages, one side at a time, in this series. At the follow-up, facial appearance, hearing, speech assessment, some facial angles and incidence of crossbites were examined. In the 39 unilateral cleft cases, 80% had an acceptable appearance while 20% needed secondary surgery of the lip and nose as rated independently by four doctors. In the 14 bilateral cases 50% needed secondary operation of the lip and nose. Speech assessment in the bone-grafted group was good or superior to that in a non-bone-grafted group of patients with clefts of the primary and the secondary palate. Open nasality and consonant articulations were also taken into consideration. No permanent hearing impairment was noted in these patients although they are prone to chronic ear diseases. No serious maldevelopment of the facial skeleton was noted in our study following primary, early bone grafting. The incidence of crossbite was comparatively low. This type of treatment is continuing at our centre since the results are promising. Comparison of similar studies from other centres with long-term follow-ups are called for.     

Evaluation of oral and nasal halitosis parameters in patients with repaired cleft lip and/or palate.

OBJECTIVE: The objective of this study was to investigate the relationship between halitosis parameters in patients with and without cleft lip and/or palate. STUDY DESIGN: Forty-two subjects were examined. They were divided into group I, postgraduate students of Bauru Dental School (FOB); and group II, individuals with repaired cleft lip and/or palate. The concentration of volatile sulfur compounds (VSC) was assessed with a portable sulfide monitor and the values were correlated to the salivary flow rate and weight of tongue coating. RESULTS: There was a relationship between the presence of tongue coating and VSC levels, as well as between salivary flow rate and VSC levels in group II. The same group also revealed a significant correlation between weight of tongue coating and salivary flow rate. There were no significant differences between groups as regards the Halimeter oral measurement. CONCLUSIONS: Individuals with repaired cleft lip and/or palate can have the same VSC levels as subjects without clefts.     

膨体聚四氟乙烯充填修复单侧唇腭裂面中份凹陷畸形

目的:探讨膨体聚四氟乙烯(e-PTFE)充填修复单侧唇腭裂患者面中份凹陷畸形的可行性和治疗效果。方法:2002年6月至2005年6月,收治了15例无法接受正颌正畸治疗的单侧唇腭裂术后畸形患者,均伴有牙槽突裂,临床表现为严重的面中份凹陷并伴鼻畸形。所有患者首先接受唇裂二期修复术,然后应用膨体聚四氟乙烯充填矫正面中份凹陷畸形,同时行患侧鼻翼软骨悬吊。所有患者随访6～24个月,拍摄术前、术后面部照片并进行比较。结果:术后患者面中份凹陷畸形得以矫正,患侧鼻翼基底抬高,面形对称,鼻外形有了明显改观,面容改善显著。结论:无条件接受正颌正畸治疗的唇腭裂患者,可从美容角度应用膨体聚四氟乙烯充填整复面中份凹陷畸形,方法简单可靠。     

General body growth in children with clefts of the lip, palate, and craniofacial structure

This paper discusses general body growth in children with craniofacial clefts. Body growth is important in such patients because morphology reflects the cumulation of metabolism over time. The same hormones that direct general body growth also govern the ontogeny of the head and face. Body growth varies in children with different types of clefts. We found no average differences from US norms for those with isolated clefts of the lip alone or those with bilateral clefts of the lip and palate. Children with unilateral clefts of the lip and palate and with isolated cleft palate were significantly shorter than their unaffected peers. Males with these defects were also thinner than normal based on average standard deviation scores for body mass indices. Both unilateral and bilateral clefts of the lip and palate predominated in males, while isolated cleft lip was more frequent in females. Our results indicate that congenital metabolic variation contributes to the development of orofacial clefting and influences postnatal development in certain types of cleft. Accordingly, cleft type is important to growth prognosis, and growth status is relevant to optimization of therapy in orofacial cleft patients.     

双牙列义齿修复唇腭裂患者咬合关系紊乱的临床疗效观察

目的：观察双牙列义齿对唇腭裂患者上下颌咬合关系紊乱、面部形态畸形、功能障碍的美容修复效果。方法：对18例唇腭裂、牙槽突裂患者采用上颌前牙双牙列义齿修复,观察修复后面容、咀嚼功能改善效果及患者满意度。结果：随访2年,18例患者对面部美观的改善、咀嚼功能及发音功能的恢复、修复的治疗费用均比较满意。结论：双牙列可摘义齿可以达到较好修复效果,是一种简单、经济,实用的修复方法。     

Embryonic development of the head and neck: Part 3, the face

The embryology of the face is presented with respect to changes affecting the mandible, maxilla, upper and lower lips, palate, nose, and oral cavity. The embryonic development of the teeth and salivary glands is also included. Various facial clefts, including cleft lip and cleft palate, are discussed, in addition to some congenital anomalies affecting the nose and oral cavity.     

Palatal Fistulae Following Cleft Palate Surgery

The occurrence and treatment of palatal fistulae have been studied in 1108 CLP patients who had their primary operations performed during the years 1954–69. No fistulae were recorded in 263 patients with incomplete cleft of the primary palate only. These patients were excluded, leaving 845 patients for analysis. The Le Mesurier or Millard technique had been used for the primary lip operation, and the von Langenbeck procedure for closure of the palate; in complete clefts, the anterior part of the palate had been closed using Veau's vomer flap operation simultaneously with lip closure. The observation period ranged from 7 to 22 years, during which time each patient was examined at least once and the majority on several occasions by members of the cleft palate team. The overall incidence of fistulae was 18%. Fistulae were recorded in 11.3% of all complete clefts of the primary palate, and in 36.1% of all complete total clefts. In cases of cleft palate only, fistulae were found in 3.5% of the incomplete clefts, and in 20% of the complete clefts. In patients with bilateral complete clefts, closure of both sides of the lip and anterior palate in one operation seemed to have greatly increased the risk of fistula formation. There was a much higher incidence of fistulae in patients operated on during the years 1954–61 than in those treated in the period 1962–69. Fistula symptoms requiring surgical intervention were recorded in 113 patients. Closure of the fistula was achieved in 84.1%. Of 18 patients with a residual fistula. 17 were asymptomatic or had symptoms so slight that they were considered insignificant and not justifying operation.     

Association between maternal diabetes mellitus and newborn oral cleft.

Diabetes mellitus has been implicated in several studies as a possible etiological factor of various congenital anomalies. Oral clefts are common congenital malformations that may severely affect the quality of life. The authors conducted a population-based case-control study using the 1996 National Center for Health Statistics United States Natality database to investigate whether maternal diabetes mellitus is a risk factor (p < 0.05) for having a newborn with an oral cleft. The patients consisted of 2,207 live births with cleft lip/palate, and the control subjects were 4,414 randomly selected live births, excluding those with other congenital defects. After adjusting for potential confounding variables, diabetic mothers were found to be 1.352 times (95% confidence interval, 1.004-1.821; p < 0.05) more likely than nondiabetic mothers to have a newborn with cleft lip/palate. In counseling expectant mothers, early glycemic control may be an important factor in decreasing the incidence of this congenital anomaly.     

Normal and abnormal development of the lip and palate

Largely because fusion of the lip and the palate are developmental weak points, common facial clefts may arise in a great many ways, both experimentally and in man. However, we believe that the vast majority of human clefts have similar origins with minor variations. One must always question the appropriateness of animal models. Apparently appropriate animal models are giving us considerable insight into the manner in which genetic and environmental factors alter development and how they interact with one another in the developing embryo. These studies help us understand the nature of the multifactorial threshold concept as it applies to cleft lip and cleft palate, and they emphasize the potential importance of even "minor" environmental factors in determining on which side of the threshold for clefting an individual embryo may fall.     

Three-dimensional nasal morphology in cleft lip and palate operated adult patients

Nasal morphology was assessed three-dimensionally in 18 cleft lip and palate operated patients aged 19 to 27 years, and in 161 sex- and age-matched control subjects. Comparisons were performed by Student t and Watson-Williams' tests. No differences were found in nasal volume or surface. Nasal width, alar base width, and inferior width of the nostrils were significantly larger in male patients than in the reference men. The nasal bridge was shorter. Similar differences were found in the female patients. In addition, the right nostril was larger and the nasal height shorter. In men, the nasolabial and the nasal tip angles were smaller in the patients than in the reference subjects, whereas the facial convexity angle was larger in the patients. In conclusion, the nose of adult operated cleft lip and palate patients differed from that of normal control subjects. Surgical corrections of the cleft lip and palate failed to provide a completely normal appearance. The methods might be used to indicate where additional procedures might be performed to approximate a reference population.     

Minimum standards for the management of cleft lip and palate: efforts to close the audit loop. Royal College of Surgeons of England.

Intercentre audit in the late 1980s revealed poorer outcomes for facial growth for British patients with cleft lip and palate than equivalent patients in northern Europe. A subsequent survey of the surgical practices in England and Wales, under the auspices of the Surgical Audit and Epidemiology Unit, revealed the widespread involvement of low-volume operators in cleft care, a tendency for low-volume operators to have an incomplete network of associated professionals, and non-standardised record keeping protocols. Recommendations for minimum standards of care for children born with cleft lip and palate were produced by a multidisciplinary steering group. A further investigation is planned to determine their validity and to provide a baseline for future audit cycles.     

Synthesis of the standard of treatment of cleft lip and cleft palate by 11 francophone teams en 2001

Influenced by Eurocleft project, the authors proposed a synthesis of the protocol of treatment for cleft palate and/or cleft lip patient by 11 french and belgian teams. If the goal are similar (restored anatomy with good appearance, good speech, normal hearing, facial growth and dental arch correct, good social integration) the methods to obtain this outcome are different in each cleft unit. Consensual points and dissensions were described in the discussion.     

Influence of cleft palate closure by osteotomy technique on growth of the dentomaxillary complex in human beings

Properly done, osteotomy cleft palate closure in human beings reproduces a normal dentomaxillary complex in patients with an incomplete cleft palate and in those with a narrow unilateral complete lip and palate cleft. In wider complete clefts, the dentomaxillary complex is influenced by the constrictive action of the lip muscle during closure rather than by the osteotomy procedure. Plaster casts of osteotomy surgical cases late postoperatively demonstrate the normal growth pattern achieved. Variations in cleft palate osteotomy have been worked out for every type of cleft palate.     

Long-term influence of infant periosteoplasty on facial growth and occlusion in patients with bilateral cleft lip and palate

Abstract This retrospective, long-term study evaluated the influence of two different treatment protocols, one including infant periosteoplasty, on facial growth and occlusion in patients with complete bilateral cleft lip and palate (BCLP). Thirty-five patients with records of 5-, 8- and 16-19-year-olds were included. Sixteen of these received infant periosteoplasty (BCLP-pp) to the cleft alveolus in conjunction with lip repair and a one-stage closure of the palate. The remaining 19 patients with a two-stage closure of the palate did not have an infant periosteoplasty (BCLP-np). The bone formation induced by periosteoplasty in the BCLP-np group was insufficient and both groups had secondary bone grafting to the alveolar clefts before the eruption of the lateral incisor or the canine. Facial growth was evaluated with cephalometry at the recorded ages and dental arch relationships with the Huddart and Bodenham crossbite scores at the age of 16-19 years. Until 19 years a significant retrusion of the maxillary position (SNA) was observed in both groups. At 16-19 years of age there was no significant difference of maxillary protrusion (SNA), intermaxillary position (ANB), maxillary length (ss-pm) or vertical skeletal relationships (ML/NSL, Ml/NL) between the two groups. However, a significant difference of the crossbite scores was found. The BCLP-pp group did not show more facial growth problems but more malocclusion and the insufficient bone formation of the alveolar clefts after infant periosteoplasty required a secondary bone grafting.     

Epidemiology of orofacial clefts in Finland: a review

Epidemiological studies on clefts in Finland seem to give support to the following theories: 1. Both genetic and environmental factors seem to play a role in the pathogenesis of cleft lip and/or cleft palate, which in the majority of cases are probably two different anomalies. 2. The incidence of cleft lip and/or cleft palate in Finland has increased, probably because of a change in the environmental factors. 3. The incidence of cleft palate in Finland is higher than anywhere, which seems to be the result of differing genetic factors. 4. The exogenous factors remain unidentified, but in cleft lip and/or cleft palate parallel fluctuations and an increasing trend have been noticed, arguing for similar and simultaneous factors. 5. More patients with cleft palate than cleft lip/palate have "cleft syndromes."