Bite force of children with repaired unilateral and bilateral cleft lip and palate

ObjectiveTo assess the bite force (BF) of children with repaired cleft lip and palate (CLP).DesignChildren aged 6–12 years, with and without CLP, were divided into the following 5 groups: (1) control group (CON): 34 children without CLP (17 female, 17 male, mean age 8.2 ± 1.4); (2) cleft lip group (CL): 31 children with cleft lip involving the pre-maxilla (15 female, 16 male, mean age 9.7± 1.3); (3) unilateral CLP group (UCLP): 36 children with complete unilateral CLP (11 female, 25 male, mean age 9.4± 1.6); (4) bilateral CLP group (BCLP): 32 children with complete bilateral CLP (11 female, 21 male, mean age 9.5± 1.7); and 5) cleft palate group (CP): 17 children with complete cleft palate (9 female, 8 male, mean age 9.4± 1.6). Briefly, in this clinical trial, BF was assessed before alveolar bone grafting with a gnathodynamometer (IDDK, Kratos, Cotia, SP, Brazil). For CON, BCLP, CL and CP groups, BF was obtained in the anterior and posterior region of the maxilla. For the UCLP group, BF was assessed in the anterior and posterior regions of both segments. Differences among groups were evaluated by ANOVA test, and Tukey’s test was used to assess any correlations among variables (P < 0.05).ResultsUnexpectedly, no differences of BF were observed among CON and any of the cleft groups. However, a stronger BF was observed in the CL group when compared to the UCLP and BCLP groups. Next, no differences were observed between the cleft side and the noncleft side in the UCLP group. Lastly, in all groups, BFs from the anterior region of the maxilla were less when compared to the posterior regions.ConclusionThe BF of children with CLP is no different from children without CLP.     

Craniofacial development in children with unilateral cleft lip and palate

Unilateral cleft lip and palate is the most common cleft in humans. We investigated the craniofacial morphology of Turkish children with unilateral complete cleft lip and palate who had operations to close the cleft lip when they were 3 months old and to close the palate at 12 months. They were not given orthopaedic or orthodontic treatment. We compared 42 patients with unilateral complete cleft lip and palate (UCCLP) with 45 control children without UCCLP at mean ages of 13 and 15 years. The children with UCCLP had considerable morphological deviations compared with the matched children without clefts. They had significantly shorter and more posteriorly positioned maxillas (p<0.01). There was also an increase in cranial base angle (p<0.05), mandibular plane and gonial angle (p<0.01). There was a reduction in the posterior facial height (p<0.05) and an increase in the anterior facial height (p<0.01). The profile of the soft tissue was more convex (p<0.001) and the upper lip was thinner than in the children in the control group (p<0.01), and their noses were relatively further backwards and downwards (p<0.01).     

Palate morphology after unilateral and bilateral cleft lip and palate closure

The aim of the present study was to compare the morphology of the hard palate of patients with uni- and bilateral cleft lip and palate after palatoplasty using vomer and palatal pedicled flaps with the palatal morphology of non-cleft individuals. Eighty patients were enrolled into this retrospective study: 40 patients with cleft lip and palate (30 unilateral, 10 bilateral) and 40 non-cleft patients with class I occlusion, who served as controls. Analysis of the development of the maxillary arch and evaluation of palatal morphology were accomplished from reformatted CT scans from plaster casts of the maxilla at the age of 4, 10 and 15 years (cleft patients) and 10 years (controls). Width and symmetry of the maxillary arch and morphology of the hard palate were assessed in the canine and molar region and compared both among the cleft groups and the controls. Maxillary arch width as assessed from plaster casts did not differ significantly between uni- and bilateral cleft patients and was not significantly different from controls at the age of 10. Deviation from symmetry was present in both types of cleft and significant in unilateral clefts when compared to bilateral clefts and non-cleft patients. Palatal morphology did not differ significantly between uni- and bilateral clefts until the age of 15, but was significantly different from control patients in the molar area at the age of 10 presumably due to the medial shift of soft tissue flaps used for palatoplasty. It is concluded that palatoplasty significantly alters hard palate morphology particularly in the posterior area. The relevance of this alteration for speech and articulation remains to be explored.     

Prevalence of intranasal ectopic teeth in children with complete unilateral and bilateral cleft lip and palate.

OBJECTIVE: The objective of this study was to determine the prevalence of ectopic eruption of intranasal teeth. DESIGN: This was a retrospective study, where records of children with repaired cleft lip and palate were analyzed. SETTING: The study was conducted at a large craniofacial center, the Hospital for Rehabilitation of Craniofacial Anomalies, USP, Bauru, S?o Paulo, Brazil. SUBJECTS: The sample consisted of 815 records from patients with bilateral cleft lip and palate (BCLP) and 1,495 records from patients with unilateral cleft lip and palate (UCLP). The age of the subjects was 5 to 10 years old and the groups included both males and females. RESULTS: The results showed that 0.61% of the children with BCLP and 0.40% of those with UCLP had an intranasal tooth. The prevalence of an intranasal tooth for the whole group was 0.48%, and it appeared to be more common in females.     

Dental age in children with a complete unilateral cleft lip and palate.

OBJECTIVE: To assess dental age in children with a complete unilateral cleft lip and palate and to compare this with a noncleft control group. DESIGN: Two-group, mixed-longitudinal cohort study. SETTING: Cleft group from an academic center for cleft lip and palate treatment. Noncleft control group from the same population. PATIENTS: Participants included 70 Caucasian children with a full complement of teeth and a complete unilateral cleft lip and palate (45 boys and 25 girls) from the Cleft Palate Craniofacial Center at the Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands. The control group (90 boys and 91 girls) was taken from the Nijmegen Growth Study. MAIN OUTCOME MEASURE: Dental age was assessed on orthopantomograms. In the unilateral cleft lip and palate group, linear interpolation in individual age curves was applied to obtain the dental age at 5, 9.5, and 14 years of age. For these ages, a comparison was made with the noncleft control group. RESULTS: Boys and girls with a unilateral cleft lip and palate showed a significant delay in dental age, as compared with their noncleft peers at all three ages. This delay was more pronounced in boys than in girls. The gender effect was significant at chronological ages 5 and 14 years. CONCLUSIONS: Children with a complete unilateral cleft lip and palate have a delay in dental age, compared with noncleft children.     

Dental maturity in children with a complete bilateral cleft lip and palate.

OBJECTIVE: Dental age in children with a bilateral cleft lip and palate (BCLP) was assessed and compared with children without cleft. DESIGN: Dental age was estimated for 74 children with a complete BCLP (54 boys and 20 girls) from 364 orthopantomograms. Nonlinear regression curves were made between 5 and 14 years of age for boys and girls separately. A comparison was made with a sample of Dutch children (91 girls and 90 boys) without oral clefts for three different age groups, namely 5, 9.5, and 14 years of age. SETTING: Data collection was carried out at the Cleft Palate Center, University Medical Center Nijmegen (The Netherlands). A sample from the Nijmegen Growth Study was used as a normative sample. RESULTS: At 5 years of age, boys with a BCLP were significantly delayed in dental age compared to boys without cleft. After that age, no significant differences in dental age were found. For girls with a BCLP, no difference in dental age with the girls without cleft could be found. CONCLUSION: Dental age in BCLP showed a tendency to be delayed at 5 years of age. At the ages of 9.5 and 14 years of age, no differences were found. Further investigation on the development of individual teeth is suggested to gain more insight into the origin of this delay.     

A three-in-one surgical approach for unilateral cleft lip and palate

A single stage surgical procedure, combining the Le Fort I osteotomy, oro-nasal fistula closure and secondary osteoplasty, for the treatment of adolescents and adults with both an orthognathic deformity and a persistent oro-nasal fistula is described. During the same procedure the cleft alveolar ridge is fused by means of a bone transplantation. This three-in-one surgical procedure is intended for the unilateral cleft lip and palate case.     

Craniofacial comparisons in 22-month-old lip-operated children with unilateral complete cleft lip and palate and unilateral incomplete cleft lip.

OBJECTIVE: The objective of the study was to analyze the craniofacial morphology in infants with unilateral complete cleft lip and palate (UCCLP) in which the lip and the anterior part of the palate had been surgically closed at 2 months of age and to compare the morphology with that of a control group with unilateral incomplete cleft lip (UICL) in which the lip had also been surgically closed at 2 months of age. DESIGN: The sample consisted of a total of 108 cleft children all fulfilling the entry criteria, besides diagnosis, as follows: The child was of Danish origin; the age of the child was between 650 and 750 days (approximately 22 months) at the time of examination; the child was healthy except for its single cleft malformation; the surgical procedure in each group had been performed at about 2 months of age by the same surgeon. The surgical methods used were a Tennison procedure (UICL group) and a Tennison procedure supplemented by palatovomer plasty (UCCLP group). METHODS: The method of investigation was infant cephalometry in the lateral, frontal, and axial projections. Linear, angular, and area variables describing the craniofacial morphology were calculated and supplemented by mean plots from the cephalometric projections in the two groups. RESULTS AND CONCLUSIONS: Statistical analysis based on Student's t test showed that the facial morphology in the 22-month-old UCCLP group differed significantly from that of the UICL group. The most pronounced differences were found in the maxillary complex and the mandible. The deviations observed in the UCCLP group at 22 months of age were similar to those previously observed at 2 months of age. However, several of the dysmorphic traits had become less pronounced; some had remained the same; and a few had become worse with time.     

Asymmetry of the maxilla in children with complete unilateral cleft lip and palate

Craniofacial asymmetry was analyzed in 31 children with unilateral cleft lip and palate (UCLP) and compared to a group of 24 children with incomplete clefts of the lip (CL). Symmetry was evaluated from 32 variables on posteroanterior cephalometric radiographs. Two types of asymmetry were identified: In the first, there was a positional deviation and a change of arch shape of the maxillary segment on the cleft side. The basal maxillary width was similar in the two groups. At the dentoalveolar level a decrease in width was localized to the cleft side in the UCLP group. Maxillary height of the cleft segment was reduced. The second type was related to the anterior part of the maxilla and the nasal septum. The inferior border of the bony part of the nasal septum deviated towards the cleft side. The anterior nasal spine and the midpoint between the upper central incisors deviated toward the noncleft side, but to a different degree indicating a vertical tilting of the premaxillary region.     

Fundamental care programme in children with cleft lip and palate

By means of examination for caries-morbidity and the degree of treatment by patients with cleft lip and palate will be referred to the inadequate care of this patients. Longitudinal studies show the sequences of caries and extractions for the development of dentition. As a result of this will be decuced demands for the dentistry for children of patients with cleft lip and palate.     

Tooth development in children with cleft lip and palate. An international inquiry into unilateral cleft lip, jaw and palate

In a cross-sectional study of 106 European children with unilateral complete cleft lip, alveolus and palate ranging from 10 to 15 years of age, dental maturity was determined using orthopantomograms. The method and standards (the 50th percentile line) of Demirjian were used. The study shows a significant delay of dental maturity in both male and female cleft-affected patients. This delay in tooth development supports Van Limborgh's theory that the origin of clefts is due to the delayed growth and development of parts of the dentofacial area.     

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.     

Craniofacial morphology in children with operated complete unilateral cleft lip and palate

The objective of the study was to compare the craniofacial characteristics of children with operated unilateral complete cleft lip and palate (UCLP) with those of noncleft children. Lateral and posteroanterior cephalometric radiographs of subjects with UCLP and controls who were matched for sex, age, and ethnic origin were analyzed and compared. There were a total of 21 subjects with UCLP (10 boys and 11 girls) from the Orthodontic Department of Selcuk University and 15 controls (7 boys and 8 girls) from the Orthodontic Department of Ankara University. The nasal bone length in the group with cleft did not differ significantly from that in the control group. Subjects with UCLP included in the study appeared to have shorter faces, smaller mandibulae, greater lateral orbital width, and smaller sella turcicae compared with controls. Unilateral cleft lip and palate affects the intracranial morphology as well as dentofacial structures.     

Changes after presurgical orthopedic treatment in children with unilateral cleft lip and cleft palate]

The study analyses the changes occurring in the maxillary arches of 30 infants with complete unilateral clefts of the lip and palate following presurgical maxillary orthopaedic treatment. 15 similar cases not receiving such treatment were used as controls together with 30 normal subjects. Photocopies of models of the arches at birth and 4 months were analyzed by computer and the area of palatel tissue measured using stereophotogrammetry. In the presurgical cases, the palatal cleft was significantly narrowed due to the transverse and antero-posterior dimensions of the arches increasing less than in the controls. The narrowing of the cleft was particularly marked in the alveolar region because the presurgical treatment minimised the antero-lateral (outward) rotation of the lesser segment which otherwise would have occurred. Somewhat surprisingly, the study showed that presurgical treatment tended to inhibit growth of palatal tissue and it was concluded therefore that the narrowing of the defect was due mainly to the growth pattern of the maxillary arch being modified by the appliances.     

单侧完全性唇腭裂儿童患侧前牙发育研究

目的 分析单侧完全性唇腭裂儿童（ＵＣＬＰ）患侧尖牙发育特点。方法 ５３例８～１２岁ＵＣＬＰ患儿,采用Ｂｒｏｕｗｅｒｓ方法,测量并比较术前曲面断层中健侧及患侧恒上尖牙长度,并观察恒上切牙缺失和畸形情况。结果 ＵＣＬＰ患儿健、患侧恒上尖牙长度有显著性差异（Ｐ〈０．０１）;患侧侧切牙缺失３５．８％,患侧上中、侧切牙畸形４７．２％。结论 患者患侧恒上尖牙发育明显迟缓,并伴有不同程度患侧侧切牙缺失、中、侧切     

Nasolabial symmetry and aesthetics in children with complete unilateral cleft lip and palate

The objective of this study was to evaluate the association between nasolabial symmetry and aesthetics in children with complete unilateral cleft lip and palate (CUCLP). Frontal and basal photographs of 60 consecutively treated children with CUCLP (cleft group: 41 boys and 19 girls, mean (SD) age 11 (2) years) and 44 children without clefts (control group: 16 boys and 28 girls, mean (SD) age 11(2) years), were used for evaluation of nasolabial symmetry and aesthetics. Nasal and labial measurements were made to calculate the coefficient of asymmetry (CA). The 5-grade aesthetic index described by Asher-McDade et al. was used to evaluate nasolabial appearance. Correlation and regression analysis were used to identify an association between aesthetics and CA, sex, and the presence of CUCLP. Ten measurements in the cleft, and 2 in the control, group differed significantly between the cleft and non-cleft (or right and left) sides, respectively. The significantly higher values of 9 of 11 CA in the children with CUCLP indicated that they had more asymmetrical nasolabial areas than children without clefts. However, the regression analyses showed that only a few CA were associated with nasolabial aesthetics. In conclusion, nasolabial aesthetics and nasolabial symmetry seem to be only weakly associated in patients with CUCLP.