Difference in alveolar molding effect and growth in the cleft segments: 3-dimensional analysis of unilateral cleft lip and palate patients.

OBJECTIVE: This study was performed to observe the alveolar molding (AM) effect and growth of unilateral cleft lip and palate (UCLP) patients using 3-dimensional (3D) analysis. STUDY DESIGN: The sample consisted of 16 Korean UCLP infants who were treated using presurgical nasoalveolar molding (PNAM) appliance and rotation-advancement cheiloplasty. The maxillary models were obtained at the initial visit, after PNAM treatment 1 month before cheiloplasty, and 2 months after cheiloplasty. RESULTS: The cleft gap was reduced by AM of the greater segment (GS) during PNAM treatment and of the anterior alveolar segments (AAS) through lip pressure after cheiloplasty. Although forward growth of GS was restrained by the PNAM treatment, it resumed after cheiloplasty. The amount of increase in the area and distance variables were largest in the posterior alveolar segments (PAS) only after cheiloplasty. CONCLUSION: Alveolar molding took place mainly in AAS during PNAM treatment, and growth occurred mainly in PAS after cheiloplasty.     

单侧完全性唇腭裂患者术前鼻牙槽骨整形的回顾性研究

目的：对接受术前鼻牙槽骨整形的单侧完全性唇腭裂患者进行回顾性研究,指导唇腭裂的术前非手术治疗。方法本研究回顾性分析了58例接受术前鼻牙槽骨整形的单侧唇腭裂患者,对正畸后未发生齿槽偏移和正畸后发生齿槽偏移的患者进行相关变量测量,并对测量结果进行统计学分析。结果本研究纳入的58例唇腭裂患者,有4例患者发生正畸后齿槽舌侧偏移,其余的54例患者正畸后未发生齿槽偏移。两组患者的前方齿槽裂隙宽度在矢状方向和垂直方向（PP’-Y、PP’-Z）存在显著差异,健侧齿槽前方与齿槽后方水平方向之间的夹角（∠PTT’）也存在统计学差异。结论单侧完全性唇腭裂患者在正畸前可能潜在齿槽偏移畸形,与前方齿槽在矢状和垂直方向裂隙畸形宽度,及健侧齿槽前方成角角度相关。无齿槽偏移患者可以直接使用矫治器缩窄裂隙宽度,而对于正畸后可能发生齿槽舌侧偏移的患者,需先矫正偏移畸形再缩小裂隙宽度。     

单侧唇腭裂中牙槽嵴裂的手术治疗

为16例单侧唇腭裂中的牙槽嵴裂患者,采用自体髂骨骨松质(13例)或羟基磷灰石(3例)充填,并以上唇粘膜瓣和裂隙两侧粘骨膜瓣移转封闭裂隙的治疗方法。其中12例随访1～5年,自体骨移植者有9例,全部发生骨连续,并有7     

单侧唇腭裂中牙槽嵴裂的手术治疗

为１６例单侧唇腭裂中的牙槽嵴裂患者，采用自体髂骨骨松质（１３例）或羟基磷灰石（３例）充填，并以上唇粘膜瓣和裂隙两侧粘骨膜瓣移转封闭裂隙的治疗方法。其中１２例随访１～５年，自体骨移植者有９例，全部发生骨连续，并有７例或从骨移植区长出。羟基磷灰石者３例无一例有牙萌出。认为缺损修补以自体骨移植为好，羟基磷灰石不宜用于未成年人。     

Early cheiloplasty : its effects on alveolar cleft

Summary Early cheiloplasty is performed within the first ten days of life in healthy new borns. Sixteen unilateral and six bilateral cleft lip patients were operated on. All had alveolar and palatal clefts. Pre- and postoperative maxillary models were taken and compared with those obtained from late repaired clefts in which an extraoral traction (EOT) device was used preoperatively. Early operation had a significant occlusive effect on alveolar arch, but there was no alteration of the palatal clefts and palatal shelves.Presented at the Sixth Congress of the European Section of the International Confederation for Plastic and Reconstructive Surgery (September 3–6, 1989, Istanbul, Turkey)     

单侧唇裂手术前后唇鼻部外观变化的数据分析

目的获得单侧唇裂患儿术前唇鼻形态的数据资料,根据唇鼻畸形特征设计手术修复方案,通过术后临床观察,评价手术效果。方法单侧唇裂患儿85例,分为单侧完全性唇裂组、单侧不完全性唇裂组。术前、术后6个月分别测量裂隙两侧唇长、唇高、人中嵴高度、鼻底宽度和鼻小柱高度,采用配对t检验来比较各组患儿裂隙两侧测量值的差异。结果单侧唇裂患儿术前裂隙两侧唇鼻部各项参数均有统计学意义（P〈0．01）;短期术后随访表明,两组1岁以内患儿在健一患侧唇长和鼻底宽度方面具有统计学意义（P〈0．01）,裂隙侧唇长较健侧小,鼻底宽度较健侧大。完全性唇裂组患儿术后半年患侧鼻小柱高度小于健侧。1～2岁患儿在健一患侧唇长、唇高、人中嵴高度、鼻底宽度和鼻小柱高度方面差异无统计学意义。结论测量单侧唇裂患儿唇长、唇高、鼻底宽度、鼻小柱高度和人中嵴高度,对术前手术设计和术后对称性评估有很大的帮助。短期随访表明,1岁以内单侧唇裂患儿患侧唇长变短,鼻底增宽,在今后的唇裂修复中,需要通过改进手术方法来解决。     

单侧牙槽嵴裂动物模型的建立及牙槽嵴裂对鼻软组织生长发育的影响

目的 建立单侧牙槽嵴裂动物模型,研究牙槽嵴裂对鼻软组织发育的影响.方法 选用10只标准同窝实验犬,自身对照,随机确定实验侧和对照侧.采用外科手术的方法在实验侧造成10 mm ×15 mm的单侧牙槽嵴裂.术后10周处死动物,通过螺旋CT进行头颅三维重建,应用Amira软件对两组动物进行外鼻定点,行线距及角度测量并分析数据;另解剖双侧鼻翼软骨,于软骨内1/2处、穹隆角、外1/2、外1/4处垂直于软骨长轴切开,水平包埋,常规组织学处理,HE染色,进行图像分析.采用SPSS 15.0软件对数据进行配对t检验,分析比较软骨发育的差别.结果 大体观察:实验侧牙槽嵴裂裂隙未愈合,双侧鼻翼发育程度不一致,患侧发育较健侧差,并伴有患侧鼻翼外侧脚下陷;鼻尖位置向患侧偏斜,鼻孔呈不同程度的不对称,鼻小柱向健侧偏斜.组织学观察:健侧软骨外侧脚1/2处和1/4处中央细胞密度、面积、周长均比患侧发育良好,差异有统计学意义.结论 单侧牙槽嵴裂异常力学结构对外鼻的形态及鼻翼软骨发育具有一定的影响.     

Palatoalveolar outcome at 18 months following simultaneous primary cleft lip repair and posterior palatoplasty.

It is frequently reported that early repair of the soft palate induces narrowing of the remaining palatal cleft and thus facilitates later hard palate closure. However, to the best of our knowledge, there have been no comparative studies to test this hypothesis. The purpose of this retrospective study was to evaluate the change of palatoalveolar morphology following primary lip repair and posterior palatoplasty. Dental plaster models of patients with complete unilateral cleft of lip and palate (UCLP) were used to measure the width of the cleft and palatal arch. Twenty-six patients received simple posterior palatoplasty (PP group) simultaneous with primary lip repair, and 20 patients did not (NPP group). The dental models included one preoperative cast at 2 months (T1) and two or three casts at 6 (T2), 12 (T3), and 18 (T4) months before final palate closure. The linear measurements performed were width of alveolar cleft (Ca); width of palatal cleft between the canines (Cc), molars (Cm), and tuberosities (Ct); the palatal arch distance between the canines (Dc); the widest distance between molars (Dm) and the tuberosities (Dt); and the palatal height between the canines (Hc) and tuberosities (Ht). The raw measurements and the calculated cleft-to-arch ratios of Cc/Dc, Cm/Dm, and Ct/Dt were compared between the two groups. The results showed gradual narrowing of the width of cleft from T1 to T4. Narrowing of alveolar cleft width (Ca) from T1 to T2 was dramatic. The palatal arch (Dc, Dm, Dt) showed no change to mild increase in width. The cleft-to-arch ratios decreased with time. The palatal height remained the same or slightly increased over time. There were no significant differences observed between the PP and NPP groups among these measurements except for the Ct and Ct/Dt at T4. In conclusion, after initial lip repair, there was a decrease of the width of cleft in patients with complete UCLP during the 18-month period, and simple posterior palatoplasty did not further narrow the cleft nor influence palatal arch development.     

Millard法修复单侧唇裂患儿手术前后面部形态的三维分析

目的 利用可见光三维扫描仪分析评价Millard法修复单侧唇裂的效果.方法 随机收集第四军医大学口腔医院2009年5至6月收治的单侧唇裂患儿的I临床资料,共19例,均为一期修复,其中Ⅱ度唇裂7例,Ⅲ度12例.利用3DSS扫描获得患儿手术前、后面部形态数据,将其导入逆向工程软件Geomagie Studio 10.0中生成j维数字化模型.在软件中精确测量手术前、后健、患侧鼻小柱长度、鼻底宽度、鼻翼长度等数据,对测得数据以SPSS12.0统计软件包进行配对t检验及单样本t检验.结果 无论是Ⅱ度还是Ⅲ度单侧唇裂患儿,其鼻底宽度、鼻基部宽度、鼻翼长度、唇长术前、后的差异均有统计学意义(P<0.05,P<0.01).Ⅱ度唇裂患儿术后鼻小柱高度、鼻翼口角距的非对称率与正常人群非对称卒的差异有统计学意义(P<0.05);m度唇裂患儿术后鼻小柱高度、鼻底宽度、鼻基部宽度、鼻翼门角距、唇长的非对称率与正常人群的非对称率差异有统计学意义(P<0.05,P<0.01).结论 Millard法修复单侧唇裂.患儿术后鼻底封闭,鼻小柱偏斜畸形获得矫治,唇弓形态恢复较好,但患侧唇高均有不同程度地下降不足,健、患侧鼻小柱高度的不对称仍较明显.Ⅲ度唇裂患儿术后患侧鼻底宽度仍比健侧宽.     

Cleft lip and palate patients prior to delayed closure of the hard palate: evaluation of maxillary morphology and the effect of early stimulation on pre-school speech

Speech and maxillary development were analysed in two groups of patients with unilateral cleft lip and palate; both groups had early jaw orthopaedic treatment and a surgical regimen that included two-stage lip surgery (mean ages of 2 and 19 months) and soft palate repair (8 months). Closure of the hard palate was postponed until the children were 8 to 10 years of age. The first group comprised 10 consecutive patients who were analysed at 5 and 7 years of age, and the second group seven patients who were studied at the age of 5. Both groups were thus investigated before the repair of the cleft in the hard palate. In addition to surgical and jaw orthopaedic treatment, the second group of patients received early stimulation of lip and tongue tip movements. Our results indicated that hypernasality was less a problem than was retracted palatal or velar articulation of dental consonants. These deviations tended to be reduced, however, after early stimulation. There seemed to be no clear association between the size of the residual cleft in the hard palate and the extent of speech development. The average size of the residual cleft in our patients was comparatively small, and decreased further during follow up. We conclude that preschool children with unilateral cleft lip and palate may develop good speech, in spite of the residual cleft, if they use an intraoral plate and are given extra lip and tongue tip stimulation, together with early speech therapy if necessary.     

A comparative study of maxillary growth following rotation-advancement and triangular flap unilateral cleft lip repairs: an experimental study in rabbits

The present study was designed to investigate 2 features of maxillary growth following Millard rotation-advancement and Tennison triangular flap cleft lip repairs in rabbits with surgically created defects simulating unilateral cleft lip and cleft alveolus. Sixty purebred New Zealand rabbits were used in this experiment. The animals were divided into 4 groups: 2 control groups (unoperated and unrepaired) and 2 experimental groups (lip repair with rotation-advancement and lip repair with triangular flap). Nineteen metric cranial variables were measured directly from the cleaned skulls. Direct cephalometric measurements were taken in the following dimensions: maxillary length, width and height, posterior facial width, and nasal deflection. Significant differences were noted between Millard rotation-advancement group and Tennison triangular flap group in 2 of 6 measurements of maxillary length. Analysis of variance revealed significantly statistical differences between Millard rotation-advancement group and Tennison triangular flap group in 3 of 6 measures of maxillary width. Analysis of variance revealed no significantly statistical differences between Millard rotation-advancement group and Tennison triangular flap group in maxillary height. Statistical differences were noted between Millard rotation-advancement group and Tennison triangular flap group in posterior facial width. There was no significantly statistical difference between Millard rotation-advancement group and Tennison triangular flap group for the nasal deflection measurements. The results of this study indicated that the features of maxillary growth were different between the 2 lip-repair techniques in rabbits with surgically created defects simulating unilateral cleft lip and alveolus.     

Current status of presurgical infant orthopaedic treatment for cleft lip and palate patients: A critical review

Rehabilitation of cleft lip and palate (CLP) patients is a challenge for all the concerned members of the cleft team, and various treatment modalities have been attempted to obtain aesthetic results. Presurgical infant orthopaedics (PSIO) was introduced to reshape alveolar and nasal segments prior to surgical repair of cleft lip. However, literature reports lot of controversy regarding the use of PSIO in patients with CLP. Evaluation of long-term results of PSIO can provide scientific evidence on the efficacy and usefulness of PSIO in CLP patients. The aim was to assess the scientific evidence on the efficiency of PSIO appliances in patients with CLP and to critically analyse the current status of PSIO. A PubMed search was performed using the terms PSIO, presurgical nasoalveolar moulding and its long-term results and related articles were selected for the review. The documented studies report no beneficial effect of PSIO on maxillary arch dimensions, facial aesthetics and in the subsequent development of dentition and occlusion in CLP patients. Nasal moulding seems to be more beneficial and effective in unilateral cleft lip and palate patients with better long-term results.KEY WORDS: Bilateral cleft lip and palate, long-term results, nasoalveolar moulding, presurgical infant orthopaedics, unilateral cleft lip and palate     

Maxillo-mandibular relationship in untreated and surgically treated patients with unilateral complete cleft lip and palate: A cephalometric evaluation

Background

Cleft lip and palate is the most frequently encountered birth defect resulting from an incomplete union of the lateral nasal process and maxillary process during development. A cephalometric assessment was carried out to compare the maxillo-mandibular relationship in untreated and surgically treated patients with unilateral complete cleft lip and palate (UCCLP).

Methods

This retrospective study included lateral and frontal cephalograms of 100 non-syndromic UCCLP patients of Indian origin within an age range of 12–20 years, divided in to two groups. Group I consisted of 50 untreated UCCLP patients. Group II consisted of 50 UCCLP patients who had undergone surgical intervention for cleft lip and palate repair before puberty.

Results

Maxilla in surgically treated patients was found to be significantly shorter in the anteroposterior and vertical direction along with retroposition and clockwise rotation with respect to the cranial base. The mandible was found shorter in length and posteriorly positioned with respect to the cranial base along with downward and backward rotation in group II patients. Class III skeletal pattern was observed in group II patients but was not as severe as anticipated though the maxilla is short and retropositioned because of some compensation being done by the shorter mandibular length and clockwise rotation of the mandible. Measurements on frontal cephalogram showed decreased maxillary width, nasal height and nasal width in surgically treated cases.

Conclusions

The findings of this study suggested that surgical intervention at early age has significant restraining effect on maxillary growth that results in class III skeletal relationship/tendency. Level of Evidence: Level IV, therapeutic study.     

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.     

Left or right hand dominance in children with cleft lip and palate.

The relationship between unilateral cleft lip, bilateral cleft lip, palatal clefting and left-right hand dominance was studied in 337 patients with cleft lip and/or palate aged between 3 and 14 years. There was no statistically significant difference in the laterality of handedness between different types of cleft nor between unilateral left and right sided cleft lip with or without cleft palate.     

Maxillary dental arch and occlusion in patients with unilateral cleft lip and palate treated with different delays in closure of the hard palate after early velar repair.

We wanted to find out if growth of the maxilla in 26 patients with unilateral cleft lip and palate (UCLP) was adversely affected by having the residual cleft of the hard palate repaired earlier than had been done previously in a 2-stage palatal closure protocol. The ages at repair of the hard palate of the present patients ranged from 38 to 89 months. Dental casts from ages about 3 years (before any repair of the hard palate), 5, 7, and 10 years of age were analysed. The results indicated that earlier repair of the cleft in the hard palate did not influence maxillary growth differently from the later repair.     

Unilateral superiorly-based nasolabial island flap for the reconstruction of the philtrum.

We present a case of reconstruction of the philtrum with a unilateral superiorly-based nasolabial island flap following a secondary Millard's bilateral cheiloplasty in a 23-year-old man with cleft lip and palate. His philtrum consisted of a full-thickness skin graft transplanted at one of his previous operations.     

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。