The Effect of Presurgical Treatment on Palatal Tissue Area in Unilateral Cleft Lip and Palate Subjects

Abstract

The investigation measures the area of palatal tissue at birth and at four months in three groups of subjects: (1) 30 complete unilateral cleft lip and palate cases who received presurgical maxillary orthopaedic treatment; (2) 15 similar cases who did not receive such treatment and were used as controls; (3) 30 normal children with intact palates.

The changes occurring in the three groups of cases over the four month period are compared. In particular it was noted that presurgical treatment retarded the growth of palatal tissue. The significance of this in relation to the other findings and presurgical treatment generally is discussed.     

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.     

上颌-鼻软骨整形矫治器在婴儿双侧完全性唇腭裂术前正畸中的应用

目的 探讨上颌-鼻软骨整形矫治器在婴儿期双侧完全性唇腭裂术前正畸中的应用价值.方法 对50例双侧唇腭裂患儿,随机分为试验组(n＝30)与对照组(n＝20),试验组于出生10 d～1个月内进行上颌-鼻软骨整形矫治器矫治,对照组均不做术前正畸.两组患儿正畸治疗前(T1)后(T2)对比上唇裂隙、上前牙槽突裂隙关闭程度,对比两组唇腭裂联合整复术后3个月鼻翼外观满意度,作出评价.结果 两组患儿T1、T2两侧上唇裂隙及牙槽突裂隙宽度差别无统计学意义(P＞0.05).患儿术后鼻翼外观满意度试验组87%,高于对照组60%(P＜0.05).结论 该治疗有效减少上唇及上颌骨牙槽突的裂隙宽度,改善鼻外观,达到降低手术难度,增加手术效果的目的.     

Sucking efficiency of early orthopaedic plate and teats in infants with cleft lip and palate

Intraoral negative pressure during bottle feeding with two kinds of teats (a regular Nuk and a cleft Nuk) was measured in 7 infants with cleft lip and palate, 8 infants with cleft palate, 2 infants with cleft lip, 4 infants with operated cleft lip and palate and 7 normal infants. Infants with cleft lip and palate or cleft palate were unable to generate negative pressure before cleft lip and palate closure. The presence or absence of an early orthopaedic plate did not make any difference. In infants with unoperated cleft lip and with operated cleft lip and palate, peak negative pressure during feeding differed little from that of normal infants.     

Dental treatment of predental and infant patients with clefts and craniofacial anomalies.

Children with cleft lip and/or palate differ in facial morphology and dentition from normal noncleft children. This paper reviews the current understanding of early dento-maxillary development in children with palatal clefts and the role of presurgical orthopedic treatment prior to primary palatal surgery. Finally, shortcomings of previous approaches to studying the outcome of treatment are presented, with a challenge to reevaluate how success is measured in the new millennium.     

Presurgical changes in unilateral cleft palate subjects.

This investigation utilizes computerized measuring and statistical techniques, stereophotogrammetry, and a newly developed method of measuring palatal surface areas to study changes in the maxillary arch dimensions at birth and at 4 months in 3 groups of subjects: (1) 30 complete unilateral cleft lip and palate cases who were treated by presurgical maxillary orthopaedics; (2) 15 similar cases who had no such treatment and served as controls; and (3) 30 normal children. The changes occurring in the 3 groups over the 4-month period were compared. In particular, it was noted that presurgical treatment had a constrictive effect on general arch growth and that it also retarded the growth of palatal tissue. The significance of this in relation to other findings and to presurgical treatment in general is discussed.     

双侧完全性唇腭裂新生儿进行鼻-齿槽塑形治疗的临床研究

目的观察鼻-齿槽塑形治疗(presurgical nasal-alveolar molding,PNAM)对双侧完全性唇腭裂婴儿的临床疗效。方法对20例出生10天~3个月的双侧完全性唇腭裂新生儿进行鼻-齿槽的整形,测量治疗前后的双侧上唇裂隙宽度、前鼻突到唇裂距离、鼻小柱长度及唇裂交角,并用SPSS21.0软件进行统计分析。结果经过3~4个月的PNAM治疗后,双侧上唇裂隙宽度、前鼻突到唇裂距离明显减小,鼻小柱长度明显增加,均有统计学意义;唇裂交角增大,但无统计学意义。鼻外形左右基本对称,鼻翼外形恢复不明显,鼻小柱位于面部正中位置。结论 PNAM塑形治疗能有效减少双侧完全性唇腭裂婴儿的上唇裂隙宽度,压低前鼻突,伸长鼻小柱,改善鼻外观,降低手术难度。     

A rapid solution to align the severely malpositioned premaxilla in bilateral cleft lip and palate patients.

OBJECTIVE: To describe a laboratory modification of the maxillary cast to make an improved nasoalveolar molding plate used in presurgical orthopedics for infants with bilateral cleft lip and palate. CONCLUSIONS: Modifying the nasoalveolar molding plate may reduce the presurgical treatment time for the bilateral cleft lip and palate patient.     

Primary repair of the alveolar cleft

Nasoalveolar fistula and oropharyngeal fistula of the anterior palatal region are very commonly seen in cases when there are concomitant clefts of the lip and the palate. Absence of adequate tissue in that region complicates the treatment and necessitates new tissue transfers from near or distant tissues. Today, the techniques used for correcting cleft lip cannot successfully solve these 2 problems. In this study, we describe a technique that depends on the principle of using the lip mucosal tissues that remains during the Tennison cleft lip correction technique, with a flap designation, to correct the tissue defect of the cleft between the foramen incisivum and lip and the alveolar region. Twenty-two patients (13 boys and 9 girls), with ages ranging from 3 to 53 months (mean, 24 mo), with unilateral cleft lip and palate underwent surgery with this new technique. In all these patients, clefts in the anterior palatal and alveolar regions were successfully corrected. Fistula was observed in none of these patients in these regions. Through this method, clefts in the anterior palatal and alveolar regions can be corrected during repair of cleft lips.     

术前应用Hotz夹板矫正唇腭裂患儿的牙槽和腭部畸形

目的:观察术前应用Hotz夹板矫正完全性唇腭裂患儿腭部及牙槽畸形的临床效果。方法:29例完全性唇腭裂婴儿分为治疗组和对照组,治疗组24例,戴用Hotz夹板;对照组5例,不戴Hotz夹板。观察治疗组戴用Hotz夹板的一般情况,比较对照组与治疗组牙槽裂隙及腭部裂隙宽度的变化,并采用SPSS11.0的t检验进行统计学处理。结果:治疗组戴用Hotz夹板3个月后,两侧牙槽突基本接触,移位的牙槽突恢复到正常位置,腭部裂隙和牙槽裂隙的宽度明显缩小,P<0.05;对照组腭部和牙槽裂隙增宽,牙槽突移位程度增加。结论:术前应用Hotz夹板,可以有效地矫正完全性唇腭裂患儿的腭部和牙槽畸形,缩小裂隙。     

Orthodontic and surgical aspects of cleft palate treatment

The growth pattern of the face in cleft lip and palate patients is determined by intrinsic, functional and iatrogenic factors. Probably the iatrogenic factors are the most important. Orthodontic and orthognatic aspects of cleft palate treatment are described, being divided in five stages: 1. presurgical orthopedic treatment prior to lipclosure; 2. early orthopedic treatment of maxillary hypoplasia; 3. reconstruction of the alveolar cleft with bonegrafting and/or orthodontic treatment; 4. orthodontic treatment and 5. combined surgical/orthodontic treatment.     

Sagittal growth of the facial skeleton of 6-year-old children with a complete unilateral cleft of lip, alveolus and palate treated with two different protocols

OBJECTIVE: The purpose of the study was to compare sagittal growth of the facial skeleton of 6-year-old children treated in two cleft centres with different surgical protocols. MATERIAL AND METHODS: Each group consisted of 20 consecutive non-syndromic children with complete unilateral cleft lip, alveolus and palate. They all had presurgical orthopaedics with a passive plate and external strapping until lip repair. Centre 1 had lip repair at the age of 3 months and one stage palatal closure at the age of 1 year. Closure of the alveolar cleft was planned at 9 years with bone grafting. In centre 2 lip repair was performed at the age of 6 months, soft palate repair at 12 months and hard palate repair together with mucoperiosteal closure of the alveolar cleft at the age of 30 months. At the time of investigation, the children from both centres had not received any postoperative orthodontic treatment. Sagittal growth was evaluated on lateral cephalograms using the angles SNA, SNB, ANB and SNPg. For control, Droschl standards were used. The Mann-Whitney U test was used for statistical analysis. RESULTS: There was no statistically significant difference in SNA, SNB, ANB and SNPg between the centres at the age of 6 years. There were no children with a class III jaw relationship. The sagittal dimensions were close to the values of non-cleft control persons (Droschl standards). CONCLUSION: There was considerable similar sagittal growth of the facial skeleton in both centres which has not been affected by the different surgical protocols so far. A final evaluation should be delayed until the growth of the facial skeleton is complete.     

不同基托设计的双重牙列修复对唇腭裂患者咀嚼效能和语音的影响

目的:对唇腭裂患者术后采用不同基托设计的双重牙列修复前后的咀嚼效能和语音效果进行评价,判断其修复效果。方法:选择6例腭侧孔腔在1cm×1cm以内,或腭部隐裂患者,分别给予双重牙列修复,一种是颊侧基托和假牙列的双重牙列,另一种是颊侧基托和假牙列并在腭侧作基托,覆盖孔腔和隐裂。分别在初戴前及初戴后、初戴1个月后行咀嚼效能和语音测试,采用SPSS11.0软件包对资料进行配对t检验。结果:2种设计方式的双重牙列初戴后,1个月咀嚼效能显著提高(P<0.01),被检敏感音之间的差异主要集中在第2共振峰(F2)和第3共振峰(F3)上(P﹤0.05)。2种设计之间比较,咀嚼效能和语音检测均无显著差异。结论:2种设计方法均可显著提高咀嚼效能,改善语音功能。唇腭裂患者如腭侧孔腔很小,在1cm×1cm以内,或腭部隐裂患者,不必行腭侧基托设计,语音、咀嚼效能和美观同样得到提高和改善。     

Construction of the new dental arch in the prosthetic rehabilitation of cleft lip and palate. Case report

The authors describe the prosthodontic rehabilitation of an adult patient with unilateral cleft lip and palate. After the surgical and orthodontic treatment of cleft lip and palate patients the prosthodontic treatment was started to correct the palatal defect, the malocclusion and the missing teeth. The authors emphasize on preliminary steps by using diagnostic casts and try-in dentures and they also suggest other directives in the dental management of cleft lip and palate patients.     

Two-stage palatoplasty,is it still a valuable treatment protocol for patients with a cleft of lip,alveolus, and palate?

IntroductionSpeech development is of utmost importance and requires early closure of a palatal cleft. On the other hand, it is well known that all types and timings of surgical repair of facial clefts are detrimental to maxillary growth. Nevertheless, these days one is more and more confronted with a world-wide tendency in favour of the one-in-all operation to close clefts of the lip, alveolus, and palate. Therefore, a three-centre study was performed for testing – once more – the value of two-stage palatoplasty as a means to reduce the detrimental effects of surgery on palatal growth and at the same time to also enable early speech development.Material and methodsPlaster casts from 85 patients have been re-evaluated. All of them had a complete unilateral cleft of lip, alveolus, and palate. They had been treated according to the old therapy protocols followed in either one of the three different cleft centres many years ago, namely in Hamburg, (Western) Germany, Iowa City, IO, USA, and Rostock, (in those days still Eastern) Germany. The impressions had been taken already in 1987 from patients being either 8 years (36 pts.) or 16 years of age (49 pts.). Three different treatment protocols had been followed for these patients in those centres in those days: The main difference was that in centres A and B the palates were closed in two stages whilst in centre C palatoplasty was performed in just one operation.ResultsThe most interesting results regarding the palatal growth were that: 1. In centre C (one-stage palatoplasty) the patients had more constricted palates. 2. In centre A (two-stage palatoplasty) the patients had least often an anterior cross-bite.Discussion and ConclusionIt appears that it was possible to show once more that closing the palate in one stage at age 1 year or less is interfering most with maxillary growth. This study leads us to conclude that two-stage palatoplasty is still a valuable treatment protocol for patients with a complete unilateral cleft of lip, alveolus, and palate, especially as apparently good guidance of speech development can lead to satisfactory speech for cleft patients in whom the hard palate was closed at a later age.     

Evaluation of fistula rates in three cleft palate techniques without relaxing incisions

The aim of the present study was to investigate the incidence of postoperative fistula formation from a hybrid cleft palate repair compared to that from two well-established techniques.We performed a modified technique, Sommerlad-Furlow (SF), which combined the repositioning of the levator veli palatini muscles as described by Sommerlad with the double opposing Z-plasty of Furlow to lengthen the soft palate. A retrospective cohort study was conducted to evaluate patients who underwent cleft palate repair utilizing SF, Sommerlad, or Furlow techniques with the incidence of palatal fistula as the target endpoint.A total of 1,164 patients were included in the present study and underwent the following techniques: 603 cases with SF, 244 cases with Furlow, and 317 cases with Sommerlad. In addition to not requiring relaxing incisions, SF advantages included a consistently lower fistula rate compared to that of the Sommerlad technique, as well as the lowest fistula rate in patients with both hard and soft palate clefts without a cleft lip (OR:2.62 95% CI: 1.35, 5.09). However, the differences among the three techniques did not reach statistical significance in terms of a bilateral or unilateral cleft lip/palate, or in patients with a soft palate only or a submucosal cleft palate(OR: 2.22,95% CI:0.77, 6.37).Based on the results of our study, the Somerlad-Furlow technique should be preferred whenever possible.     

Cleft lip and palate in Denmark, 1976-1981: epidemiology, variability, and early somatic development

The present investigation describes the incidence and variability of the primary cleft condition in all Danish infants born with cleft lip, cleft palate, or both, from 1976 to 1981 and analyzes general somatic growth from birth to age 22 months. Because of excellent sampling conditions in Denmark, the study material is nearly complete. Six hundred and seventy-eight infants with facial clefts were born during the period, corresponding to 1.89 per 1,000 of all newborns. Six hundred and two patients were examined--most of them twice: at 2 months and at 22 months. Material uptake included plaster casts of the upper jaw, cephalometric films in three projections, anthropometric registrations, and information from hospital charts. A detailed grading of the clefts according to severity was carried out. Sex distribution was 61% males and 39% females, of whom 34% had isolated cleft lip, 39% combined cleft lip and palate, and 27% an isolated cleft palate. Left-sided clefts were most frequent. In the combined cleft lip and palate group, 90% exhibited subtotal or total clefts, whereas the clefts were less severe in the isolated cleft lip and isolated cleft palate patients. Birth weight and length showed values close to the average for Danish newborns, but a lag was seen in infants in whom severe palatal cleft was included. The extended method of classification was suggested to select subgroups for special care.     

Congenital fistula of the palate

Four cases of congenital fistula of the palate are presented. All four patients had a fistula which was situated in the vault with a bifid uvula, submucous separation of the palatal muscles, deformities of the palatal plates and unilateral cleft lip. Velopharyngeal incompetence appeared in primarily treated children. The aetiology and surgical treatment of the congenital defect are discussed.     

完全性唇腭裂婴儿术前正畸治疗的临床研究

目的 观察术前鼻-牙槽突矫治器(PNAM)在完全性唇腭裂婴儿术前矫治中的作用.方法 采用术前鼻-牙槽突矫治器对45例非综合征性完全性唇腭裂患儿(平均年龄为18.33 d)进行唇裂术前正畸治疗,测量治疗前后的鼻小柱倾斜度、鼻小柱长度、鼻孔宽度、鼻孔高度和牙槽骨裂隙宽度,并用SPSS 10.0软件进行统计分析.结果 经PN...     

An intraoral appliance for management of the protrusive premaxilla in bilateral cleft lip

Management of the protruding premaxilla and prolabium in bilateral cleft lip and palate can be a confounding problem. This report introduces an intraoral traction appliance that has been successfully used to move the premaxilla and prolabium to a more favorable position for surgical repair of the bilateral cleft lip. The appliance consists of a palatal baseplate for anchorage and a latex rubber traction strip looped over the prolabium to retract the premaxillary segment. The results in five cases are presented and compared to two cases where no presurgical management was performed and lip repair had been delayed for medical reasons. Advantages and disadvantages of the appliance are discussed.