phenylephrine-hydrochloride and Cleft-Palate

While primary cleft lip nasal deformity has been well described, secondary cleft lip nasal deformity reflects the combination of residual deformity that follows primary operative maneuvers and growth-related nasal distortions. Secondary cleft lip nasal deformities are further associated with underlying skeletal and dentofacial abnormalities along with soft tissue constriction adding to the complexity of the deformity and posing major aesthetic and functional challenges to the multidisciplinary care team. Definitive rhinoplasties are performed to address these deformities and improve the quality of life in cleft patients following skeletal maturity and ideally after all underlying skeletal discrepancies have been corrected by orthognathic surgery. Maxillary advancement with or without mandibular setback is often required after careful planning and orthodontic preparation. Patients with cleft lip benefit tremendously from definitive rhinoplasty irrespective of inevitable residual discrepancies that remain and adjuvant therapies could enhance the overall outcome.

Topics: Cleft Lip; Cleft Palate; Esthetics, Dental; Humans; Nose; Orthognathic Surgery; Palate; Quality of Life; Rhinoplasty

The purpose of this review is to provide an in-depth look at the current perioperative and intraoperative practices for unilateral cleft lip repair. The contemporary literature reveals trends towards incorporation of curvilinear and geometric hybrid lip repairs. Perioperative practices are trending in new directions as well with the use of enhanced recovery after surgery (ERAS) protocols to reduce morbidity and length of stay, continued use of nasoalveolar molding, and a tendency to favor outpatient repair with more utilization of same day surgery centers. There is much room for growth, with new and exciting technologies on the horizon to improve upon cosmesis, functionality, and the operative experience.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nose

Congenital frontonasal dysplasia (CFND) is a rare heterogeneous collection of facial deformities. Due to the range of complexity, surgical management is not standardized.. We present a severe case of CFND and approach to managing multiple defects with a focus on rhinoplasty.. This infant was born full term with a large mass instead of a nose, a bilateral cleft lip and palate, and hypertelorbitism. Our primary concerns initially were to address communication with the intracranial cavity, preserve a nasal lining, and improve nasal appearance and airway function in the short term without interfering with subsequent rhinoplasty and adult nasal appearance.. This complex case of CFND is more severe than anything we encountered in our literature review and demonstrates the necessity for multidisciplinary approach to multiple craniofacial defects. Future plans for this patient include rhinoplasty with auricular graft, scar revision, and addressing tip support.

Topics: Adult; Cleft Lip; Cleft Palate; Craniofacial Abnormalities; Face; Humans; Infant; Nose; Rhinoplasty

Topics: Cleft Lip; Cleft Palate; Humans; Nose

Nasoalveolar molding (NAM) is a technique that is utilized in patients with cleft lip/palate before performing lip surgery. This procedure has been shown to result in a more aesthetic nose with lesser columellar deviation and reduced scaring. The aim of our study was to evaluate the long-term results of NAM and gingivoperiosteoplasty in patients with cleft lip and palate.. An electronic search of databases (ie, PubMed, ISI Web of Science, EMBASE, Scopus, and Google Scholar) from inception to March 2021 was performed and after selecting the eligible studies, relevant data were collected using piloted extraction forms. The success rate of NAM and gingivoperiosteoplasty, and Bergland score were pooled using random-effects inverse variance meta-analysis.. Seven studies were included in this meta-analysis and systematic review. The pooled mean success rate of NAM with gingivoperiosteoplasty (GPP) based on the continuity of alveolar bone structure was 71% (95% confidence interval [CI] = 54-85). This means that in 71% of cases NAM + GPP treatment eliminated the need for future bone grafts. Also, no significant difference between the success rate (risk ratio = 1.00, 95% CI = 0.64-1.58) and mean Bergland score (mean difference = 0.64, 95% CI = -1.04 to 2.31) of NAM + GPP and skeletal bone graft was found.. Nasoalveolar molding and gingivoperiosteoplasty was successful in 71% of cases treating patients with cleft lip and palate. This treatment is similar with the secondary alveolar bone graft in both the success rate and the alveolar height that it generates while being less invasive and with lower morbidity.

Topics: Alveolar Process; Bone Transplantation; Cleft Lip; Cleft Palate; Esthetics, Dental; Humans; Infant; Nasoalveolar Molding; Nose; Retrospective Studies

The aim of this systematic review was to establish the effect of different surgical repairs for the lip on nasal symmetry. PubMed, Scopus, Embase, Cochrane CENTRAL, and Ovid databases search was performed initially for only English-language articles, in patients with unilateral complete cleft lip with or without cleft alveolus and palate (UCCLAP) who were younger than 1 year of age and undergoing cleft lip repair, and are published from the earliest data available up to December 31, 2020. The primary outcome variable was nasal symmetry, with reported complications being secondary variables. A qualitative synthesis was provided. A total of 19,828 records were obtained, and 17 articles were selected for final review. Assessment of the risk of bias of the included randomized controlled trials (RCTs) (N-1) was done with the Cochrane Risk of Bias 2 (RoB-2) tool, and the ROBINS-I tool was used for non-randomized studies (n = 14). Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to evaluate the quality of the body of evidence. The majority of the included studies compared the triangular repair with the rotation advancement (RA) techniques, and preferred RA or its modifications. In terms of the nasal symmetry, the Fisher repair proved to be superior to the RA technique. Neither RA nor straight line repair was superior to one another. The Delaire technique may be preferred over the modified RA. Also, satisfactory outcomes were observed with simultaneous lip-nose repair. This systematic review examined a plethora of techniques, and the heterogeneity between studies was very high regarding type of surgery, method of nasal symmetry assessment, and length of follow-up, thus producing low-quality evidence; therefore, results should be interpreted with caution. Future research requires RCTs with larger sample sizes and appropriate length of follow-up, and surgeries preferably performed by a single experienced surgeon.

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Treatment Outcome

The aim of this systematic review and meta-analysis was to investigate long-term treatment effects of nasoalveolar molding (NAM) in patients with unilateral cleft lip and palate (UCLP).. Included manuscripts met the following criteria: (1) involved patients with UCLP who received NAM; (2) included comparison group(s) who either received non-NAM passive presurgical infant orthopedic appliances (PSIO) or who did not receive any PSIO; (3) reported at least one objective or validated measure of nasolabial, craniofacial, or palatal form; and (4) had patient follow-up beyond 4 years of age.. A total of 12 studies were included in this review. Meta-analyses were possible for Asher-McDade parameters and cephalometric measurements. Compared to patients who did not receive any PSIO, those who underwent NAM therapy were more likely to have good to excellent frontal nasal form (Risk ratio: 2.4, 95% CI: 1.24-3.68) and vermillion border (Risk ratio: 1.8, 95% CI: 1.19-2.71). However, there were no statistically significant differences in cephalometric measurements between these groups. Additionally, there were no statistically significant differences between patients receiving NAM versus non-NAM PSIO. There was insufficient evidence to determine the impact of NAM on dental arch development.. The preponderance of evidence in this review suggests that NAM produces benefits in nasolabial aesthetic form when compared with no appliance-based presurgical treatment. However, there is insufficient evidence to conclude whether NAM produces such benefits when compared with other passive PSIOs.

Topics: Cleft Lip; Cleft Palate; Esthetics, Dental; Humans; Infant; Nasoalveolar Molding; Nose; Treatment Outcome

Within the treatment protocols of patients with cleft lip and palate, the nasoalveolar molding (NAM) acquire more followers every day.Their benefits have been well documented, but not equally their complications. The purpose of this study was to describe the complications produced during treatment with Grayson presurgical NAM in nonsyndromic infants with complete unilateral cleft lip and palate.. Bibliographic review on 8 databases using search algorithms. By applying the exclusion and inclusion criteria, 21 articles were detected, which were analyzed in full text. Complication, cause, and solution data were presented in supplemental tables.. Complications are related to soft tissues, hard tissues, and those derived from care.. irritation, ulceration, gingival, facial, or nasal bleeding. Candidiasis. An overexpanded nostril creation to improper placement or modifications of the nasal stent at home.The most frequent were lip and cheeks skin irritation by taping, and gingival ulceration due to excessive pressure.. misalignment of alveolar segments and the premature eruption of teeth.. inadequate device retention, adherence problems to treatment, poor/excessive care of the caregiver, intolerance to the device, eating problems, breathing, and socioeconomic issues.. The main complications occur in soft tissues, related to the retention mechanisms and an inadequate adjustment of the device.The benefits of NAM exceed the complications. It is necessary to know them to avoid any harmful results since they could prolong or stop the treatment, compromising the result. The active collaboration of the family in the insertion and maintenance of the device is crucial for success.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Nasoalveolar Molding; Nose; Preoperative Care

Cleft lip and palate patients represent one of the most challenging groups of patients for septorhinoplasty, presenting as a complex surgical obstacle for even the most seasoned surgeons. These individuals have undergone several surgeries throughout their lives, resulting in a considerable amount of scar tissue, significant asymmetries and structural deficits. Key factors in successfully treating cleft lip and palate patients are the reconstruction of the absent/asymmetric cartilages and the replacement of bony structures. The use of autogenous rib cartilage allows the surgeon to create various grafts as well as fortify the soft tissue to resist persistent soft tissue deformities.

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Rhinoplasty

Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Maxilla; Nose; Orthopedic Procedures; Plastic Surgery Procedures

Nasoalveolar molding (NAM) is a powerful tool in the treatment of patients with unilateral or bilateral cleft lip and palate. The primary goal of NAM is to improve alignment of critical anatomic elements before surgical repair of the unilateral or bilateral cleft lip. Modifications of the position of the alveolar segments and their associated lip elements, the lower lateral cartilages, and the columella achieved with NAM are helpful for creating a suitable platform for tension-free lip repair.

Topics: Cartilage; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Preoperative Care

This systematic review aims to evaluate nasoalveolar molding (NAM) in the context of burden of care defined as physical, psychosocial, or financial burden on caregivers.. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 5 databases were searched from inception through December 24, 2019, for keywords and subject headings pertaining to cleft lip and/or palate and NAM.. Clinical studies on NAM with reference to physical (access to care, number of visits, distance traveled), psychosocial (caregiver perceptions, family interactions, breast milk feeding), and financial (direct and indirect costs) burden were included.. Study selection was performed by 2 independent reviewers.. The search identified 1107 articles and 114 articles remained for qualitative synthesis. Burden of care domains were discussed but not measured in 43% of articles and only 25% assessed burden of care through a primary outcome. Of these, 20 articles reported on physical, 8 articles on psychosocial, and 12 articles on financial burden. Quality of evidence is limited by study design and risk of bias.. Nasoalveolar molding has been indiscriminately associated with burden of care in the literature. Although NAM may not be the ideal treatment option for all patients and families, the physical considerations are limited when accounting for the observed psychosocial advantages. Financial burden appears to be offset, but further research is required. Teams should directly assess the impact of this early intervention on the well-being of caregivers and advance strategies that improve access to care.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Female; Humans; Nasoalveolar Molding; Nose

There are several different types of nasal emission that can occur during speech due to either velopharyngeal dysfunction or abnormal articulation in the pharynx. Nasal emission can be inaudible or very loud and distracting, depending on the size of the velopharyngeal opening and the physics of the flow. Nasal emission can be obligatory and/or compensatory (due to abnormal structure) or it can be caused by a misarticulation that results in a substitution of a pharyngeal sound for an oral sound, despite normal velopharyngeal structure. Nasal emission can occur on all pressure-sensitive phonemes or it can be phoneme-specific. Although it is generally recognized that the loud and distracting form of nasal emission (called nasal turbulence or nasal rustle) is due to a small velopharyngeal opening, the causality of the distracted sound is debated. This article provides a brief review of the types of nasal emission, the terms used to describe it, and the potential causes. This article also stresses the need for further research to clarify the causality of the sound generated by a small velopharyngeal opening.

Topics: Articulation Disorders; Cleft Palate; Humans; Nose; Pharynx; Speech; Velopharyngeal Insufficiency

Proboscis lateralis (PL) is a rare malformation, reported for the first time in 1861 by Forster in his monograph on congenital malformations of the human body. The abnormal side of the nose is represented by a tube-like rudimentary nasal structure, attached at any point along the embryonic fusion line between the anterior maxilla and the frontonasal processes. As clefts of the lip (and alveolus) are bilateral or unilateral, an arrhinia can be bilateral (total) or unilateral. In this case it is a 'hemi-arrhinia' (or heminasal agenesis. The arrhinias represent three groups of anomalies, each with different levels of clinical severity, some involving association with the labio-palatal cleft or agenesia of the premaxilla (1). In PL the nasal cavity on the affected side is replaced by a tubular appendage located off-center from the midline of the face, arising commonly from the medial aspect of the roof of the orbit (2). It is usually associated with heminasal aplasia or hypoplasia, microphthalmia, and - less commonly - with midline clefting. Associated brain and cranial vault anomalies are seen in 19% of these patients. PL is usually unilateral, with very few symmetrical/bilateral cases being reported (3). Morpho-aesthetic and psychological problems are frequent concerns for the patients and their families. In this study, the authors describe a clinical case and the chosen surgical technique, as well as reviewing the alternative techniques present in the literature.

Topics: Cleft Palate; Congenital Abnormalities; Esthetics, Dental; Humans; Nose; Nose Diseases

Correlation between nasoalveolar molding and surgical, aesthetic, functional and socioeconomic outcomes following primary repair surgery: A systematic review. Maillard S, Retrouvey JM, Ahmed MK, Taub PJ. J Oral Maxillofac Res. 2017;8(3):e2.. No financial support was reported.. Systematic review.

Topics: Cleft Lip; Cleft Palate; Humans; Nose

Nasal surgery in children, most often performed after trauma, can be performed safely in selected patients with articulate, deliberate, and conscientious operative plan. All nasal surgery in children seeks to avoid disruption of the growth centers, preserving and optimizing nasal growth while improving the form and function of the nose. A solid appreciation of long-term outcomes and effects on growth remain elusive.

Topics: Animals; Child; Cleft Palate; Hematoma; Humans; Infant, Newborn; Nasal Obstruction; Nasal Septum; Nose; Nose Deformities, Acquired; Rhinoplasty; Turbinates

Nasal deformity associated with typical cleft lip can cause aesthetic and functional issues that are difficult to address. The degree of secondary nasal deformity is based on the extent of the original cleft deformity, growth over time, and any prior surgical correction to the nose or lip. Repair and reconstruction of these deformities require comprehensive understanding of embryologic growth, the cleft anatomy, as well as meticulous surgical technique and using a spectrum of structural grafting. This article reviews cleft lip nasal deformity, presurgical care, primary cleft rhinoplasty, and definitive cleft septorhinoplasty with a focus on aesthetics and function.

Topics: Adult; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Infant, Newborn; Male; Medical Illustration; Models, Anatomic; Nasal Septum; Nose; Photography; Preoperative Care; Rhinoplasty

The morphogenesis of midfacial processes requires the coordination of a variety of cellular functions of both mesenchymal and epithelial cells to develop complex structures. Any failure or delay in midfacial development as well as any abnormal fusion of the medial and lateral nasal and maxillary prominences will result in developmental defects in the midface with a varying degree of severity, including cleft, hypoplasia, and midline expansion. Despite the advances in human genome sequencing technology, the causes of nearly 70% of all birth defects, which include midfacial development defects, remain unknown. Recent studies in animal models have highlighted the importance of specific signaling cascades and genetic-environmental interactions in the development of the midfacial region. This review will summarize the current understanding of the morphogenetic processes and molecular mechanisms underlying midfacial birth defects based on mouse models with midfacial developmental abnormalities.

Topics: Animals; Cleft Palate; Disease Models, Animal; Gene-Environment Interaction; Genome, Human; Humans; Maxilla; Mice; Nose; Signal Transduction

Clefts of the primary palate in the dog are uncommon, and their repair can be challenging. The aims of this article are to provide information regarding pathogenesis and convey practical information for the repair of these defects.

Topics: Animals; Cat Diseases; Cats; Cleft Lip; Cleft Palate; Dog Diseases; Dogs; Nose; Plastic Surgery Procedures

Johanson-Blizzard syndrome (JBS) is considered as an infrequent, but clinically easily recognizable autosomal recessive entity by the pathognomonic combination of congenital exocrine pancreatic insufficiency and hypoplastic alae nasi, in addition to other distinctive findings such as scalp defects, hypothyroidism, and rectourogenital malformations. There are few reports of patients with JBS in association with facial clefting, referring all to types 2 to 6 of Tessier's classification that can be characterized properly as oblique facial clefts (OFCs). We describe the clinical aspects in four patients with JBS and extensive OFCs. In all of them, the diagnosis of JBS was confirmed by the demonstration of homozygous or compound-heterozygous mutations in the UBR1 gene. Additionally, we review three previously reported cases of JBS with OFCs. Taking into account a number of approximately 100 individuals affected by JBS that have been published in the literature we estimate that the frequency of OFCs in JBS is between 5% and 10%. This report emphasizes that extensive OFCs may be the severe end of the spectrum of facial malformations occurring in JBS. No obvious genotype phenotype correlation could be identified within this cohort. Thus, UBR1 should be included within the list of contributory genes of OFCs, although the exact mechanism remains unknown. © 2016 Wiley Periodicals, Inc.

Topics: Alleles; Anus, Imperforate; Cleft Palate; Consanguinity; Craniofacial Dysostosis; Diagnostic Imaging; DNA Mutational Analysis; Ectodermal Dysplasia; Eye Abnormalities; Female; Genetic Association Studies; Genotype; Growth Disorders; Hearing Loss, Sensorineural; Humans; Hypothyroidism; Infant, Newborn; Intellectual Disability; Introns; Male; Maxillofacial Abnormalities; Mutation; Nose; Pancreatic Diseases; Phenotype; Ubiquitin-Protein Ligases

Over the last decade, presurgical orthopedic molding for the patient with cleft lip and palate has become much more common; it is even reasonable to assume it may be the standard of care for those wide unilateral and bilateral clefts with substantial dentofacial deformities. In 2013, there was a comparative study of nasoalveolar molding methods, comparing the Grayson-NAM device and DynaCleft. The results showed the 2 to be equivocal with both methods significantly reducing the cleft width and improving the nasal asymmetry.

Topics: Alveolar Process; Athletic Tape; Cleft Lip; Cleft Palate; Gingivoplasty; Humans; Infant, Newborn; Models, Dental; Nose; Orthopedic Fixation Devices; Preoperative Care; Rhinoplasty; Stents

Diprosopus is a subtype of symmetric conjoined twins with one head, facial duplication and a single trunk. Diprosopus is a very rare congenital anomaly.. This is a systematic review of published cases and the presentation of two new cases born in Argentina. We estimated the prevalence of conjoined twins and diprosopus using data from the National Network of Congenital Anomalies of Argentina (RENAC).. The prevalence of conjoined twins in RENAC was 19 per 1,000,000 births (95% confidence interval, 12-29). Diprosopus prevalence was 2 per 1,000,000 births (95% confidence interval, 0.2-6.8). In the systematic review, we identified 31 diprosopus cases. The facial structures more frequently duplicated were nose and eyes. Most frequent associated anomalies were: anencephaly, duplication of cerebral hemispheres, craniorachischisis, oral clefts, spinal abnormalities, congenital heart defects, diaphragmatic hernia, thoracic and/or abdominal visceral laterality anomalies. One of the RENAC cases and three cases from the literature had another discordant nonmalformed twin.. The conjoined twins prevalence was similar to other studies. The prevalence of diprosopus was higher. The etiology is still unknown. The presence of visceral laterality anomalies may indicate the link between diprosopus and the alteration or duplication of the primitive node in the perigastrulation period (12-15 days postfertilization). Pregnancies of more than two embryos may be a risk factor for diprosopus. Given the low prevalence of this defect, it would be useful to perform studies involving several surveillance systems and international consortiums. Birth Defects Research (Part A), 2016. © 2016 Wiley Periodicals, Inc. Birth Defects Research (Part A) 106:993-1007, 2016. © 2016 Wiley Periodicals, Inc.

Topics: Abnormalities, Multiple; Anencephaly; Argentina; Cerebrum; Cleft Palate; Face; Female; Heart Defects, Congenital; Hernia, Diaphragmatic; Humans; Male; Neural Tube Defects; Nose; Prevalence; Risk Factors; Twins, Conjoined

Cleft rhinoplasty has spurred much interest in literature because of the difficult task in obtaining a normal nasal form, function, and development. The pursuit of perfection has resulted in myriad techniques, modifications, and innovations to optimize results, but no one protocol or algorithm was proved to be completely satisfactory. Controversies still exist in timing, surgical approach, nonsurgical techniques, and outcome assessment. This article submits a humble contribution that might hopefully help in reaching consensus. Throughout a period of 18 years, 800 patients with different ages and types of clefts were managed by single surgeon using various procedures to correct their nasal deformities. These procedures included preoperative naso-alveolar molding, gingivoperiosteoplasty, primary closed or open rhinoplasty, postoperative nasal stents and nasal molding, and secondary open septorhinoplasty. The outcome was judged by panel assessment and computer-assisted anthropometry. Clinical results were satisfactory for most patients, parents, and surgeon panel. Computer-assisted anthropometry proved helpful in outcome assessment and analysis. Cleft rhinoplasty is neither optional nor separable from cleft lip repair. It requires clear perception of the complex pathogenesis and the governing dynamics of the cleft deformity. A perfect nose with no deformity is unusual, but a reasonably good result is attainable when the principles of nasal repair are fully grasped and faithfully applied.

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Retrospective Studies; Rhinoplasty

Rhinoplasty for the cleft lip and palate patient is very challenging and surgical outcome of the nose is difficult to evaluate. Discussions of aesthetic evaluation of the nose in cleft lip and palate patients remain problematical. Many different nose aesthetic evaluation methods have been described in the literature; they differ even among articles published in a single year.. To analyse the literature concerning aesthetic evaluation of the nose in cleft lip and palate patients and to identify the most objective method for such evaluation postoperatively.. The literature was reviewed using MedLine and PubMed sources dated between January 1996 and December 2014. In total, 118 full text articles in English language were selected. Exclusion criteria were: case reports, surgical reviews, literature review, and single evaluations of nasal function.. Measurements were obtained from two-dimensional images in 73 articles. Noses were evaluated from 3D images in 22 and by clinical examination in 15. Other methods were evaluation from dental/facial casts, cephalometric evaluation, computer tomography and video recording. In 26 articles some combination of methods was used.. The most popular evaluation method is still two-dimensional photography and measurements using anthropometric facial landmarks. Measurements from three-dimensional images seem to be the most objective method and automated facial anthropometric landmark protraction seems to hold promise for the future.

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Nose Diseases; Rhinoplasty

Modern cleft surgery requires four-dimensional and functional anatomic understanding of the cleft (and noncleft) lip, nose, and alveolus. Some techniques for nasolabial repair rely more on precise anatomic geometry, whereas others afford the surgeon a more flexible design. Consistent anthropometry enables accurate assessment and reporting of long-term outcomes; such reports are needed to guide perioperative care, delineate optimal repair principles, and resolve ongoing controversies.

Topics: Anthropometry; Cleft Lip; Cleft Palate; Humans; Infant, Newborn; Nose; Oral Surgical Procedures; Plastic Surgery Procedures

Orthopedic and orthodontic management of patients born with clefts of the lip, alveolus and palate is based on the application of basic biomechanical principles adapted to the individualized cleft anatomy. This article focuses on orthopedic and orthodontic preparation for 2 stages of interdisciplinary orthodontic/surgical cleft care: presurgical infant orthopedics (nasoalveolar molding) for lip/alveolus/nasal surgical repair and maxillary arch preparation for secondary alveolar bone grafting. These preparatory stages of orthopedic/orthodontic therapy are undertaken with the goal of restoring normal anatomic relationships to assist the surgeon in providing the best possible surgical care.

Topics: Alveolar Process; Alveolar Ridge Augmentation; Cleft Lip; Cleft Palate; Humans; Nose; Orthodontics, Corrective; Orthopedic Procedures; Plastic Surgery Procedures; Preoperative Care

Cleft surgeons seek to provide the best results in the fewest surgeries. Gingivoperiosteoplasty (GPP) is one option to achieve this goal. Although it may normalize early form and function and obviate secondary alveolar bone grafting, it has been associated with iatrogenic dentofacial restriction requiring more extensive treatment later. GPP technique associated with nasoalveolar molding (NAM) uses passive presurgical molding with strict patient-selection criteria. Data on the benefits of NAM-GPP are favorable but long-term outcome studies are required before its final role in cleft care is determined. This article describes the history, technique, perioperative care, and preliminary outcomes of NAM-GPP.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Gingivoplasty; Humans; Infant, Newborn; Nose; Oral Surgical Procedures; Orthodontics, Corrective; Orthopedic Procedures; Patient Selection; Periosteum; Pharyngeal Muscles; Plastic Surgery Procedures; Preoperative Care

The cleft nasal deformity remains the most likely stigma of the cleft to remain plainly visible despite vigorous and repeated attempts at correction. This deformity is present at birth, but evolves over time. Certain aspects can be treated early, but some, such as the dorsal and septal deformity continue to develop as facial growth proceeds through adolescence. This article presents a conceptual mechanism and a philosophy of conservative reliable gains starting at the primary operation, with the long-term view of achieving definitive correction at maturity. Cogent planning of longitudinal care of the deformity from infancy leads to solid, predictable results.

Topics: Adolescent; Child; Child, Preschool; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Oral Surgical Procedures; Rhinoplasty

After studying this article, the participant should be able to: (1) Describe the components of unilateral and bilateral secondary cleft lip nasal deformity. (2) Discuss current methods of assessing the deformity and outcomes. (3) Discuss primary treatment options including the use of preoperative orthopedics, nasal molding techniques, and the primary cleft rhinoplasty. (4) Design a treatment plan for cleft patients that will optimize the outcome of nasal appearance and function. (5) Discuss the evidence regarding outcomes of current practices, and describe areas where more research is needed.. This is the third Maintenance of Certification article on the secondary cleft lip nose deformity. In the first article, Guyuron defined the deformities and described techniques for the definitive (adult) rhinoplasty. The second article, by Zbar and Canady, presented evidence regarding the assessment, surgical treatment, and outcomes from the literature published between 1999 and 2009. In this article, the authors summarize important points from the first two articles and then concentrate on the evidence for the following topics: (1) methods currently used in evaluating the severity of the deformities; (2) methods used in evaluating outcomes of different treatments; (3) benefits of rhinoplasty performed at the time of the lip repair and evidence for the effect of rhinoplasties performed after infancy but before maturity; (4) presurgical orthopedics and nasoalveolar molding; (5) common surgical techniques used in primary cleft rhinoplasties; and (6) impact of the nasal deformity on quality of life. Overall, there is little high-level evidence regarding the outcomes of cleft nasal deformity treatment, leaving much room for future study.

Topics: Cleft Lip; Cleft Palate; Education, Medical, Continuing; Evidence-Based Medicine; Humans; Nose; Plastic Surgery Procedures; Rhinoplasty

Topics: Cleft Lip; Cleft Palate; Humans; Nasal Septum; Nose; Postoperative Complications; Rhinoplasty; Risk Factors; Speech Disorders; Velopharyngeal Insufficiency

Cleft lip and palate patients have many defects particularly nasal deformities. The nasoalveolar molding (NAM) technique is an adjunctive treatment, which not only corrects deviated alveolar segments but also addresses nasal deformity before cheiloplasty. NAM technique is claimed to facilitate primary surgical correction and to provide favorable esthetic outcomes. However, there is limited evidence to confirm the special benefits ofNAM technique since so far there have been no truly long term controlled clinical trials to evaluate outcomes of treatment based on pre-surgical NAM technique. NAM technique can aid surgeons in their primary repairs ofnasal deformities but there should be concern about cost-risk benefits and ability ofparents to manage home care. Further studies based on properly designed and managed long-term clinical trials are still neededfor reaching consensus on special benefits ofNAM technique compared with other treatment protocols.

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Plastic Surgery Procedures; Surgery, Oral

The need to be aware of the dynamics of cartilage development and growth is encountered by surgeons whenever they attempt to correct craniofacial defects such as unilateral or bilateral cleft lip/cleft palate or midfacial injuries after trauma. Within the craniofacial region, the nasal septal cartilage and the sphenoethmoidal and sphenooccipital cranial synchondroses are distinguished from other craniofacial cartilages in possessing intrinsic growth potential. Indeed, growth of the nasal septal cartilage outstrips the growth of other skeletal and soft tissues in the midface to such an extent that it is the pacemaker for growth of the face and anterior portion of the skull. We revisit and reinforce the importance of the nasal septum as pacemaker with analysis of 3 classes of evidence: in vivo growth of the nasal septum in nonhuman mammalian models; composition and in vitro growth of nasal septal cartilage or chondrocytes; and experience from the surgical repair of unilateral or bilateral facial clefts.

Topics: Animals; Chondrocytes; Cleft Lip; Cleft Palate; Humans; Maxillofacial Development; Models, Animal; Nasal Cartilages; Nasal Septum; Nose; Plastic Surgery Procedures

In the past two decades, presurgical nasoalveolar molding has been applied increasingly in the care of patients with a cleft to improve nasal symmetry and facilitate closure of the lip and secondary rhinoplasty. Many cleft centers do not apply presurgical molding, because its effect is disputed. This review aims to quantify the effect of nasal symmetry in the long term.. A systematic review of the literature with the intention of performing a meta-analysis was performed. The search terms "cleft" AND ("molding" OR "moulding") were used in three databases. Twelve studies met the following inclusion criteria: (1) participants were humans with nonsyndromic unilateral cleft; (2) data concerning the effect of nasoalveolar molding on symmetry of the nose are reported or can be deduced; (3) article was written in English, German, or Dutch.. The heterogeneity of the study designs, outcome variables, outcome variable expressions, follow-up periods, and inadequate data reporting made it impossible to calculate effect sizes and to perform a meta-analysis. All studies had a low Grading of Recommendations Assessment, Development and Evaluation level. Five studies reported exclusively positive effects on nasal symmetry, six studies reported mixed effects, and one study reported exclusively no effects.. Results of studies of nasoalveolar molding are inconsistent regarding changes in nasal symmetry; however, there is a trend toward a positive effect. Studies concerning nasoalveolar molding in unilateral cleft lip, jaw, and palate are heterogeneous and lack adequate reporting. Recommendations for future research were provided to construct a consensus about the effect of nasoalveolar molding.. Therapeutic, III.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Combined Modality Therapy; Facial Asymmetry; Humans; Infant; Nose; Orthopedic Procedures; Plastic Surgery Procedures; Treatment Outcome

Surgical cleft repair aims to restore function of the oro-nasal sphincter and oro-nasal soft tissues and re-establish the complex relationship between perioral and perinasal muscle rings without compromising subsequent mid-facial growth and development. Here we review the surgical anatomy of this region, optimal timing for surgical repair and current thinking on the use of surgical adjuncts. In addition, an overview of current surgical techniques available for the repair of cleft lip, cleft palate and velopharyngeal insufficiency is presented. Finally, we briefly discuss nasal revision surgery and the use of osteotomy, including distraction osteogenesis in the cleft patient.

Topics: Cleft Lip; Cleft Palate; Combined Modality Therapy; Humans; Lip; Nose; Osteogenesis, Distraction; Osteotomy; Plastic Surgery Procedures; Velopharyngeal Insufficiency

In the era of evidence-based medicine, new treatment protocols and interventions should be routinely evaluated for their efficacy by reviewing the available evidence. In the cleft literature, nasoalveolar molding has garnered attention over the last decade as a new option for improving nasal form and symmetry before primary surgical repair. Systematic review of the evidence is, however, currently lacking. This review evaluates whether nasoalveolar molding can improve nasal symmetry and form toward the norm, as well as whether nasoalveolar molding demonstrates advantages over other protocols in achieving this goal. A literature search of five databases plus relevant reference lists retrieved 98 articles regarding nasoalveolar molding, 21 of which reported objective outcome measures of nasal symmetry and form, and six of which were able to be given evidence level ratings, all in the unilateral cleft population. Statistical analysis was not possible given the range of techniques and outcomes. Studies of bilateral cleft were not given evidence level ratings, given the inability to separate the effects of nasoalveolar molding from other primary nasal interventions in studies that would have otherwise been rated. In unilateral cleft lip-cleft palate, there was some evidence that nasoalveolar molding may improve nasal outcomes, though comparison with other techniques was limited. Despite a relative paucity of high-level evidence, nasoalveolar molding appears to be a promising technique that deserves further study.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Evidence-Based Medicine; Facial Asymmetry; Humans; Mandibular Reconstruction; Nose; Plastic Surgery Procedures; Rhinoplasty

Given the multiple permutations in craniofacial malformations, classification of median craniofacial dysplasia or midline Tessier no. 0 to 14 clefts has been difficult and disjointed. In this review, the authors present a summary of normal embryology, prior terminology, and their proposed new classification system. Median craniofacial dysplasia has tissue agenesis and holoprosencephaly at one end (the hypoplasias), frontonasal hyperplasia and excessive tissue (the hyperplasias) at the other end, and abnormal splitting or clefting and normal tissue volume (dysraphia) occupying the middle portion of the spectrum. These three distinct subclassifications have different forms of anomalies within their groups.

Topics: Cleft Palate; Craniofacial Abnormalities; Craniofacial Dysostosis; Face; Holoprosencephaly; Humans; Nose; Skull; Terminology as Topic

Alopecia present from birth includes a broad differential diagnosis and often represents a diagnostic and therapeutic challenge for the involved physician.. An initial correct diagnosis and classification is essential because structural hair defects may be the expression of a genetic disorder affecting hair growth, part of a congenital syndrome with accompanying hair malformations, or a marker for an underlying metabolic disorder and may impact the mental and physical development of a child. Pathological hair loss rarely occurs in the first year of life; however, it may be a leading symptom of many congenital diseases.. In recent years, the clinical and microscopic features of hereditary hair shaft disorders have been characterized and classified. Furthermore, significant progress has been made in our knowledge of genes that control the normal development and differentiation of hair follicles, and thus the research is to define and classify the hair disorders within a genetic basis.. In this article we discuss several types of genotrichosis and provide a practical classification based on their clinical features.

Topics: Alopecia; Aneurysm; Carcinoma, Basal Cell; Child; Cleft Lip; Cleft Palate; Deafness; Ectodermal Dysplasia; Eczema; Facies; Fingers; Growth Disorders; Hair Diseases; Hallermann's Syndrome; Histiocytoma, Benign Fibrous; Humans; Hypotrichosis; Ichthyosis; Intellectual Disability; Keratitis; Langer-Giedion Syndrome; Microcephaly; Nose; Skin Diseases, Genetic; Skin Neoplasms

The comprehensive management of cleft lip and palate has received significant attention in the surgical literature over the last half century. It is the most common congenital facial malformation and has a significant developmental, physical, and psychological impact on those with the deformity and their families. In the United States, current estimates place the prevalence of cleft lip and palate or isolated cleft lip at approximately 1 in 600. There is significant phenotypic variation in the specific presentation of facial clefts. Understanding outcome data is important when making clinical decisions for patients with clefts. This article provides an update on current primary cleft lip and palate outcome data.

Topics: Age Factors; Cleft Lip; Cleft Palate; Humans; Lip; Maxillofacial Development; Nose; Palatal Obturators; Palate, Hard; Palate, Soft; Patient Care Planning; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome

The nose is a prominent feature of the human face. Congenital malformations of the nose, whether functional or anatomic, affect the physiologic and psychologic wellness of children who have these anomalies. Congenital nasal abnormalities may be overt or subtle and can occasionally cause life-threatening emergencies at birth. A discussion of nasal embryology and development provides the basis for the discussion of some of the important congenital abnormalities seen in clinical practice. The final portion of the article is devoted to several of the more common syndromes in which nasal abnormalities are encountered.

Topics: Acrocephalosyndactylia; Cleft Lip; Cleft Palate; Dermoid Cyst; Humans; Nose; Nose Neoplasms

The case of a newborn female patient with unilateral cleft lip, alveolus and palate is presented with a markedly sunken nasal wing at the cleft side. This finding may lead to a very unsatisfactory aesthetic result after primary cheiloplasty and nasoplasty.. Five months prior to surgery, the patient was treated with a palatal plate and additionally with a nasoalveolar conformer for 4 months thereof. The device consisted of an acrylic pelotte (attached to the maxillary plate with a wire) which lifted the nasal dome and was activated regularly. Under this presurgical treatment, the cleft edges moved closer to each other by 1.8 mm at the alveolar ridge and by 4.5 mm in the palatal area. The nasal wing was lifted by 5 mm. This was enabling elevation of the nasal wing during primary surgery in the case described. Questions are raised as to the remaining effects on nasal symmetry until completion of growth and, on the other hand, as to the chances to reduce postsurgical alar relapse by continued nasal molding beyond primary surgery.. Presurgical nasal molding seems to improve aesthetics of the nose in patients with unilateral clefts of lip, alveolus and palate and distinctly flattend nasal wings.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Female; Humans; Infant, Newborn; Lip; Nose; Palatal Obturators; Preoperative Care

We report a patient with partial tetrasomy 9q resulting from a de novo triplication of 9q13q22.1. The clinical features, including microcephaly, beaked nose, short palpebral fissures, camptodactyly, joint contractures, and moderate developmental delay were similar to trisomy 9q, although our patient also had unique features including cleft palate and several unexplained fractures. The latter could be secondary to abnormal tone and contractures. Although tetrasomy 9p is a well-known entity, our patient, to our knowledge, is the first and only individual reported to have tetrasomy 9q.

Topics: Abnormalities, Multiple; Aneuploidy; Chromosome Banding; Chromosomes, Human, Pair 9; Cleft Palate; Developmental Disabilities; Hand Deformities, Congenital; Humans; Infant; Karyotyping; Male; Microcephaly; Nose

As an application of developmental anatomy, functional matrix cleft repair has scientific value. It tests out many aspects of periosteal physiology, and it is based squarely on concepts central to orthodontics. The "molecular revolution" has melded together developmental anatomy and genetics to create a new and clinically relevant model of facial development. This article outlines the scientific rationale for cleft repair based on this model.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Mouth; Nose; Plastic Surgery Procedures; Surgical Flaps; Time Factors; Treatment Outcome

Previously it was thought that primary correction of nasal deformity in cleft lip patients would cause developmental impairment of the nose. It is now widely accepted that simultaneous correction of the cleft lip nasal deformity has no adverse effect on nasal growth. Thus, the authors tried to evaluate the results of primary correction of cleft lip in Asian patients. Of 412 cases of cleft lip, 195 cases were corrected by means of the conventional method from June of 1992 to June of 1997, and 217 cases were corrected by simultaneous rhinoplasty from July of 1997 to October of 2001. The average patient age was 3 months. Photographs and anthropometric evaluation were used to evaluate the results. Nasal tip projection, columellar length, and nasal width were measured in 60 randomized normal children, 30 randomized children treated with the conventional method, and 30 randomized children with primary nasal repair. Data were analyzed using t tests, and the level of significance was 5 percent (p < 0.05). In cases of simultaneous repair, nasal tip projection and columellar length were increased 24.8 percent and 28.8 percent, respectively. Nasal width was increased 12.3 percent in the cases of simultaneous repair and 12.6 percent in the cases without primary rhinoplasty. Simultaneous repair of cleft lip and nasal deformity in Asian patients showed that more symmetry of nostril and nasal dome projection and better correction of buckling and alar flaring were achieved. More balanced growth and development of the alar complex was achieved, and no interference with nasal growth was encountered.

Topics: Anthropometry; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Infant; Korea; Male; Nose; Rhinoplasty; Treatment Outcome

By contrast with the poor maxillary growth following primary surgery in infancy, unoperated adult cleft lip and palate subjects are known to have good facial growth. There is a strong consensus to consider that scarring from primary surgery is the main cause of this problem, particularly scarring from secondary epithelialization of denuded palatal bone, or of closure of the cleft in one layer. In an attempt to improve the outcome of facial growth, a lot of protocols have developed but, currently, none of them appears more valid and the differences between them are more in favor of the personal influence of each surgeon and his team. We are not in agreement with the widely spread opinion attributing the poor results to a severe hypoplasia which could explain the cleft itself. Actually, these patients have a normal potential of growth, but they need normal functions to show it. We think that oral breathing, so frequent among these patients, is enough to explain their poor growth. Over the past 22 years, we have tried to restore, with encouraging results, a nasal breathing mode, as early as 6 years of age, through precise secondary surgery of the nostril and the septum. But with experience, we have concluded that changing the first habit of oral breathing into a nasal one is particularly difficult in cleft patients, and that a nasal mode of breathing should be established once the primary surgery, in order to avoid compensation mechanisms and their consequences. For the last 6 years, our current protocol has allowed to achieve consistently this objective, with an evident influence on the outcome of the growth of the maxilla in complete unilateral and bilateral clefts. A longer follow-up is necessary to confirm it, but henceforth, all those who know the essential role of nasal breathing for a normal facial growth should endorse this process.

Topics: Cleft Lip; Cleft Palate; Clinical Protocols; Humans; Maxilla; Maxillofacial Development; Nose; Respiration; Treatment Outcome

Nonsyndromic cleft of the lip and/or palate (CLP or orofacial cleft) derives from an embryopathy with consequent failure of the nasal process and/or palatal shelves fusion. This severe birth defect is one of the most common malformations among live births. Nonsyndromic CLP is composed of two separate entities: cleft lip and palate (CL+/-P) and cleft palate only (CPO). Both have a genetic background, and environmental factors probably disclose these malformations. In CL+/-P, several loci have been identified, and, in one case, a specific gene has also been found. In CPO, one gene has been identified, but many more are probably involved. Because of the complexity of the genetics of nonsyndromic CLP as a result of the difference between CL+/-P and CPO, heterogeneity of each group caused by the number of involved genes, type of inheritance, and interaction with environmental factors, we discuss the more sound results obtained with different approaches: epidemiological studies, animal models, human genetic studies, and in vitro studies.

Topics: Animals; Chromosome Mapping; Cleft Lip; Cleft Palate; Disease Models, Animal; Environment; Epidemiologic Studies; Humans; Nose; Palate

This addendum to the "State of the Art Dental Treatment of Predental and Infant Patients With Clefts and Craniofacial Anomalies," by Prahl-Andersen (Cleft Palate Craniofac J. 2000;37:528532), offers an extended perspective on this controversial subject. This article reviews the role of combined nasal and alveolar (nasoalveolar) molding in the primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. The background of presurgical nasoalveolar orthopedic molding, the technique, and the literature are presented. The proposed benefits of treatment from the traditional techniques of presurgical orthopedics have been shown to be unsubstantiated (Kuijpers-Jagtman and Prahl, 1996). A close comparison of the proposed benefits of earlier forms of presurgical orthopedics, along with those of the current technique of nasoalveolar molding, is presented.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Orthopedic Procedures; Orthotic Devices; Preoperative Care

Topics: Abnormalities, Multiple; Chromosome Deletion; Chromosomes, Human, Pair 2; Cleft Palate; Coloboma; Heart Septal Defects, Ventricular; Humans; Infant; Intellectual Disability; Male; Nose; Retina

A newborn with some kind of facial cleft displays certain characteristics of the nose, upper lip, and jaw caused by abnormal influence on specific growth sites and growth mechanisms. Treatment, particularly surgery, attempts to counteract this aberrant development, for both functional and aesthetic reasons. However, not infrequently, therapy impedes future midfacial growth to a greater or lesser degree. To better understand the varying growth influence, this article aims to review certain aspects of growth of the middle third of the face in both normal and cleft subjects. The normal elongation of the maxilla, to give space for the molars, is usually not affected by lip surgery but rather by scar tissue from palatal repair. The displacement of the upper jaw in relation to the vomer is recognized. Early surgery should therefore avoid affecting the growth of the vomero-(pre)maxillary suture if possible. Periosteal growth, necessary for the development of dentoalveolar structures, might be affected by scar tissue from palatal repair. Different ways to reduce the development of palatal scars and their negative effects on growth are discussed.

Topics: Cicatrix; Cleft Lip; Cleft Palate; Facial Bones; Humans; Infant, Newborn; Lip; Maxilla; Nose; Palate; Risk Factors

5p- is a well-defined syndrome, but phenotypic correlations of 5q are poorly described in the literature. We present a case of a female child with interstitial deletion in the 5q13.1q15 region. Comparison of the clinical features of this patient with others reported in the literature suggests an emerging clinical syndrome defined by short stature, failure to thrive, mental retardation, slanting palpebral fissures, malformed ears, short neck and depressed nasal bridge. Based on our endocrine testing, we hypothesize that the short stature could be, in part, due to growth hormone deficiency. The recent assignment of growth hormone receptor gene to the short arm of chromosome 5 and the presence of several genes for growth factors and growth factor receptors on 5q raise interesting possibilities for the explanation of short stature in such cases.

Topics: Adult; Body Height; Child; Chromosome Deletion; Chromosomes, Human, Pair 5; Cleft Palate; Ear; Failure to Thrive; Female; Foot Deformities, Congenital; Growth Disorders; Growth Hormone; Heart Defects, Congenital; Humans; Infant, Newborn; Male; Nose; Pregnancy; Syndactyly; Syndrome

Topics: Amniotic Band Syndrome; Cleft Palate; Coloboma; Eyelids; Face; Facial Bones; Humans; Hypertelorism; Infant; Infant, Newborn; Lip; Male; Nose; Skin Abnormalities; Skull

The Gorlin-Goltz syndrome is characterized by four primary symptoms: multiple nevoid basal cell epitheliomas that usually undergo malignant transformation; jaw keratocysts that show constant growth; skeletal anomalies; and intracranial calcifications. A myriad of additional findings may also be noted. Among the most frequent are: palmar and plantar pits, a characteristic flattened facies and broad nasal root, frontal and parietal bossing, mandibular prognathia, hypertelorism, strabismus, dystrophia of the canthi, and clefts of the lip, alveolus, and/or palate. In this study, we review the literature and our 25 cases of Gorlin-Goltz syndrome patients, questioning their incidence of cleft formations (8.5%) as compared to the general population (0.1%). It is our contention that all patients who present with an orofacial cleft warrant deeper investigation as to the presence of additional signs indicative of Gorlin-Goltz syndrome. The nevi turn malignant with time, and thus, early diagnosis, follow-up, and treatment are imperative.

Topics: Adult; Alveolar Process; Basal Cell Nevus Syndrome; Brain Diseases; Calcinosis; Cell Transformation, Neoplastic; Cleft Lip; Cleft Palate; Diagnosis, Differential; Eyelid Diseases; Face; Facies; Female; Follow-Up Studies; Foot Deformities; Frontal Bone; Hand Deformities; Humans; Hypertelorism; Incidence; Jaw Cysts; Male; Mouth Abnormalities; Nose; Parietal Bone; Prognathism; Strabismus

Grafting of the alveolar ridge with autogenous bone is an integral stage of contemporary management of complete cleft lip and palate cases. Alveolar bone grafting restores continuity of the dental arch, closes oronasal fistulae, supports the alar base, and facilitates spontaneous eruption of permanent teeth adjacent to the cleft. However, timing of the graft and the selection of materials have been topics of much debate in the literature. This article discusses an alternative donor site in cases where rehabilitation has passed the recommended time. Harvesting bone from the third molar regions allows not only the removal of impacted third molars during the same surgical procedure, but also eliminates the morbidity associated with additional surgical sites such as the ilium or mandibular symphysis. This report should not be interpreted as a recommendation for the use of this alternative site in cases where grafting is carried out within the optimal time period, which is usually in the mixed dentition stage. However, when grafting is necessary in young adults suffering from complete cleft lip and palate, the third molar region may provide another acceptable donor site.

Topics: Adolescent; Adult; Alveolectomy; Alveoloplasty; Bone Transplantation; Cleft Lip; Cleft Palate; Female; Humans; Lip; Molar, Third; Nose; Palate; Tooth Extraction; Tooth, Impacted

Topics: Cleft Lip; Cleft Palate; Humans; Nose

The hope for the improvement of the treatment of patients with a cleft malformation of lip, alveolus, hard and soft palate, and nose (LAHSN) is to review and to compare new concepts and methods. But research in this way presumes an exact, reliable and reproduceable diagnosis and documentation. This article reviews previously published diagnosis and documentation systems, and also suggests a concise and simple system to record a cleft lip and palate diagnosis. The anatomical regions of the cleft are considered as well as their extent. A three way division to record the extent of the malformed regions is proposed. It is a extensively used diagnosis recording system.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Documentation; Humans; Nose; Terminology as Topic

Asymmetric embryopathies--severe malformations and disruptions--that affect the craniofacial region are discussed, including anomalies of the eye, nose, mouth, and ear. Asymmetric Tessier clefts are also discussed.

Topics: Cleft Lip; Cleft Palate; Ear, External; Eye Abnormalities; Facial Asymmetry; Humans; Infant, Newborn; Mouth Abnormalities; Nose; Skull

Although great advances in treatment of oro-facial clefts have been made over the past 50 years; in developing countries, due to social stigmas and unavailability of specialised medical facilities and personnel to the majority of the population, there is an increasing incidence of patients coming late for repair of oro-facial clefts. This presents a challenge to both plastic, oral surgeons and associated specialists. The aim of the present article is to demonstrate, in the form of a case report, an alternative surgical technique that has be successful in 8 cases for the late repair of severe bilateral cleft palate utilizing locally available and affordable materials. The objective of managing patients with cleft palate in developing countries is to provide the best repair and rehabilitation with as few operations and in-patient care as possible due to limited financial resources experienced by the majority of in-patients. A multidisciplinary approach to the management of oro-facial clefts is emphasised.

Topics: Alveolar Process; Child; Cleft Lip; Cleft Palate; Developing Countries; Financing, Personal; Follow-Up Studies; Hospitalization; Humans; Kenya; Male; Maxilla; Nose; Palate; Surgical Flaps

In this second part of a diptych on cleft lip and nose, the nose deformity is analysed. The lip/nose adhesion and the growth guidance plate are as important for the functional primary rhinoplasty as for the definitive lip repair.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Nose; Rhinoplasty

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Rhinoplasty

Clefts of the lip and palate frequently produce nasal deformities that tend to reduce the size of the nasal airway. Surgical correction of nasal, palatal, and pharyngeal structures may compromise breathing further. A significant number of individuals with cleft noses mouthbreathe to some extent because of the high prevalence of airway compromise.

Topics: Abnormalities, Multiple; Cleft Lip; Cleft Palate; Humans; Nose; Palatal Expansion Technique; Prosthodontics; Pulmonary Ventilation; Respiration; Surgical Flaps

Individuals with cleft lip and palate often require orthognathic surgery to establish facial harmony and optimal occlusal function. Surgery to the skeletal components of the face can accomplish predictable alterations in jaw relations. The soft tissue response to those skeletal movements, however, is difficult to predict, as it is also for the noncleft individual. In addition there is the variability of the repaired cleft lip. The study included 30 persons with complete unilateral cleft lip and palate, operated for midface deficiency using a Le Fort I maxillary advancement at a mean age of 18.0 years. Some relapse occurred in the immediate postoperative period, but after 1 year the mean advancement of the maxilla was 4.9 mm (best fit of anterior maxilla) and 5.6 mm (incisal edge). Both skeletal and soft tissue changes were negligible after that time. The ratio of upper lip advancement to underlying incisor advancement was 0.65 to 1. Although the lip response was highly correlated to the underlying bony movement, the variation was sufficient to preclude accurate prediction. The upper lip thinned with maxillary advancement, but this was not related to the original lip thickness. Coincident mandibular surgery had no appreciable effect on upper lip movement.

Topics: Adolescent; Adult; Cephalometry; Chin; Cleft Lip; Cleft Palate; Face; Female; Humans; Lip; Longitudinal Studies; Male; Mandible; Maxilla; Nose; Osteotomy; Vertical Dimension

Clefts of the lip and palate frequently produce nasal deformities that tend to reduce the size of the nasal airway. Approximately 70% of the cleft population have nasal airway impairment and about 80% "mouth-breathe" to some extent. Surgical correction of nasal, palatal, and pharyngeal structures may further compromise breathing. Type of cleft appears to affect airway size, with unilateral clefts demonstrating the smallest airway. Although a pharyngeal flap may further decrease airway size, some individuals do not notice a postoperative change because of airway compromise prior to flap placement. Speech is a modified breathing behavior that uses the respiratory system to provide an energy source and involves structures within the respiratory tract to modulate this energy into meaningful sounds. The oral, nasal, and pharyngeal structures that are affected by cleft lip and palate during breathing are often compromised for speech as well. The nasal airway plays an important role in controlling speech pressures when velopharyngeal function is impaired. A "good" nose for breathing is often a "bad" nose for speech under such circumstances.

Topics: Adult; Child; Cleft Lip; Cleft Palate; Humans; Nose; Pulmonary Ventilation; Respiration; Speech

Lateral cephalometric films of operated (Op) and non-operated (Nop) patients with cleft lip and alveolus, cleft lip and palate or cleft palate only, were compared to determine whether the shape or position of the mandible is affected by lip and/or palate surgery. The sample included 204 adult cleft patients, Caucasians of both sexes with one of the following three cleft types: complete unilateral lip and alveolus (n = 50), complete unilateral lip and palate (n = 68), and isolated palate (n = 86). The comparison involved 113 cleft patients operated at the conventional timing and 91 cleft patients who had received no surgical or orthodontic treatment. Comparison was done in order to ascertain if the surgery performed had had any influence upon mandibular growth. The results indicated that, in all three cleft types, the surgery did not induce significant changes in the mandibular growth.

Topics: Adult; Alveolar Process; Alveoloplasty; Cephalometry; Chin; Cleft Lip; Cleft Palate; Female; Humans; Male; Mandible; Mandibular Condyle; Maxillofacial Development; Nasal Bone; Nose; Sella Turcica

Topics: Cleft Lip; Cleft Palate; Hearing Loss, Conductive; Humans; Lip; Maxilla; Nose; Osteotomy; Treatment Outcome; Velopharyngeal Insufficiency

FND is a non-uniform malformation complex with symptoms ranging between severe hypertelorism with bidfid nose and cranium bidfidum occultum with agenesis of the corpus callosum. Etiology and pathogenesis are discussed on the basis of a case history and some hints regarding differential diagnosis and genetic counselling are given. The exclusively sporadic occurrence of FND tells against a hereditary pathomechanism. Consequently, there is no recurrence risk. However, in families with an affected child, malformations generally tend to occur a little more often.

Topics: Abnormalities, Multiple; Agenesis of Corpus Callosum; Cerebral Ventricles; Cleft Lip; Cleft Palate; Diagnosis, Differential; Humans; Hypertelorism; Infant, Newborn; Male; Nose

Topics: Adolescent; Adult; Age Factors; Alveolar Process; Bone Transplantation; Child, Preschool; Cleft Lip; Cleft Palate; Facial Muscles; Humans; Infant; Lip; Maxilla; Maxillofacial Development; Mouth; Nasal Septum; Nose; Palate; Pharynx; Speech; Velopharyngeal Insufficiency

Topics: Cleft Palate; Electromyography; Endoscopy; Fiber Optic Technology; Fluoroscopy; Humans; Methods; Nose; Palate; Pharynx; Respiration; Television; Ultrasonography

Topics: Child; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Nose Deformities, Acquired; Plastics; Rhinoplasty; Surgery, Plastic

Topics: Abdomen; Abdominal Cavity; Breast; Cleft Lip; Cleft Palate; Humans; Nose; Plastic Surgery Procedures; Surgery, Plastic; Thigh

The aim is to compare the facial esthetics following nasoalveolar molding (NAM) versus computer-aided design NAM (CAD/NAM) in patients with bilateral cleft lip/palate (CLP).. The trial is a randomized comparative trial with a 1:1 allocation ratio.. Thirty infants with bilateral complete cleft lip and palate were recruited.. Patients were randomized between NAM and CAD/NAM groups. The treatment steps described by Grayson were followed for the NAM group. In the CAD/NAM group, digitized maxillary models were made to create a series of modified virtual models, which were used to fabricate the molding plates using 3-dimensional printing technology. The nasal stents were then added to the intraoral plates following the Grayson method. The study lasted for 4 months.. The assessment of the changes observed in the interlabial gap and nasolabial esthetics was done using standardized 2-dimensional photographs. The correlation between dental arch changes and extraoral facial esthetics was studied.. Both modalities showed improvement in nasolabial esthetics before the lip surgery. No statistically significant difference was found between NAM and CAD/NAM groups in any of the assessed variables.. Both interventions were effective in the management of infants with bilateral CLP.

Topics: Cleft Lip; Cleft Palate; Esthetics, Dental; Humans; Infant; Nasoalveolar Molding; Nose

To assess the influence of virtual reality (VR) in parent acceptance of the pre-surgical nasoalveolar molding (PNAM) as a pre surgical care to the cleft lip and palate affected infants.. Descriptive Cross sectional pilot study design was planned to assess the pre surgical management of the cleft lip and palate. Twenty parents/caregivers of the infants were randomly divided into two groups. Twelve participants received education through conventional education module (Group I) using verbal explanation supported by the photographs. Another 12 participants received education through customized VR based educational video (Group II). After the education, the parents were provided with questionnaire to assess the acceptance of the treatment procedure. The survey response rate was represented in percentage.. The results of the study indicated that most of the parents were aware of the feeding plate or obturators as an aid in assisting feeding practices among cleft lip and palate affected infants. However, only 33% of participants in Group I were able to understand the doctor's explanation regarding the PNAM whereas 100% of participants in Group II were able to visualize the benefits of PNAM. These participants were willingly accepting PNAM as essential pre-surgical care.. Innovative approaches are essential in patient education modalities as the success of any treatment outcome largely depends on the patient acceptance. Within the limits of this study, VR has been successful in the educating the parents and caregivers regarding the acceptance of PNAM therapy in cleft affected infants.

Topics: Cleft Lip; Cleft Palate; Cross-Sectional Studies; Humans; Infant; Nose; Parents; Pilot Projects; Preoperative Care; Virtual Reality

The aim of this randomized controlled trial was to assess the effectiveness of taping alone in changing nose and lip aesthetics in infants with unilateral complete cleft lip and palate before and after surgical lip repair.. The study design was a prospective, balanced, randomized, parallel-group, single-blinded, controlled trial. All the steps were carried out in the Department of Orthodontics of Cairo University in Egypt. Thirty-one infants with nonsyndromic unilateral complete cleft lip and palate were randomly assigned to either no treatment (control) or taping groups. In the taping group, all infants received horizontal tape between the two labial segments, aiming to decrease the cleft gap. No other interventions were performed in this group. Standardized photographs and videos were taken of the infants in both groups at the beginning of the treatment (T1), directly before surgical lip repair (T2), and 2 weeks after surgical lip repair (T3). Photographs and shots from videos were calibrated and used for outcome assessment. Blinded assessors carried out all the measurements digitally on the standardized photographs at T1, T2, and T3 using computer software.. Significant changes in all the measurements were recorded in the taping group at T2 before surgical lip repair in comparison with the control group. At T3, no differences were found between the two groups.. Taping is a successful intervention in changing nose and lip aesthetics before surgical lip repair. After surgical lip repair, both groups had matching aesthetics.. Therapeutic, I.

Topics: Cleft Lip; Cleft Palate; Esthetics; Humans; Infant; Nose; Prospective Studies; Treatment Outcome

The aim is to compare between the clinical effectiveness of nasoalveolar molding (NAM) versus the computer-aided design NAM (CAD/NAM) in patients with bilateral clefts.. The trial is a randomized comparative trial with 1:1 allocation ratio.. Thirty infants with bilateral complete cleft lip and palate were recruited.. Patients were randomized between NAM and CAD/NAM groups. The treatment steps described by Grayson were followed for the NAM group. In the CAD/NAM group, digitized maxillary models were made to create series of modified virtual models which were used to fabricate the molding plates using 3-dimensional printing technology. The nasal stents were then added to the plates following Grayson method. The study lasted for 4 months.. The primary outcome was to evaluate the changes in the intersegment cleft gap. Secondary outcomes included the analysis of the maxillary arch in transverse, anteroposterior, and vertical dimensions as well as the premaxillary deviation and rotation. Chair side time was assessed for both methods.. Both modalities decreased the intersegment cleft gap. The CAD/NAM plates caused more reduction in the total arch length by 1.99 mm (-3.79 to 0.19,. Both interventions were effective in narrowing the cleft gap. Similar maxillary changes were found in both groups. The CAD/NAM modality required less chair side time compared to the NAM treatment.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Computer-Aided Design; Humans; Infant; Nasoalveolar Molding; Nose; Treatment Outcome

The purpose of this study was to evaluate the short-term effect of series of preadjusted vacuum formed nasoalveolar molding VF NAM aligners on the morphology of nose, lip, and maxillary arch in infants with unilateral cleft lip and palate (UCLP).. Prospective clinical trial.. Unilateral cleft lip and palate patients referred to outpatients' clinic.. Sixteen nonsyndromic infants with UCLP, less than 2 months of age were included from April 2017 to April 2018.. All infants received VF NAM therapy. Standardized digital frontal and basilar photographs and 3D digital models were taken before initiation of VF NAM therapy (T1) and after completion of VF NAM therapy (T2).. Changes in morphology of the nose, lip, and maxillary arch.. Statistical analysis comparing T1 and T2 measurements was performed. Frontal and basilar photographic analysis showed a statistically significant reduction of columella displacement, interlabial gap distance, and nostril width at cleft side (CS), while the nasal height, nostril height at CS, nostril width at noncleft side (NCS), columella deviation angle, nasal tip protrusion, and nostril area at both CS and NCS increased significantly with VF NAM therapy. The nasal width, nostril height at NCS showed no significant change after presurgical VF NAM aligners therapy. The analysis of digital models demonstrated a statistically significant reduction of alveolar cleft width, anterior arch width, arch length, midline deviation, and palatal cleft width, while the posterior arch width and arch perimeter increased significantly with VF NAM therapy.. Vacuum formed NAM therapy was effective in reducing the nasoalveolar deformities associated with infants with UCLP and improved the alveolar morphology and nasal symmetry.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Nasoalveolar Molding; Nose; Prospective Studies; Treatment Outcome; Vacuum

Quantitative assessment of 3-dimensional progressive changes of the maxillary geometry in unilateral cleft lip palate (UCLP) with and without nasoalveolar molding (NAM).. The study was designed as a prospective 2-arm randomized controlled clinical trial conducted in parallel. Forty infants with nonsyndromic UCLP were randomly assigned into a NAM-treated group (n = 20) and non-NAM treated group (n = 20). A total of 120 laser-scanned maxillary casts were collected and blindly analyzed via a modified algorithm at T0 (initial visit; baseline), T1 (after 3 wk; first interval), and T2 (after 6 wk; second interval). The main outcome measures were the amount and rate of cleft gap changes, the midline position, and the transverse, sagittal, and vertical growth through intervals.. More than 50% of the cleft gap (56.42%; P < 0.001) was reduced in the first 3 wk of alveolar molding (AM). The end point of the AM was obtained in 6 wk (86.25%; P < 0.001); then, the kinks of the greater segment were noticed. The AM effect decreased as far as posterior; the anterior arch width reduced slightly (1.23%; P < 0.001), while the middle and posterior arches increased slightly (P > 0.999 and P = 0.288, respectively). The posterior arch width was the least changing and was considered a baseline, while the anterior was the pivot of the segment rotation. Both groups showed different patterns of segment rotation and sagittal growth. The non-NAM treated group showed a slight increase in cleft gap length, arch width, and midline position.. Based on this study, it was concluded that the NAM treatment is effective in minimizing cleft severity and realigning maxillary segments without the deterioration of the transverse and vertical arch growth. Near follow-up visits are recommended to monitor the rapid gap reduction within the first 3 wk. Further trials are recommended to compare the outcomes regarding the sagittal growth to reference values (ClinicalTrials.gov NCT03029195).. The results of this study will help clinicians understand nasoalveolar molding biomechanics that may improve the treatment outcomes for patients with unilateral cleft lip and palate. The trial data can be a valuable guide to the qualitative and quantitative predictive virtual molding in computer aided design-simulated nasoalveolar molding therapy. The modified algorithm can be used by researchers to quantify the rate, the sequence, and the direction of the maxillary segments movement in unilateral cleft lip and palate.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Nasoalveolar Molding; Nose; Prospective Studies

The aim of the current study was to introduce and measure the effectiveness of a new 3D-printed nasoalveolar molding (D-NAM) appliance on improving the maxillary arch dimensions (MADs) in infants with unilateral complete cleft lip and palate (UCLP) before surgical lip repair.. A prospective, balanced, randomized, parallel groups, single-blinded, controlled trial.. All the steps of the current study were carried in the Department of Orthodontics, Cairo University in Egypt.. Thirty-four, nonsyndromic infants with UCLP.. The eligible infants were randomly assigned into either no-treatment (control) or to the new D-NAM groups. In D-NAM group, the maxillary models were 3D scanned into virtual models onto which segmentation and alveolar segments approximation were performed. Approximation movements were divided into 3 models representing 3 activation steps. On each of these models, virtual appliance construction was performed followed by 3D printing of the appliance. Nasal stent was added manually to the appliances of the second and third steps. Horizontal tapes were applied to infants in the D-NAM group only.. A Blinded assessors carried all the MADs measurements virtually on digital models collected at the beginning (T1) and after (T2) treatment.. Clinically and/or statistically significant improvements in all the measured MADs were recorded in D-NAM group at T2 before surgical lip repair in comparison to control group.. The introduced D-NAM/3D-printed appliance is a simple and efficient technique to improve the MADs in infants with UCLP before surgical lip repair.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Egypt; Humans; Infant; Nasoalveolar Molding; Nose; Palate; Printing, Three-Dimensional; Prospective Studies

The objective of this study was to assess the efficacy of presurgical nasoalveolar molding (PNAM) on long-term nasal symmetry and shaping after primary cheiloplasty in patients with unilateral complete cleft lip/palate (UCL/P).. This was a two-group, parallel, retrospective, randomized clinical trial.. The setting for this study was the Chang Gung Craniofacial Center in Taoyuan, Taiwan.. Patients were divided into one of the following two groups: infants with UCL/P who underwent PNAM (PNAM group, n = 42) and infants with UCL/P who did not undergo PNAM (non-PNAM group, n = 42).. Interventions included PNAM and primary cheiloplasty without nasal cartilage dissection.. In this study, 4- to 5-year postoperative full-face and submental oblique photographs were taken of all patients and scored from 1 to 5 points by 10 medical evaluators. The scores were statistically analyzed using repeated-measures analysis of variance, and P < .05 was considered to represent statistical significance.. After 1 to 3 months of PNAM but before primary cheiloplasty, the displaced nasal and alveolar cartilage showed obvious improvement. However, the scores in the PNAM and non-PNAM groups at 4 to 5 years postoperatively were 66.62 ± 14.25 and 66.31 ± 15.08, respectively. There was no significant difference between the two groups ( F = 0.009, P = .923).. PNAM as an early-stage adjunctive therapy for nasal deformity correction is beneficial before primary cheiloplasty, but it is insufficient to maintain long-term nostril symmetry after primary cheiloplasty without nasal cartilage dissection.

Topics: Alveolar Process; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Male; Maxillofacial Development; Nasal Cartilages; Nose; Orthopedic Procedures; Palatal Obturators; Photography; Plastic Surgery Procedures; Preoperative Care; Retrospective Studies; Taiwan; Treatment Outcome

The objective of this study was to investigate the long-term effect of presurgical nasoalveolar molding (PNAM) on growth of the maxillary arch through early childhood until 6 years of age in complete unilateral cleft lip and palate (UCLP) patients presenting for PNAM at different ages. Complete UCLP patients who were treated at our centre were divided into two groups. The study group underwent PNAM and was further subdivided into three subgroups (PNAM initiated within 1 month, between 1 and 6 months, and between 6 and 12 months of age in subgroup I, II, and III, respectively). The control group did not undergo PNAM and was further subdivided into three subgroups. Patients were evaluated at T1 (first visit), T2 (before cheiloplasty), and T3 (at 6 years). Between T1and T2, the intersegment distance (ISD) reduced significantly in the study group but increased in the control group, whereas the intercanine width (ICW) in both the study and control groups did not show significant change. Between T2 and T3, ISD and ICW were reduced significantly in the control group due to arch collapse, whereas in the study group, ISD reduced slightly with ICW remaining almost similar to noncleft norms. We conclude that reduced ISD following PNAM improves arch symmetry and stability, and thus may prevent arch collapse in the long term.

Topics: Alveolar Process; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Infant; Infant, Newborn; Male; Maxillofacial Development; Nose; Orthopedic Procedures; Palatal Obturators; Plastic Surgery Procedures; Preoperative Care; Prospective Studies; Treatment Outcome

To compare the effectiveness of nasoalveolar molding (NAM) in infants with complete unilateral cleft lip and palate presenting before and after 6 months of age and justify its use in older infants presenting for treatment.. The university NAM protocol was followed for 150 patients who were included in the study. NAM was performed by 1 month of age (group I, n = 50), at 1 to 6 months of age (group II, n = 50), and at 6 months to 1 year of age (group III, n = 50). Seven linear anthropometric measurements were compared using dentofacial models.. Statistical analysis before and after NAM showed that group I had 83, 176, 69, and 142% improvement in intersegment distance, nasal height, nasal dome height, and columella height, respectively. Group II had 53, 44, 30, and 67% improvement. Group III had 45, 38, 28, and 62% improvement.. Patients in all 3 groups showed improvement with the NAM protocol. Although patients who presented for treatment before 1 month of age benefited the most, those who presented at 6 months to 1 year of age benefited as much from NAM as those who presented at 1 to 6 months, thus validating its use in these patients.

Topics: Age Factors; Alveolar Process; Anatomic Landmarks; Cephalometry; Cleft Lip; Cleft Palate; Dental Arch; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Lip; Male; Maxilla; Nasal Cartilages; Nose; Orthotic Devices; Palatal Obturators; Plastic Surgery Procedures; Prospective Studies; Prosthesis Design; Treatment Outcome

Computer-assisted design and computer-aided manufacturing (CAD/CAM) technology in nasoalveolar molding (NAM) should save time and manpower and reduce family input in cases of cleft lip and palate.. Intraoral casts from 12 infants with complete unilateral cleft lip and palate were taken immediately after birth (T1) and after (T2) NAM treatment, digitalized, and transformed into STL data. The infants were randomized into Group 1 (n = 6) receiving conventional NAM treatment or Group 2 receiving CAD/CAM NAM (n = 6). We analyzed the following variables by using Geomagic software: intersegmental alveolar distance (ISAD); intersegmental lip distance (ISLD); nostril height cleft/noncleft (NHc/nc); nasal width cleft/noncleft (NWn/nc); and columella deviation angle (CDA).. In both groups, all variables except NHnc and NWnc were changed significantly between T1 and T2. The analysis of the mean differences of the variables in Group 1 and 2 showed no significant differences, with a comparable incidence of clinical alterations such as skin or mucosal irritations.. NAM plates can be produced virtually by using CAD/CAM technology. The CAD/CAM NAM results show no significant differences from the conventional technique. We present our clinically usable virtual CAD/CAM workflow for producing a basic NAM plate.

Topics: Cleft Lip; Cleft Palate; Computer-Aided Design; Humans; Infant; Nose; Splints; Treatment Outcome

Despite the increasing use of nasoalveolar molding in early cleft treatment, questions remain about its effectiveness. This study examines clinician and caregiver appraisals of primary cleft lip and nasal reconstruction with and without nasoalveolar molding in a nonrandomized, prospective, multicenter study.. Participants were 110 infants with cleft lip/palate (62 treated with and 48 treated without nasoalveolar molding) and their caregivers seeking treatment at one of six high-volume cleft centers. Using the Extent of Difference Scale, standard photographs for a randomized subset of 54 infants were rated before treatment and after surgery by an expert clinician blinded to treatment group. Standard blocked and cropped photographs included frontal, basal, left, and right views of the infants. Using the same scale, caregivers rated their infants' lip, nose, and facial appearance compared with the general population of infants without clefts before treatment and after surgery. Multilevel modeling was used to model change in ratings of infants' appearance before treatment and after surgery.. The expert clinician ratings indicated that nasoalveolar molding-treated infants had more severe clefts before treatment, yet both groups were rated equally after surgery. Nasoalveolar molding caregivers reported better postsurgery outcomes compared with no-nasoalveolar molding caregivers (p < 0.05), particularly in relation to the appearance of the nose.. Despite having a more severe cleft before treatment, infants who underwent nasoalveolar molding were found by clinician ratings to have results comparable to those who underwent lip repair alone. Infants who underwent nasoalveolar molding were perceived by caregivers to have better treatment outcomes than those who underwent lip repair without nasoalveolar molding.. Therapeutic, II.

Topics: Caregivers; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Infant; Male; Nose; Pilot Projects; Plastic Surgery Procedures; Prospective Studies; Risk Assessment; Surgeons; Treatment Outcome

Repair of unilateral cleft lip and nasal deformity in three dimensions requires anticipation of changes in the fourth dimension that can be determined by periodic and objective assessment.. Fifty patients with unilateral cleft lip with or without cleft palate underwent primary repair from 1999 to 2004 and were followed through 2014. Anthropometry was performed immediately postoperatively and at a first and second follow-up interval, occurring at an average age of 6.6 and 11.5 years, respectively. Measured differences between cleft and noncleft sides included heminasal width (subnasale-alare), cutaneous labial height (subnasale-crista philtri inferior, subalare-crista philtri inferior), and transverse labial width at the cutaneous-vermilion border (crista philtri inferior-chelion). Contrasts for the rates of growth were assessed with t tests for correlated measures. Using the same method, the difference between growth on cleft and noncleft sides in the second period was compared to that in the first period.. Heminasal width remained narrower on the cleft side, but this difference decreased over time. Subnasale-crista philtri inferior remained longer on the cleft side; there was no difference between the rate of growth on the cleft and noncleft sides in the second period. Subalare-crista philtri inferior remained shorter on the cleft side by a consistent difference at both times of follow-up measurements. Transverse labial width at the cutaneous-vermilion border remained shorter on the cleft side, but this difference decreased in the second period.. Understanding how nasolabial features change with growth is critical to crafting the initial repair of unilateral cleft lip and nasal deformity.. Therapeutic, IV.

Topics: Child; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Infant; Lip; Male; Nose; Plastic Surgery Procedures; Prospective Studies; Treatment Outcome

To study the growth and speech outcomes in children who were operated on for unilateral cleft lip and palate (UCLP) by a single surgeon using two different treatment protocols.. A total of 200 consecutive patients with nonsyndromic UCLP were randomly allocated to two different treatment protocols. Of the 200 patients, 179 completed the protocol. However, only 85 patients presented for follow-up during the mixed dentition period (7-10 years of age). The following treatment protocol was followed. Protocol 1 consisted of the vomer flap (VF), whereby patients underwent primary lip nose repair and vomer flap for hard palate single-layer closure, followed by soft palate repair 6 months later; Protocol 2 consisted of the two-flap technique (TF), whereby the cleft palate (CP) was repaired by two-flap technique after primary lip and nose repair. GOSLON Yardstick scores for dental arch relation, and speech outcomes based on universal reporting parameters, were noted.. A total of 40 patients in the VF group and 45 in the TF group completed the treatment protocols. The GOSLON scores showed marginally better outcomes in the VF group compared to the TF group. Statistically significant differences were found only in two speech parameters, with better outcomes in the TF group.. Our results showed marginally better growth outcome in the VF group compared to the TF group. However, the speech outcomes were better in the TF group.

Topics: Child; Cleft Lip; Cleft Palate; Clinical Protocols; Dental Arch; Dentition, Mixed; Female; Follow-Up Studies; Humans; Lip; Male; Malocclusion; Maxilla; Nose; Open Bite; Overbite; Palate, Hard; Palate, Soft; Photography; Prospective Studies; Speech; Speech Disorders; Surgical Flaps; Vomer

Recombinant human bone morphogenetic protein (rhBMP)-2 has been used in some craniofacial centers worldwide. However, its influence on nasal morphology is unknown. Thus, the objective of this investigation was to assess the effect of maxillary alveolar reconstruction on nasal position and symmetry in unilateral complete cleft lip patients who underwent traditional iliac crest bone grafting transferring versus reconstruction using rhBMP-2.. Nineteen unilateral complete cleft lip patients were randomly divided into two groups. In group 1, patients underwent traditional iliac crest bone grafting transferring (n = 11) and in group 2, patients underwent alveolar reconstruction using collagen matrix with lyophilized rhBMP-2 (n = 8). Computerized tomography (CT) imaging was performed preoperatively and at 6 months postoperatively using a previously standardized protocol. Linear distances using anatomic landmarks were performed using tridimensional CT data reformatted by the OsiriX(®) software. Quantitative and qualitative measurements to assess intra- and inter-group nasal position modifications were performed.. Intra-group pre- and postoperative comparisons showed significant differences (p < 0.05) in two linear measurements of group 1, while group 2 did not present a difference (p > 0.05). Group 2 presented significant postoperative enhancement (p < 0.05) in the quantitative nasal symmetry in one measurement. Qualitative analysis showed postoperative nasal symmetry enhancement in 75% of the measurements of group 2 and 36% of group 1. There was no statistically significant difference in the inter-group comparisons.. Our study demonstrated that both groups showed similar effect on nasal symmetry.

Topics: Alveolar Ridge Augmentation; Bone Morphogenetic Protein 2; Brazil; Child; Cleft Lip; Cleft Palate; Female; Humans; Ilium; Imaging, Three-Dimensional; Male; Maxilla; Nose; Plastic Surgery Procedures; Radiographic Image Interpretation, Computer-Assisted; Recombinant Proteins; Retrospective Studies; Tomography, X-Ray Computed; Transforming Growth Factor beta; Treatment Outcome

Objective : Cleft surgeons often show 10 consecutive lip repairs to reduce presentation bias, however the validity remains unknown. The purpose of this study is to determine the number of consecutive cases that represent average outcomes. Secondary objectives are to determine if outcomes correlate with cleft severity and to calculate interrater reliability. Design : Consecutive preoperative and 2-year postoperative photographs of the unilateral cleft lip-nose complex were randomized and evaluated by cleft surgeons. Parametric analysis was performed according to chronologic, consecutive order. The mean standard deviation over all raters enabled calculation of expected 95% confidence intervals around a mean tested for various sample sizes. Setting : Meeting of the American Cleft Palate-Craniofacial Association in 2009. Patients, Participants : Ten senior cleft surgeons evaluated 39 consecutive lip repairs. Main Outcome Measures : Preoperative severity and postoperative outcomes were evaluated using descriptive and quantitative scales. Results : Intraclass correlation coefficients for cleft severity and postoperative evaluations were 0.65 and 0.21, respectively. Outcomes did not correlate with cleft severity (P  =  .28). Calculations for 10 consecutive cases demonstrated wide 95% confidence intervals, spanning two points on both postoperative grading scales. Ninety-five percent confidence intervals narrowed within one qualitative grade (±0.30) and one point (±0.50) on the 10-point scale for 27 consecutive cases. Conclusions : Larger numbers of consecutive cases (n > 27) are increasingly representative of average results, but less practical in presentation format. Ten consecutive cases lack statistical support. Cleft surgeons showed low interrater reliability for postoperative assessments, which may reflect personal bias when evaluating another surgeon's results.

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Reproducibility of Results; Sample Size

The objective of this randomized controlled clinical trial was to compare the soft tissue changes after maxillary advancement using conventional orthognathic surgery (CO) and distraction osteogenesis (DO) in patients with cleft lip and palate (CLP).. The study group of 39 CLP patients with maxillary hypoplasia underwent either CO or DO with 4 to 10 mm of maxillary advancement. Lateral cephalographs were taken preoperatively and postoperatively at regular intervals. A series of skeletal, dental, and soft tissue landmarks was used to evaluate the changes in the soft tissue and the correlation of hard and soft tissue changes and ratios.. Significant differences were found between the CO and DO patients at A point in both maxillary advancement and downgrafting in the early follow-up period. On soft tissue landmarks of pronasale, subnasale, and labial superius, significant differences were found between the 2 groups at 6 months postoperatively only with maxillary advancement. There was better correlation of hard and soft tissue changes with maxillary advancement. The nasal projection was significantly different between the 2 groups at the early and intermediate period. There was much more consistent hard to soft tissue ratios in maxillary advancement with DO than with CO.. Both CO and DO can induce significant soft tissue changes of the upper lip and nose, particularly with maxillary advancement. DO generates more consistent hard to soft tissue ratios.

Topics: Adolescent; Alveolar Process; Anatomic Landmarks; Bone Plates; Cephalometry; Cleft Lip; Cleft Palate; Face; Female; Follow-Up Studies; Frontal Bone; Humans; Incisor; Internal Fixators; Lip; Male; Maxilla; Molar; Nose; Orthognathic Surgical Procedures; Osteogenesis, Distraction; Osteotomy; Osteotomy, Le Fort; Recurrence; Sella Turcica; Speech; Treatment Outcome; Young Adult

The objectives of this study were to: evaluate the effects of nasoalveolar moulding (NAM) in complete unilateral cleft lip and palate infants presenting for treatment at different ages; propose a new NAM protocol in these patients; improve the predictability of NAM. Study groups comprised: group I (n=15) treated with NAM within 1 month of age; group II (n=15) treated with NAM between 1 and 5 months of age.. group III (n=15) comprised of non-cleft 18-month old children. A standard protocol was followed. Patients were evaluated before initiation of NAM, before cheiloplasty and at 18 months. 7 linear anthropometric measurements were compared using dento-facial models. Statistical analysis before and after NAM revealed that group I patients demonstrated 81%, 198%, 69% and 145% improvement in intersegment distance, nasal height, nasal dome height and columella height respectively; whilst group II patients demonstrated 51%, 33%, 21% and 38% improvement for the same. At 18 months, group I patients closely resembled group III patients. This study concluded that the effects of NAM were most significant in group I. Group II patients also benefited from NAM, although to a lesser extent. This study validates the use of NAM in infants presenting late for treatment.

Topics: Age Factors; Alveolar Process; Cephalometry; Cleft Lip; Cleft Palate; Clinical Protocols; Cooperative Behavior; Counseling; Dental Arch; Dental Prosthesis Design; Female; Follow-Up Studies; Humans; Infant; Infant Care; Infant, Newborn; Male; Maxilla; Nasal Cartilages; Nose; Palatal Obturators; Parents; Plastic Surgery Procedures; Preoperative Care; Prospective Studies; Stents; Treatment Outcome

This clinical randomized controlled trial was performed to compare the effects of distraction osteogenesis (DO) and conventional orthognathic surgery (CO) on velopharyngeal function and speech outcomes in cleft lip and palate (CLP) patients. Twenty-one CLP patients who required maxillary advancement ranging from 4 to 10 mm were recruited and randomly assigned to either CO or DO. Evaluation of resonance and nasal emission, nasoendoscopic velopharyngeal assessment and nasometry were performed preoperatively and at a minimum of two postoperative times: 3-8 months (mean 4 months) and 12-29 months (mean 17 months). Results showed no significant differences in speech and velopharyngeal function changes between the two groups. No correlation was found between the amount of advancement and the outcome measures. It was concluded that DO has no advantage over CO for the purpose of preventing velopharyngeal incompetence and speech disturbance in moderate cleft maxillary advancement.

Topics: Adolescent; Bone Plates; Cleft Lip; Cleft Palate; Endoscopy; Female; Follow-Up Studies; Humans; Internal Fixators; Male; Maxilla; Nose; Orthognathic Surgical Procedures; Osteogenesis, Distraction; Osteotomy, Le Fort; Speech; Speech Disorders; Speech Intelligibility; Treatment Outcome; Velopharyngeal Insufficiency; Velopharyngeal Sphincter; Voice; Voice Quality; Young Adult

Previously it was thought that primary correction of nasal deformity in cleft lip patients would cause developmental impairment of the nose. It is now widely accepted that simultaneous correction of the cleft lip nasal deformity has no adverse effect on nasal growth. Thus, the authors tried to evaluate the results of primary correction of cleft lip in Asian patients. Of 412 cases of cleft lip, 195 cases were corrected by means of the conventional method from June of 1992 to June of 1997, and 217 cases were corrected by simultaneous rhinoplasty from July of 1997 to October of 2001. The average patient age was 3 months. Photographs and anthropometric evaluation were used to evaluate the results. Nasal tip projection, columellar length, and nasal width were measured in 60 randomized normal children, 30 randomized children treated with the conventional method, and 30 randomized children with primary nasal repair. Data were analyzed using t tests, and the level of significance was 5 percent (p < 0.05). In cases of simultaneous repair, nasal tip projection and columellar length were increased 24.8 percent and 28.8 percent, respectively. Nasal width was increased 12.3 percent in the cases of simultaneous repair and 12.6 percent in the cases without primary rhinoplasty. Simultaneous repair of cleft lip and nasal deformity in Asian patients showed that more symmetry of nostril and nasal dome projection and better correction of buckling and alar flaring were achieved. More balanced growth and development of the alar complex was achieved, and no interference with nasal growth was encountered.

Topics: Anthropometry; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Infant; Korea; Male; Nose; Rhinoplasty; Treatment Outcome

To analyze the results of a consecutive series of palate re-repairs performed using the operating microscope and identify predictive factors for outcome.. Prospective data collection, with blind assessment of randomized recordings of speech and velar function on lateral videofluoroscopy and nasendoscopy.. One hundred twenty-nine consecutive patients with previously repaired cleft palates and symptomatic velopharyngeal incompetence (VPI) and evidence of anterior insertion of the levator veli palatini underwent palate re-repairs by a single surgeon from 1992 to 1998. Syndromic patients, those who had significant additional surgical procedures at the time of re-repair (23 patients), and all patients with inadequate pre- or postoperative speech recordings were excluded, leaving a total of 85 patients in the study.. Palate re-repairs, with radical dissection and retropositioning of the velar muscles, were performed using the operating microscope with intraoperative grading of anatomical and surgical findings.. Pre- and postoperative perceptual speech assessments using the Cleft Audit Protocol for Speech (CAPS) score, measurement of velar function on lateral videofluoroscopy, and assessment of nasendoscopy recordings.. There were significant improvements in hypernasality, nasal emission, and nasal turbulence and measures of velar function on lateral videofluoroscopy, with improvement in the closure ratio, velopharyngeal gap at closure, velar excursion, velar movement angle, and velar velocity.. Palate re-repair has been shown to be effective in treating VPI following cleft palate repair, both in patients who have not had an intravelar veloplasty and those who have had a previous attempt at muscle dissection and retropositioning. Palate re-repair has a lower morbidity and is more physiological than a pharyngoplasty or pharyngeal flap.

Topics: Adolescent; Adult; Airway Resistance; Child; Child, Preschool; Cleft Palate; Endoscopy; Female; Fluoroscopy; Humans; Male; Microsurgery; Middle Aged; Nose; Palatal Muscles; Palate; Palate, Soft; Pharynx; Prospective Studies; Reoperation; Single-Blind Method; Speech; Speech Disorders; Statistics as Topic; Statistics, Nonparametric; Treatment Outcome; Velopharyngeal Insufficiency; Video Recording

The methods of assessment of nose deformation in patients with unilateral cleft lip and palate have been presented. The study covered 45 patients with clefts, of 14-20 years of age who had undergone the infant surgery, and 45 patients at the same age serving as controls. The condition of nasal septum has been clinically examined in both groups and the nasal resistance has been measured by means of front and rear rhinomanometry. In the cleft group 80% of patients presented their cartilaginous septum deviated to the non-cleft side, and 85% had their bony septum deviated to the cleft side. In the cleft group, the front rhinomanometry revealed significantly higher resistance on the cleft side than on the non-cleft side and in controls. The rear rhinomanometry showed no significant differences in both groups, except the patients with clefts, who had been submitted to surgery with pharyngeal flap, in whom higher values of resistance had been found.

Topics: Adolescent; Adult; Airway Resistance; Cleft Lip; Cleft Palate; Female; Humans; Male; Manometry; Nasal Septum; Nose; Nose Deformities, Acquired; Pharynx; Surgical Flaps

This study was undertaken by several members of the University of Florida Craniofacial Center to assess the results of palatoplasty performed by the method devised by Larisa Y. Frolova, M.D. in 1971.. The assessment was based on evaluation of each subject's speech and velopharyngeal function through perceptual measures, nasometry, and video-nasendoscopy.. The study took place at the National Pediatric Center for Congenital Maxillofacial Pathology, Moscow, Russia, under the auspices and with the cooperation of Dr. Frolova, director of the program.. One hundred twelve children (40 girls and 72 boys; age range, 4 to 10 years; mean age, 7.5 years) with repaired cleft palate who had undergone palatoplasty 2 to 4 years earlier and had no secondary surgery were randomly selected from the center's clinical files by the staff. Subjects with known conditions that could jeopardize normal speech development were excluded.. Each subject was assessed for speech and velopharyngeal function with a battery of perceptual measures and videonasendoscopy.. The percentage of subjects judged to have normal resonance was 55.5%. An additional 9.5% of the subjects judged to be hyponasal increased the rate of nonhypernasal outcome to 64%.. The Furlow double-Z palatoplasty has had an increasing rate of success (up to 87%), whereas the Frolova technique has a success rate of only 55% to 65%.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Endoscopy; Female; Humans; Male; Methods; Nose; Palate, Soft; Pharynx; Postoperative Period; Retrospective Studies; Speech; Speech Production Measurement; Video Recording

Outcome of treatment in 85 children with unilateral cleft, lip, alveolus, and palate who had been treated according to four regimes was studied using lateral skull radiographs, extra oral photographs, intra oral radiographs and orthopantographs. The treatment regimes differed with regard to: the inclusion of presurgical orthopaedics in one group, the type of lip closure, the type and timing of palatal closure, and timing of bone grafting to the alveolus. A method of pooling subgroups and comparing lateral skull radiographs from different centres was developed to obtain more meaningful comparisons between centres. The maxillary, mandibular, and vertical hard tissue development as well as the soft tissue profile were studied using lateral skull radiographs. The appearance of the extraoral soft tissue was assessed by a panel using photographs. The tooth status and the success of transplants in the cleft area were evaluated using intra oral radiographs and orthopantographs. Treatment regimes that did not include bone grafting seemed to be most favourable for maxillary and mandibular development. Treatment regimes without bone-grafting and those that included bone grafting at 10 years of age seemed to be most favourable for the vertical skeletal proportions. The soft tissue profile was developed best after regimes that included bone grafting at 10 years of age. Facial appearance was equally good in the group that received bone grafts at 6 months after presurgical orthopaedics and in the group that received bone grafts at 10 years of age. Tooth status and the percentage of successful transplants were best in the group that received bone grafts after the eruption of the incisors but before the eruption of the canines.

Topics: Adolescent; Alveolar Process; Alveoloplasty; Bone Transplantation; Cephalometry; Child; Cleft Lip; Cleft Palate; Clinical Protocols; Face; Female; Humans; Lip; Longitudinal Studies; Male; Mandible; Maxilla; Maxillofacial Development; Nose; Orthodontics, Corrective; Tooth Abnormalities; Treatment Outcome; Vertical Dimension

Many cleft centers incorporate NasoAlveolar Molding (NAM) into their presurgical treatment protocols. However, there are limited data on eligible patients who do not receive or complete NAM. This study characterizes the demographics associated with non-utilization or completion of NAM.. A single-institution retrospective review was performed of all patients with cleft lip and alveolus undergoing primary unilateral and bilateral cleft lip repair from 2012-2020. Patients were grouped based on utilization or non-utilization of NAM. Demographic and treatment data were collected, including documented reasons for not pursuing or completing NAM.. Of 230 eligible patients, 61 patients (27%) did not undergo or complete NAM (no-NAM). In this group, 37 (60.7%) received no presurgical intervention, 12 (19.7%) received presurgical nostril retainers, 3 (4.9%) received lip taping, 1 (1.6%) received a combination of taping/nostril retainers, and 8 (13.1%) discontinued NAM. The most common reasons for not receiving NAM were sufficiently aligned cleft alveolus (21.3%), medical complexity (16.4%), late presentation (16.4%), and alveolar notching (18%). Compared to the NAM group, the no-NAM group had significantly lower rates of prenatal cleft diagnosis/consult, and significantly higher proportion of non-married and non-English speaking caregivers. Multivariable analysis controlling for insurance type, primary language, prenatal consult, marital status, and age at first appointment found that age at first appointment is the only statistically significant predictor of NAM utilization (. Common reasons for non-utilization of NAM include well-aligned cleft alveolus, medical complexity, and late presentation. Early presentation is an important modifiable factor affecting rates of NAM utilization.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nasoalveolar Molding; Nose; Retrospective Studies; Treatment Outcome

This study compares patients undergoing early cleft lip repair (ECLR) (<3-months) and traditional lip repair (TLR) (3-6 months) with/without nasoalveolar molding (NAM) to evaluate the effects of surgical timing on weight gain in hopes of guiding future treatment paradigms.. Retrospective review.. Children's Hospital of Los Angeles, California.. A retrospective chart review evaluated patients who underwent ECLR or TLR ± NAM from November 2009 through January 2020.. No intervention was performed.. Patient demographics, birth and medical history, perioperative variables, and complications were collected. Infant weights and age-based percentiles were recorded at birth, surgery, 8-weeks, 6-months, 12-months, and 24-months postoperatively. The main outcomes were weight change and weight percentile amongst ECLR and TLR ± NAM groups.. 107 patients met inclusion criteria: ECLR,. ECLR significantly increased patient weights 24-months postoperatively when compared to TLR ± NAM. Specifically compared to TLR-NAM, ECLR weights were significantly greater at all time points past 6-months postoperatively. The results of this study demonstrate that ECLR can mitigate feeding difficulties and malnutrition traditionally seen in patients with cleft lip.

Topics: Alveolar Process; Child; Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Nose; Retrospective Studies; Weight Gain

Presurgical infant orthopedics (PIO) reduces the severity of the original cleft and burden on patients and their parents, provides better esthetics and function, and enables surgeons to achieve better surgical repair. To reduce the alveolar cleft width and to predict treatment difficulty using PIO, various measures were examined in pretreatment cast models.. Retrospective case-control pilot study.. The patients were 22 infants with non-syndromic unilateral cleft lip and palate (UCLP), and cast models of these infants were used.. After PIO using passive plates, infants with UCLP were divided into two groups: contact group (12 cases with close proximity of the greater and lesser segments) and non-contact group (10 cases without proximity of segments). The two groups were compared, and variables related to the proximity between alveolar clefts were examined.. There was no significant difference in age at PIO initiation between the two groups. However, the treatment duration was significantly longer in the non-contact group than in the contact group. Among the 13 variables, the initial lateral deviation of the nasal septum was significantly larger in the contact group than in the non-contact group. A significant positive correlation was observed between the initial lateral deviation of the nasal septum and reduction of the alveolar cleft width by PIO.. Initial lateral deviation of the nasal septum is a predictive factor for the proximity between alveolar segments in infants with UCLP at the PIO.

Topics: Cleft Lip; Cleft Palate; Esthetics, Dental; Humans; Infant; Nose; Orthopedics; Pilot Projects; Preoperative Care; Retrospective Studies

This study aimed to investigate the outcomes of using a novel nasal clip designed for nostril retention after primary unilateral cleft rhinoplasty.. This is a retrospective study.. Department of Cleft Lip and Palate in a stomatological hospital.. A retrospective study was conducted on 57 patients who had a unilateral complete cleft lip without cleft palate and underwent primary surgical repair.. The patients were categorized into 3 groups: the group in which the conventional nasal retainer was used, that in which the nasal clip was used, and the control group in which no postoperative nasal retainer was used. The nasal retainer or our nasal clip was applied 7 days after primary surgical repair and kept in the nostrils of children from 6 to 12 months.. Noses underwent photogrammetry preoperatively, postoperatively, and at follow-up. The nose was also subjectively scored at the follow-up.. The nasal retainer and the nasal clip significantly minimized relapse as determined by nasal tip deviation. The nasal clip sustained nasal symmetry, as determined by the postoperative nostril width ratio, better than did the conventional retainer. After 6 to 12 months, the nasal clip achieved better columellar morphology and a more symmetric nasal base than did the conventional nasal retainer. Statistical differences in subjective scores between the control and nostril retention groups were noted.. The application of the novel nasal clip after primary unilateral cleft rhinoplasty preserves nasal morphology and reduces postoperative relapse without the need for adhesive tape.

Topics: Child; Cleft Lip; Cleft Palate; Humans; Nasal Septum; Nose; Retrospective Studies; Rhinoplasty; Surgical Instruments; Treatment Outcome

This study aimed to evaluate the three-dimensional changes in maxillary alveolar morphology after using modified NAM in patients with complete unilateral cleft lip and palate.. This is a retrospective study.. The study was carried out in the dental hospital, Faculty of Dentistry of Naresuan University, Phitsanulok, which serves as a tertiary care center.. The population sample consisted of 19 patients with nonsyndromic complete unilateral cleft lip and palate.. All patients received the modified NAM treatment based on the treatment protocol of the Naresuan University Cleft and Craniofacial Center, Thailand.. Dental models obtained at pre-treatment (T0) and post-treatment (T1) were scanned to construct the digital models. The maxillary digital models that showed dimensional changes between T0 and T1 were measured using a computer graphic software.. The modified NAM resulted in a significant decrease in the anterior cleft width, posterior cleft width, and anterior arch width. Conversely, it caused a significant increase in the length of the lesser cleft segment and the greater segment rotation. However, the change in the height of both segments and posterior arch width was not found to be significant.. The modified NAM was an effective device for reducing the alveolar cleft width while improving the alignment of alveolar cleft segments.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Nasoalveolar Molding; Nose; Retrospective Studies; Treatment Outcome

The objective of the study was to assess nasolabial aesthetics in patients with complete unilateral cleft lip, with or without cleft palate (UCL ± P) using two scoring systems.. A cross-sectional study conducted in a tertiary care government hospital.. Photographic records of 91 patients with complete UCL ± P from the age group of 5-18 years (mean age = 13.2 ± 3.14 years) were included.. A panel of three orthodontists with varying experience in cleft management rated nasolabial aesthetics using two scoring systems, that is Asher Mc-Dade index (AMAI) and Cleft Aesthetic Rating Scale (CARS). Intraclass correlation coefficient, Fleiss' kappa and Cronbach's alpha were used to measure the internal consistency amongst three raters and Spearman-Brown formula was used for measuring overall reliability. Time required for assessment of each photograph was compared with ANOVA.. Overall, both AMAI and CARS showed high reliability and outcome assessment with good inter-rater reliability and internal consistency, when used independently by orthodontists having varied experience. Statistically significant difference was present in time taken for assessment of nasolabial aesthetics with CARS index (8.75 ± 1.65 seconds) as compared to AMAI (18.62 ± 3.49 seconds).. Asher Mc-Dade index and CARS are equally reliable and consistent for the assessment of nasolabial aesthetics in patients with UCL ± P. However, considerably less time was taken for the assessment using CARS index as compared to AMAI. The use of CARS index is recommended for the initial assessment and screening of patients by orthodontists using two dimensional photographs.

Topics: Adolescent; Child; Child, Preschool; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Esthetics; Esthetics, Dental; Humans; Nose; Reproducibility of Results; Retrospective Studies

Proboscis lateralis is a rare craniofacial anomaly in which a rudimentary nasal appendage arises at the medial canthal area. The severity depends on organ involvement, including eyes, nose, cleft lip/palate, and/or concomitant intracranial anomalies. Here, we present a child with proboscis lateralis and associated trans-ethmoidal encephalocele. We suggest doing the preoperative CT and/or MRI to rule out associated intracranial anomalies and reliably preoperative planning tools. Moreover, we proposed an alternative nasal reconstructive technique using a composite graft from the proboscis mass at the same time as encephalocele repair with promising results.

Topics: Abnormalities, Multiple; Child; Cleft Lip; Cleft Palate; Encephalocele; Humans; Nose; Nose Diseases; Respiratory System Abnormalities

We present a novel digital workflow to provide presurgical infant orthopedic (PSIO) treatment for a patient with a unilateral cleft lip/palate utilizing nasoalveolar molding (NAM) and a custom postsurgical nasal stent.. Within the US military healthcare system, the Joint Base San Antonio Craniofacial Anomalies Team utilizes dental scanners, predictive 3D modeling software, and 3D printing technology in a digital workflow for NAM appliance fabrication.. Soft tissue facial scanning, peri-oral scanning, and dental putty impressions are used to facilitate fabrication and measure outcomes. Digital modeling software and 3D resin printing are utilized to manufacture the prescribed devices.. Extra-oral facial scans and intra-oral impressions are compared between 3 timepoints: pre-treatment, posttreatment with NAM, and postsurgical treatment.. The ability to share workflows, establish outcome standards, and streamline patient care will continue to advance best practices in digital PSIO.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nasoalveolar Molding; Nose; Stents; Workflow

Removable nasal obturators provide a treatment option for a range of patients presenting with velopharyngeal dysfunction without eliminating the possibility for future surgery, speech therapy, or the provision of other devices. The presented technique describes the fabrication of a 1-piece silicone nasal obturator to reduce hypernasality and nasal airflow errors without causing significant hyponasality. The obturator has minimal visibility and minimal risk of inhalation.

Topics: Cleft Palate; Humans; Nose; Velopharyngeal Insufficiency

Congenital clefts of the maxillofacial area still remain of current interest in reconstructive facial surgery. While their frequency grows up, the issues of effective surgical primary and secondary interventions are not completely solved yet. The article presents the main problems associated with the elimination of the deformations and our modifications of methods for their correction.. The study was conducted based on the Centre [2] and the University [1], Russian Federation. The project was carried out within the framework of the state assignment of the Ministry of Science and Higher Education of the Russian Federation, mnemocode 0669-2020-0008.. The research is based on the results of complex treatment of 112 patients with unilateral clefts of the upper lip and palate from the age of 5 to 34 years, 68 patients of them also carried out secondary surgeries.. The methods of performing rhinocheiloplasty by moving a "sliding" flap, of eliminating a ctenoid plica appearing after primary surgeries are presented, described, explained, and substantiated in the article.. The proposed methods gave a good or satisfactory result in 92.8% of the operated patients, which allows them to be considered effective for eliminating congenital and postoperative nasal deformities in patients with facial clefts.

Topics: Adolescent; Adult; Child; Child, Preschool; Cleft Lip; Cleft Palate; Humans; Nose; Plastic Surgery Procedures; Rhinoplasty; Young Adult

Secondary rhinoplasty is a challenging procedure, requiring a precise preoperative diagnosis of nasal deformities before correcting them. As there is currently no accepted outcome measurement tool available to assess unilateral cleft lip and palate (UCLP) nose sequelae before secondary rhinoplasty. The goal of this retrospective study is to identify the nose deformities and rate them in an evaluation scale that allows collecting and analyzing cleft nose data. Our retrospective cohort is composed of 29 patients with UCLP, who underwent secondary rhinoplasty between 2010 and 2021 in a cleft center, with a mean age of 23years old. Evaluation of deformities is made from preoperative two-dimensional photography. The assessment photographic tool is a custom-designed scale of 16 items. A binary scoring system is used by two experts to assess nasolabial deformities. The most encountered sequelaes are the alar foot displacement (93%), the enlarged tip (90%) and the nostril horizontalization (86%). The inter-examiner ICC for total rating was calculated at 0.911 and indicated a strong level of reliability that was highly significant (P<0.05). The simplicity, reliability and reproducibility of the proposed assessment system could be interesting for clinicians, in order to diagnose the nasal deformities before surgery, but also to assess postoperative success of a secondary rhinoplasty and thus to compare several surgical techniques.

Topics: Adult; Cleft Lip; Cleft Palate; Humans; Nose; Nose Diseases; Reproducibility of Results; Retrospective Studies; Rhinoplasty; Treatment Outcome; Young Adult

Secondary rhinoplasty on patients with cleft is a challenging procedure, and the most important criterion for evaluating the surgery success is patient satisfaction even if it's subjective.. To evaluate patient satisfaction following secondary cleft rhinoplasty with a specific assessment for patients with Unilateral Cleft Lip and Palate (UCLP).. Our retrospective cross-sectional study is composed of 29 patients with UCLP with a mean age of 23years old, who underwent secondary rhinoplasty between 2010 and 2021 in our department. The survey was conducted postoperatively using a cleft-nose specific custom designed questionnaire based on the Byrne questionnaire, over the phone. This satisfaction questionnaire comprises six questions about physical appearance and one question about functional aspect. Patients were asked to answer "yes" or "no" or to rate from 0 (no improvement) to 10 (perfect result) depending on the question.. Twenty out of 29 people responded to the questionnaire, representing an answer rate of 69%. The average score given by the patient for nasolabial scar improvement was 7.2/10, and the one concerning global improvement was 8.2/10. All patients would be ready to undergo the same procedure again, knowing the final result. A functional improvement concerning breathing or snoring was reported in 45% of cases. All dorsum or tip issues were improved after surgery (P=0,07).. Our results demonstrate high patient satisfaction after cleft rhinoplasty, which encourages the continuation of this surgery. We would recommend the use of this simple questionnaire to allow a more accurate evaluation of patient outcomes.

Topics: Adult; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Esthetics; Humans; Nose; Patient Satisfaction; Personal Satisfaction; Retrospective Studies; Rhinoplasty; Surveys and Questionnaires; Treatment Outcome; Young Adult

Despite advances in cleft lip treatment, various levels of residual deformity remain after primary repair of cleft lip and palate. The aim of the current study was to compare the stability of short- and long-term postoperative nasal symmetry. This retrospective study included 100 consecutive non-syndromic patients with unilateral complete cleft lip who underwent primary cleft lip repair with follow-up of 5 years. Measurements taken from basal and frontal standard photograph views, obtained preoperatively (T1) and immediately (T2), 1 year (T3), and 5 years postoperative (T4), were analysed. Paired and independent t-tests were applied to assess the significance of differences and relationships, while the inter-class correlation coefficient was used to assess reliability; P < 0.05 was considered significant. The male to female ratio was 1:1; mean age at the time of surgery was 0.43 ± 0.25 years. All patients showed significant improvements following unilateral complete cleft lip repair. All variables measured at T3 revealed a significant relapse when compared to T2, except alar base position, which showed a constant mean across all postoperative follow-ups. Late relapse (T3-T4) was not significant for alar collapse, alar base position, or columellar angle (all P > 0.05). On the other hand, columellar height (P = 0.003), and nostril height (P = 0.038) and width (P = 0.007) showed significant improvements during the late relapse period. In conclusion, the majority of the relapse and changes following the nasal cleft repair occurred within the first postoperative year. However, nasal asymmetries tended to remain stable or reduced during the first 5 postoperative years.

Topics: Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Infant; Male; Nasal Septum; Nose; Reproducibility of Results; Retrospective Studies; Rhinoplasty; Treatment Outcome

Nasal airway obstruction is an increasingly recognized phenomenon in patients with cleft lip and/or palate and has the potential to significantly affect quality of life in this patient population. To date, the effect of secondary cleft rhinoplasty on cleft-related nasal airway obstruction has not been studied.. Patients undergoing secondary cleft rhinoplasty at the Children's Hospital of Philadelphia from 2015 to 2021 were identified. Preoperative and postoperative Nasal Obstruction Symptom Evaluation scores were recorded. Alterations in scores were evaluated for variation depending on patient characteristics, operative maneuvers, and postoperative nasal stenting.. Nasal airway obstruction was present in mild to moderate severity in patients before secondary cleft rhinoplasty. Postoperatively, obstruction improved or resolved in the domains of nasal blockage/obstruction, trouble breathing through the nose, and ability to get enough air through the nose during exertion (P < 0.05). Overall composite Nasal Obstruction Symptom Evaluation scores improved (P < 0.05). Lateral crural strut grafting was associated with improvement in nasal blockage, whereas alar revision and tip sutures were associated with worsening in specific nasal symptoms. Patients who underwent nasal stenting were found to report less trouble breathing after surgery than patients who did not (P < 0.05).. Nasal airway obstruction is present in mild to moderate severity in patients with cleft lip and/or palate, and the subjective severity of obstruction is decreased by secondary cleft rhinoplasty. Specific operative maneuvers are associated with alterations in nasal airway obstructive symptoms, and nasal stenting is associated with an improvement in trouble breathing after secondary cleft rhinoplasty.. Therapeutic, IV.

Topics: Child; Cleft Lip; Cleft Palate; Humans; Longitudinal Studies; Nasal Obstruction; Nose; Quality of Life; Rhinoplasty; Treatment Outcome

The advantages of nasoalveolar molding (NAM) treatment for cleft lip and palate (CLP) patients have been well documented. A modified design for bilateral CLP was introduced.. This paper aimed to: 1- quantify the soft tissue changes after applying modified NAM treatment to these patients; and 2-compare post-surgical changes to a control group where no NAM was used.. At a tertiary care paediatric hospital, a historical cohort group of complete BCLP patients (n=15) was compared to a prospectively collected group of complete BCLP patients who underwent NAM therapy (n=15). In the NAM group (mean age: 1.1mos±0.2), a new modification of the NAM appliance was implemented. In the control group (mean age: 5mos±0.2), no NAM treatment was adopted prior to lip closure surgery. Soft tissue nasolabial segments were measured on initial (T1), post-NAM (T2) and 3 months post-surgery (T3) photographs; measurements were analysed statistically.. In the NAM group, cleft size was reduced by 68 to 70% in 4-5months and all measurements improved between T1 and T2. Columellar crest inclination decreased by 74%, columellar length increased by 184%, nostril and bialar widths decreased by 36% and 16%, respectively. The lip philtrum was elongated by 49.5%. At T3, all soft tissue variables statistically improved better in NAM versus non-NAM groups.. The modified NAM appliance provided improved results of lip approximation and nasal measurements compared to non-NAM treatment.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Cohort Studies; Humans; Infant; Nasal Septum; Nasoalveolar Molding; Nose

With a frequency of 1 per 500 live births, a cleft lip and palate is one of the most frequent congenital malformations. Untreated, it leads to disturbances in feeding, speech, hearing, tooth position and esthetics. A multifactorial genesis is assumed. The fusion of the different facial processes takes place in the first 3 months of pregnancy and a cleft can develop during this time. Surgical treatment includes the early anatomical and functional restoration of the affected structures within the first year of life in order to enable normal intake of food, articulation, nasal breathing and middle ear ventilation. Breastfeeding is possible in children with a cleft formation but alternative feeding methods, such as finger feeding, often have to be used. In addition to the surgery for primary closure of the cleft, otorhinolaryngological (ENT) interventions, speech therapy, orthodontic treatment as well as other surgical interventions are part of the interdisciplinary treatment concept.. Lippen-Kiefer-Gaumen-Spalten gehören mit 1:500 Lebendgeborenen zu den häufigsten angeborenen Fehlbildungen. Unbehandelt führen sie zu Störungen in Ernährung, Sprechen, Hören, Zahnstellung und Ästhetik. Von einer multifaktoriellen Genese wird ausgegangen. Die Verschmelzung der Gesichtsfortsätze findet in den ersten 3 Schwangerschaftsmonaten statt; in dieser Zeit kann eine Spalte entstehen. Die chirurgische Behandlung beinhaltet die anatomische und funktionelle Wiederherstellung der betroffenen Strukturen innerhalb des 1. Lebensjahres, um Nahrungsaufnahme, Lautbildung, Nasenatmung und Mittelohrbelüftung zu normalisieren. Stillen ist bei Kindern mit einer Spaltbildung möglich, oft muss aber auf alternative Fütterungsmethoden wie z. B. das „Finger feeding“ zurückgegriffen werden. Neben den Operationen zum primären Spaltverschluss sind HNO-Eingriffe, logopädische und kieferorthopädische Therapie sowie weitere chirurgische Interventionen Teil des interdisziplinären Behandlungskonzepts.

Topics: Child; Cleft Lip; Cleft Palate; Female; Humans; Nose; Pregnancy; Speech

Nasoalveolar molding (NAM) has become standard treatment in the authors' craniofacial center. There are two types of presurgical NAM: the Grayson and Figueroa techniques. The Grayson method involves active alveolar molding, and the Figueroa method involves passive alveolar molding. The authors previously found no differences in number of clinic visits, costs, or 6-month postoperative outcome between the two techniques. The authors extended the previous study to evaluate facial growth between these two groups.. In this randomized single-blind study, conducted between May of 2010 and March of 2013, the authors recruited 30 patients with unilateral complete cleft lip and palate and randomized them for Grayson or Figueroa presurgical NAM. Standard lateral cephalometric measurements at 5 years were used to determine facial growth.. Twenty-nine patients completed 5 years of follow-up. There were no statistically significant differences in facial cephalometric measurements between the two groups.. Presurgical NAM using either a passive or active NAM technique produced similar facial growth patterns after unilateral cleft lip and palate repair.. Therapeutic, II.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Nasoalveolar Molding; Nose; Single-Blind Method; Treatment Outcome

The long-term effects of nasoalveolar molding (NAM) on patients with bilateral cleft lip and palate (BCLP) are unknown. The authors report clinical outcomes of facially mature patients with complete BCLP who underwent NAM and gingivoperiosteoplasty (GPP).. A single-institution retrospective study of nonsyndromic patients with complete BCLP who underwent NAM between 1991 and 2000 was performed. All study patients were followed to skeletal maturity, at which time a lateral cephalogram was obtained. The total number of cleft operations and cephalometric measures was compared with a previously published external cohort of patients with complete and incomplete BCLP in which a minority (16.7%) underwent presurgical orthopedics before cleft lip repair without GPP.. Twenty-four patients with BCLP comprised the study cohort. All patients underwent GPP, 13 (54.2%) underwent alveolar bone graft, and nine (37.5%) required speech surgery. The median number of operations per patient was five (interquartile range, two), compared with eight (interquartile range, three) in the external cohort ( P < 0.001). Average age at the time of lateral cephalogram was 18.64 years (1.92). There was no significant difference between our cohort and the external cohort with respect to sella-nasion-point A angle (SNA) [73 degrees (6 degrees) versus 75 degrees (11 degrees); P = 0.186] or sella-nasion-point B angle (SNA) [78 degrees (6 degrees) versus 74 degrees (9 degrees); P = 0.574]. Median ANB (SNA - SNB) was -3 degrees (5 degrees) compared with -1 degree (7 degrees; P = 0.024). Twenty patients (83.3%) underwent orthognathic surgery.. Patients with BCLP who underwent NAM and GPP had significantly fewer total cleft operations and mixed midface growth outcomes at facial maturity compared with patients who did not undergo this treatment protocol.. Therapeutic, III.

Topics: Adolescent; Cleft Lip; Cleft Palate; Humans; Infant; Nasoalveolar Molding; Nose; Retrospective Studies

Alveolar cleft is one of the key links of cleft lip and palate reconstruction due to its close relationship with tooth and jaw coordination and nasolabial deformity. The alveolar bone graft repairs the hole in the gum ridge and stabilizes the bone arch, providing better support for the base of the nose and new bone for the roots of the developing teeth to grow into. Unfortunately, bone graft failure in the traditional way, even among minor clefts, bony hypoplasia, or absence that affects the nasal base and piriform rim, is common. Two-stage alveolar bone grafting, which has advantages in addressing the underlying skeleton and deficiency, could be an optional surgical procedure for nasal floor reconstruction in adult patients with a broad alveolar cleft.. 牙槽突裂因其与牙颌协调、鼻唇畸形的密切关系是唇腭裂整复的关键环节之一。传统成年牙槽突裂整复因较低的成功率，特别是鼻翼基底的重建不足，成为颌面外科医师的主要困扰，而鼻翼基底的良好重建是防止鼻畸形复发的关键因素之一。本文根据成年牙槽突裂的畸形特点提出成年牙槽突裂的两阶段整复理念与技术流程，以供参考与讨论。.

Topics: Adult; Alveolar Bone Grafting; Bone Transplantation; Cleft Lip; Cleft Palate; Humans; Nose; Treatment Outcome

To compare the perspective of healthcare providers (orthodontists), cleft patients and laypersons in judging nasolabial aesthetics in patients with complete unilateral cleft lip, with or without cleft palate (UCL ± P) using 2 scoring systems.. This cross-sectional study was conducted in a tertiary care government hospital.. Photographic records of 100 patients with complete UCL ± P from the age group of 5-18 years (mean age-12.2 ± 3.93 years) were included in this study.. Photographic records of 100 patients with complete UCL ± P from the age group of 5-18 years were included. A panel of 3 orthodontists, 3 laypersons and 3 cleft patients rated nasolabial aesthetics using 2 scoring systems i.e. Asher-McDade index (AMAI) and Cleft Aesthetic Rating Scale (CARS). Spearman's split-half reliability, Intra-class correlation coefficient and Cronbach's alpha were computed to measure internal consistency and reliability. Inter-panel agreement between pair of groups was determined by means of Spearman correlation coefficient.. Estimated reliability of CARS for 3 raters in each panel was in moderate agreement for orthodontists and cleft patients (0.849 and 0.810). Good repeatability and agreement were recorded with moderate to high intra-panel reliability for all parameters of both AMAI and CARS. Overall inter-panel agreement was moderate for both AMAI and CARS. Pair-wise inter-panel agreement showed a moderately positive correlation in both scales (AMAI and CARS) by cleft patients and professionals.. CARS index can be reliably used for assessment of nasolabial aesthetics by cleft patients, professionals and lay persons on 2D facial photographs. Patients were more critical than clinicians and laypersons using both indices (CARS and AMAI) as they are more self-aware and conscious. Thus, a clear communication between clinician and patient regarding expectations, perception and satisfaction with surgical results is strongly recommended.

Topics: Adolescent; Child; Child, Preschool; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Esthetics; Esthetics, Dental; Humans; Nose; Reproducibility of Results; Retrospective Studies

Topics: Cleft Lip; Cleft Palate; Humans; Nasal Cartilages; Nose; Rhinoplasty; Treatment Outcome

Cleft lip and palate is the most common congenital defect of the head and neck, occurring in 1 of 700 live births. Diagnosis often occurs in utero by conventional or 3-dimensional ultrasound. Early cleft lip repair (ECLR) (<3 months of life) for unilateral cleft lip (UCL), regardless of cleft width, has been the mainstay of lip reconstruction at Children's Hospital Los Angeles since 2015. Historically, traditional lip repair (TLR) was performed at 3 to 6 months of life ± preoperative nasoalveolar molding (NAM). Previous publications highlight the benefits of ECLR, such as enhanced aesthetic outcomes, decreased revision rate, better weight gain, increased alveolar cleft approximation, cost savings of NAM, and improved parent satisfaction. Occasionally, parents are referred for prenatal consultations to discuss ECLR. This study evaluates timing of cleft diagnosis, preoperative surgical consultation, and referral patterns to validate whether prenatal diagnosis and prenatal consultation lead to ECLR.. Retrospective review evaluated patients who underwent ECLR versus TLR ± NAM from 2009 to 2020. Timing of repair, cleft diagnosis, and surgical consultation, as well as referral patterns, were abstracted. Inclusion criteria dictated: age < 3 months for ECLR or 3 to 6 months for TLR, no major comorbidities, and diagnosis of UCL without palatal involvement. Patients with bilateral cleft lip or craniofacial syndromes were excluded.. Of 107 patients, 51 (47.7%) underwent ECLR whereas 56 underwent TLR (52.3%). Average age at surgery was 31.8 days of life for the ECLR cohort and 112 days of life for the TLR cohort. Furthermore, 70.1% of patients were diagnosed prenatally, yet only 5.6% of families had prenatal consults for lip repair, 100% of which underwent ECLR. Most patients were referred by pediatricians (72.9%). Significance was identified between incidence of prenatal consults and ECLR (P = 0.008). In addition, prenatal diagnosis was significantly correlated with incidence of ECLR (P = 0.027).. Our data demonstrate significance between prenatal diagnosis of UCL and prenatal surgical consultation with incidence of ECLR. Accordingly, we advocate for education to referring providers about ECLR and the potential for prenatal surgical consultation in the hopes that families may enjoy the myriad benefits of ECLR.

Topics: Alveolar Process; Child; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Quality Improvement; Referral and Consultation; Retrospective Studies

This study describes the compliance rate with home massage therapy in children in the postsurgical stage of primary cheiloplasty or rhinocheiloplasty and the factors that facilitate or hinder its execution.. The parents of 15 children treated at the Gantz Foundation - Children's hospital for cleft lip and palate in Santiago, Chile were recruited. Parents received instructions to perform massages at home 5 times daily and were followed up for 3 months by recording in a log. Qualitative information on facilitators and barriers was collected in a focus group session.. Compliance rate was close to 75%, and the factors that facilitated the execution were performing the massage with some distracting activity and noticing the positive changes in the appearance of the scars. The most important factors that hindered the execution were the infant's crying and changes in the routine.. The authors conclude that the compliance rate is high and suggest that parents and guardians identify and implement a routine with a distracting activity that allows the massage to be carried out effectively.

Topics: Child; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Rhinoplasty

The study aimed to evaluate the effect of nasoalveolar molding (NAM) therapy through reverse engineering, or its absence, to obtain symmetry of the face and maxillary arch. Twenty-six babies with unilateral cleft lip and palate received treatment with NAM, and 12 babies with unilateral cleft lip and palate without presurgical orthopedics (control group). Patients were molded and photographed in 2-stages: the first month of life (T1/pre) and after the use of NAM/before the cheiloplasty (T2/post). In the digital models, the analyses performed were arch perimeter, arch length, and labial frenulum angle. The photographs allowed us to analyze nasal width, mouth width, columella angle, and nostril area. The results demonstrated that there was an increase in arch perimeter and arch length in control and NAM groups in the T2 period in comparison to T1. Labial frenulum angle was reduced in the NAM group compared to the NAM-T1 and control-T2 periods. Treatment with NAM yielded a reduction in nasal width in the period of T2 compared with T1. Columella angle was enhanced after NAM use in T2 and, was different from control group. The nostril area was reduced in the NAM group in T2 compared with control group. Nasoalveolar molding therapy reduced the labial frenulum angle, contributing to a reduction in the extension of the cleft. The NAM protocol improved facial symmetry, mainly through nasal effects, whereas the absence of orthopedic therapy yielded a commitment to the face and maxillary arch symmetry.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Nasal Septum; Nasoalveolar Molding; Nose; Preoperative Care; Treatment Outcome

Passive alveolar molding (PAM) and nasoalveolar molding (NAM) are established presurgical infant orthodontic (PSIO) therapies for cleft lip palate (CLP) patients. PAM guides maxillary growth with a modified Hotz appliance, while NAM also uses extraoral taping and includes nasal stents. The effects of these techniques on alveolar arch growth have rarely been compared.. We retrospectively compared 3D-scanned maxillary models obtained before and after PSIO from infants with unilateral, non-syndromic CLP treated with PAM (n = 16) versus NAM (n = 13). Nine anatomical points were set digitally by four raters and transversal/sagittal distances and rotations of the maxilla were measured.. Both appliances reduced the anterior cleft, but NAM percentage wise more. NAM decreased the anterior and medial transversal width compared to PAM, which led to no change. With both appliances, the posterior width increased. The alveolar arch length of the great and small segments and the sagittal length of the maxilla increased with PAM but only partially with NAM. However, NAM induced a significant greater medial rotation of the larger and smaller segment compared to PAM with respect to the lateral angle.. NAM and PAM presented some significant differences regarding maxillary growth. While NAM reduced the anterior cleft and effectively rotated the segments medially, PAM allowed more transversal and sagittal growth.. The results of this study should be taken into consideration when to decide whether to use PAM or NAM, since they show a different outcome within the first few months. Further studies are necessary regarding long-term differences.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Maxilla; Nasoalveolar Molding; Nose; Preoperative Care; Retrospective Studies; Treatment Outcome

This study aimed to explore the relationship between alveolar cleft and secondary nasal deformity post unilateral cleft lip repair in adults.. A total of 27 patients aged 16-30 years old with unilateral secondary nasal deformity and alveolar cleft were included, 13 of whom underwent bone grafting. Spiral CT data of all preoperative and postoperative patients who had alveolar bone grafting were collected. Then, Mimics software was used for three-dimensional reconstruction to evaluate the correlation between the width, height, and volume of the alveolar cleft and those of the nasal deformity. The difference in nasal deformity before and after alveolar bone grafting was also explored.. The width of the alveolar cleft was positively correlated with the difference in bilateral nostril floor width (. Alveolar cleft is closely related to secondary nasal deformities post unilateral cleft lip repair, especially nasal floor deformities. Alveolar bone grafting benefits adult patients for the improvement of secondary nasal deformities post unilateral cleft lip repair.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Humans; Imaging, Three-Dimensional; Nose; Rhinoplasty; Treatment Outcome; Young Adult

Cleft palate is the absence of the vault of the mouth resulting in communication between the nose and the mouth. The current frequency of cleft is 0.3% among black people. The incriminated etiological factors of this congenital malformation are exogenous and genetic. The diagnostic is clinical and above all marked by the consequences linked to the cleft, which are multiple morphological problems entailing difficulties from the first days of life (sackling impossible in the event of total cleft lip and palate), functional disorders linked to cleft velopalatine by bucco-nasal reflux, major phonation disorder, dysfunction of the Eustachian tubes causing hearing and otorhinolaryngology (ORL) disorders, breathing disorders. Thanks to the progress of ultrasound, the diagnosis can sometimes be made during pregnancy. Obstetric ultrasound can diagnose cleft lip and palate from the 16th week of amenorrhea. The Veau-Wardill classification based on embryology makes it possible to understand the different types.The care is now organized in a multidisciplinary frameware where the coordination of each specialty will make it possible to harmonize the different treatments. The current attitude is based on the principe of early management to restore the functionality of the velopalatine muscle straps as quickly as possible, reducing the risk of phonatory and auditory sequelae.Concerning cleft palates, the data are fragmented and almost non-existent in the Central African Republic, hence the interest in publishing this clinical case highlighted by chance. We report a clinical case of neglected cleft palate in a 13-year-old girl discovered during a cleft lip and palate screening campaign at the Pediatric University Hospital of Bangui.

Topics: Adolescent; Central African Republic; Child; Cleft Lip; Cleft Palate; Female; Hospitals; Humans; Nose

To compare dynamic nasolabial movement between end-of-treatment cleft and a matched non-cleft group in adult patients.. Thirteen treated adult participants with unilateral cleft lip and palate had images taken using a facial motion capture system performing a maximum smile. Seventeen landmarks were automatically tracked. For each landmark pair, on either side of the midline, changes in the x, y, and z directions were used to analyze the magnitude of displacement and path of motion. An asymmetry score was developed at rest, mid-smile, and maximum smile to assess the shape of the mouth and/or nose.. At maximum smile, displacement of right and left cheilion was clinically and statistically (p < 0.05) less in the cleft group. The lip asymmetry score was greater (p < 0.05) at each time point in the cleft group using the clinical midline. Using Procrustes superimposition, the differences were significant (p < 0.05) only at rest and mid-smile. The alar bases were displaced significantly less (p < 0.05) in the z direction in the cleft group. The asymmetry score of the alar base was significantly higher using the clinical midline than using Procrustes superimposition in patients with cleft conditions (p < 0.001). In the cleft group, at maximum smile, the right and left cristae philter moved significantly less (p < 0.05) in the x and z directions.. There was an increase in asymmetry score of the corners of the mouth and alar bases from rest to maximum smile. The lips were similar in shape but oriented differently in the faces of patients with cleft conditions than in individuals without those conditions.

Topics: Adult; Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Imaging, Three-Dimensional; Motion Capture; Nose

There is a lack of standardized surgery for cleft rhinoplasty. We felt that the technique described by Dr Louise Caouette Laberge is an ideal way to approach this problem, thus we tried to quantify the outcome of surgery by volumetric assessment.. We recorded 3D images using an Artec scanner and performed volume calculations of the cleft side and noncleft side of the nose. These readings were taken once in the preoperative and then 2 weeks postoperative. Another scan of the face was performed 2 years after the surgery to compare the volumes of the cleft and noncleft side nostril.. Of the 31 patients with unilateral cleft lip operated on (mean age 3-8 months), we found a significant increase in the cleft side volume at 3 weeks postoperative from 3.95 mm

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nose; Rhinoplasty; Treatment Outcome

Bone morphogenetic proteins (BMPs) are required for craniofacial bone development. However, it remains elusive how BMP signaling regulates craniofacial cartilage development. To address this question, we utilized a genetic system to enhance BMP signaling via one of BMP type I receptors ALK2 in a chondrocyte-specific manner (hereafter Ca-Alk2:Col2-Cre) in mice. Ca-Alk2:Col2-Cre mice died shortly after birth due to severe craniofacial abnormalities including cleft palate, defective tongue, and shorter mandible formation. Histological analysis revealed that these phenotypes were attributed to the extensive chondrogenesis. Compared with controls, enhanced SOX9 and RUNX2 production were observed in nasal cartilage of Ca-Alk2:Col2-Cre mice. To reveal the mechanisms responsible for enlarged nasal cartilage, we examined Smad-dependent and Smad-independent BMP signaling pathways. While the Smad-independent BMP signaling pathway including p38, ERK, and JNK remained silent, the Smad1/5/9 was highly phosphorylated in Ca-Alk2:Col2-Cre mice. Interestingly, Ca-Alk2:Col2-Cre mice showed enhanced S6 kinase phosphorylation, a readout of mammalian target of rapamycin complex 1 (mTORC1). These findings may suggest that enhanced Smad-dependent BMP signaling positively regulates the mTOR pathway and stimulates chondrocytes toward hypertrophic differentiation, thereby leading to enlarged nasal cartilage formation in mice.

Topics: Animals; Chondrogenesis; Cleft Palate; Mammals; Mice; Nasal Cartilages; Nose; Signal Transduction

Null.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Nasoalveolar Molding; Nose; Plastic Surgery Procedures

The aim of this study is to evaluate where exactly children and adolescents of the same group look when they interact with each other, and attempt to record and analyse the data recorded by eye-tracking technology.. 60 subjects participated in the study, evenly divided into three age categories of 20 each in pre-school/primary school age (5-9 years), early adolescence (10-14 years) and late adolescence/transition to adulthood (15-19 years). Age groups were matched and categorized to be used both for creating the picture series and testing. Photographs of patients with both unilateral and bilateral cleft lip and palate were used to create the series of images which consisted of a total of 15 photos, 5 of which were photos of patients with surgically treated cleft deformity and 10 control photos with healthy faces, that were presented in random order. Using the eye-tracking module, the data on "area of first view" (area of initial attention), "area with longest view" (area of sustained attention), "time until view in this area" (time of initial attention) and "frequency of view in each area" (time of sustained attention) were calculated.. Across all groups, there was no significant difference for the individual regions for the parameters of initial attention (area of first view), while the time until first fixation of one of the AOIs (time until view in this area) was significant for all facial regions. A predictable path of the facial scan is abandoned when secondary facial deformities are present and attention is focused more on the region of an existing deformity, which are the nose and mouth regions.. There are significant differences in both male and female participants' viewing of faces with and without secondary cleft deformity. While in the age group of the younger test persons it was still the mouth region that received special attention from the male viewers, this shifted in the male test persons of the middle age group to the nose region, which was fixed significantly more often and faster. In the female participants, the mouth and nose regions were each looked at for twice as long compared to the healthy faces, making both the mouth and the nose region are in the focus of observation.

Topics: Adolescent; Child; Child, Preschool; Cleft Lip; Cleft Palate; Craniofacial Abnormalities; Esthetics, Dental; Eye-Tracking Technology; Female; Humans; Male; Nose; Perception

A prospective study utilizing image analysis to assess nostril openings in post-operative patients with cleft lip and cleft lip nose deformities. This preliminary study seeks to employ two-dimensional (2D) images to fabricate a custom-made nostril retainer. This study was performed at Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand. This study included 30 healthy volunteers and 15 patients with cleft lip and cleft lip nose deformities. The nostril opening width and height for all participants were measured, and photographs were taken. An image analysis application was used to fabricate a three-dimensional (3D) custom-made nostril retainer. The mean differences between the direct measurements of the nostril aperture and the measurements obtained through the program did not exceed 2 mm in terms of nostril height, width, or columella. Two-dimensional photographs can be used to create a custom-made, three-dimensional nostril retainer. This retainer allows post-operative patients to maintain their nares without needing to visit the hospital, thereby reducing the cost of care.

Topics: Cleft Lip; Cleft Palate; Humans; Image Processing, Computer-Assisted; Nasal Septum; Nose; Prospective Studies; Treatment Outcome

Unilateral complete cleft lip and palate (UCCLP) is one of the most severe clinical subphenotypes among nonsyndromic cleft lip and/or palate (NSCL/P), that complicates surgical repair operations. Presurgical nasoalveolar molding (PNAM) is a technique used to reshape the nose, lip and alveolar bone of infants with UCCLP before surgery (the modified Mohler rotation advancement cheiloplasty and two flap palatoplasty), with the potential to facilitate surgical repair. However, the effectiveness of PNAM treatment is still a matter of debate. In this paper, the 3Shape scanning system and 3dMD stereophotography were used to assess the short-term and long-term effects of PNAM treatment on the dental arch morphology and nasolabial features of patients with UCCLP, respectively. The findings indicated that PNAM treatment negatively affects both short-term and long-term dental arch shape compared to the treatment without PNAM, particularly in terms of limiting the transverse width of the maxillary canine-to-midline. Regarding the nasal and labial symmetry, PNAM improves the symmetry of the nasal alae in patients over 7 years old and the symmetry of the lip in patients under 7 years old. Moreover, UCCLP patients who received PNAM treatment exhibited a shorter and wider shape of the nostril on the cleft side compared to those without PNAM treatment. In clinical practice, the multidisciplinary team should carefully consider the advantages and disadvantages of the outcomes of PNAM treatment when treating infants with cleft lip and palate.

Topics: Alveolar Process; Child; Cleft Lip; Cleft Palate; Dental Arch; Humans; Infant; Nasoalveolar Molding; Nose; Preoperative Care

Nasolabial esthetics is 1 of the most important issues in the evaluation of treatment outcomes in patients with unilateral cleft lip and palate (CLP). Frontal and basal view photographs are commonly used to evaluate nasolabial esthetics in patients with unilateral CLP. High-quality photography plays an important role in evaluating the treatment outcomes and poor quality photographs can result in errors, whereas evaluating the treatment results. Facial proportions and angles are important in the esthetic perception of the face. Hence, this study aimed to determine the effects of positioning errors on the ratio and angle measurements in photographs of patients with unilateral CLP.. In the clinical and computer environment, a mechanism was set up to take photos at standard and at different angles. A real-size unilateral CLP silicone doll was constructed for the photographs to be taken in the clinical setting. A test-retest was performed to determine the reliability of the measured values.. The correlation coefficients for the first measurement and remeasurement values were statistically significant; positive and strong correlations were obtained.. Based on the data obtained from our study, the angle and ratio measurements obtained from the two-dimensional photographs provided reliable results.

Topics: Cleft Lip; Cleft Palate; Esthetics; Esthetics, Dental; Humans; Nose; Reproducibility of Results

The aim of this study is to describe the growth of the upper lip after reconstruction with a Pfeifer wave-line incision in patients with unilateral and bilateral cleft lip and palate (CL/P) in the long term. This was a longitudinal, monocentric, retrospective study. Metric standardized lip length measurements were taken annually from the age of 6 months to the age of 16 years. Defined anatomical points were determined which describe the lip length from the nasal entrance to the highest point of the Cupid's bow. The lip length of the unaffected side in unilateral cleft patients was taken as control. A total of 234 patients with cleft lip with/without cleft palate (CL/P) were included in the study. At the time of the primary surgery, the medial sides in unilateral clefts were 2-4 mm and the lateral sides 1.5-2 mm shorter than the normal unaffected side (p≤0.001). Two main periods of growth, one during childhood (first to sixth years) and one during adolescence (12th-16th years) were seen. At the age of 16 years, the end of the observation period, the lip length in unilateral clefts resulted in a clinically not noticeable shortening of the cleft side (0.37±0.26 mm). There was no correlation between lip length development and primary cleft width at the time of primary cleft lip surgery at 6 months. The upper lip in patients with bilateral clefts developed symmetrically without any obvious asymmetry. Both sides showed a lip length difference of 0.1±0.05 mm at the age of 16 years (p=0.1). Compared to the upper lip length of the control group, bilateral clefts showed a slight tendency toward a longer upper lip (p=0.52). Within the limitations of the study it seems that when lip length development is a priority in cleft lip surgery, Pfeifer wave-line procedure is good option to achieve symmetric results in unilateral and bilateral cleft lip surgery and, therefore, is a relevant option among a variety of other techniques.

Topics: Adolescent; Cleft Lip; Cleft Palate; Humans; Infant; Lip; Nose; Retrospective Studies

This multicenter study aimed at comparing different techniques of lip and nose repair with or without NAM and primary anterior rhinoplasty in pre-adolescent children. Patients with unilateral clefts of lip, alveolus, and palate who had undergone cleft lip and nose repair were evaluated in a prospective three-centre study using standardized monochromatic, cropped photographs. Four cleft surgeons evaluated the aesthetics of the central part of the face when the patients had reached age ten years. Seventy-six sets of photographs out of 87 patients were evaluated. The overall ratings of lips and noses did not differ much between centres. However, noses of centres 1 (mean 0.74; SD 0.57) and 2 (mean 0.76; SD 0.60) had been rated better than centre 3 (mean 1.32; SD 0.78; p = 0.0078), especially "Deformation of upper part of nostril rim or poor position of alar cartilage". Centre 3 had produced better looking scars (mean 0.33; SD 0.48); p = 0.0036. Within the limitations of the study it seems that NAM and primary anterior rhinoplasty including postoperative nasal stents should be performed whenever possible in order to achieve a favorable shape of the nose and to reduce the need for secondary corrective surgery.

Topics: Child; Cleft Lip; Cleft Palate; Esthetics, Dental; Humans; Nose; Prospective Studies; Rhinoplasty

Topics: Cleft Lip; Cleft Palate; Humans; Muscles; Nose

Topics: Cleft Lip; Cleft Palate; Humans; Muscles; Nose

The aim of this retrospective long-term study was to assess the influence of primary columella lengthening and presurgical nasoalveolar molding (NAM) on the skeletal development at the completion of growth in patients with bilateral cleft lip and palate (BCLP). Lateral cephalometric radiographs at the completion of growth of consecutively treated patients BCLP patients, operated by the same surgeon, who had undergone NAM were compared with a second group of BCLP patients who were not treated with NAM. The groups were matched for sex and age. Independent samples t tests were carried out. 23 Lateral cephalometric radiographs of BCLP patients (mean age 18.2 ± 1.3 years) who had undergone NAM were compared with a second group of 23 BCLP patients (mean age 18.4 ± 1.3 years) who were not treated with NAM. The only two significant differences were observed in Ans-Me/N-Me (control group = 0.6 ± 0.02; sample group = 0.57 ± 0.05; p = 0.019) and ILs^AnsPns (control group = 105.5 ± 7.9; sample group = 112.4 ± 8.6; p = 0.007). No other significant differences were observed in terms of facial skeletal development between the two groups. Presurgical NAM performed during infancy in BCLP patients does not seem to have negative effects on the skeletal development at the completion of craniofacial growth compared to the group of patients treated without NAM.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Humans; Nasal Septum; Nasoalveolar Molding; Nose; Retrospective Studies; Young Adult

Many surgical procedures used to treat patients with unilateral complete cleft lip do not include a complete primary rhinoseptoplasty, which is delayed until the end of growth as part of secondary surgery. Primary cheilorhinoseptoplasty using the Talmant technique has been performed at Lapeyronie University Hospital, Montpellier for 15 years. This retrospective study evaluated and compared the functional and aesthetic results obtained in such patients at 4-6 years after surgery with those obtained without primary rhinoseptoplasty in patients undergoing the Tennison-Malek technique. This study included a cohort of 60 children who presented a unilateral complete cleft lip: 29 were operated on with the Tennison-Malek technique and 31 with the Talmant technique. Three functional and 14 aesthetic criteria were evaluated. All functional criteria showed better results in the Talmant group: nocturnal nasal breathing (P < 0.001), incidence of closed rhinolalia (P = 0.0019), and presence of asymmetric nasal breathing (P < 0.001). Concerning the aesthetic results, all criteria evaluated on the frontal and basal photographs of each patient showed significantly better results in the Talmant technique group. The rate of satisfactory results was> 75% for 12 of the 14 criteria in the Talmant group, compared with none of the 14 criteria in the Tennison-Malek group.

Topics: Child; Cleft Lip; Cleft Palate; Esthetics; Humans; Infant; Nose; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome

This review will compare the efficacy of nasoalveolar molding plates fabricated using a digital workflow to conventional fabrication methods or no intervention in infants with cleft lip or palate.. Nasoalveolar molding reduces the severity of orofacial defects in infants with cleft lip or palate using a series of adaptable plates for the maxillary arch. The conventional method needs multiple patient visits at short intervals for treatment. A digital workflow can be used to fabricate multiple plates in one appointment, which eliminates human error, reduces the number of appointments, and allocates more time for patient care for the orthodontic team than appliance fabrication.. This review will consider clinical studies that report the results of digital nasoalveolar molding in infants with cleft lip or palate and compare it to the conventional method or to no treatment. Outcomes of interest will be objective measures of craniofacial form, nasolabial measurements, or palatal form.. This review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases including PubMed, Embase, Cochrane Oral Health Group Trial Register, and ClinicalTrials.gov will be searched using appropriate keywords. Publications in English will be considered. Screening based on titles and abstracts will be done after de-duplication, followed by full-text reading for selection based on the inclusion criteria. Data extracted from the studies will be tabulated and assessed for risk of bias. If applicable, a meta-analysis of the pooled data will be conducted.. PROSPERO CRD42020186452.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Meta-Analysis as Topic; Nasoalveolar Molding; Nose; Review Literature as Topic; Systematic Reviews as Topic

The aim of this investigation was to determine whether the nasal form of patients with unilateral cleft lip and palate treated with presurgical nasoalveolar molding therapy, primary lip-nose surgery, and postsurgical nostril retainer was different from that of patients treated with presurgical nasoalveolar molding and primary lip and nose surgery alone.. This cross-sectional, retrospective review focused on 50 consecutive patients with nonsyndromic unilateral cleft lip and palate: 24 treated with nasoalveolar molding and primary lip and nose surgery followed by postsurgical nostril retainer (group 1) compared with 26 patients treated with nasoalveolar molding and primary lip and nose surgery without postsurgical nostril retainer (group 2). Polyvinyl siloxane nasal impressions were performed at an average age of 12 months and 6 days. Bilateral measurements of alar width at maximum convexity, total alar base width, nasal tip projection, columella length, and nostril aperture width and height were recorded. Statistical comparisons of cleft-side versus noncleft side nasal measurements were performed within group 1 and group 2, as well as comparisons of differences between the two groups.. Cleft-side nasal dimension was statistically significantly better in group 1 than in group 2 across all measures except nasal projection ( p < 0.05). Group 1 showed less difference between the cleft side and noncleft side in all six measurements than did group 2 ( p < 0.05).. There was a significant difference in the nasal shape of patients who used a postsurgical nostril retainer compared with those who did not. Patients who used a postsurgical nostril retainer showed better nasal shape at an average age of 12 months compared with the control group.. Therapeutic, III.

Topics: Cleft Lip; Cleft Palate; Cross-Sectional Studies; Humans; Infant; Nasal Septum; Nasoalveolar Molding; Nose; Rhinoplasty; Treatment Outcome

Cleft lip and/or palate affects approximately one in 700 live births. Optimal timing for repair of cleft lip has yet to be objectively validated. Earlier repair takes advantage of a high degree of plasticity within the nasal cartilage and maxilla. The authors present patients enrolled in an early cleft lip repair protocol facilitating effective repair of the cleft lip and nostril.. American Society of Anesthesiologists class I to II patients with unilateral cleft lip and/or palate undergoing repair before 3 months of age were enrolled over 5 years. Perioperative data, surgical and anesthetic complications, preoperative and postoperative nostril breadth, nostril width, nasal angle, lip length, frontal nasal breadth, and commissure length measured as ratios between the cleft and noncleft sides were abstracted. Early cleft lip repair and nasoalveolar molding patients were matched for cleft lip severity using the cleft width ratios and compared.. The surgical and anesthetic complication rate for 100 early cleft lip repair patients was 2 percent. Operative and anesthetic times were 123 ± 37 minutes and 177 ± 34 minutes, respectively. Hospital length of stay was 1 ± 0 day. Age at repair between early cleft lip repair and nasoalveolar molding was 33 ± 15 days and 118 ± 33 days, respectively. After early cleft lip repair, preoperative to postoperative distance from symmetry for all anthropomorphic measurements improved ( p < 0.001). Comparing severity-matched early cleft lip repair to nasoalveolar molding patients, similar improvements were observed, suggesting equivalent results ( p > 0.05).. Early cleft lip repair provides an efficacious method for correcting the cleft lip and nasal deformity that simulates nasoalveolar molding.. Therapeutic, III.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Maxilla; Nasoalveolar Molding; Nose; Treatment Outcome

Patients with alveolar cleft unrepaired suffer from nasal deformities of different magnitude. Bone and cartilage grafts are harvested through several incisions. In this study, we present a method to simultaneously correct nasal deformities and repair alveolar cleft using grafts from the nasal septum.. All 6 patients with unilateral cleft lip and palate have alveolar cleft unrepaired combined with nasal deformity. Computed tomography scans and 3-dimensional-printed models of vomer and ethmoid bone were used for the purpose of preoperative design and for assessing the magnitude of deformity. Grafts of bone and cartilage from deviated septum were harvested by septoplasty through which dorsum deviation was corrected. Bone grafts from vomer and ethmoid were then fixed to the prepared alveolar cleft to repair the defect and elevate the alar base. Septal cartilage was adjusted into different shapes of grafts and deformities of nasal tip, nostrils, and columella were then corrected by rhinoplasty to restore the symmetry of the nose.. Symmetry of nostrils was improved. The height of alar base on the cleft side was elevated to the level close to the noncleft side. Deviation of the septum, nasal dorsum, and columella was corrected. Projection of the nasal tip was adjusted to facial midline. Midface aesthetics was generally improved.. Application of septal grafts reduce the number of incisions. One-stage repair of alveolar cleft and nasal deformities, with the aid of digital design, improves the postoperative experience and the general outcome of the surgery.

Topics: Cartilage; Cleft Lip; Cleft Palate; Esthetics, Dental; Ethmoid Bone; Humans; Nasal Septum; Nose; Nose Diseases; Rhinoplasty; Treatment Outcome; Vomer

Presurgical infant orthopaedics (PSIO) in infants with cleft lip and palate focuses on improving the anatomical conditions of the lip, palate and nose before the first lip surgery; however, its effectiveness has not been proven.. To develop a core outcome set for reporting anthropometry-based outcomes in studies appraising the PSIO before primary cleft lip repair in unilateral cleft lip palate (UCLP).. Literature search to identify anthropometric measures. The operational definition and schematic representation of each were elaborated, grouping those apparently the same. By using Delphi methodology with a consensus of 10 subject-matter experts, three rounds were conducted to select a core outcome set of anthropometric measures with a validity V coefficient ≥80% among considered necessary to evaluate the PSIO in UCLP.. A total of 101 anthropometric measures were identified in the literature to evaluate PSIO in UCLP. Of these, consensus validated the content of the core outcome set, which comprises 18 anthropometric measures, including columella height, nasal tip projection, projection alar length, width of nostril, nasal basal width, angle of columella, cleft lip segment, height of the non-cleft lip, height of the cleft lip, intersegment distance, arch length, greater segment length, lesser segment length, lateral deviation of the incisal point, posterior width of palatal cleft, arch width, grater segment rotation and lesser segment rotation.. Standardised outcome measures are necessary to evaluate and ensure the quality of treatment in CLP. The core outcome set for anthropometric evaluation validated by consensus subject-matter experts is a clinically useful and low-cost tool for PSIO effectiveness studies.

Topics: Anthropometry; Cleft Lip; Cleft Palate; Consensus; Delphi Technique; Humans; Infant; Nasal Septum; Nose; Orthopedics; Outcome Assessment, Health Care; Treatment Outcome

Documenting cleft lip and palate morphology prior to surgery is standard care. Presurgical orthopedic treatment also requires a 3D cleft model. Endangering the airway, conventional impressions require additional safety measures and resources. We investigate the implementation and risks of digital impressions for the youngest patients with orofacial clefts.. We report a retrospective cohort study of patients with cleft lip and palate, aged up to 6 years, treated at two cleft centers in Europe (Basel (A), Warsaw (B)). We scanned with the Medit i500 (Medit Corp, Seoul, South Korea). Center A for presurgical orthopedics and prior surgery from June 2020 to March 2022. Center B prior surgery from December 2020 to May 2021. Scanning data were analyzed for adverse events and adverse device effects, scanning duration, and number of images according to cleft type and age.. We analyzed 342 digital impressions in 190 patients (center A: 71, B: 119). The median age was 8.7 months with a range from the first day of birth (presurgical orthopedics) to six years of life (early alveolar bone grafting). No adverse events or adverse device effects were observed. The median scan duration was 85.5 s for cleft palate and 50 s for cleft lip and nose (IQR 56 s and 39 s, respectively).. Digital impressions with intraoral scanners are safe in patients with cleft lip and palate from newborn to preschool age. Given the funding to purchase an intraoral scanner, interfaces to electronic patient records, and point-of-care 3D printing, cleft centers can successfully implement this technology.

Topics: Aged; Child, Preschool; Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Nose; Retrospective Studies

Nasoalveolar molding (NAM) is a presurgical orthopedic procedure, mainly focusing upon the aesthetic outcome of the treatment goal by reducing the number of reconstructive surgeries performed later for the purpose of esthetics. It was reported a very small proportion of pediatric dentists are providing presurgical intervention and the practice of NAM still side stepping among various dental practitioners.. The study was aimed to assess the knowledge and attitude among various dental specialties regarding NAM procedure in cleft patients.. A questionnaire-based cross-sectional survey was carried out among 180 dental professionals (pedodontists, orthodontists, prosthodontists, oral surgeons). A total of 180 questionnaires were prepared, out of which 98 were filled through direct personal interview and 82 were circulated via Google forms. Results were analyzed using chi-square test, Mann-Whitney. There was statistically significant difference in the cumulative knowledge scores between specialty with. Dental specialists in India have a positive attitude toward presurgical orthopedics. Majority of them agreed that there is great improvement in the aesthetic outcomes of surgeries after NAM intervention.

Topics: Child; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Dentists; Esthetics, Dental; Humans; Infant; Nasoalveolar Molding; Nose; Professional Role

Utilize 3-dimensional (3D) photography to evaluate the nasolabial changes in infants with bilateral cleft lip and palate (BCLP) who underwent nasoalveolar molding (NAM) and primary reconstructive surgery.. This is a retrospective serial longitudinal study of consecutively enrolled infants from September 2012 to July 2016 with BCLP who underwent NAM before primary lip and nose reconstructive surgery. It included infants who had digital 3dMD stereophotogrammetry records at initial presentation (T1), completion of NAM (T2), and 3 weeks following primary repair (T3). Twelve infants fulfilled the inclusion criteria. 3dMD Vultus software was used to orient images and plot 16 nasolabial points with. After NAM therapy, statistically significant changes in the position of subnasale and labius superius improved nasolabial symmetry. Both retruded after NAM were displaced downward after NAM and surgical correction with respect to soft tissue nasion. The nasal tip's projection was maintained with NAM and surgical correction. The columella lengthened from 1.4 to 4.71 mm following NAM.. There was a significant improvement in the nasolabial anatomy after NAM, and this was further enhanced after primary reconstructive surgery.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Longitudinal Studies; Nasal Septum; Nasoalveolar Molding; Nose; Reproducibility of Results; Retrospective Studies

The aim of this study was to assess the nasal shape of young adults with BCLP treated with primary surgical columella lengthening and nasoalveolar molding (NAM).. A group of 28 young adult patients with BCLP (mean age: 19.1±1.4 years) was compared through normalized photogrammetry to a control of 28 age- and sex-matched noncleft young adults.. Nasal protrusion and length of the columella were not different from noncleft young adults. On the other hand, nasolabial angle, columellar width, interalar, and nasal tip width were significantly wider than the noncleft controls. Thus, 27% of the patients have requested at this time secondary correction of the excessive nasal width.. Both NAM and primary rhinoplasty in patients with BCLP resulted in a near normal length of the columella and nasal projection until young adulthood. Nevertheless, width of all nasal features was significantly wider than the noncleft population and required secondary nasal correction in one-third of the sample.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Humans; Nasal Septum; Nasoalveolar Molding; Nose; Young Adult

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nasoalveolar Molding; Nose; Preoperative Care; Retrospective Studies; Weight Gain

To assess the effectiveness of the presurgical nasoalveolar molding appliance among infants with unilateral cleft lip and palate.. In this prospective study, 95 pairs of casts of infants with unilateral cleft lip and palate treated by presurgical nasoalveolar molding were selected at the Children's Hospital 1 at Ho Chi Minh City, Vietnam. The average time of treatment was 3 months. All casts were scanned and measured using 3-dimensional technology before and after treatment. Paired. There was a statistically significant increase in the nostril height in cleft side (. Nasoalveolar molding appliance is effective in improving the morphology of nostril and maxillary alveolar. Understanding this helps orthodontists and surgeons in treatment outcome expectations.

Topics: Alveolar Process; Child; Cleft Lip; Cleft Palate; Humans; Infant; Nasal Septum; Nasoalveolar Molding; Nose; Preoperative Care; Prospective Studies

Children with cleft palate exhibit differences in the 4 temporal components of nasalization (nasal onset and offset intervals, nasal consonant duration, and total speech duration), with various patterns having been noted based on different languages. Thus, the current study aimed to examine the temporal aspects of velopharyngeal closure in children with and without cleft palate; this is the first study to do so in the Turkish language.. This study evaluated and compared the 4 temporal characteristics of velopharyngeal closure in children (aged 6-10 years) with (n = 28) and without (n = 28) cleft palate using nonword consonant and vowel speech samples, including the bilabial nasal-to-stop combination /mp/ and the velar nasal-to-stop combination /ηk/. Acoustic data were recorded using a nasometer, after which acoustic waveforms were examined to determine the 4 temporal components of nasalization. Flexible nasoendoscopy was then used to evaluate velopharyngeal closure patterns.. With regard to the 4 closure patterns, significant differences in the nasal offset interval (F4-25 = 10.213, p = 0.04; p < 0.05) and the nasal consonant duration ratio (F4-25 = 12.987, p = 0.02; p < 0.05) were observed for only /ampa/. The coronal closure pattern showed the longest closure duration (0.74 s). Children with cleft palate showed prolonged temporal parameters in all 4 characteristics, reflecting oral-nasal resonance imbalances. In particular, the low vowel sound /a/ was significantly more prolonged than the high vowel sounds /i/ and /u/.. The examined temporal parameters offer more accurate characterizations of velopharygeal closure, thereby allowing more accurate clinical assessments and more appropriate treatment procedures. Children with cleft palate showed longer nasalization durations compared to those without the same. Thus, the degree of hypernasality in children with cleft palate may affect the temporal aspects of nasalization.

Topics: Child; Cleft Lip; Cleft Palate; Humans; Nose; Speech; Speech Production Measurement; Velopharyngeal Insufficiency

To evaluate nostril morphology post-cheiloplasty after patients with unilateral cleft lip and palate (UCLP) use of the nasal creator device.. This is a prospective study. Sixteen patients with nonsyndromic UCLP treated at Khon Kaen University underwent cheiloplasty and then wear the nasal creator device for 6 months. Three-dimensional images were taken, from which 5 lines and 8 landmark points were evaluated prior to (T0) and 1 day (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after cheiloplasty. A Repeated Measure ANOVA was used to evaluate nostril changes between time periods and a paired t-test was used to compare values between the affected and non-affected side at T4 (P < .05).. On the affected side, the nostril height significantly increased from T0 (2.46±0.89 mm) to T4 (4.22±1.03 mm), and the nostril width significantly decreased from T0 (9.46±2.57 mm) to T4 (7.34±1.41 mm). On the non-affected side, the nostril height significantly increased from T0 (3.39±0.78 mm) to T4 (4.65±1.07 mm), and the nostril width was not significantly different from T0 (6.00±1.25 mm) to T4 (6.59±0.95 mm). The alar base width was not significantly different between T0 (30.18±2.72 mm) and T4 (29.82±1.69 mm). Nostril height and width were not significantly different by T4 when comparing the affected and non-affected sides.. Using nasal creator device for 6 months significantly increased the nostril height and decreased nostril width and alar base width after cheiloplasty.

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Photogrammetry; Prospective Studies; Thailand; Treatment Outcome

Although many cleft teams have adopted nasoalveolar molding to improve nasal form, few comparative studies have assessed the postoperative benefits of this treatment. Given that reported outcomes have been contradictory and that treatment involves considerable burden to families, the purpose of this study was to assess objective and subjective changes from nasoalveolar molding at approximately 5 years of age.. All patients with complete unilateral cleft lip and palate who underwent primary cheiloplasty performed by a single surgeon over a 7-year period were reviewed. Patient results were grouped into nasoalveolar molding or no-nasoalveolar molding. Cleft severity and aesthetic outcomes were assessed by panels of raters who independently ranked subject images at presentation, immediately preoperative (after molding), and at 5-year follow-up. Objective symmetry was measured using standard anthropometric analysis on three-dimensional images.. Among 41 patients included, 16 successfully completed nasoalveolar molding. Both groups were similar at presentation; however, the nasoalveolar molding group had improved appearance following molding (p < 0.05). After surgery, at 5 years of age, the nasoalveolar molding group had better rank scores for overall appearance (p < 0.05), cleft nostril height, and cleft medial lip height (p < 0.05). Regression analysis revealed that nasoalveolar molding treatment was the most significant predictor of overall nasal appearance at 5 years, but that treatment team experience and initial severity were also significant predictors (p < 0.05). Qualitative audit following analysis identified favorable and unfavorable features of nasoalveolar molding.. In children with complete unilateral cleft lip and palate, nasoalveolar molding was associated with better overall nasal aesthetics and improved cleft nostril height and cleft medial lip height at approximately 5 years of age.. Therapeutic, III.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Esthetics; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Nasoalveolar Molding; Nose; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome

The aim of this study was to determine the amount of deviation in nasolabial shape in patients with a cleft compared with an average non-cleft face, and to assess whether this difference is related to nasolabial aesthetics. Three-dimensional stereophotogrammetric images of 60 patients with a unilateral cleft were used. To quantify shape differences, four average non-cleft faces were constructed from stereophotogrammetric images of 141 girls and 60 boys. Three-dimensional shape differences were calculated between superimposed cleft faces and the average non-cleft face for the same sex and age group. Nasolabial aesthetics were rated with the modified Asher-McDade Aesthetic Index using a visual analogue scale (VAS). Mean VAS scores ranged from 51.44 to 60.21 for clefts, with lower aesthetic ratings associated with increasing cleft severity. Shape differences were found between cleft faces and the average non-cleft face. No relationship was found for the VAS, age, and sex, except that a lower VAS was related to a higher nose and lip distance between the superimposed cleft and average non-cleft faces for nasal profile (P= 0.02), but the explained variance was low (R

Topics: Cleft Lip; Cleft Palate; Esthetics, Dental; Female; Humans; Imaging, Three-Dimensional; Male; Nose

This cross-sectional study utilizes 3-dimensional analysis to assess nasal morphology in patients with bilateral cleft lip and palate (BCLP) compared to controls across the timeline of cleft care.. Retrospective comparative cross-sectional study.. Tertiary pediatric academic institution.. One hundred and twelve patients with BCLP and an equal number of age and sex-matched control participants.. Nasolabial angle, nasal length, nasal protrusion, columella length, columella width, nasal tip width, alar width, and alar base width were collected at each time point. The measurements were collected pre-nasoalveolar molding (NAM) therapy, post-NAM therapy, post-primary cleft rhinoplasty, 1 year, 5 years, 10 years, and 15 years of age.. Nasolabial angle and nasal tip width were significantly different from controls from pre-NAM through 15 years of age time points. Nasal length was not significantly different at any time point. Alar width and alar base width were significantly different from pre-NAM through 10 years of age time points. Nasal protrusion, columella length, and columella width were significantly different from pre-NAM through 5 years of age time points.. This study demonstrates that three-dimensional photogrammetry is effective in assessing the changes in nasal morphology that occur throughout the course of care in patients with BCLP from before cleft lip repair to the completion of nasal growth.

Topics: Child; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Humans; Nose; Retrospective Studies; Rhinoplasty; Treatment Outcome

To validate a newly developed method for capturing 3-dimensional (3D) images of the nasolabial region for assessing upper lip scarring and asymmetry in surgically managed unilateral cleft lip and palate (UCLP) cases.. Validation study, single cohort.. Eighteen surgically managed UCLP cases were recruited, the nasolabial region of each face was scanned using an intraoral scanner (IOS) to produce 3D images. The images were manually segmented to allow the calculation of surface area of the scar and upper lip asymmetry. Five professionals and 5 lay assessors subjectively evaluated the same images and graded the upper lip scarring and asymmetry at 2 separate occasions. The relationship between the subjective and objective assessments was evaluated.. Moderate correlation was found between subjective and objective evaluations of the upper lip scarring and total asymmetry. The captured 3D images were of good quality for the objective measurements of lip asymmetry and residual scarring. Moderate to strong correlations were detected between the 2 panels (T ranging between 0.5 and 0.9) with no significant difference (. The IOS is a useful tool for the capture of the nasolabial morphology. The captured 3D images are a reliable source for measuring lip asymmetry and scar surface area. The method has sufficient validity for routine clinical use and for objective outcome measures of the surgical repair of cleft lip.

Topics: Cleft Lip; Cleft Palate; Face; Facial Asymmetry; Humans; Imaging, Three-Dimensional; Lip; Nose

To assess social and demographic influences on caregiver success and difficulty with nasoalveolar molding (NAM).. Retrospective review identified patients who began NAM between April 22, 2013, and April 18, 2017, at the New York University Langone Medical Center. Records were reviewed, and the following sociodemographic data retrieved: parental marital status, parental ages, number of siblings, distance traveled to clinic, insurance coverage, concurrent medical conditions, and need for an interpreter.. Patients were included if complete charting was available; 106 patients met the inclusion criteria; 79 patients with unilateral and 27 with bilateral clefts.. Chart entries indicating incorrect appliance usage, emergency visits, phone calls, and noncompliance were recorded. Alveolar cleft gap closure was measured on pre- and posttreatment models in unilateral cases. Multiple regression analyses were performed to assess the influence of social variables on these outcomes.. Alveolar cleft gap closure was 7.2 ± 3.0 mm, or 78.5% ± 19.1%. Cleft closure increased with paternal age by 0.33 mm (. Alveolar cleft gap closure was more successful for older fathers, younger mothers, and married couples. Married couples were also less likely to experience treatment difficulties such as incorrect appliance usage or inadequate duration of wear, as were those with private insurance coverage.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Nasoalveolar Molding; Nose; Retrospective Studies; Treatment Outcome

To compare the effects of presurgical infant orthopedics using 2 different methods, that is, the Dynacleft with Nasal elevator system versus the modified Grayson's technique in patients with complete unilateral cleft lip and palate.. Prospective comparative cohort study.. Twenty-eight patients were divided into 2 groups, that is,. The analysis of cast (primary outcome) and photographic (secondary outcome) measurements showed improved nasal asymmetry and alveolar correction in both groups which showed no significant intergroup difference when assessed using the independent. Both methods proved effective in improving the nasal asymmetry, reducing the alveolar cleft gap, and approximating the lips together; but care must be taken when applying the alveolar molding vector in the Dynacleft system.

Topics: Cleft Lip; Cleft Palate; Cohort Studies; Elevators and Escalators; Humans; Infant; Nose; Orthopedics; Preoperative Care; Prospective Studies

The aim of this study is to assess the effect of nasoalveolar molding (NAM) versus no-NAM on nasal morphology in patients with unilateral cleft lip and palate (UCLP) at the time of nasal maturity.. A retrospective, single-institution review was conducted on all non-syndromic patients with UCLP. Inclusion criteria included age 14 years or above, unilateral cleft repair at the time of infancy, and adequate photography taken at nasal maturity and prior to rhinoplasty. Exclusion criteria included age less than 14 years, syndromic diagnosis, and rhinoplasty prior to nasal maturity. Ten parameters were measured twice from standardized clinical photographs using the Dolphin Imaging Software for establishment of intrarater reliability. Subjective analysis was achieved through completion of the Asher McDade grading scale by 3 expert cleft practitioners.. Nostril height, columellar angle, alar cant, vertical alar height, alar height angle, nasofacial angle, and nasolabial angle were found to be significantly less severe in patients who had undergone NAM in conjunction with surgical repair when compared with those who had undergone surgical repair alone. Asher McDade grading revealed significant improvement in nasal form, nasal symmetry/deviation, nasal profile, vermillion border, and overall score in patients who underwent NAM compared to no-NAM.. The use of presurgical NAM during infancy can improve nasal symmetry and nasal proportions at the time of nasal maturity.

Topics: Cleft Lip; Cleft Palate; Humans; Nasoalveolar Molding; Nose; Reproducibility of Results; Retrospective Studies; Treatment Outcome

Surgical outcomes for patients with complete cleft lips are not as ideal as those achieved for milder phenotypes. We hypothesized that in addition to the greater width of the cleft, patients with complete cleft lip and palate exhibit a greater degree of hypoplasia and asymmetry.. Stereophotographs of 14 infants with unrepaired unilateral complete and 14 with incomplete cleft lips were measured using Vectra imaging software (Canfield Imaging). Unpaired. Degree of asymmetry of the nasal base, sn-al, and sn-sbal was significantly greater for patients with complete clefts (. More severe, complete cleft lips demonstrate statistically significant greater asymmetry in surgically relevant dimensions. There was greater width of the nasal base. Vertical asymmetry of cupid's bow was unaffected by cleft severity, but that asymmetry was greater in patients with complete clefts due to hypoplasia of the lateral lip element. This may contribute to the less favorable results in these patients.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Lip; Nose; Reproducibility of Results

To reassess reliability and validity of the Submental Nasal Appearance Scale (SNAS) compared to the preliminary pilot study, for assessment of patient photographs with repaired unilateral cleft lip and palate (UCLP). When utilizing the SNAS, 3 nasal features (1. nasal outline; 2. alar base position; 3. nostril axis) must be graded according to symmetry between the cleft and noncleft side using a 5-point scale with reference photographs for each feature. The mean score calculated from the graded features reflects the overall degree of nasal symmetry, which is considered an important goal when repairing UCLP.. Fifty patient photographs were selected and cropped, displaying the submental view. Six raters assessed these photographs using the SNAS and a separate 5-point scale to assess the overall submental appearance. Interrater reliability was determined for both methods and correlation was calculated between these as an indication of construct validity.. Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.. Six- to 9-year-old patients with repaired UCLP.. Interrater reliability of 0.73 and 0.48 was found for the SNAS and overall appearance assessment, respectively, while in the pilot study values of 0.79 and 0.69 were found. Correlation of 0.59 and 0.74 was found in the current and pilot study, respectively, between the SNAS and overall appearance assessment.. The SNAS is a reliable tool to assess nasal symmetry from the submental perspective. Reliability of the SNAS is higher compared to grading overall appearance, but validity of the SNAS was less well supported.

Topics: Child; Cleft Lip; Cleft Palate; Humans; Netherlands; Nose; Pilot Projects; Reproducibility of Results

The study addresses whether the growth of the nasal dorsum is disturbed by cleft treatments, for cleft lip only (CL) and cleft lip with cleft palate (CLP).. A total of 576 patients with cleft (278 CL, 298 CLP) and 333 individuals without orofacial clefts were retrospectively enrolled. Cleft lip only group was treated with a modified Millard technique combined with Tajima incision for rhinoplasty at 3 to 6 months. The CLP group underwent the same lip repair technique and then underwent a Sommerlad palatoplasty at 9 to 12 months. Lateral cephalometric radiographs of all individuals were taken to evaluate the nasal length and nasal dorsum height. Dunn test was used to analyze the difference (. Compared with control, in CL, nasal bone angle and nasal dorsum angle increase by age similarly (5-18 years,. Treatments in both CL and CLP could be the important factors in disturbing the growth of cartilaginous portion of the nasal dorsum (including nasal tip) and the nasal dorsum height.

Topics: Adolescent; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Humans; Nose; Retrospective Studies; Rhinoplasty; Treatment Outcome

"Nasal rustle" is a type of nasal emission associated with a small velopharyngeal (VP) gap and distracting loud noise. Currently, the mechanisms behind noise generation are unclear. In this study, we use a combination of retrospective and prospective data to test the hypotheses that bubbling of secretions could be a source of audible noise.. Retrospective: Nasopharyngoscopy records of 151 patients with nasal rustle were reviewed to determine if bubbling occurred during their nasopharyngoscopy examination. Prospective: Nine children with nasal rustle and bubbling of secretions were suctioned with the scope in place to assure removal of secretions. The Nasometer II was used to record the children's production of oral sentences prior to and post suctioning. All sentences were analyzed for the presence or absence of noise, nasalance scores, and Cepstral Peak Prominence (CPP). Intra-and inter-judge reliability of coding was high.. Retrospective: 70% of the patients with nasal rustle had bubbling of secretions during nasopharyngoscopy. Prospective: Percentages of audible noise were reduced significantly post suctioning (Friedman's Test, Chi-square = 24.5, p = 0.001) with the greatest decrease in syllables with fricatives and bilabial stops (p < 0.05). The average CPP and nasalance scores pre-vs post-suctioning showed no significant differences (p = 0.91, 0.29).. Retrospective: The high percentage of patients with nasal rustle had bubbling of secretions when producing speech in nasopharyngoscopy evaluations. Prospective: The incidence of audible noise was reduced as a result of suctioning. This suggests that the presence of secretions contributes to the production of nasal rustle.

Topics: Child; Cleft Palate; Humans; Nose; Prospective Studies; Reproducibility of Results; Retrospective Studies; Speech; Speech Production Measurement; Velopharyngeal Insufficiency

To compare nasal and upper airway dimensions in patients with cleft lip and palate (CLP) who underwent nasoalveolar molding (NAM) with those without NAM during infancy using acoustic pharyngometry and rhinometry.. Eccovision acoustic pharyngometry and rhinometry (Sleep Group Solutions) was used for assessment of mean area and volume of nasal and upper airway in patients with complete unilateral CLP (age range 16-21 years) treated with NAM (group 1, n = 19) versus without NAM (group 2, n = 22).. The mean nasal cross-sectional areas and volume were higher in group 1 compared to group 2 on both cleft (. Nasoalveolar molding being one of the first interventions in chronology of treatment of patients with CLP, its long-term outcome on nasal and upper airway patency needs to be ascertained. The results of the present study show that the patients with CLP who have undergone NAM during infancy have better improvement in nasal and upper airway patency compared with those who had not undergone NAM procedure. The basic advantages of being noninvasive, nonionizing and providing dynamic assessment of nasal and upper airway patency make acoustic pharyngometry and rhinometry a diagnostic tool of choice to be used in patients with CLP.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Humans; Nasoalveolar Molding; Nose; Young Adult

To gain more insight into the assessment of "atypical" nasal and lip appearance outcomes compared to "typical" appearance outcomes after unilateral cleft lip and palate (UCLP) repair, when judged by professionals, patients with repaired UCLP, and laypeople.. An online survey containing 3 series of photographs with various degrees of "typical" and "atypical" nasal and lip appearance outcomes after UCLP repair was sent to 30 professionals, 30 patients with repaired UCLP, and 50 laypeople in 2 countries. Participants were instructed to rank the photographs from excellent to poor based on overall appearance. Mean rank positions of photographs were analyzed and differences in mean rank score between "typical" and "atypical" results were assessed using a T-test. Agreement of ranking between the 3 groups was assessed with an analysis of variance analysis.. Amsterdam UMC, location VUmc, Netherlands and Boston Children's Hospital, Boston, USA.. Photographs of 6- to 18-year-old patients with repaired UCLP.. "Atypical" appearance outcomes were ranked significantly less favorably (small nostril:. Noses with a smaller nostril and lips containing a whistling deformity were perceived as poorer outcome compared to the "typical" results. Professionals, patients, and laypeople are in agreement when assessing these outcomes.

Topics: Adolescent; Child; Cleft Lip; Cleft Palate; Humans; Judgment; Lip; Nose

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nasoalveolar Molding; Nose; Orthodontic Appliances, Removable; Workflow

After many years in clinical practice, the authors found that the long-term aesthetics of the upper lip and nose following repair of a unilateral cleft lip deformity using the Huaxi method remained unsatisfactory. The immediate postoperative effect was often good, while the long-term postoperative effect was poor. Therefore, this study aimed to evaluate the characteristics and influencing factors of a modified Huaxi method for repairing unilateral cleft lip over time, and to explore the relationship between immediate and long-term outcomes after cleft lip surgery.. Patients with unilateral cleft lip who visited the Department of Maxillofacial Surgery of the Stomatological Hospital of Zunyi Medical University from June 2014 to March 2016 were selected. The study group consisted of 51 consecutive patients (30 boys and 21 girls), aged between 3 months and 2 years. Of these, 24 presented with complete unilateral cleft lip (12 wore a nasoalveolar mold as required, 12 did not) and 27 with incomplete unilateral cleft lip (13 wore a nasoalveolar mold as required, 14 did not). Photographs were taken of 51 patients before surgery and immediately, 7 days, and 6 months postoperatively. Various indexes of nasolabial contour of each patient were measured using iWitness photogrammetry, and the slit width; lip height ratio, lip width ratio, nostril width ratio, and nostril height ratio of the healthy side; and degree of deviation of the nasal columella were calculated.. Long-term symmetry of lip height and width remained stable postoperatively (P > 0.05), whereas nostril height symmetry was significantly reduced (P > 0.05). Nasal width symmetry and midpoint deviation of the nasal columella were stable in patients with nasoalveolar molding (P > 0.05), but significantly decreased in patients without nasoalveolar molding (P < 0.05). In patients with complete unilateral cleft lip, there was a significant correlation between fissure width and lip width symmetry 6 months postoperatively (r = 0.431, P < 0.05).. The symmetry of the upper lip is satisfactory and stable following surgical repair with the modified Huaxi technique. However, undercorrection of nasal symmetry is commonplace. Fissure width and nasoalveolar molding may influence long-term aesthetics following unilateral cleft lip repair.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Esthetics, Dental; Female; Humans; Infant; Lip; Male; Nasal Septum; Nose; Treatment Outcome

At the declaration of the global pandemic on March 11, 2020, many hospitals and institutions developed a tiered framework for the stratification and prioritization of elective surgery. Cleft lip and palate repair was classified as low acuity, and nasoalveolar molding (NAM) clinics were closed. Anticipating the consequences of delayed cleft care and the additional burden this would cause families, we reassessed our risk-stratification and perioperative algorithms. We hypothesized we could safely optimize nasolabial repair without burdening our care systems and without increasing COVID-19-related morbidity/mortality.. Our multidisciplinary cleft team reevaluated patient selection to maximize surgical impact. Perioperative protocols were adjusted, and COVID-19 preoperative testing was utilized before nasolabial repair and prior to suture removal under anesthesia.. Early in the pandemic, unilateral cleft repair was prioritized and successfully completed on 9 patients. There were no complications related to COVID-19. Nasoalveolar molding clinic was reopened after total patient volume was significantly decreased.. We offer an approach for surgical management of nasolabial clefts during a global pandemic. Although guidelines have suggested postponing all cleft care, we found that at our dedicated pediatric hospital with low burden of COVID-19 and adequate resources, we could follow a strategy to safely resume cleft care while decreasing burden on our patients' families and care delivery systems.

Topics: Child; Cleft Lip; Cleft Palate; COVID-19; Humans; Nose; Pandemics; SARS-CoV-2

CIRPLAST is a nonprofit volunteer plastic surgery program that has provided free surgery for patients with cleft lip and palate deformities in different parts of Peru since 1995. In 2015, the author reported 6,108 patients that had been successfully operated on by the CIRPLAST team over a 20-year period. A technique, developed by the author, for the straight-line vertical cleft lip closure without skin flaps of the unilateral cleft lip, was mentioned in that publication but it was not described. 1 The purpose of this article is to present the technique, which has been successfully employed in all the CIRPLAST cleft missions in Peru, for the past 25 years.. The straight-line vertical cleft closure does not rely on measurements or skin flaps, and it can be used to close any degree of unilateral cleft lip cleft. The procedure is simple and dependable. After incising the cleft borders on both sides of the cleft, the orbicularis oris muscle is liberated from the surrounding tissues, segmented, and then moved down toward the free border of the lip, so that the cupid's bows can be placed in its normal horizontal position, together with the philtrum on the medial lip, providing normal fullness and pouting of the lower part of the upper lip. Lip length results from the orbicularis oris muscle repair and not from skin flaps. The associated nasal deformity is addressed at the same time as the lip repair, by freeing on the cleft side, the lower lateral cartilage (alar cartilage) from the external nasal skin through a rim incision, and then elevating the cartilage together with its vestibular skin, to place it in its normal position at the tip of the nose, and fixing it there with sutures.. The anatomic, functional, and esthetic results of the lip closure together with the correction of the associated nasal deformity have been satisfactory, when comparing the repaired cleft side with the normal side, for symmetry.. The straight-line vertical cleft lip closure, based on the orbicularis oris muscle repair, can be used to close any degree of lip clefting, including very wide clefts, without skin flaps. The associated cleft nasal deformity is corrected before the lip closure. The procedure has been used in all the CIRPLAST cleft missions in Peru for the past 25 years, and the outcomes of the repair over time have been satisfactory and stable.

Topics: Cleft Lip; Cleft Palate; Esthetics, Dental; Humans; Nose; Peru; Rhinoplasty

The present study was designed to investigate the usefulness of combining two different ordinal scaling indices, infant index (I-I) and 5-point aesthetic index (5-PAI), for the assessment and prediction of esthetic outcome of primary lip repair for patients with unilateral cleft lip.. The nasolabial appearance of the patients was evaluated before primary lip repair and at 5 years of age using cropped facial photographs with frontal and oblique views. The I-I and 5-PAI employ expanded reference photographs and objective esthetic variables for judgment.. The inter- and intrarater Kappa values of both I-I and 5-PAI demonstrated good to very good agreement (range: 0.74-0.84 for I-I and 0.62-0.77 for 5-PAI). Furthermore, both the declination of the columella and the deformity of the alar cartilage in I-I showed a correlation with nasal rating score of 5-PAI and were identified as predictable independent parameters (declination of the columella: Rs = 0.37, P = 0.04; deformity of the alar cartilage: Rs = 0.35, P = 0.02).. The combined use of I-I and 5-PAI with expanded reference photographs and objective variables could be useful for obtaining greater accuracy of the esthetic assessment and predicting postsurgical nasolabial esthetics at infancy.

Topics: Cleft Lip; Cleft Palate; Esthetics; Esthetics, Dental; Face; Humans; Infant; Nasal Cartilages; Nose

Nasoalveolar molding (NAM) was developed to facilitate easier treatment and better outcomes for cleft lip and palate (CLP) patients. The aim of this study was to investigate the parental burden and possible intercultural differences of this treatment modality, which is often argued to burden parents to an extraordinary amount.. Standardized questionnaires (available in English, Mandarin, and German) with 15 non-specific and 14 NAM-specific items to be retrospectively answered by Likert scales by parents of unilateral CLP patients with completed NAM treatment.. The parents of 117 patients from two treatment centers in Taiwan and Germany were included. A very high level of overall satisfaction was found in both countries with significant intercultural differences in prenatal parent information, feeding problems, dealing with 3rd party's perception, and experienced personal effort.. NAM is an effective treatment tool for children's CLP deformities and their caregivers in overcoming the feeling of helplessness. Intercultural differences may be due to infrastructural reasons, cultural attitudes and habits, or different public medical education.. In addition to facilitating easier surgical treatment, NAM can be seen as a powerful coping strategy for parents dealing with a CLP deformity of their child and does not seem to burden them extraordinarily.

Topics: Alveolar Process; Child; Cleft Lip; Cleft Palate; Humans; Infant; Nasoalveolar Molding; Nose; Parents; Retrospective Studies

The repair of nasal deformities secondary to cleft lip and palate is complex and requires reliable preoperative nasal 3-dimensional assessment. This study explored nasal end (defined as the lower third of the external nasal and vestibular parts of the nasal cavity) deformities secondary to unilateral complete cleft lip and palate.. Three-dimensional nasal end morphometric measurements were obtained from 48 patients who had undergone Millard cleft lip repair and reached skeletal maturity (cleft group) and from 36 age- and ethnicity-matched normal subjects (control group). For the cleft group, paired t tests and 1-way analysis of covariance were used to evaluate the internal and external morphological characteristics of the cleft and noncleft sides of the nasal end, and correlation analysis was done to evaluate the relationship between cleft-side measurements.. In the cleft group, the cleft side showed significantly smaller nasal vestibular volume and skin area, nostril area, nasal column length, and nostril height and greater nostril base length and nasal alar length than the noncleft side (all P < 0.05). Controlling for sex, there were significant differences in the nasal vestibular volume and skin area, internal nasal valve area, long nostril diameter, nostril base length, columella length, nostril height, and nasal alar length between the cleft and control groups (all P < 0.05). On the cleft side, the area of the skin lining of the nasal vestibule positively correlated with the alar length (r = 0.67, P < 0.05).. Three-dimensional nasal end reconstruction provides a more detailed preoperative nasal end morphological evaluation than previously available techniques.. Level III, case-control study.

Topics: Case-Control Studies; Cleft Lip; Cleft Palate; Humans; Nasal Septum; Nose; Rhinoplasty; Tomography, X-Ray Computed; Treatment Outcome

Currently, the treatment protocol for cleft palate at several centers around the world involves primary lip repair around 3-4 months of age, using presurgical nasoalveolar molding, which is done soon after birth. Unfortunately, in cases where treatment is delayed, the potential for repositioning the nasoalveolar apparatus is severely limited. The purpose of this paper is to illustrate a novel use of an expansion screw appliance to aid in the faster and more efficient active molding of the premaxillary and lateral maxillary segments in infants for whom the start of PNAM therapy is delayed, without the side effects commonly seen with pin-retained active molding appliances.

Topics: Bone Screws; Cleft Lip; Cleft Palate; Humans; Infant; Nasoalveolar Molding; Nose; Preoperative Care

As patients grow older, the unilateral cleft lip nasal deformity becomes more noticeable than the repaired lip. The authors assessed nasal revisions over 20 years of the senior author's management of unilateral complete cleft lip.. One hundred patients who underwent primary two-stage nasolabial correction of unilateral complete cleft lip between 1991 and 2001 were reviewed.. The median patient age was 21 years at the time of analysis. Only 13 percent of patients did not require nasal revision after primary nasolabial repair. One to two nasal revisions were undertaken in 65 percent of patients. The extent of nasal maneuvers during primary labial repair was associated with the number of revisions. Recently treated patients had fewer revisions. Female patients were more likely to undergo several revisions. Of patients who had semiopen suspension sutures at primary repair, 61 percent had this maneuver repeated two or more times. In contrast, patients who had closed suspension sutures at primary repair underwent more nasal revisions and later required more nasal maneuvers. Nasal revision before skeletal maturity was significantly associated with another nasal revision after completion of skeletal growth. Twenty-seven percent of patients eventually required an aesthetic or functional rhinoplasty in adulthood.. Patients with a severe initial nasal deformity require multiple revisions. Semiopen suspension sutures are associated with fewer revisions. Revision of the nasal cartilages or alar base can often be performed in the intermediate phase, in combination with other operations.. Therapeutic, IV.

Topics: Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Male; Nose; Reoperation; Retrospective Studies; Rhinoplasty; Young Adult

Worm's eye view photograph has been widely used for anthropometric analysis. However, it is difficult to secure objectivity because it cannot be captured at a constant head-up degree. This study aimed to analyze whether anthropometric nasal measurements in worm's eye view differ from the actual values.. A total of 40 patients with unilateral cleft lip nasal deformities were included. The 30° and 60° head-tilted two-dimensional (2D) photographs were captured from the three-dimensional (3D) images. The real measurements were obtained from 3D images and 2D measurements were obtained from the captured images. The cleft/non-cleft side ratios of the nostril height, width, and alar base width were compared between 3D and 2D images.. There was a significant difference in the nostril height between the 3D and 30° values (3D = 0.82, 30° = 0.92, P < 0.001) but no meaningful difference was noted between the 3D and 60° values (3D = 0.82, 60° = 0.84, P = 0.31). There was no significant difference in the nostril width among the 30°, 60°, and 3D values. A significant difference was found in the alar base width between the 3D values and both the 30° (3D = 0.998, 30° = 1.04, P = 0.026) and 60° (3D = 0.998, 30° = 1.03, P = 0.029) values.. This study demonstrates that 2D photographs do not accurately reflect actual values. The nostril height and alar width ratio can be changed depending on the head-up position. The 3D systems are more accurate and less affected by the subject's head position. Therefore, the 3D imaging system is advocated for the anthropometric analysis of unilateral cleft lip nasal deformity.

Topics: Anthropometry; Cleft Lip; Cleft Palate; Humans; Nose; Reproducibility of Results; Rhinoplasty; Treatment Outcome

The primary aim of this study was to demonstrate whether primary rhinoplasty shows aesthetic and psychosocial advantages for children with a complete unilateral cleft lip and palate. The second aim was to determine the satisfaction levels concerning the dentofacial appearance. Group A corresponded to patients from a center specialised in primary cheilo-rhinoplasty with 20 years' experience and Group B to patients who did not benefit from primary rhinoplasty. Children and their parents filled in a custom-designed satisfaction questionnaire on dentofacial appearance and its psychosocial impact. The variables studied were the main criterion (the nose) and secondary criteria (the upper lip, the smile, the profile and the face as a whole). 56 families consented to be involved in the study. The children did not rate statistically differently their social relationships if they had primary rhinoplasty or not. Parents however expressed very different views. They considered the nasal appearance of the children who had primary rhinoplasty as statistically more attractive and evaluated their psychosocial experience as significantly better. For the other parts of the face, in both groups, satisfaction levels of dentofacial appearance and psychosocial comfort were good (scores above 80/100). Yet, 44% of the families would go for further interventions, especially concerning the nose (13% of whom were in Group A and 42% in Group B). Within the limitations of this study, primary rhinoplasty seems to improve the patient's well-being and social life and, therefore, should be considered whenever appropriate.

Topics: Child; Cleft Lip; Cleft Palate; Esthetics, Dental; Humans; Nose; Rhinoplasty; Treatment Outcome

Bilateral cleft lip deformities makeup 10% of orofacial clefts and are uncommon when compared to unilateral cleft lip.1,2 These cleft deformities have significant physical and long-term psychosocial effects on not only the patient but their family. With bilateral cleft lip deformity, the cutaneous approximation of the lateral lip segments are dependent on a sufficient prolabium to reconstruct the philtrum.3,4 Deficient skin equates to tight midline closure and subsequent unsightly scarringIn the subclinical phenotype of bilateral cleft lip and palate, where the patient has an absent or deficient prolabium, achieving tension free closure in the primary surgical setting is a reconstructive dilemma.5 This clinical report describes the use of a full-thickness skin graft to reconstruct the philtrum in a 12-month-old boy with bilateral cleft lip deformity, absent prolabium, absent columella and absent nasal septum to provide an aesthetic subunit repair.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Lip; Male; Nose; Plastic Surgery Procedures; Rhinoplasty; Skin Transplantation

To evaluate the effectiveness of autologous costal cartilage-based open rhinoplasty in the correction of secondary unilateral cleft lip nasal deformity.. Between January 2013 and June 2020, 30 patients with secondary unilateral cleft lip nasal deformity were treated, including 13 males and 17 females; aged 14-41 years, with an average of 21.7 years. Among them, 18 cases were cleft lip, 9 cases were cleft lip and palate, and 3 cases were cleft lip and palate with cleft alveolar. The autologous costal cartilage-based open rhinoplasty was used for the treatment, and the alar annular graft was used to correct the collapsed alar of the affected side. Before operation and at 6-12 months after operation, photos were taken in the anteroposterior position, nasal base position, oblique position, and left and right lateral positions, and the following indicators were measured: rhinofacial angle, nasolabial angle, deviation angle of central axis of columella, nostril height to width ratio, and bilateral nasal symmetry index (including nostril height, nostril width, and nostril height to width ratio).. The incisions healed by first intention after operation, and no complications such as acute infection occurred. All 30 patients were followed up 6 months to 2 years, with an average of 15.2 months. During the follow-up, the patients' nasal shape remained good, the tip of the nose and columella were basically centered, the back of the nose was raised, the collapse of the affected side of nasal alar and the movement of the feet outside the nasal alar were all lessened than preoperatively. The basement was elevated compared to the front, and no cartilage was exposed or infection occurred. None of the patients had obvious cartilage absorption and recurrence of drooping nose. Except for the bilateral nostril width symmetry index before and after operation, there was no significant difference (. Autologous costal cartilage-based open rhinoplasty with the alar annular graft is a safe and effective treatment for secondary unilateral cleft lip nasal deformity.. 探讨开放式自体肋软骨移植鼻整形术在单侧唇裂继发鼻畸形整复中的治疗效果。.. 2013 年 1 月—2020 年 6 月，收治 30 例单侧唇裂继发鼻畸形患者。男 13 例，女 17 例；年龄 14～41 岁，平均 21.7 岁。其中唇裂 18 例，唇腭裂 9 例，唇腭裂伴齿槽嵴裂 3 例。应用开放式自体肋软骨移植鼻整形术治疗，术中使用肋软骨鼻翼环状移植物矫正患侧塌陷的鼻翼。术前及术后 6～12 个月摄正位、鼻基底位、斜位及左右侧位照片，测量以下指标：鼻面角、鼻唇角、鼻小柱中轴偏斜角、同侧鼻孔高度与宽度比、鼻部双侧对称指数（包括鼻孔高度、鼻孔宽度及鼻孔高度与宽度比的对称指数）。.. 术后切口均Ⅰ期愈合，未出现急性期感染等并发症。30 例患者均获随访，随访时间 6 个月～2 年，平均 15.2 个月。随访期间患者鼻部形态保持良好，鼻尖及鼻小柱基本居中，鼻背抬高，患侧鼻翼塌陷、鼻翼外侧脚外移等均较术前减轻，双侧鼻孔间差异减小，患侧鼻基底较术前抬高，无软骨外露、感染等发生。患者均无明显的软骨吸收及鼻翼下垂复发。除双侧鼻孔宽度对称指数手术前后比较差异无统计学意义（. 开放式自体肋软骨移植鼻整形术可以有效修复单侧唇裂继发鼻畸形，手术效果稳定可靠。.

Topics: Cleft Lip; Cleft Palate; Costal Cartilage; Female; Humans; Male; Nasal Septum; Nose; Rhinoplasty; Treatment Outcome

The intermediate cleft tip rhinoplasty is frequently performed during childhood to address nasal tip anomalies in cleft patients before the most critical period of psychosocial development. The authors previously described the component restoration intermediate cleft tip rhinoplasty technique for the unilateral cleft nose, which was developed to systematically address the lining deficiency, cleft lower lateral cartilage malpositioning, and cleft lateral cartilage weakness using a combination of lower lateral cartilage release, lateral cartilage repositioning, and placement of an auricular composite chondrocutaneous graft. In this work, the authors evaluate the utility of this technique to the bilateral cleft nose. Preoperative and postoperative (mean ± SD, 18.6 ± 10.8 months) photographs of bilateral cleft patients treated with the component restoration intermediate cleft tip rhinoplasty (n = 7) were evaluated using photogrammetric measurements and aesthetic assessments. From preoperatively to postoperatively, the columella length-to-alar width ratio on basal photographs increased (0.19 ± 0.05 versus 0.28 ± 0.05; p = 0.001). On lateral view, the columella-labial angle decreased from preoperatively to postoperatively [138 degrees (interquartile range, 132 to 144 degrees) versus 123 degrees (interquartile range, 122 to 139 degrees); p = 0.04]. Aesthetic ratings performed by four blinded observers also improved from preoperatively to postoperatively (1.6 ± 0.8 versus 2.4 ± 0.7; p = 0.004). As a comparison, bilateral cleft nose patients who did not undergo intermediate cleft tip rhinoplasty (n = 3) of similar ages were subjected to the same photogrammetric and aesthetic analyses, which showed no differences from preoperatively to postoperatively. In combination, the current work suggests that the component restoration technique in the bilateral intermediate cleft tip rhinoplasty improves nasal tip support and aesthetic outcomes.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Male; Nose; Photography; Rhinoplasty; Time-to-Treatment; Treatment Outcome

Nasoalveolar molding (NAM) is an accepted presurgical treatment modality for newborns with cleft lip and palate (CLP). However, the therapy is time-consuming and requires high expertise. To facilitate the treatment, we reveal an algorithm for the automated generation of patient individual NAM devices for neonates with bilateral cleft lip and palate (BCLP) and present results of software validation.. The algorithm was implemented utilizing Python 2.7 and Blender 2.78a based on 17 digitized (3D-scanning) impressions of maxillae with BCLP. The algorithm segments alveolar structures, bridges clefts, and generates a series of NAM device designs, destined for 3D-printing for subsequent treatment. The datasets were used for first software tests. For validation, a follow-up study was carried out using six new, independent maxilla models. The generated NAM plate designs were examined regarding their potential clinical usability. Furthermore, a deviation analysis was carried out, which measured the plate models' and upper jaw models' surface deviations.. Series of NAM devices were generated automatically in 21 out of 23 cases. We calculated an average surface deviation of 0.140 mm (SD: 0.016 mm). Four out of six plate series (follow-up trials) were assessed as probably usable with minor adjustments.. The algorithm generates 3D-printable series of NAM device designs reliably. We expect most of the series to be clinically usable and that the first plates of each series will fit the patients' maxillae.. The proposed algorithm has the potential to reduce the therapist's manual work and therefore time effort/costs related to NAM.

Topics: Algorithms; Cleft Lip; Cleft Palate; Equipment Design; Follow-Up Studies; Humans; Infant, Newborn; Nasoalveolar Molding; Nose

Objective assessment of the unilateral cleft lip nasal deformity and the longitudinal changes with treatment is critical for optimizing cleft care.. Consecutive patients undergoing cleft lip repair and foundation-based rhinoplasty were included (n = 102). Three-dimensional images preoperatively, postoperatively, and at 5 years of age were assessed and compared to age-matched controls. Images were normalized to standard horizontal, craniocaudal, and anteroposterior axes.. Cleft subalare was similar in position relative to controls but was 1.6 mm retrodisplaced. Subnasale was deviated 4.6 mm lateral to midline and had the greatest displacement of any landmark. Noncleft subalare was displaced 2.3 mm laterally. Regression analysis with deviation of subnasale from the midline as a dependent variable revealed progressive lateral displacement of noncleft subalare, narrowing of noncleft nostril, and intercanthal widening. Surgery corrected nasal base displacements along all axes, resulting in landmark positions similar to controls. Symmetry of nasal base correction persisted at 5-year follow-up, with no recurrent cleft alar base retrusion, regardless of initial cleft type.. Unilateral cleft lip nasal deformity may be "driven" by displacement of the anterior nasal spine and caudal septum. The cleft alar base is normal in position but retruded, whereas the noncleft alar base is displaced laterally. Changes with surgery involve anterior movement of the cleft alar base but also include medial movement of the noncleft alar base and columella. Symmetry of correction, including alar base retrusion, was stable over time and did not rely on alveolar bone grafting.

Topics: Alveolar Bone Grafting; Anatomic Landmarks; Case-Control Studies; Child, Preschool; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Imaging, Three-Dimensional; Infant; Longitudinal Studies; Male; Nose; Postoperative Period; Preoperative Period; Rhinoplasty; Severity of Illness Index; Time Factors; Treatment Outcome

The care of unilateral cleft lip (UCL) patients is extremely variable. Historical benchmarks for perioperative and intraoperative choices by cleft surgeons were produced by Sitzman et al (Plast Reconstr Surg. 2008;121:261e-270e) in 2005. However, emerging data and cleft lip repair methods around this period were not captured by this study. The aim of this study was to update the current practice patterns of cleft lip surgeons.. An electronic survey was distributed to surgeons in the American Cleft Palate Association. Demographic data about the surgeon were collected as well as their choices regarding perioperative and intraoperative cleft lip care.. Eighty-six surgeons responded to the survey. Nearly 40% of surgeons have changed their technique for UCL repair with Fisher anatomical subunit repair gaining significant popularity. Nasoalveolar molding is also being used more frequently (41% vs 22%). At the time of the cleft lip repair, closure of the nasal floor is occurring in 83.1% of patients and primary cleft rhinoplasty is being performed routinely 57% of the time.. Over the last 10 years, there has been an increase in the use of modified rotation advancement repairs and Fisher anatomic subunit approximation technique for treatment of UCL. There continues to be a lack of evidence regarding superiority of specific repair techniques or the benefits of adjunct procedures, which results in varying practice patterns. Educating all cleft surgeons on practices that are well supported is important to improve care to cleft patients.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nose; Rhinoplasty; Surgical Flaps; Treatment Outcome

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nasoalveolar Molding; Nose; Treatment Outcome

Presurgical nasoalveolar molding (PNAM) is a key step in the early management of cleft babies. It involves making an impression of the alveolar segments and the lip elements, after which an appliance is fabricated and activated to achieve optimal alveolar and nasal positions for a superior surgical result. These appliances are fabricated and activated in babies as young as 10 days, and the molding is ideally carried on till the baby is ready for the primary lip repair. This article outlines in detail a digital method of fabricating the PNAM appliance using a combination of intraoral scans, computer-assisted digital software, and computer-assisted machining, facilitated by milling machines. This process obviates impression making and the subsequent laboratory procedures.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Plastic Surgery Procedures; Preoperative Care

Current tumor therapies can impair velopharyngeal function and lead to the development of hypernasality and nasal regurgitation. This article describes a prosthetic restoration of velopharyngeal dysfunction with a multidisciplinary approach including a speech pathologist and videofluoroscopic and nasal endoscopic procedures.

Topics: Cleft Palate; Endoscopy; Humans; Nose; Nose Diseases; Speech Disorders; Velopharyngeal Insufficiency

Over the last few decades it has been shown that nasoalveolar molding (NAM) has had an effect on the correction of nasal cartilage deformities and the alveolar process. This three-dimensional (3D) analysis evaluated the effects of NAM on the alveolar cleft region in patients with unilateral cleft lip and palate. Alveolar gap volumes were measured in a retrospective review of 40 dental casts of 20 patients with unilateral clef lip and palate before and after treatment. Ten patients who began undergoing NAM immediately after birth were included in this study. An additional 10 patients with unilateral clefts but without NAM were included as a control group. All of the casts (pretreatment and post-treatment) were 3D scanned, and the cleft volumes and anterior gap widths underwent computer-aided evaluations. NAM resulted in a significant reduction (p < 0.05) in alveolar gap volume and anterior cleft width from birth until lip closure time, while half of the control group showed slight increases in cleft volume. Based on these results, NAM is an effective and helpful treatment that can be used to significantly reduce alveolar gap volume and anterior cleft width in patients with unilateral clefts. Harmonization of the dental arch and a reduction in the alveolar cleft region are desirable treatment goals.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Nose; Retrospective Studies; Treatment Outcome

The aim of this study was to adapt the Simplified Nasometric Assessment Procedures-Revised (SNAP-R) [1] to Turkish, gather norms from Turkish speakers, and test the sensitivity and specificity of the adapted test. Finally, this study was designed to determine if there are any differences in average nasalance scores due to age, gender, and vowel content of the passage.. 240 children without any known speech, language or hearing disorders and 40 children with cleft palate participated in the study. Participants were divided into three groups according to their age (ages 4-7; 8-12; and 13-18). Data for this descriptive study was collected in the school settings and in a center of speech and language therapy.. This study showed a slight increase in nasalance with age, but no difference in nasalance based on gender. Furthermore, the nasalance score is determined by vowel content of the passage and that high vowels have higher nasalance than the low vowels.. This paper offers a new test for nasometric evaluation in the Turkish language, which has relatively high specificity and sensitivity in the evaluation of hypernasality.

Topics: Adolescent; Child; Child, Preschool; Cleft Palate; Female; Humans; Language; Male; Nose; Sensitivity and Specificity; Speech; Speech Production Measurement; Turkey; Voice Disorders; Voice Quality

To evaluate patient-reported aesthetic and psychosocial outcomes of secondary cleft lip and nose revision procedures.. Single-center cohort study.. Tertiary care pediatric hospital.. Patients who underwent secondary revision procedures for cleft lip and nasal defect (N = 42).. Patients were administered a survey during a routine postoperative clinic visit.. Outcome measures were planned prior to data collection and included improvement in appearance seen in lip and nose, satisfaction with revision procedure, changes in self-confidence, likelihood to participate in social activities, and effect on teasing by peers.. Patients agreed that an improvement was seen in the appearance of their lip (1.93) and nose (1.98) following surgery. Overall, patients felt satisfied with the results of their revision procedure (1.76). An improvement in confidence and decrease in feelings of self-consciousness was reported. Patients were teased less by their peers and more likely to participate in social activities.. Secondary revision procedures of the cleft lip and nasal defect provide a patient-reported improvement in appearance and a positive psychosocial impact on patient's lives.

Topics: Child; Cleft Lip; Cleft Palate; Cohort Studies; Esthetics, Dental; Humans; Nose; Patient Satisfaction; Patient-Centered Care; Personal Satisfaction; Rhinoplasty; Treatment Outcome

To detect the appearance and distribution of factors regulating remodeling, innervation, growth, and vascularity of the nasal tissue affected by cleft lip and palate (CLP).. Morphological analysis of human tissue.. Cleft and craniofacial center.. Fifteen patients who underwent CLP rhinoplasty, 7 control patients.. Rhinoplasty.. Immunohistochemistry was performed with protein gene product (PGP) 9.5, transforming growth factor β1 (TGFβ1), vascular endothelial growth factor (VEGF), cluster of differentiation 34 (CD34), matrix metalloproteinase 2 (MMP2), MMP9, and tissue inhibitor of metalloproteinase 2 (TIMP2). The results were evaluated semiquantitatively. Spearman rank order correlation coefficient and Mann-Whitney. Cleft lip and palate-affected tissue revealed dense and loose connective tissue, adipose cells, and hyaline cartilage, along with numerous CD34-positive endotheliocytes and regions of VEGF-positive neoangiogenesis. We observed moderate to numerous PGP 9.5-positive nerve fibers. Transforming growth factor β1, MMP2, MMP9, and TIMP2 were found in cartilage and connective tissue. Cleft lip and palate-affected tissue compared to control samples showed a statistically significant difference in PGP 9.5 (. The moderate expression of TGFβ1 and increased distribution of VEGF, MMP2, MMP9, and TIMP2 demonstrate an active extracellular matrix remodeling and angiogenesis, performed by proteases. The cartilaginous septum of the nose is an example of balance between tissue degradation and its suppression, demonstrated by the relationship between MMPs and TIMPs and the presence of VEGF.

Topics: Cleft Lip; Cleft Palate; Humans; Matrix Metalloproteinase 2; Neuropeptides; Nose; Palate; Rhinoplasty; Tissue Inhibitor of Metalloproteinase-2; Vascular Endothelial Growth Factor A

To analyze the effects of presurgical nasoalveolar molding (PNAM) in newborns with cleft lip and palate and evaluate its postsurgical stability at 1-year follow-up using a nasal stent.. Prospective clinical trial.. Department of Orthodontics, Maulana Azad Institute of Dental Sciences, Delhi.. Patients with cleft lip and palate of 0 to 6 months. Sample size 25 recruited, 16 satisfactorily completed the procedure.. Presurgical nasoalveolar molding done as indicated in all the patients. Postsurgical external nasal stents were given for 1 year to maintain the nasal correction.. Changes in cleft defect and maxillary arch were recorded pre- and post-PNAM. Changes in nasal morphological parameters assessed pre- and post-PNAM and 1 year after surgical repair following the use of nasal stent.. There was a significant reduction in cleft defect assessed both intraorally ( 4.16 mm) and extra orally ( 4.42 mm) at the end of PNAM therapy (average treatment time 4 months). The nasal morphology improved with an increase in columella height (1.5 mm) and reduction in columella width. Bialar width reduced (2.90 mm) with an increase in nostril height ( 2.10 mm). Better symmetry was achieved in all cases as the nostril height and width difference changed significantly pre- and post-nasoalveolar molding. The percentage increase in columella height was greater for infants less than 6 weeks.. Presurgical nasoalveolar molding considerably reduces the cleft gap and improves arch form making surgical union easier along with improved nasal morphology which can be maintained at 1-year postsurgery by use of a postsurgical external nasal stent.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Nasoalveolar Molding; Nose; Preoperative Care; Prospective Studies; Treatment Outcome

To report the early experience using a new internal trans-nasal Le Fort I distractor in patients with cleft lip and palate.. Patients with cleft lip and palate and severe maxillary deficiency, who were treated with the trans-nasal Le Fort I distractor, were retrospectively reviewed. Cephalometric images were evaluated preoperatively and at least 6 months postoperatively. Speech outcomes were measured before and at least 6 months after surgery. Patient experience with the device was documented and complications were recorded.. Five male patients with bilateral cleft lip and palate (ages 11-19) underwent the maximum advancement allowed by the device (25 mm). Follow-up averaged 2 years. Average SNA changed from 75.5°preoperatively to 84.6°postoperatively. Average ANB angle changed from -2.8° to 7.4°, or a tendency to Class 2 overcorrection. There was an overall increase in upper anterior facial height by 7.5 mm. All patients achieved acceptable postoperative occlusions. Two patients with borderline velopharyngeal function preoperatively developed velopharyngeal insufficiency postoperatively that did not resolve 6 months postoperatively, necessitating further surgery. Families reported ease of turning with minimal discomfort reported by patients. All patients maintained normal mouth opening during and after the distraction phase. Two of the patients developed localized pin site infections after the distraction phase that were treated successfully with oral antibiotics.. The trans-nasal Le Fort I distractor can be an effective device to advance the deficient maxilla and is well tolerated by patients.

Topics: Adolescent; Cephalometry; Child; Cleft Lip; Cleft Palate; Humans; Male; Maxilla; Nose; Osteotomy, Le Fort; Retrospective Studies; Speech; Velopharyngeal Insufficiency; Young Adult

Rhinoplasty for cleft lip nasal deformities challenges all cleft surgeons. There is great variability of phenotypical anatomy, but iatrogenic changes and scarring from the previous surgeries add another layer of complexity. Rhinoplasties on a patient with cleft lip-palate are technically and intellectually challenging to master requiring a patient-tailored approach. The shape and structure of the nose are changed to improve both function and aesthetic appearance. In the primary setting, nasoalveolar molding is a form of presurgical infant orthopaedics used for preparation before the cleft lip and nose repair. Intermediate stages should be conservative to minimize scarring, while the definitive cleft rhinoplasty utilizes cartilage grafts from septum, ear, or rib to sculpt the nose. Hereinto, we will outline the controversies, the evidence supporting certain techniques, and our preferences.

Topics: Cicatrix; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Rhinoplasty

Nasal asymmetry is one of the most frequent characteristics of patients with cleft lip and palate. The anthropometric measurement (AM) is an accessible and reliable method that can be used by specialists to evaluate nasal asymmetry in patients with cleft lip and palate. The aim of this study was to evaluate the effectiveness of an educational intervention applied to cleft lip and palate specialists to increase the accuracy of AM in the evaluation of nasal asymmetry.. Quasi-experimental study.. In the first phase of the study, five of the 13 AM reported a mean difference (MD) > 1.5 mm, and 12 of the 13 AM showed results greater than 2 SD (standard deviations). In the second phase, the results showed 11 of the 13 AM with MD < 1 mm, and 9 of the 13 AM were less than 2 SD.. The intervention carried out with the manual of AMs increased the knowledge of the specialists on the anatomy points and AM that can be used to evaluate the nasal asymmetry in patients with cleft lip and palate. Educational intervention help to increase the agreement between examiners to perform a reliable evaluation of nasal asymmetry in patients with these conditions.. La asimetría nasal es una de las características más frecuentes de los pacientes con labio y paladar hendido; la medición antropométrica (MA) es un método accesible y confiable que puede ser utilizado por los especialistas para evaluarlo. El objetivo de este estudio fue evaluar la efectividad de una intervención educativa aplicada a especialistas que tratan pacientes con labio y paladar hendido para incrementar la precisión en las MA en la evaluación de la asimetría nasal.. Estudio cuasiexperimental.. En la primera fase del estudio, 5 de las 13 medidas antropométricas reportaron una diferencia de medias (DM) > 1.5 mm, y 12 de las 13 MA mostraron resultados mayores a dos desviaciones estándar (DE). Los resultados en la segunda fase evidenciaron 11 de las 13 MA con DM < 1 mm, y 9 de las 13 MA fueron menores a dos DE.. La intervención realizada con el Manual de medidas antropométricas aumentó los conocimientos de los especialistas sobre la anatomía, puntos y MA que se pueden utilizar para evaluar la asimetría nasal en pacientes con labio y paladar hendido. La intervención educativa ayuda a aumentar el acuerdo entre los evaluadores para realizar una evaluación confiable de la asimetría nasal en pacientes con estos padecimientos.

Topics: Adult; Aged; Anthropometry; Cleft Lip; Cleft Palate; Female; Health Personnel; Humans; Male; Middle Aged; Nose; Reproducibility of Results; Specialization

The aim of the current study is as follows: (1) to study whether wearing the presurgical nasoalveolar molding appliance (PNAM) had facilitated the establishment of. Saliva samples of 61 infants (4.5 ± 2.06 months old) were collected from the following 3 groups: PNAM (n = 23), healthy (n = 30), and cleft lip and palate (CLP) without any treatment (n = 8). Saliva samples were assessed using selective agar to enumerate total. A total of 63 patients (30 healthy patients, 23 patients with cleft lip/palate who had PNAM appliance and 8 patients with cleft lip/palate who did not use the appliance) were seen in this study. There is a significant difference in pH (. Higher bacterial count and lower pH were found in the PNAM group. Cleft lip and/or palate patients wearing the PNAM appliance are at higher risk for dental caries.

Topics: Cleft Lip; Cleft Palate; Dental Caries; Humans; Infant; Nasoalveolar Molding; Nose; Preoperative Care

Topics: Cleft Palate; Endoscopy; Fiber Optic Technology; Humans; Nose; Velopharyngeal Insufficiency

The aim of this paper is to re-introduce Kilner and Calnan's technique of closing the nasal and buccal layers in V-Y pushback palatoplasty by using the spring carrier on the mouth gag.After flap elevation and dissection, the first suture is inserted through the nasal layer of the mucosa at the level of the posterior border of the hard palate. This 3-0 stitch is left untied until later. The nasal layer is approximated by inserting a series of 4-0 sutures so that the knots can be tied on the mucosal surface inside the nose. All sutures are inserted before any are tied. The sutures are inserted consecutively, moving from the hard palate region toward the uvula. The sutures may be held on the spring suture carrier attached to the mouth gag; they should be covered by a damp swab. When all sutures have been inserted, they are then tied firmly with three knots, working from behind to forward, and cut short by the surgeon. The buccal layer is closed starting from the uvula and moving toward the hard palate. A series of interrupted mattress sutures are inserted to unite the mucosa and the velar muscles. The inserted sutures are tied before the next stitch. They may be cut by the assistant, leaving 3 to 4 mm beyond the knot.In this technique, the untied sutures could be arranged well on the spring suture carrier attached to the mouth gag. When covered by a damp swab, the catgut sutures did not dry up.

Topics: Cleft Palate; Female; Humans; Male; Nose; Palate, Hard; Plastic Surgery Procedures; Surgical Flaps; Suture Techniques; Sutures; Uvula

We aimed to evaluate velopharyngeal function and speech outcomes of Sommerlad palatoplasty combined with sphincter pharyngoplasty in surgical repair of cleft palate in patients over five years old. Fifty-eight patients were reviewed between the years 2013 and 2017, 31 of whom were treated with Sommerlad palatoplasty combined with sphincter pharyngoplasty, (mean age 15 (range 9 - 22) years), and 27 were treated with Sommerlad palatoplasty alone (mean age 18 (range 10-25) years). Velopharyngeal function was evaluated by radiographic lateral cephalometry and nasoendoscopy. Hypernasality, nasal emissions, and intelligibility were used to assess speech. The rate of velopharyngeal competence was 20/31 in the palatoplasty plus pharyngoplasty group and 7/27 in the palatoplasty alone group after surgical treatment (p=0.003). The improvements in hypernasality (p=0.024), air emission (p=0.004), and speech intelligibility (p=0.004) in the palatoplasty plus pharyngoplasty group was better than that in the palatoplasty alone group. It has been suggested that the surgical approach with the palatoplasty together with the sphincter pharyngoplasty has a higher rate of success in surgical repair of older patients with cleft palate.

Topics: Adolescent; Adult; Cephalometry; Child; Child, Preschool; China; Cleft Palate; Humans; Nose; Nose Diseases; Pharynx; Speech; Treatment Outcome; Velopharyngeal Insufficiency; Young Adult

It is believed that the use of the nasopharyngeal cannula can maintain the patent upper airway in the immediate post-operative period of orthognathic surgery. The present study is a randomized clinical trial with the objective of evaluating the difference in the use of the nasopharyngeal cannula in the post-operative period of orthognathic surgery with respect to permeability and discomfort. The sample was composed of 26 individuals with repaired cleft lip and palate randomly distributed in 2 groups with and without nasopharyngeal cannula. The evaluation was composed by Visual Analogue Scale (VAS), test with Altman mirror in 4 pre-operative periods, 6, 24, 30 hours after the operation. Rhinomanometry was also performed, a flow- pressure technique in 2 distinct moments, 6 and 24 hours after surgery. As a result, greater discomfort, greater obstruction as well as a reduction in the area of bilateral minimum nasal cross-section (ASTM) and increased resistance in the group with nasopharyngeal cannula are observed. In the intra-group comparison with the lowest ASTM values, the test group showed a significant difference between the first and the second moments (P = 0.001). It can be concluded that the nasopharyngeal cannula contributes to increase discomfort, worsens airway permeability by decreasing ASTM and increasing nasal resistance. Regarding the length of stay of the nasopharyngeal cannula, it can be said that from 6 hours onwards it does not contribute to the reduction of discomfort, airway permeability and assist in hemostasis.

Topics: Adult; Cannula; Cleft Lip; Cleft Palate; Female; Humans; Male; Middle Aged; Nasopharynx; Nose; Orthognathic Surgical Procedures; Orthopedic Procedures; Permeability; Young Adult

To evaluate the symmetry and stability of nasolabial area of unilateral complete cleft lip (UCCL) after primary repair with the method of rotation descent step by step.. Thirty patients with UCCL who were operated on were photographed before, 1 week after and 1 year after surgery, the distances from alare point (al), sub alare point (sba), christa phlitri point (cph) and chelion point (ch) to the facial vertical midline (VML) were measured and compared with the opposite side by paired t test. Statistical analysis was performed with SPSS 19.0 software package.. There were significant differences in al, sba and cph between the cleft side and non-cleft side before(P<0.05) and 1 week after surgery; significant differences were found in al, sba and ch between the affected and unaffected side (P<0.05); but 1 year after surgery, there was no significant difference between the two sides except sba. After surgery, all the distances from VML were less than those before surgery. There was no significant difference in symmetry rate between 1 week and 1 year after surgery for all the points except sba.. The results indicated that the method of rotation descent step by step is very helpful in reconstruction of lip symmetry, but primary repair can not achieve full recovery of nasal symmetry.

Topics: Cleft Lip; Cleft Palate; Face; Humans; Nose; Plastic Surgery Procedures; Rotation; Treatment Outcome

Presurgical nasoalveolar molding (NAM) is the most common preoperative treatment for cleft lip and palate. However, NAM may have some limitations such as requiring high technical sensitivity and frequent visits. To simplify the device, some scholars have changed the traditional NAM into a split-NAM consisting of a alveolar molding plate and a nasal hook. This study compared the shaping effect of split NAM and traditional NAM on nasolabial soft tissue using three-dimensional (3D) measurement.. A total of 39 patients with unilateral cleft lip and palate (UCLP) were enrolled and divided into 2 groups. 13 patients were treated with split-NAM while the other 26 patients were treated with traditional NAM. 3D images of all patients' craniofacial soft tissue before and after NAM treatment were recorded and measured by three-dimensional software. Statistical analysis of measurements in both groups was performed using SPSS software.. After treatment, nasal soft tissue symmetry in the split-NAM group was better improved than that in the NAM group in vertical and anterior-posterior direction, but was worse improved in transverse direction. There was no significant difference in labial soft tissue symmetry between two groups.. The split NAM can better elevate the alar and nostrils of the cleft side, and have a better forward effect on alar outer edge, nasal base, and nostrils. However, the traditional NAM can better reduce the width of nasal base.

Topics: Child; Cleft Lip; Cleft Palate; Humans; Imaging, Three-Dimensional; Nasoalveolar Molding; Nose; Plastic Surgery Procedures; Splints

To identify demographic factors that influence choosing nasoalveolar molding (NAM) in the treatment of cleft lip with or without cleft palate (CL±P), and NAM treatment compliance.. This work is a retrospective cohort study.. Tertiary pediatric hospital.. One hundred forty-nine patients with a diagnosis of unilateral complete CL±P receiving treatment when NAM was offered (January 1, 2008-July 26, 2016).. Demographic variables collected included race, ethnicity, ZIP code, number of caregivers, caregiver employment status, and health insurance status. Medical variables collected included diagnosis, treatment pursued, compliance with NAM, completion of NAM, and the treating cleft surgeon and orthodontist. Data were analyzed via Fisher exact tests, χ. Univariate analyses identified the following significant factors predicting the pursuit of NAM: race and insurance type (both. There are disparities in patient choice of NAM at our center for children with complete cleft lip. African American patient families were less likely to pursue this intervention. A stronger understanding of the barriers that lower income and minority patients face is needed in order to better characterize disparities in cleft care.

Topics: Alveolar Process; Child; Cleft Lip; Cleft Palate; Hospitals, Pediatric; Humans; Nasoalveolar Molding; Nose; Retrospective Studies

Nasoalveolar molding (NAM) was introduced over 20 years ago as adjunctive therapy for the correction of cleft lip and palate. In the current study, we propose a new approach using a digital workflow and 3-dimensional printing to fabricate clear aligner NAM devices.. A polyvinyl siloxane (PVS) impression of an infant with a unilateral complete cleft lip and palate (UCLP) is acquired and poured, and the stone model is scanned with an intraoral scanner. The stereolithography file is digitized, and the alveolar segments are digitally segmented and moved to the desired final position. The total distance moved is divided into a sequence of 1-1.5 mm increments, creating a series of digital models. The models are 3-dimensionally printed along with button templates to allow free form positioning of the button on each model. A Vacuform machine (Taglus, Mumbai, India) was used to fabricate a 0.040-in aligner for each stage.. We present 1 case that was treated successfully with this approach. Appointments for the NAM adjustments were primarily to monitor progress and counseling with less time spent adjusting the appliance. The appointment length was reduced by over 30 minutes. Benefits of the aligner are improved fit, more precise increments of activation, reduced chairside time, and potentially minimized number of visits.. NAM custom aligners may provide similar benefits to the traditional approach while reducing the burden of care by reducing the number of visits and appointment duration. Further studies with a sample and longitudinal observations are needed to investigate the benefits of the proposed digital approach.

Topics: Cleft Lip; Cleft Palate; Humans; India; Infant; Nose; Orthodontic Appliances, Removable; Preoperative Care; Workflow

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nose; Workflow

The aim of this prospective study was to evaluate the adherence frequency of Candida albicans and non-albicans Candida species in newborn babies with Cleft Lip and Palate (CLP) who receive presurgical orthopedic therapy with Nasoalveolar Molding (NAM) appliances. This study comprised of 25 CLP newborns including 8-right unilateral, 8-left unilateral and 7-bilateral CLP. First swab samples were taken from the hard palate when the baby was referred and renewed after 3 days. Following the 7th day of delivery of NAM appliance, the swab samples were retaken from both the hard palate and the NAM appliance. Samples were renewed with 2-month intervals. The last swab samples were taken one month after the surgery. Oral swabs were cultured on CHROMagar Candida medium for the growth of yeasts.. There were no statistically significant differences between the time points regarding C. albicans proliferation frequency and severity rates on the palate. No significant difference was found due to the type of cleft and sex in terms of candidal colonization. A constant increase in proliferation frequency of non-albicans on the palatal mucosa was observed between all of the time points. Although the results were insignificant, there was a constant increase in C. albicans proliferation which presented a decrease following primary lip surgery.. The appliance might not only cause an increase in the colonization of C. albicans but also provide the continuation of the colonization. Therefore, mouth cleaning is important even after primary lip surgery.

Topics: Alveolar Process; Candida albicans; Cleft Lip; Cleft Palate; Humans; Infant, Newborn; Nose; Prospective Studies

Patients with cleft lip with or without cleft palate suffer from varying degrees of nasal deformity, often requiring nasal reconstruction to provide improved form and function. Rib cartilage is an excellent source of grafting material for nasal reconstruction and is available either as an autologous or allogenic graft. There is a paucity of literature comparing outcomes of autologous and allogenic rib grafts in pediatric cleft rhinoplasty.. A retrospective chart review was performed on patients who underwent cleft rhinoplasty with autologous or allogenic rib grafting at a tertiary pediatric hospital between January 1, 2003 and December 31, 2017. Outcome data were gathered over a 6-month postoperative period.. There were 23 cleft rhinoplasties performed with rib graft, 12 with autologous rib and 11 with allogenic rib. Those in the autologous group tended to be older than those in the allogeneic group (15.6 ± 4.4 v 12.4 ± 5.2 years, p = 0.13). The most common types of grafts used were columellar strut (20/23), shield graft (9/23), and unilateral or bilateral batten grafts (7/23). Length of stay was significantly longer for patients who underwent autologous rib grafting compared with those with allogenic rib grafting (25.8 ± 4.7 v 11.9 ± 7.2 h, p < 0.05). Each group reported one complication.. Autologous and allogenic rib grafts are safe and effective in pediatric rhinoplasty. The most common grafts used in this sample were columellar strut, batten, and shield grafts. Autologous rib grafts were more likely to be used in older patients and require longer hospital stay compared to allogenic grafts.

Topics: Adolescent; Allografts; Autografts; Child; Cleft Lip; Cleft Palate; Costal Cartilage; Female; Humans; Length of Stay; Male; Nasal Septum; Nose; Retrospective Studies; Rhinoplasty; Young Adult

Topics: Adolescent; Adult; Child; Cleft Palate; Female; Humans; Male; Nose; Speech; Surgery, Oral; Velopharyngeal Insufficiency; Young Adult

The objectives were to assess the treatment outcomes of unilateral cleft lip and palate after primary surgery on nasolabial soft tissue of children ages 4-5 years old as compared with unaffected children and to establish a nasolabial soft tissue norm within Khon Kaen.. This cross-sectional study consisted of 60 unaffected subjects living in Khon Kaen province and 20 subjects with repaired complete unilateral cleft lip and palate who were treated at Srinagarind Hosipital, Khon Kaen, Thailand. 3D images were taken by a Morpheus 3D Scanner and measured by the Morpheus 3D program. Independent t-tests and paired t-tests were used to analyze the significant differences between subjects with cleft and unaffected subjects.. There were statistically significant differences (p<0.05) of nasolabial measurements between affected subjects and unaffected subjects. Unilateral measurements showed decreased nostril height, columella lengths, and nose protrusion from ala base and ala length in the affected group. In addition, bilateral measurements found decreased upper lip protrusion, philtrum length, upper lip height, upper vermillion thickness, and lip angle.. This study attempted to establish a norm for evaluating the treatment outcome of cleft lip and cleft palate repair at Srinagarind Hospital in relation to unaffected or noncleft individuals. The results suggest that the noncleft side in affected patients is not an optimal surgical guide for cleft repair and the surgeon should correct both sides of lip and nose features according to the norms. A surgical treatment plan should emphasize correcting nostril height, columella length, nose protrusion from ala base, ala length, and upper lip features.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Humans; Imaging, Three-Dimensional; Nose; Thailand

To justify the use of the Sequential Splints Method of presurgical orthopedic treatment for children with unilateral cleft lip and palate depending on extent of initial deformation and to estimate long-term results.. The method was applied in 17 unilateral cleft lip and palate infants who received treatment at the age from 4 days to 3 months. There was a control group of 28 cleft lip and palate patients operated with no early orthodontics. Average age in both groups at the time of research was 3.8±0.9 years. Comparative assessment was conducted before the beginning of the post-operative orthodontic treatment for the following parameters: residual width of the alveolar process cleft, presence of lateral incisor's bud, the extent of the nose deformation on the cleft side.. It was found that residual width of the alveolar process cleft was, on average, 5.95 mm in the main group and 12.6 mm in the control group. The percentage of the lateral incisor adentia was 28% in the main group and 66% in the control group. The mean score of alar nose deformation was 3.9 and 3.1 points, correspondingly.. According to obtained results patients who did not receive the presurgical orthopedic treatment were more likely to have residual deformations and larger residual width of the alveolar process cleft. There was higher risk of teeth germs loss in the control group. The Sequential Splints Method of presurgical orthopedic treatment is recommended as a necessary part of the treatment for the unilateral cleft lip and palate.. Обосновать необходимость применения метода предоперационного ортопедического лечение (ПОЛ) детей с односторонней расщелиной губы, альвеолярного отростка и неба (ОРГН) с использованием коррекционных капп в зависимости от степени тяжести первоначальной деформации и оценить отдаленные результаты лечения.. Проанализирован послеоперационный статус пациентов с ОРГН, получавших ПОЛ методом коррекционных капп в возрасте от 4 дней до 3 мес, которые составили основную группу из 17 пациентов и пациентов, не получавших ПОЛ, которые вошли в группу сравнения из 28 пациентов. Возраст исследуемых пациентов был в среднем 3,8±0,9 года. Всем детям обеих групп в послеоперационном периоде до начала ортодонтического лечения проводилась сравнительная оценка следующих параметров: ширина остаточного диастаза между фрагментами; наличие зачатка 2-го постоянного резца со стороны расщелины; степень выраженности деформации крыла носа на стороне расщелины.. Выявлено, что ширина расщелины альвеолярного отростка после проведенных пластик губы и неба в основной группе составила в среднем 5,95 мм, в группе сравнения — 12,6 мм. Выявлено также, что у детей, получавших ПОЛ, процент адентии второго резца со стороны расщелины более чем в 2 раза ниже (28%), чем в группе сравнения, где процент адентии составил 66%. Степень деформации крыла носа в основной группе в среднем составила 3,9, а в группе сравнения — 3,1 балла, что достоверно меньше.. При отсутствии ПОЛ у пациентов со второй или третьей степенью деформации в большей степени сохраняется величина первичного диастаза, что влияет негативно на эстетический результат хейлоринопластики. Через 2—2,5 года после хирургических операций у пациентов сохраняется достаточно широкий костный дефект, соответственно, у них имеется риск утраты объема костного регенерата после костной пластики альвеолярного отростка верхней челюсти. Кроме того, у этих пациентов, вероятнее всего, из-за избыточного натяжения тканей и, как следствие, нарушения кровообращения в зоне хирургического вмешательства в послеоперационном периоде увеличивается риск потери зачатка постоянного второго резца на стороне расщелины. В связи с этим ПОЛ методом коррекционных капп следует рекомендовать как обязательный этап в комплексной реабилитации пациентов с односторонней расщелиной губы, альвеолярного отростка и неба.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Preoperative Care; Splints

Patients presenting with a unique unilateral cleft phenotype may be at risk of nasal airway obstruction which can be exacerbated by presurgical infant orthopedic (PSIO) appliance therapy and lip taping. Four patients presented to the UPMC Children's Hospital of Pittsburgh Cleft-Craniofacial Center with a cleft phenotype characterized by: An anteriorly projected greater alveolar segment and medial collapse of the lesser segment posteriorly, leading to cleft alar base displacement posteromedial to the anteriorly projected greater segment. Resultant bilateral nasal airway obstruction: cleft ala drape over the leading edge of the greater segment's alveolus (cleft side obstruction) and caudal septum displacement secondary to attachments to the orbicularis oris from the noncleft side (noncleft side obstruction). The patient described presented at 3 months old from an outside institution, where PSIO therapy was undertaken. A second opinion was sought due to concern of significant difficulty in breathing and feeding with the PSIO oral plate. Lip-nose adhesion (LNA) was elected and airway obstruction was immediately relieved after this intervention. Lip-nose adhesion releases the tethered cleft side alar base from the pyriform rim of the posteromedially collapsed lesser segment and unites the superior lip and nostril sill-relieving the cleft side nostril obstruction. During the LNA, the caudal septum is surgically released from the anterior nasal spine and is uprighted, relieving the obstructed noncleft nostril. In this cleft anatomy, the treatment alternatives of modification to the PSIO appliance or LNA should be carefully considered in consultation with the surgeon, PSIO provider, and the infant's caretakers.

Topics: Airway Obstruction; Child; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Phenotype

An 8-day-old male infant with unilateral cleft lip, alveolus, and palate had a wide alveolar defect, soft tissue deformity, and a markedly sunken nasal wing at the cleft side. The patient was treated with a series of 3D-printed molding plates and synchronously with a nasal hook. The cleft edges moved closer by 9 mm at the alveolar ridge and the nasal wing was lifted considerably. Split-type 3D printing of presurgical nasoalveolar molding helped to reduce the cleft gap, improve the arch form, approximate lip segments, and distinctly improve the morphology of the nose by correcting the flattened nasal wings.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Computer-Aided Design; Dental Impression Technique; Humans; Infant, Newborn; Male; Models, Dental; Nose; Orthognathic Surgical Procedures; Palate; Plastic Surgery Procedures; Printing, Three-Dimensional; Treatment Outcome

The purpose of this study was to evaluate a single center's experience with adult patients who had cleft lip, cleft palate, or both. The authors aimed to identify common long-term needs in this patient population and evaluated the relationship of team-based care in meeting those needs. To do so, the authors retrospectively reviewed chart records from a single private practice and tertiary referral cleft center for all patients who were ≥15 years of age and who had a history of clefts of the lip or palate, or both, from January 1, 2013, to June 30, 2014. The authors compared the concerns of the patients who received cleft-team-based care by a single, multidisciplinary cleft team; multiple multidisciplinary cleft teams; or no formal cleft team. The authors analyzed data for 142 patients. The most common patient concerns were lip aesthetics (64%), nose aesthetics (61%), septal deviations (47%), nasal obstruction (44%), malocclusion (32%), oronasal fistulas (29%), and speech (21%). Oronasal fistulas were more commonly reported in the group of patients who had care by multiple teams (42.9%; P < .001). Malocclusion was more commonly reported in the group of patients who had care by multiple teams (50%; P = .001). The authors found that adult patients who have undergone rehabilitation for cleft lip and palate appear to have a common set of long-term needs. Multidisciplinary cleft-team-based care appears to be the most effective way to address these needs.

Topics: Adolescent; Adult; Aged; Cleft Lip; Cleft Palate; Female; Humans; Male; Malocclusion; Middle Aged; Nose; Oral Fistula; Retrospective Studies; Speech; Time Factors; Treatment Outcome; Young Adult

The aim was to evaluate the anxiety and depression of both the father and mother of an infant with cleft lip and palate (CLP) before, during and after nasoalveolar molding (NAM) therapy and before and after the lip surgery.. Forty mothers (age range: 18-36; mean ± SD: 23.6 ± 4.51) and 40 fathers (age range: 19-40; mean ± SD: 26.9 ± 4.69) of infants with CLP were asked to answer the 21-item Beck Depression as well as Anxiety Inventory (BDI and BAI) at 1 week after birth and before any intervention (T1), after impression taking (T2), after 2 months of NAM (T3), immediate before primary surgery (T4) and approximately 1 month of recovery after surgery (T5).. Maternal and paternal depression levels between T1, T2, T3, T4, and T5 showed significant differences (P < 0.05). The BDI scores decrease from T2 to T3 and T4 to T5. The increases of scores from T3 to T4 were significant (P < 0.05). The maternal depression and anxiety levels were higher than the paternal ones in all time periods. The BDI and BAI levels were lesser in mothers and fathers of babies with unilateral than bilateral CLP (P < 0.05).. Hence realizing of recovery, being in contact with the cleft team and other families, and having an active role in the therapy, the maternal and parental well-being increase with NAM therapy. However, depression and anxiety levels significantly increase before the lip surgery. It may be recommended that the cleft team deliver information and psychological support especially at birth and before the surgical approaches.

Topics: Adolescent; Adult; Anxiety; Cleft Lip; Cleft Palate; Fathers; Female; Humans; Male; Mothers; Nose; Young Adult

Audible nasal emission is a speech disorder that involves undesired sound generated by airflow into the nasal cavity during production of oral sounds. This disorder is associated with small-to-medium sized velopharyngeal openings. These openings induce turbulence in the nasal cavity, which in turn produces sound. The purpose of this study is to examine the aeroacoustic mechanisms that generate turbulent sound during production of a sibilant /s/ with and without a small opening of the velopharyngeal valve. The models are based on two pediatric subjects who were diagnosed with severe audible nasal emission. The geometries were delineated from computed tomography scans taken while the subjects were sustaining a sibilant sound. Large eddy simulation with the Ffowcs Williams and Hawkings analogy was used to predict the flow behavior and its acoustic characterization. It shows that the majority of the acoustic energy is produced by surface loading, which is related to dipole sources that resonate in the nasal cavity. The quadrupole source term that is associated with the unsteady shear layers is seen to be less significant. It also shows that closure of the velopharyngeal valve changes the far-field spectrum significantly because aeroacoustic mechanisms in the nasal cavity are eliminated.

Topics: Child; Cleft Palate; Humans; Nose; Sound; Sound Spectrography; Speech Disorders; Speech Production Measurement; Velopharyngeal Insufficiency; Vibration

To quantify 3-dimensional (3D) nasal changes in infants with unilateral cleft lip with or without cleft palate (UCL±P) treated by nasoalveolar molding (NAM) and cheilorhinoplasty and compare to noncleft controls.. Retrospective case series of infants treated with NAM and primary cheilorhinoplasty between September, 2012 and July, 2016. Infants were included if they had digital stereophotogrammetric records at initial presentation (T1), completion of NAM (T2), and following primary cheilorhinoplasty (T3). Images were oriented in 3dMD Vultus software, and 16 nasolabial points identified.. Twenty consecutively treated infants with UCL±P.. Nasoalveolar molding and primary cheilorhinoplasty.. Anthropometric measures of nasal symmetry and morphology were compared in the treatment group between time points using paired Student t tests. Postsurgical nasal morphology was compared to noncleft controls.. Nasal tip protrusion increased, and at T3 was 2.64 mm greater than noncleft controls. Nasal base width decreased on the cleft side by 4.01 mm after NAM and by 6.73 mm after cheilorhinoplasty. Columellar length of the noncleft to cleft side decreased from 2:1 to 1:1 following NAM. Significant improvements in subnasale, columella, and nasal tip deviations from midsagittal plane were observed. Treatment improved symmetry of the alar morphology angle and the nasal base-columella angle between cleft and noncleft sides.. Three-dimensional analysis of UCL±P patients demonstrated significant improvements in nasal projection, columella length, nasal symmetry, and nasal width. Compared to noncleft controls, nasal form was generally corrected, with overcorrection of nasal tip projection, columella angle, and outer nasal widths.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nose; Photogrammetry; Retrospective Studies; Treatment Outcome

In unilateral cleft lip and palate, the reconstructed nasal floor is sometimes uplifted regardless of the reconstructive method used. We used a 5-0 absorbable anchoring suture, the oronasal transfixion suture (ONT suture), to fasten the reconstructed nasal floor to the orbicularis oris muscle to prevent this deformity. This study was performed to evaluate the effects of the ONT suture.. Blind retrospective study of photography and chart review.. Shinshu University Hospital, tertiary care, Nagano, Japan. Private practice.. Ninety-three consecutive patients with unilateral complete cleft lip and palate who had undergone primary nasolabial repair in our department and affiliated hospitals between 1999 and 2011 participated in this study. Finally, 45 patients were included.. The ONT suture was put in place at the time of primary nasolabial repair.. The height of the nasal floor was evaluated on submental view photographs at 5 years old.. The ONT suture was applied in 21 patients. The height of the nasal floor on the cleft side was significantly closer to that on the noncleft side with the ONT suture than without the ONT suture ( P = .008).. The ONT suture is effective to prevent uplifted nasal floor deformity on the cleft side// in unilateral complete cleft lip and palate at the time of primary nasolabial repair.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Japan; Nose; Retrospective Studies; Sutures; Treatment Outcome

Cleft lip and palate (CLP) patients have various problems with nasal anatomy beyond just oronasal separation. The alar base, concha, and septum are over impressed in these individuals. Additionally, skeletal class III deformity is seen. These conditions may limit nasal function. In our study, 15 unilateral patients with CLP older than 15 years (10 females, 5 males; mean age: 19.13) who had received surgery were included as the study group, and 15 participants with noncleft skeletal class III deformities were included as the control group (10 females, 5 males; mean age: 19.20). The individuals' nasal airway volumes (total/cleft side/noncleft side/control/ nasal passages) were examined and compared statistically. The results showed that the study group had significantly higher values in terms of total airway volume ( P < .05). Additionally, there were significant differences between the cleft side and noncleft side volumes, between the cleft side volumes and the volumes of the control group participants, and between the noncleft side volumes and the volumes of the control group participants ( P < .05). There was no difference between the groups in terms of nasopharyngeal ( P = .39) and nasal passage volumes ( P = .73). The results show there are some problems regarding nasal airway volume in patients with CLP, even when lip, palate, and alveolar cleft operations have been performed. The aim of this study was to evaluate differentiation of nasal airway volumes between unilateral patients with CLP and individuals with noncleft skeletal class III serving as the control group.

Topics: Cleft Lip; Cleft Palate; Cone-Beam Computed Tomography; Female; Humans; Male; Nose; Young Adult

Traditional nasoalveolar molding (NAM) requires steep learning curve for clinicians and significant compliance from parents. Nasal springs have been developed by the author to simplify presurgical nasal molding. This article presents the design, construction, and application of the spring. The treatment goal is to improve nasal deformity prior to primary repair in infants born with incomplete unilateral cleft lip with or without cleft palate.. The design, fabrication, and utility of the nasal spring are described. The spring has a simpler design and construction compared to a traditional NAM appliance.. Two patients with incomplete unilateral cleft lip with and without cleft palate are presented.. The spring is constructed and delivered. The active arm of the spring can be 3-dimensionally (3-D) adjusted to mold the alar cartilage of the affected nostril. The spring does not require an oral plate for adherence as a traditional NAM appliance does, hence an oral impression is not needed. The spring is easy for clinicians to adjust. It also requires less compliance by parents.. The presurgical molding achieved by the use of a nasal spring improved surgical nasolabial aesthetic outcomes.. The nasal springs are effective in reducing the initial cleft nasal deformity. This facilitates primary surgical cleft lip and nose correction and improves surgical outcomes in patients with incomplete unilateral cleft lip with or without cleft palate.

Topics: Cleft Lip; Cleft Palate; Esthetics, Dental; Humans; Infant; Nose; Preoperative Care

Longitudinal evaluation of asymmetry of the surgically managed unilateral cleft lip and palate (UCLP) to assess the impact of facial growth on facial appearance.. Prospective study.. Glasgow Dental Hospital and School, University of Glasgow, United Kingdom.. Fifteen UCLP infants.. The 3-D facial images were captured before surgery, 4 months after surgery, and at 4-year follow-up using stereophotogrammetry. A generic mesh which is a mathematical facial mask that consists of thousands of points (vertices) was conformed on the generated 3-D images. Using Procustean analysis, an average facial mesh was obtained for each age-group. A mirror image of each average mesh was mathematically obtained for the analysis of facial dysmorphology. Facial asymmetry was assessed by measuring the distances between the corresponding vertices of the original and the mirror copy of the conformed meshes, and this was displayed in color-coded map.. There was a clear improvement in the facial asymmetry following the primary repair of cleft lip. Residual asymmetry was detected around the nasolabial region. The nasolabial region was the most asymmetrical region of the face; the philtrum, columella, and the vermillion border of the upper lip showed the maximum asymmetry which was more than 5 mm. Facial growth accentuated the underlying facial asymmetry in 3 directions; the philtrum of the upper lip was deviated toward the scar tissue on the cleft side. The asymmetry of the nose was significantly worse at 4-year follow-up ( P < .05).. The residual asymmetry following the surgical repair of UCLP was more pronounced at 4 years following surgery. The conformed facial mesh provided a reliable and innovative tool for the comprehensive analysis of facial morphology in UCLP. The study highlights the need of refining the primary repair of the cleft and the potential necessity for further corrective surgery.

Topics: Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Imaging, Three-Dimensional; Infant; Nose; Prospective Studies; United Kingdom

This report describes the design and printing of personalized nasal stents for cleft lip using 3-dimensional (3D) technology.. We used silicone rubber to make the impressions, a 3D laser scanner to obtain 3D data, and Dental SG resin cartridges as printing material. We printed the personalized nasal stents using a photosensitive resin printer.. We placed the stents in patients after cleft lip surgery. They enabled personalized adjustment and good anastomosis, with a low probability of slipping from the nasal cavity.. With this technique, we can provide good nasal support for patients with cleft lip.

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Printing, Three-Dimensional; Rhinoplasty; Stents

Describe the surgical repositioning of the premaxilla using an innovative minimally invasive endonasal approach and secondary bone graft at the same time. We want to emphasize the importance of virtual surgical planning in this technique.. A total of 6 patients with bilateral complete cleft lip and palate underwent a surgical repositioning of the premaxilla. Virtual surgical planning was performed in all cases. The ages varied between 8 and 12 years and all were male. Five patients were in the mixed dentition phase and 1 patient was in the definitive phase. Three of the patients had been prepared with presurgical nasoalveolar molding. The other 3 were not prepared for various reasons. All patients had primary repair of cleft lip and palate.. An innovative minimally invasive endonasal approach is presented that has allowed a safe 3-D reposition of the premaxilla in patients with bilateral cleft palate. A simultaneous secondary alveoloplasty with the use of absorbable osteosynthesis is a good choice to achieve symmetry and stability.. Virtual surgical planning is an exceptional instrument to make an appropriate presurgical selection of the patients in which combine the 2 procedures.

Topics: Alveoloplasty; Child; Cleft Lip; Cleft Palate; Humans; Male; Maxilla; Nose

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Rhinoplasty; Rotation

To evaluate and compare early maxillary growth in 2 groups of patients with repaired bilateral cleft lip and palate (BCLP) who had and had not received nasoalveolar molding (NAM) therapy in infancy.. Nasoalveolar molding does not have any effect on maxillomandibular growth at the early mixed dentition period.. Retrospective study.. The study group consisted of forty-two 7-year-old patients with BCLP-20 in the NAM group and 22 in the no-NAM group. The control group consisted of nineteen 7-year-old noncleft, normal patients.. Nasoalveolar molding was carried out prior to surgeries in those children who were brought in within 8 weeks of birth. Children brought in later were treated without a presurgical intervention. All patients were treated with a single-stage modified Millard cheiloplasty without gingivoperiosteoplasty. Palatoplasty was done by single-stage Bardach palatoplasty with muscle repositioning.. Hard tissue and dental cephalometric values measured on lateral cephalograms, recorded at 7 years of age.. A comparison of the mean sagittal values showed a statistically significant maxillomandibular retrusion and incisor retroclination of both BCLP groups in comparison to the control group. None of the cephalometric parameters varied statistically between NAM and no-NAM groups. The maxillomandibular relation, lower face height ratio, mandibular plane, and mandibular axis angles did not show statistically significant difference between all 3 groups.. On the basis of this study, NAM does not have any effect on maxillomandibular growth at the early mixed dentition period.

Topics: Child; Cleft Lip; Cleft Palate; Dentition, Mixed; Humans; Infant; Nose; Retrospective Studies

Posterior nasal fricatives (PNFs) are unusual articulations that occur in some children with and without cleft palate. The etiology of PNFs is unclear. A young girl with repaired cleft palate is described who exhibited inconsistent obligatory nasal turbulence during production of stops at 2 years of age. At 3 years of age, she exhibited various phonological processes and used PNFs to replace sibilants and affricates. Pressure-flow testing showed a relatively small velopharyngeal area during production of stops. These observations are consistent with obligatory nasal turbulence triggering the development of PNFs as an unusual phonological process, perhaps facilitated by reduced hearing.

Topics: Child, Preschool; Cleft Palate; Female; Hearing Tests; Humans; Nose; Phonetics; Speech; Velopharyngeal Insufficiency

The timing of cleft lip nose surgery remains controversial. The less invasive the procedure at the time of primary cleft lip repair, the less the growth and development of the nose is affected. Therefore, the nasal-stenting component of presurgical nasoalveolar molding has increasingly been used. However, not all cleft centers use such treatment. Conventional postsurgical placement of silicone nasal retainers remains popular. No report has yet compared presurgical nasal stenting (preNS) and postsurgical nasal retainer placement (postNR). In this study, postoperative nasal form outcomes after primary lip repair using preNS or postNR in patients with complete unilateral cleft lips, alveoli, and palates were compared. Patients in whom preNS alone was used for 6 months (group I) were compared with those receiving postNR (no preNS) for 6 months after primary nasal cartilage dissection (group II) and controls with no appliance (group III). Nasal anthropometric distances and angular relationships were measured photographically to assess nasal symmetry at 4 years of age in all groups. Compared to group III, groups I and II exhibited significantly greater nostril heights (P = 0.0075, P = 0.0015 respectively) and columellar deviation angles (P = 0.0020, P = 0.0221). Groups I and II did not differ significantly. No significant between-treatment difference in terms of nasal symmetry between preNS and postNR was observed. However, both treatments afforded significantly better results than no treatment. Since older infants tend to resist the placement of nasal devices, preNS is more feasible in this age group.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Nasal Cartilages; Nose; Retrospective Studies; Stents; Treatment Outcome

Evaluate the factors that influence caregiver-reported completion of nasoalveolar molding (NAM) therapy for patients with cleft lip and palate.. An IRB-approved 30-question survey.. Outpatient clinic for patients with cleft lip.. Patients with unilateral or bilateral cleft lip treated with NAM therapy.. Survey of previous experiences.. Rate of noncompletion for patients initiating NAM therapy and identifiable causes.. Of 94 patients who underwent NAM, 13 (13.8%) failed to complete NAM therapy. Reasons for incomplete treatment included: obstructive sleep apnea, device intolerance, tape issues, and lack of support. Patients who did not complete NAM therapy were less likely to have primary caregivers >30-year old (. This study shows that a high number of parents fail to complete this therapy for many reasons, personal and medical. More data are needed to elucidate true prevalence of NAM noncompletion and to establish evidence-based guidelines to reduce barriers to care for completing NAM treatment.

Topics: Adult; Child; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Preoperative Care

To provide a normal comparison group against which to judge symmetry results after cleft surgery and to introduce the thin lip correction (TLC) feature in SymNose. A lip-aspect ratio algorithm has been added to the latest version of SymNose to compensate for the higher degree of overlap in thicker lips when compared to thin lips.. Retrospective analysis of symmetry in healthy participants, using the computer-based program SymNose on both anteroposterior (AP) and base view images. Photographs of 91 noncleft children were traced twice by 3 independent investigators experienced with SymNose.. Five-year-old healthy participants from a local state school in Tavistock (West Devon, United Kingdom).. Asymmetry expressed as the perimeter mismatch percentage for nose and lip features on AP view images and for nose features on base view images.. The perimeter mismatch reference range for the nose (AP view) was 2.65% to 30.91%, for the lip 2.13% to 15.44%, for the nose (base view) 1.69% to 14.84%, for the nostrils 4.68% to 26.6%, and for the width-height ratio 1.15% to 1.80%. The perimeter mismatch percentage for the lip without TLC was significantly higher compared to the perimeter mismatch percentage with TLC (. This article provides a noncleft reference range for all perimeters drawn from SymNose against which to compare results after cleft surgery at 5 years of age. Furthermore, it shows the importance of correcting for variance in lip volume per child.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Esthetics, Dental; Humans; Nose; Retrospective Studies; United Kingdom

To develop the "Submental Nasal Appearance Scale" (SNAS), which is an easy-to-use objectified tool to represent a cleft surgeon's standard for assessment of the nasal appearance from the submental perspective.. Eighty-five photographs of patients with unilateral complete cleft lip and palate were selected and cropped, displaying the submental view. Sixty-one photographs were used to develop 5 sets of reference photographs. Three cleft surgeons graded 24 photographs with these sets and subjectively graded the overall nasal appearance as well. Internal agreement for both methods was calculated, as well as correlation between them. The SNAS was created, by only using the combination of sets that showed the highest reliability and correlation.. Boston Children's Hospital, Boston, Massachusetts.. Six- to 9-year-old patients with unilateral complete cleft lip and palate.. The intrarater and interrater reliability was 0.84 and 0.79, respectively, for the SNAS and 0.76 and 0.62, respectively, for the overall appearance assessment. The correlation was 0.74 between the methods.. The SNAS is a reliable tool that reflects a cleft surgeon's standard and could be used independently or in combination with existing rating scales using the frontal and/or lateral view, for assessment after cleft lip repair.

Topics: Child; Cleft Lip; Cleft Palate; Esthetics, Dental; Humans; Nose; Photography; Pilot Projects; Reproducibility of Results

To assess weight gain of infants with cleft lip and/or palate (CL ± P) treated with nasoalveolar molding (NAM).. Retrospective, case-control chart review.. Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.. Infants with nonsyndromic CL ± P and noncleft controls.. Prior to primary lip surgery, NAM was either included (+NAM) or not included (-NAM) in the cleft treatment protocol.. Weight gain and percentage weight gain relative to initial weight were compared among +NAM, -NAM, and control groups from birth to 7 months and from birth to 36 months.. Comparing +NAM and -NAM groups, no significant difference in weight or percentage weight gain was found in either time window. Compared to controls, from birth to 7 months, both CL ± P groups weighed less (. Comparisons of CL ± P infants treated with and without NAM showed that with the NAM appliance, despite its added complexity, there was no adverse impact on weight gain. Comparisons to noncleft, control infants suggests that NAM treatment may have a beneficial impact on weight gain.

Topics: Case-Control Studies; Child; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Retrospective Studies; Weight Gain

To analyze three-dimensional (3D) nasolabial forms and upper lip surface symmetry after primary lip repair in children with unilateral cleft lip and palate (UCLP).. Subjects were 22 Japanese children with complete UCLP who underwent primary lip repair and were followed-up for 4-6 years. The 3D coordinates of facial landmarks and the angle and radius of the approximate nasal alar circle were calculated. Upper lip surface symmetry was analyzed using histogram intersection.. The nasal tip and columella base were slightly dislocated to the cleft side, and the midpoint of Cupid's bow shifted to the non-cleft side. The nasal alar and the top of Cupid's bow were reconstructed at the same height, while the approximate nasal alar circle was smaller on the cleft side. The mean value of similarity for upper lip surface symmetry was 0.82; a subject with a higher value had more symmetrical contour lines in the visualized surface image.. Postoperative nasolabial forms were almost restored to symmetrical levels, while retaining a small nasal alar. Histogram intersection is applicable as a method for the quantitative evaluation of upper lip surface symmetry in UCLP.

Topics: Anatomic Landmarks; Cleft Lip; Cleft Palate; Female; Humans; Imaging, Three-Dimensional; Infant; Lip; Male; Nose

There is debate on the reliability of the Americleft Yardstick (AY) global nasolabial appearance assessment method. The objective was to analyze the effect of the additional basal view (BV) feature on the reliability of the AY method for Japanese children with complete cleft lip and palate (CUCLP).. Blind retrospective analysis of clinical records on 43 patients (5- to 7-year-old) with nonsyndromic CUCLP who underwent primary lip repair from 2005 to 2011.. Color pictures published in AY and Rubin's studies were used as reference pictures. Patients' photographs were cropped and rated on a 5-point scale for the vermilion border (VB), nasolabial frontal (NLF), and nasolabial profile (NLP) according to AY with/without BV assessment by Rubin's methods. Rating was performed twice by 3 oral surgeons. Intra- and inter-rater reliabilities were analyzed using weighted κ, and correlations between BV and other features were analyzed.. Overall average assessment scores were 2.742 (0.573) with AY and 2.702 (0.489) with AY+BV methods (. Present study demonstrates moderate intra- and inter-rater reliabilities obtained with the AY assessment method for Japanese children with CUCLP. Nasolabial profile standard ambiguity may lead to the poor reliability of AY assessment. Addition of the BV feature does not improve overall reliability.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Esthetics; Humans; Japan; Lip; Nose; Photography; Reproducibility of Results; Retrospective Studies

Most previous studies of speech disorders associated with cleft palate have reported a higher incidence of errors for oral stops, fricatives and affricates compared to nasal stops. However, the results of a recent ultrasound study have raised the possibility that errors affecting nasal consonants might not be as rare as originally thought. A review of the electropalatography (EPG) literature on cleft palate speech has also shown that atypical tongue-palate contact patterns can occur during nasal consonants and that nasal and oral stops are often produced with similar atypical lingual gestures. Therefore, this study investigated the production of nasal stops (/n/and/ŋ/) and the homorganic oral stops (/t/,/d/and/k/,/ɡ/respectively) in eight children with repaired cleft palate using perceptual judgements and evaluation of tongue-palate contact patterns. Results of the perceptual judgements support the findings in the literature that there was a higher per cent phoneme correct for the alveolar nasal (about 90%) than for the oral stops (60-70%). However, there was a low per cent phoneme correct for the velar nasal (about 50%) and the per cent correct as determined by the EPG data was lower than those based on perceptual judgements. Two children showed similar atypical articulatory gestures for the oral and nasal alveolar stops. We discuss the possibility that the nasal errors may be of phonemic as opposed to phonetic origin. The results underscore the importance of considering the phonological dimension of production when assessing the speech of children in this clinical group.

Topics: Child; Cleft Palate; Female; Humans; Male; Nose; Palate; Phonetics; Speech Disorders; Tongue; Ultrasonography

This study investigated the efficiency of nasoalveolar moulding (NAM) in patients presenting with bilateral cleft lip and palate (BCLP). It focused explicitly on nasal outcome and therefore made comparisons with healthy age-matched infants with normal nasal development.. Nasal impressions from 19 BCLP patients were analysed at the beginning and at the end of NAM treatment. In addition, nasal impressions from 32 healthy newborns were taken monthly for 4 months. The casts were digitalized and analysed, using defined anatomic landmarks, by two independent observers. Initial values were compared with outcome parameters at the end of NAM therapy and with the healthy cohort.. NAM significantly elongated the columella in BCLP patients, with an increase of 106.5% versus 14.5% in healthy newborns. Nostril height showed significant expansion from 4.2 mm to 5.6 mm on the right side, and from 4.3 mm to 6.2 mm on the left side.. NAM significantly elongated columella length and increased nostril height. The comparison with healthy newborns showed the effectiveness of early cartilage moulding. Detailed knowledge about absolute and relative early nasal growth was gained. However, despite highly effective NAM treatment in BCLP, nasal dimensions will not reach healthy proportions.

Topics: Cleft Lip; Cleft Palate; Humans; Infant, Newborn; Lip; Nose; Preoperative Care

The purpose of this study was to investigate the differences in facial profile development between unoperated adult cleft palate (UACP) patients and normal controls and to analyse the reasons for the differences.. A total of 50 individuals with a unilateral cleft palate and 20 normal controls were selected to undergo angular measurement of their facial profiles. Data with significant differences between the two groups were analysed.. Seven angle measurements of the facial profile showed that the mid-facial protrusion of the UACP patients had no significant differences from the control group (p > 0.05). But their angle of the medium face (N'-Trg-Sn) was significantly lower than the non-cleft controls (p < 0.05), suggesting a worse vertical development of the middle face. A significantly larger nasal tip angle (Cm-Sn/N'-Prn) for UACP patients suggested they had a rounder and blunter nasal tip (p < 0.05). The soft tissue facial angle and chin-lip angle of UACP patients had significant differences from non-cleft controls (p < 0.05), but the head position angle (Sn-Sm-THP) had no significant difference between two groups (p > 0.05), which suggested a steep mandibular plane for UACP patients but without severe retraction of the chin.. The development of facial protrusions in UACP patients is similar to that in normal adults, but the vertical development in the middle face is insufficient. Such hypoplasia may be related to the intrinsic deficiency of the maxilla. There is a tendency for flat nasal growth and insufficient development of the chin in UACP patients.. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Topics: Adult; Case-Control Studies; Cephalometry; China; Cleft Palate; Face; Facial Asymmetry; Facial Muscles; Female; Hospitals, University; Humans; Male; Nose; Orthognathic Surgical Procedures; Patient Selection; Plastic Surgery Procedures; Reference Values

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Preoperative Care

Assess the weight and contribution of each of the parameters of the Asher-McDade Scale to overall subjective assessment of nasolabial aesthetics following cleft lip repair.. Retrospective cohort evaluation.. Cleft and craniofacial center.. Forty-one patients who underwent unilateral cleft lip repair.. Unilateral cleft lip repair.. Nasolabial rating using the Asher-McDade scale and overall subjective assessment of nasolabial aesthetics using a rank score following unilateral cleft lip repair.. Strong interrater reliability was observed between the 3 raters. Significant association was determined on bivariate analysis between nasal form score (β = 27.06;. The parameters evaluated in the Asher-McDade scale have different weights and contribute differently to overall subjective assessment of nasolabial aesthetic outcomes following cleft lip repair. Adjusting for their weights results in a modified score that demonstrates superior correlation with overall subjective assessment of nasolabial aesthetic outcomes.

Topics: Cleft Lip; Cleft Palate; Esthetics; Esthetics, Dental; Humans; Nose; Reproducibility of Results; Retrospective Studies; Treatment Outcome

Palatal fistulae represent a pathological connection from the oral cavity through the hard or soft palate to the nasal cavity and can present a significant reconstructive dilemma. Surgical correction of palatal fistulae is often limited by prior treatment, including ablative procedures and radiotherapy, or previous reconstructive attempts. In light of these challenges, the nasoseptal flap represents an excellent adjacent source of vascularized tissue which may be suitable for palatal fistula repair with minimal donor site morbidity, low associated risks, and a short recovery period. The purpose of this study was to fully understand the potential utility of this reconstructive option, including the ability to harvest a composite flap including both septal cartilage and contralateral mucoperichondrium. In this single institution prospective study consisting of a series of 5 cadaver dissections, primary outcome measures were the anterior reach of the flap as compared to the anterior nasal spine and the size of the palatal defect that the nasoseptal flap could be used to successfully reconstruct. Composite flaps were successfully harvested in continuity with a disc of septal cartilage and contralateral mucoperichondrium, providing structural integrity to the reconstruction and the ability to anchor the flap to the native hard palate mucosa. The nasoseptal flap's maximum anterior reach was within 2.0 cm (standard deviation of 0.1 cm) from the anterior nasal spine and could reliably reconstruct palate defects of 2.5 cm or less. The nasoseptal flap provides a viable regional option for reconstructing defects of the hard palate. Prospective clinical trials are needed to investigate long-term reconstructive and functional outcomes of the composite nasoseptal flap in palatal reconstruction.

Topics: Cadaver; Cleft Palate; Dissection; Female; Humans; Male; Nasal Cavity; Nose; Palate, Soft; Plastic Surgery Procedures; Prospective Studies; Surgical Flaps

Bilateral complete cleft lip (BCCL) causes severe tissue deficit and usually requires multiple revisions after primary repair. In the present study, we aimed to illustrate the nasolabial changes after primary BCCL correction.. The present retrospective cohort study compared patients who had undergone BCCL and palate (BCCLP) and cleft palate only (CPO). All included patients had undergone surgery at the same treatment center (West China Hospital of Stomatology) from 2007 to 2012. The patients returned for follow-up surgery at 6 months and 5 years after their primary repair surgery. We retrieved the facial plaster casts of the enrolled patients and recorded the key nasolabial measurements. The outcome variables included the prolabial length (PL), peak distance, nasal width, and columellar length (CL). The data were analyzed using a general linear model for repeated measures, and the linear association was tested using SPSS. The level of testing efficiency (P value) was set at .05.. A total of 160 patients, 80 who had undergone BCCLP and 80 CPO controls, were included. All nasolabial measurements in the BCCLP group had increased during the 5-year follow-up period. The PL of the BCCLP group had increased more quickly than the PL of the CPO group (P = .000 < .05), but the CL had increased nearly as much (P = .270).. For the primary correction of bilateral cleft lip nose deformity, dissection and repositioning of the cleft lip and nose did not significantly inhibit the growth of the nasolabial region in the first 5 years after surgery. Nose deformities should not remain uncorrected after primary surgical repair. In contrast, cleft surgeons should focus on the finer adjustment of columella with less doubt regarding adverse effects.

Topics: China; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Lip; Nose; Retrospective Studies

The investigators hypothesized that a layperson's social perceptions of a primarily repaired adolescent cleft lip and palate (CL/P) patient is more favorable after definitive nasal reconstruction with regard to perceived social traits.. The investigators implemented a survey comparing layperson's social perceptions of 6 personality traits, 6 emotional expression traits, and 7 perceptions of interpersonal experiences before and >6 months after definitive nasal reconstruction in CL/P adolescent subjects by viewing standardized facial photographs. The sample was composed of consecutive CL/P subjects treated by one surgeon using a consistent technique involving a rib cartilage caudal strut graft through an open approach. Five non-cleft adolescent subjects who underwent cosmetic rhinoplasty involving a septal cartilage caudal strut graft through an open approach were used as a comparison group. The outcome variable was change in 6 perceived personality, 6 emotional expression traits studied, and 7 perceptions of interpersonal experiences. Descriptive and bivariate statistics were computed (p-value <0.05).. The sample was composed of 10 consecutive CL/P subjects and 5 non-cleft adolescent comparison subjects. 500 respondents (raters) completed the survey. The respondents were 54% male with 56% age 25 to 34. After definitive cleft nasal reconstruction, study subjects were perceived to be significantly more attractive (p = 0.04) and less threatening (p = 0.04). They were also perceived as less angry (p < 0.01), sad (p < 0.01), or disgusted (p < 0.01) than prior to surgery. The subjects were also perceived to be less likely to have negative interpersonal experiences (p < 0.01).. We confirmed that laypeople consistently report positive changes in adolescent CL/P subject's perceived social traits after definitive cleft nasal reconstruction. Overall, the positive changes were largely comparable between the cleft and non-cleft groups.

Topics: Adult; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Nose Diseases; Rhinoplasty; Social Perception; Treatment Outcome

The authors performed a cantilever iliac bone graft for the secondary correction of severe cleft lip-nose deformities after the completion of growth. For the purpose of clarifying effects of the cantilever iliac bone grafts and the adverse events with regard to their time course changes after this procedure, the authors retrospectively surveyed long-term morphologic changes in 65 cleft lip, alveolus, and palate patients in whom cleft lip-nose deformities were treated with a cantilever iliac bone graft (age at surgery: 14-45 years old). All postsurgical documents of facial photographs and radiologic images were reviewed to evaluate the effects and adverse events. The main adverse events were deviations of the apex of the nose, excess resorption of the grafted iliac bone, protruding deformations of the grafted iliac bone at the root of the nose, and fracture of the grafted iliac bone. Additional surgery was necessary in 10.7% of patients. Postsurgical changes in facial profiles became favorable, measured on lateral view of cephalometric radiography, achieving morphologic improvements. A cantilever iliac bone graft was effective for improving nasal deformities in cleft lip, alveolus, and palate patients, although the counter measures should be taken to these adverse events.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Female; Humans; Ilium; Male; Middle Aged; Nose; Photography; Postoperative Complications; Radiography; Reoperation; Retrospective Studies; Young Adult

To determine if cropping facial images affects nasolabial aesthetics assessments in unilateral cleft lip patients and to evaluate the effect of facial attractiveness on nasolabial evaluation.. Two cleft surgeons and one cleft orthodontist assessed standardized frontal photographs 4 times; nasolabial aesthetics were rated on cropped and full-face images using the Cleft Aesthetic Rating Scale, and total facial attractiveness was rated on full-face images with and without the nasolabial area blurred using a 5-point Likert scale.. Cleft Palate Craniofacial Unit of a University Medical Center.. Inclusion criteria: nonsyndromic unilateral cleft lip and an available frontal view photograph around 10 years of age.. a history of facial trauma and an incomplete cleft. Eighty-one photographs were available for assessment.. Differences in mean CARS scores between cropped versus full-face photographs and attractive versus unattractive rated patients were evaluated by paired t test.. Nasolabial aesthetics are scored more negatively on full-face photographs compared to cropped photographs, regardless of facial attractiveness. (Mean CARS score, nose: cropped = 2.8, full-face = 3.0, P < .001; lip: cropped = 2.4, full-face = 2.7, P < .001; nose and lip: cropped = 2.6, full-face = 2.8, P < .001).. Aesthetic outcomes of the nasolabial area are assessed significantly more positively when using cropped images compared to full-face images. For this reason, cropping images, revealing the nasolabial area only, is recommended for aesthetical assessments.

Topics: Child; Cleft Lip; Cleft Palate; Esthetics, Dental; Female; Humans; Male; Nose; Observer Variation; Photography; Plastic Surgery Procedures; Reproducibility of Results; Retrospective Studies; Visual Analog Scale

Identify factors associated with adherence to nasoalveolar molding (NAM) therapy.. Retrospective case-control study.. Tertiary referral center.. Infants with cleft lip, with or without cleft palate, referred for NAM. One hundred thirty-five patients met criteria.. Adherence to NAM therapy, defined as continuous use of the appliance and attendance of NAM adjustment visits.. Female sex (OR = 2.85, 95% CI 1.21-6.74), bilateral cleft (OR = 2.88, 95% CI 1.29-6.46), and travel distance (OR = 1.01, 95% CI 1.00-1.01) were independent predictors of nonadherence. Bilateral clefts (OR = 8.35, 95% CI 2.72-25.64) and public-payer insurance (OR = 3.67, 95% CI 1.13-11.91) for male patients were significantly associated with nonadherence, in our sex-stratified multivariate model. The majority of the families (58%) had public health insurance. Males comprised 77.0% of the cohort.. NAM treatment adherence is impaired by bilateral clefts, female sex, increased travel distance, and public insurance. Further studies are warranted to investigate how these factors affect adherence, and to develop interventions to improve adherence in families at risk due to economic or psychosocial barriers.

Topics: Alveolar Process; Caregivers; Case-Control Studies; Cleft Lip; Cleft Palate; Female; Humans; Infant; Infant, Newborn; Male; Nose; Retrospective Studies; Treatment Adherence and Compliance

To evaluate the effectiveness of pre-surgical nasoalveolar molding (PNAM) in patients with unilateral cleft lip nasal deformities. Methods: This was a retrospective study involving 29 patients with unilateral cleft lip and palate defects, of whom 13 were treated with palatal devices with nasal stents (PNAM group) and 16 were treated with palatal devices without nasal stents or surgical tapes (control group). Submental oblique photographs and orthodontic models were longitudinally obtained at the initial visit (T1) and immediately before (T2) and  after cheiloplasty (T3). Asymmetry of the external nose, degree of columellar shifting, nasal tip/ala nose ratio, nasal base angle, interalveolar gap, and the sagittal difference in the alveolar gap were measured. The study was conducted in the Orthodontic Clinic at Tokushima University Hospital, Tokushima, Japan between 1997 and 2012. Results: At T1, there were no significant intergroup differences in the first 4 asymmetry parameters. At T2, the PNAM group showed a significant improvement in all values compared to the control group. At T3, the PNAM group showed significant improvement in nasal asymmetry and columellar shifting. Model analysis showed significantly greater changes in the inter-alveolar gap and the sagittal difference of the alveolar cleft gap from T1 to T2 in the PNAM group. Conclusion: The use of PNAM is indispensable for pre-surgical orthodontic treatment at the early postnatal age.

Topics: Anatomic Landmarks; Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Nose; Photography; Plastic Surgery Procedures; Preoperative Care; Retrospective Studies; Stents

Human cleft lip with or without cleft palate (CL/P) is a common craniofacial abnormality caused by impaired fusion of the facial prominences. We have previously reported that, in the mouse embryo, epithelial apoptosis mediates fusion at the seam where the prominences coalesce. Here, we show that apoptosis alone is not sufficient to remove the epithelial layers. We observed morphological changes in the seam epithelia, intermingling of cells of epithelial descent into the mesenchyme and molecular signatures of epithelial-mesenchymal transition (EMT). Utilizing mouse lines with cephalic epithelium-specific Pbx loss exhibiting CL/P, we demonstrate that these cellular behaviors are Pbx dependent, as is the transcriptional regulation of the EMT driver Snail1. Furthermore, in the embryo, the majority of epithelial cells expressing high levels of Snail1 do not undergo apoptosis. Pbx1 loss- and gain-of-function in a tractable epithelial culture system revealed that Pbx1 is both necessary and sufficient for EMT induction. This study establishes that Pbx-dependent EMT programs mediate murine upper lip/primary palate morphogenesis and fusion via regulation of Snail1. Of note, the EMT signatures observed in the embryo are mirrored in the epithelial culture system.

Topics: Animals; Apoptosis; Body Patterning; Cells, Cultured; Cleft Lip; Cleft Palate; Embryo, Mammalian; Epithelial-Mesenchymal Transition; Face; Gene Expression Regulation, Developmental; Lip; Mice; Mice, Transgenic; Morphogenesis; Nose; Palate; Pre-B-Cell Leukemia Transcription Factor 1; Snail Family Transcription Factors

Topics: Asia, Eastern; Biological Variation, Population; Cleft Lip; Cleft Palate; Genetic Markers; Genetic Predisposition to Disease; Humans; Interferon Regulatory Factors; Lip; Nasolabial Fold; Nose; Palate

The aim of the present study is to evaluate the effects of nasoalveolar molding (NAM) therapy on nasolabial morphology three dimensionally, and compare the nasolabial linear and surface distance measurements in infants with unilateral cleft lip and palate.. Facial plaster casts of 42 infants with unilateral cleft lip and palate taken at the onset (pre-NAM) and finishing stage (post-NAM) of NAM were scanned with 3dMDface stereophotogrammetry system (3dMD, Atlanta, GA). Nineteen nasolabial linear and surface distance measurements were performed on three-dimensional images. In addition to standard descriptive statistical calculations (means and SDs), pre- and post-NAM measurements were evaluated by paired t test.. All measurements except lip gap, nostril floor width, and nostril diameter increased between pre-NAM and post-NAM. Nostril and lip height increased significantly on the cleft side (P < 0.05). No differences were present between linear and surface distance measurements except for nasal width measurement.. Nasal and lip symmetry improved with NAM. The use of surface distance measurements may be advised particularly for continuous and curved anatomic structures in which circumference differences are expected.

Topics: Casts, Surgical; Cleft Lip; Cleft Palate; Humans; Imaging, Three-Dimensional; Infant; Infant, Newborn; Lip; Nose; Photogrammetry; Retrospective Studies

Nasoalveolar Molding (NAM) is associated with ambivalent acceptance regarding effectiveness and unknown long-term results. Our purpose was to analyze the stress distribution patterns within the viscero- and neurocranium of neonates during the first phase of NAM therapy. A finite element (FE) model of a healthy four-week-old neonate was generated, derived from a computed tomography scan allowing the implementation of a bone-density-dependent material model. The influence of dental germs with variable material properties, the cleft width and area of expected force application were analyzed in a worst-case scenario. The resulting stress distribution patterns for each situation were analyzed using the software Ansys APDL. The established FE model was verified with a convergence analysis. Overall, stress patterns at the age of four weeks showed von Mises stress values below 60.000 Pa in the viscero- and neurocranium. The influences of the allocation of material properties for the dental germs, the area of force application, and the cleft width were negligible. A workflow to simulate the stress distribution and deformation in neonates attributable to various areas of force application has been established. Further analyses of the skulls of younger and older neonates are needed to describe the stress distribution patterns during NAM therapy.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Finite Element Analysis; Humans; Infant, Newborn; Models, Anatomic; Nose; Skull; Stress, Mechanical; Tomography, X-Ray Computed

To assess the improvement of nasal morphologies and ventilation after septal cartilage graft and septoplasty of patients with unilateral cleft lip and palate (UCLP).. Retrospective case-control study.. Tertiary stomatology hospital.. In total, 118 patients with UCLP who had been diagnosed with a secondary nasal deformity and had reconstructive rhinoplasty and/or septoplasty between 2010 and 2015.. Nasal Obstruction Symptoms Evaluation (NOSE) questionnaire, septum deviated angle, rhinoplasty satisfaction questionnaire, and 3-dimensional photographs.. Average follow-up period was approximately 12 months for both groups. NOSE and 3-dimensional computed tomography (3DCT) analysis demonstrated postoperative improvement in nasal airway function of those patients who underwent rhinoplasty and septoplasty simultaneously ( P < .05). Subjective assessment by patients' visual analog scale (VAS) and objective assessment by 3-dimensional stereophotography demonstrated postoperative improvement in nasal morphologies, particularly the columella deviation angle and nasal depth (representing nasal tip height), which are crucial parameters of nasal aesthetics ( P < .05).. In patients who underwent simultaneous rhinoplasty and septoplasty, nasal symmetry and ventilation function were significantly improved compared to the control group. Septum grafts could provide nasal tip support for patients with cleft lip. Three-dimensional stereophotogrammetry helped us to better visualize the surgical results. Although the septal cartilage of Asian patients is sometimes insufficient for simultaneous use for multiple grafts, septum grafts in rhinoplasty of patients with cleft lip nasal deformities could give support for nasal tips.

Topics: Airway Obstruction; Case-Control Studies; China; Cleft Lip; Cleft Palate; Esthetics, Dental; Female; Humans; Image Processing, Computer-Assisted; Male; Nasal Septum; Nose; Photogrammetry; Plastic Surgery Procedures; Retrospective Studies; Rhinoplasty; Surgical Flaps; Surveys and Questionnaires; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

Nasal stigma in patients with bilateral cleft lip and palate (BCLP) are a short columella and a flattened nasal tip.. The aim of this study was to evaluate the aesthetics of adolescents with BCLP, operated with a modified Cutting primary columella lengthening technique, associated to a modified Grayson orthopedic nasoalveolar molding (NAM).. 72 BCLP patients were operated with this approach. Standardized photographic records were taken every 2 years. A group of 23 patients between 12 and 13 years of age was compared through normalized photogrammetry to a matched control of 23 noncleft adolescents.. Nasal protrusion and length of the columella were very close to normal. On the other hand, nasolabial angle and interalar width were still excessively wide compared to the noncleft sample.. NAM and primary columella lengthening in BCLP has allowed to avoid traditional secondary columella lengthening at 5 to 6 years of age and given the patients a more pleasing, near-normal nasolabial appearance until adolescence. Some of the patients will require correction of the nasal width at a later stage.

Topics: Adolescent; Child; Cleft Lip; Cleft Palate; Esthetics, Dental; Female; Humans; Male; Nose; Palatal Obturators; Photogrammetry; Plastic Surgery Procedures; Prospective Studies; Retrospective Studies; Rhinoplasty; Treatment Outcome

To compare 3-dimensional nasal symmetry in patients with UCLP who had either rotation advancement alone or nasoalveolar molding (NAM) followed by rotation advancement in conjunction with primary nasal repair.. Pilot retrospective cohort study.. Nasal casts of 23 patients with UCLP from 2 institutions were analyzed; 12 in the rotation advancement only group (Iowa) and 11 in the NAM, rotation advancement with primary nasal repair group (New York). Casts from patients aged 6 to 18 years were scanned using the 3Shape scanner and 3-dimensional analysis of nasal symmetry performed using 3dMD Vultus software, Version 2507, 3dMD, Atlanta, GA. Cleft and noncleft side columellar height, nasal dome height, alar base width, and nasal projection were linearly measured. Inter- and intragroup analyses were performed using t tests and paired t tests as appropriate.. A statistically significant difference in mean-scaled 3-dimensional asymmetry index was found between groups with group 1 having a larger measure of asymmetry (4.69 cm. This study suggests the NAM followed by rotation advancement in conjunction with primary nasal repair approach may result in less nasal asymmetry compared to rotation advancement alone.

Topics: Adolescent; Child; Cleft Lip; Cleft Palate; Esthetics; Facial Asymmetry; Female; Humans; Imaging, Three-Dimensional; Iowa; Male; New York; Nose; Orthopedic Procedures; Pilot Projects; Retrospective Studies; Rhinoplasty; Software; Treatment Outcome

The aim of this retrospective study was to assess the influence of presurgical nasoalveolar molding (NAM) on skeletal development in patients with operated unilateral cleft lip and palate at 5 years of age.. Lateral cephalometric radiographs of 26 unilateral cleft lip and palate patients who had undergone presurgical NAM (NAM group) and 20 unilateral cleft lip and palate patients who did not have any presurgical NAM (non-NAM group) were analyzed. The radiographs were digitally traced using Quick Ceph Studio software (version 3.5.1.r (1151); Quick Ceph Systems, San Diego, Calif). Independent samples t tests were performed for statistical analysis.. No significant differences were observed in sagittal and vertical skeletal measurements between the NAM and non-NAM groups.. NAM resulted in no significant difference in skeletal development in unilateral cleft lip and palate patients compared with those without NAM in early childhood.

Topics: Alveolar Process; Cephalometry; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Male; Maxilla; Nose; Orthodontics, Corrective; Orthotic Devices; Retrospective Studies; Rhinoplasty; Stainless Steel; Treatment Outcome

1. To evaluate the orthodontic burden of care of nasoalveolar molding (NAM) and modified McNeil for the treatment of patients with complete unilateral cleft lip and palate (CUCLP). 2. To compare the esthetic outcomes of each with those of centers not utilizing infant orthopedics (IO).. Retrospective cohort study.. Institutional.. Four cohorts with repaired CUCLP (n = 149) from 3 centers.. Two cohorts were treated in the same center and had either traditional infant orthopedics (TIO) or NAM and 2 were treated in centers not employing IO.. Burden of care data for the IO groups were compared using t tests. Frontal and profile photographs at approximately age 5 were collected for ratings of nasolabial esthetics, using a modification of the Asher-McDade method. Intrarater and interrater reliabilities were determined using weighted κ statistics. Median ratings were compared using a Kruskal-Wallis test.. The burden of care of NAM was significantly greater than TIO for both the number of visits (9.9 vs 6.6, [ P < .001]); and treatment duration (127 vs 112 days, [ P < .05]). Significant differences in nasolabial esthetic ratings were noted among the 3 centers. No significant differences were observed in the nasolabial esthetic outcomes between the NAM and TIO groups.. 1. NAM required more visits and longer overall duration compared with TIO. 2. The center employing IO showed favorable nasolabial esthetics compared to those not utilizing IO. 3. No significant differences were found in the nasolabial esthetics of patients who have received NAM compared with TIO.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Infant; Male; Nose; Orthopedic Procedures; Photography; Reproducibility of Results; Retrospective Studies; Treatment Outcome

To examine the implications of nasal substitutions in the early words of toddlers with cleft palate.. Retrospective.. Thirty-four toddlers with nonsyndromic cleft palate and 20 noncleft toddlers, followed from ages 13 to 39 months.. The groups were compared for the percentage of toddlers who produced nasal substitutions in their early words. The percentage of toddlers with repaired cleft palate who produced nasal substitutions and were later suspected of having velopharyngeal dysfunction (VPD) was also examined.. Seventy-six percent of the toddlers in the cleft group (n = 26) and 35% of toddlers in the noncleft group (n = 7) produced nasal substitutions on one or more of their early words. Only 38% (10/26) of the toddlers with cleft palate who produced nasal substitutions in their early words were later diagnosed as having moderate-severe hypernasality and suspected VPD.. The presence of nasal substitutions following palatal surgery was not always an early sign of VPD. These substitutions were present in the early lexicon of children with and without cleft palate.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Infant; Longitudinal Studies; Male; Nose; Phonation; Speech Disorders; Speech Production Measurement; Velopharyngeal Insufficiency

To evaluate the aesthetics of nasolabial appearance and facial profile of children with unilateral cleft lip and palate (UCLP) submitted to 2-stage palate repair with vomerine flap.. Retrospective.. Single center.. Forty patients with UCLP, mean age of 7.81 years of both sexes, rehabilitated at a single center by 1 plastic surgeon.. Lip and anterior palate repair with nasal alar repositioning was performed at 3 to 6 months of age by Millard technique and vomer flap, respectively. Posterior palate was repaired at 18 months by Von Langenbeck technique.. Four cropped digital facial photographs of each patient were evaluated by 3 orthodontists to score the nasolabial aesthetics and profile. Frequencies of each score as well means and medians were calculated. Kappa test was used for evaluating inter- and intrarater reproducibility.. The nasal form and deviation was scored as good/very good in 70%, fair in 22.5%, and poor in 7.5% of the sample. The nasal-subnasal aesthetic was considered good/very good in 55%, fair in 30%, and poor in 15% of the sample. The lip vermilion border and the white part of surgical scar aesthetics were good/very good in 77.5% and 80%, fair in 17.5% for both categories, and poor in 5% and 2.5% of the cases, respectively. In all, 67.5% showed convex facial profile, 20% was straight, and 12.5% was concave profile.. Two-stage palatoplasty presented an adequate aesthetical results for the majority of patients with UCLP in the mixed dentition.

Topics: Child; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Male; Nose; Photography; Reproducibility of Results; Retrospective Studies; Surgical Flaps; Treatment Outcome; Vomer

The biological relatives of offspring with nonsyndromic orofacial clefts have been shown to exhibit distinctive facial features, including excess asymmetry, which are hypothesized to indicate the presence of genetic risk factors. The significance of excess soft tissue nasal asymmetry in at-risk relatives is unclear and was examined in the present study. Our sample included 164 unaffected parents from families with a history of orofacial clefting and 243 adult controls. Geometric morphometric methods were used to analyze the coordinates of 15 nasal landmarks collected from three-dimensional facial surface images. Following generalized Procrustes analysis, Procrustes ANOVA and MANOVA tests were applied to determine the type and magnitude of nasal asymmetry present in each group. Group differences in mean nasal asymmetry were also assessed via permutation testing. We found that nasal asymmetry in both parents and controls was directional in nature, although the magnitude of the asymmetry was greater in parents. This was confirmed with permutation testing, where the mean nasal asymmetry was significantly different (p < .0001) between parents and controls. The asymmetry was greatest for midline structures and the nostrils. When subsets of parents were subsequently analyzed and compared (parents with bilateral vs. unilateral offspring; parents with left vs. right unilateral offspring), each group showed a similar pattern of asymmetry and could not be distinguished statistically. Thus, the side of the unilateral cleft (right vs. left) in offspring was not associated with the direction of the nasal asymmetry in parents.

Topics: Adult; Case-Control Studies; Cleft Palate; Facial Asymmetry; Female; Genetic Predisposition to Disease; Humans; Male; Middle Aged; Nose; Parents

Oral and maxillofacial surgeons use different approaches to repair the nasal deformity of patients with a cleft lip deformity, differing in technique and timing. The aim of this longitudinal study was to analyze a new surgical technique to treat the cleft nasal deformity at 4 to 6 weeks of life using a microscope.. Twenty-seven newborn patients with a cleft lip deformity were treated by primary repair of the nasal deformity using a microscope at 4 to 6 weeks of life. The procedure includes a columellar incision, alar cartilage plication sutures according to Daniel (Plast Reconstr Surg 103:1491, 1999), and trans-columellar sutures. All patients were photographed at specific time points up to 1 year after surgery. Established angles and distances were analyzed and compared with normal values of age-matched children by Farkas (Anthropometry of the Head and Face [ed 2]. New York: Lippincott Williams and Wilkins, 1994).. All parameters improved through surgery and showed stable values at follow-up assessments. Almost ideal values concerning symmetry, as indicated by columellar deviation and nostril comparison, were obtained. Measurements of nasal morphology were similar to established norm values.. The authors recommend the early treatment of cleft nasal deformity using microscopic surgery because it shows stable and symmetrical results at least up to 1 year after surgery. Clinical observations up to adolescence suggest no growth disturbance or deterioration of nasal shape.

Topics: Anthropometry; Cleft Lip; Cleft Palate; Esthetics, Dental; Female; Humans; Infant; Infant, Newborn; Longitudinal Studies; Male; Microsurgery; Nose; Photography; Rhinoplasty; Treatment Outcome

The purpose of this study was to determine whether test-retest nasalance score variability differs between Korean children with and without cleft palate (CP) and vowel context influences variability in nasalance score.. Thirty-four 3-to-5-year-old children with and without CP participated in the study.. Three 8-syllable speech stimuli devoid of nasal consonants were used for data collection. Each stimulus was loaded with high, low, or mixed vowels, respectively. All participants were asked to repeat the speech stimuli twice after the examiner, and an immediate test-retest nasalance score was assessed with no headgear change.. Children with CP exhibited significantly greater absolute difference in nasalance scores than children without CP. Variability in nasalance scores was significantly different for the vowel context, and the high vowel sentence showed a significantly larger difference in nasalance scores than the low vowel sentence. The cumulative frequencies indicated that, for children with CP in the high vowel sentence, only 8 of 17 (47%) repeated nasalance scores were within 5 points.. Test-retest nasalance score variability was greater for children with CP than children without CP, and there was greater variability for the high vowel sentence(s) for both groups.

Topics: Child, Preschool; Cleft Palate; Female; Humans; Male; Nose; Phonation; Speech; Speech Production Measurement; Voice Quality

This study was carried out on 26 unilateral cleft lip and palate (UCLP) cases with mean age 3.6 ± 0.7 months.3D facial images were captured for each infant 2-3 days before the repair of cleft lip and at 4 months following surgery at a mean age of 8.2 ± 1.8 months, using a stereophotogrammetry imaging system. An iterative closest point (ICP) algorithm was used to superimpose the 3D facial model to its mirror image using VRMesh software. After the superimposition, the face model was divided into seven anatomical regions. Asymmetry of the entire face and of the anatomical regions was calculated by measuring the absolute distances between the 3D facial surface model and its mirror image. Colour maps were used to illustrate the patterns and magnitude of the facial asymmetry before and after surgery. There were significant decreases in the asymmetry scores for the nose, upper lip and the cheeks as a result of the surgical repair of cleft lips. Surgery did not change the magnitude of the asymmetry scores for the lower lip and chin. Residual nasolabial asymmetries were detected. The main outcome of the findings of this innovative study is to inform the required surgical refinement of primary repair of cleft lip in order to minimise facial asymmetry. We have presented a sensitive tool that could be used for comparative analysis of lip repair at various cleft centres and to guide secondary corrective surgery when required.

Topics: Cheek; Chin; Cleft Lip; Cleft Palate; Face; Facial Asymmetry; Humans; Imaging, Three-Dimensional; Infant; Lip; Nose; Photogrammetry

Rhinoplasty, as a surgical procedure to improve the appearance of the nose while preserving or improving function, is complicated and difficult to master. Revision cleft rhinoplasty offers another tier of challenge. The symmetry, proportions, and definition of the nose are affected by the native cleft deformity but also previous surgical scars, cartilage grafts, and skin excisions. Our preferred approach is to use structural cartilage grafting to establish septal and lower lateral cartilage resiliency. Internal lining deficiency is addressed with skin or lining transfer, while excess nasal tip thickness is contoured to improve definition. Of the utmost importance, the cleft nasal deformity cannot be considered in isolation, but rather a combined amalgamation of the lip muscle and scar, dentofacial occlusion, and skeletal maxillary deficiency.

Topics: Adolescent; Alveolar Bone Grafting; Cleft Lip; Cleft Palate; Humans; Male; Nasal Septum; Nose; Reoperation; Rhinoplasty; Young Adult

The study aimed to compare nasolabial aesthetics of patients with unilateral cleft lip and palate (UCLP) treated in Vietnam and Estonia using three rating methods: five-point aesthetic index, a visual analogue scale (VAS), and reference scores method.. A total of 56 patients with repaired UCLP (23 from Vietnam and 33 from Estonia) were included in this cross-sectional study. Patients' facial and profile photographs were cropped to reveal the nasolabial region and coded. Five examiners rated nasolabial aesthetics of the patients using three methods: five-point aesthetic index, 100 mm VAS, and reference scores method. Intraclass correlation coefficients were used to evaluate intrarater and interrater reliabilities.. The five-point aesthetic index had a higher reliability than VAS and reference scores method. The least aesthetic feature among Vietnamese and Estonian patients was nasal symmetry and nasolabial profile respectively. No differences in nasolabial aesthetics were found between Vietnamese and Estonian patients regardless of the rating methods (p > 0.05) except for nasal symmetry.. The five-point aesthetic index seems to produce more reproducible results. There were no significant differences in nasolabial aesthetics between the two countries. Overall average nasolabial appearance results were obtained using different treatment protocols in the two countries.

Topics: Child; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Esthetics; Estonia; Female; Humans; Lip; Male; Nose; Reference Values; Vietnam; Visual Analog Scale

Cleft lip and palate develops during embryogenesis due to an alteration in the fusion of the tissues which will form the upper lip and palate. The rate of occurrence in Chile is 1.6 per 1000 live births. The object of the present study was to determine the effectiveness of the Grayson nasoalveolar molding appliance in reducing the gap between the alveolar segments in cases of unilateral cleft lip and palate by sex, age at start of treatment, initial gap between the alveolar segments, and number of checkups.. The study design was quasi-experimental, with measurements taken before and after surgery and no control group. The authors studied the medical records and models of a sample of 52 patients with complete unilateral cleft lip and palate who were discharged after treatment using Grayson nasoalveolar molding appliance. Treatment was considered effective when the final gap was 3 mm or less. Then the percentage of cases in which treatment was effective, applying statistical tests, including log regression, to assess the influence of other variables was calculated.. The authors observed that the Grayson nasoalveolar molding appliance was effective in 69.23% of patients. Of the variables studied, the initial gap presented statistically significant differences (initial gap of 8-12 mm, effectiveness 82.61%); in the log regression, the same variable presented a statistically significant difference in the adjusted odds of effectiveness.. Grayson nasoalveolar molding appliance presents good effectiveness in reducing the gap between the alveolar segments in patients with unilateral cleft lip and palate, especially in cases with a gap of 8 to 12 mm.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Dental Impression Technique; Female; Humans; Infant; Infant, Newborn; Male; Nose; Orthodontics, Corrective

Rigid external distraction is currently performed to correct cases of severe maxillary hypoplasia. As an improvement of this technique, we propose the use of an intranasal bone-borne traction hook. This study is a retrospective chart review of the intranasal bone-borne traction hooks used in the treatment of severe maxillary hypoplasia. There were 110 patients treated with the hooks from 2005 to 2017. The maximum traction force was 7.75 kg, and there were few complications encountered during distraction. There were 76 patients who had the hooks removed under local anaesthesia. A cephalometric analysis was conducted in 56 patients. The average advancement of A-point was 9.9 ± 4.2 mm, 8.4 ± 2.5 mm, 11.0 ± 3.7 mm, 17.9 ± 4.4 mm for the trans-sutural distraction osteogenesis (DO), maxillary anterior segment DO, Le Fort I osteotomy DO and Le Fort III/II osteotomy DO, respectively. The average changes of sella-nasion-point A (SNA) were 8.89 ± 4.30 degrees, 8.21 ± 3.17 degrees, 10.49 ± 3.26 degrees, and 15.10 ± 4.00 degrees, respectively. The A point-nasion-B point (ANB) also showed increases in all procedures with P < 0.001. In conclusion, this technique sufficiently advances the midface and ensures the scars are concealed in the nasal base. The traction hook can bear a large traction force, causes minimal complications and is easily removed.

Topics: Adolescent; Adult; Anesthesia, Local; Bone and Bones; Cephalometry; Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Maxillofacial Abnormalities; Nose; Osteogenesis, Distraction; Osteotomy, Le Fort; Postoperative Complications; Retrospective Studies; Surgical Instruments; Traction; Young Adult

Normative nasalance scores are essential for the treatment and assessment purposes for clinicians. Till date, no studies have been done on nasalance in Estonia. This research was conducted to develop Estonia-specific optimized speech stimuli for Nasometer II and establish the normative nasalance scores. Ninety-two randomly selected healthy and 14 cleft palate Estonian monolingual children, aged four to seven years, were included as participants. Estonian language-specific test material was developed. The Estonian test material consisted of 24 speech stimuli. Based on the phoneme content, the stimuli were divided into three groups: (1) sentences that included oral and nasal phonemes and targeted the same phoneme distribution as in spontaneous speech, (2) sentences that included only oral phonemes and (3) sentences that were loaded with nasal phonemes. Nasometer II software was used to calculate the nasalance scores for each child and each sentence. Results indicated that there were significant differences in nasalance scores for oronasal and oral stimuli scores, and no significant differences were found in nasal stimuli scores between the study and control group. The threshold for oronasal stimuli was 42.1-18.9, oral stimuli was 27.9-3.9 and nasal stimuli was 69.4-46.2. In conclusion, Estonia-specific optimized speech stimuli were developed and normative nasalance scores were established. These normative scores can be used for the diagnosis and follow-up treatment of patients with resonance disorders, especially for patients with cleft palate.

Topics: Child; Child, Preschool; Cleft Palate; Female; Humans; Male; Nose; Phonetics; Speech; Speech Acoustics; Speech Production Measurement; Voice Quality

Bilateral complete clefts represent the result of an incomplete fusion with all the morphologic components present. It is well known that patients with bilateral cleft lip and palate have typical characteristics such as insufficient medial face development with an orthodontic class III tendency, flat nose and short columella with abnormal nasolabial angle, bilateral oronasal fistulas, alterations in the number and position of the lateral incisors, and agenesis or supernumerary teeth. Successfully solving these cases, results in a difficult challenge and studies showing extended follow-up are not frequent. Bilateral complete clefts, including medial facial dysplasia, are a rare condition, not only difficult to be included in any classification but also of complex solution. These patients require multiple surgical procedures throughout life, and long-term results are often still far from ideal. Due to surgical intervention and diminished intrinsic growth potential, surgical results may change from initially good into a progressively disappointing outcome. However, if the ideal timing and type of surgery are known, in combination with the intrinsic growth potential, these results could be ameliorated. A patient with complete bilateral cleft, presenting hypoplasia of philtrum and premaxilla, flat nose with rudimentary columella and septum, is reported. A description of her interdisciplinary treatment and long-term outcome with an adequate and stable result was observed. Being the intrinsic growth restriction mainly localized in the central mid-face, a protocol oriented to stimulate facial development during growth period could be essential to reduce the number of surgical procedures and prevent sequels. Early referral to a specialized center is mandatory to achieve a correct treatment and result.

Topics: Aftercare; Cleft Lip; Cleft Palate; Face; Female; Humans; Infant; Lip; Long Term Adverse Effects; Maxillofacial Development; Nose; Nose Diseases; Oral Fistula; Plastic Surgery Procedures; Time-to-Treatment

The objective of this study was to compare the surgical outcome between 2 patient groups with complete unilateral cleft lip and palate who underwent different types of palatoplasty.. This is a cohort study between 2 groups of patients with complete unilateral cleft lip and palate who were operated using different surgical techniques from 2008 to 2011. About 28 patients were operated using a primary lip nose repair with vomer flap for hard palate single-layer closure and delayed soft palate repair (modified Oslo protocol) and 32 patients were operated using our protocol in Lima. Data collection was accomplished by evaluation of symptomatic oronasal fistulas, presence of velopharyngeal insufficiency and evaluation of dental arch relationships (scored using the 5-year-olds' index).. Our comparative study observed statistically significant differences between the 2 groups regarding the presence of oronasal fistulas and velopharyngeal insufficiency in favor of our palatoplasty technique. A statistically significant difference was not found in functional vestibular oronasal fistula development between the studied techniques for unilateral cleft palate repair. This comparative study did not observe significant differences in dental arch relationships between the studied techniques.. In this study, better surgical outcome than modified Oslo protocol regarding oronasal fistulas and velopharyngeal insufficiency on patients with complete unilateral cleft lip and palate was observed. The results arising from this study do not provide evidence that one technique is enough to obtain better functional closure of the alveolar cleft and dental arch relationship at 5 years.

Topics: Child; Cleft Lip; Cleft Palate; Cohort Studies; Dental Arch; Female; Follow-Up Studies; Humans; Male; Nose; Oral Fistula; Palate, Hard; Palate, Soft; Peru; Surgical Flaps; Treatment Outcome; Velopharyngeal Insufficiency

Nasoalveolar molding (NAM) aims to improve nasal symmetry with a nasal stent in cleft lip and palate (CLP) patients. When plates have to be exchanged because of dentoalveolar growth or cleft reduction, the nasal stent has to be mounted onto a new plate. This procedure elongates visiting hours for patients and parents or requires second treatment sessions. This study introduces a quick-lock additive manufacturing solution for chairside nasal stent exchange called RapidNAM. A novel taping retention pin has been designed that enables nasal stent insertion. Patients with unilateral CLP were included in this study. Plaster models were digitalized and measured by two independent observers. Two methods of CAD/CAM-molding therapies were compared: (i) conventional adhesion of a nasal stent (CAD/CAM NAM); (ii) quick-lock system in which the nasal stent was transferred to another plate (RapidNAM). CAD/CAM NAM and its refinement RapidNAM significantly increased the cleft-side nasal height and tilted the nose towards symmetry. The quick-lock system minimizes wire adaptations, since the pre-existing stent can be reused. The new nasal stent development seems a feasible solution to minimize visiting hours but with clinically satisfactory results. This new nasal stent system combines traditional elements of NAM with CAD/CAM-technology.

Topics: Cleft Lip; Cleft Palate; Computer-Aided Design; Equipment Design; Humans; Imaging, Three-Dimensional; Infant, Newborn; Nose; Plastic Surgery Procedures; Stents

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Mouth; Nose; Plastic Surgery Procedures

Half-nose or heminasal aplasia is an extremely rare congenital malformation, which has a withering effect both on the patient and the family. Proboscis lateralis is a rare facial anomaly resulting in the incomplete development of one side of the nose, which was first defined in 1861 by Forster in his monograph. Proboscis lateralis, cleft nose, and nasal agenesis are rare anomalies; however, half-nose is also an extremely rare condition. In the formation of half-nose deformities, either a facial cleft or nasal dysplasia is the assumed theories of embryological origin. In the reconstruction of proboscis lateralis tissue, local flaps and forehead flaps can be used for a functional and esthetically acceptable structure. The expanded forehead flap has become commonly used in recent years. Estimating the cosmetic result of surgery is an extreme challenge because of the accompanying nasal growth of the transferred tissue and the nose. In this study, the authors report on the reconstruction of half-nose and proboscis lateralis deformity with clinical results.

Topics: Abnormalities, Multiple; Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Nose; Rhinoplasty; Surgical Flaps

The aim of this study was to describe a new approach to the presurgical orthopedic treatment of unilateral cleft lip and palate patients with severe cleft width. Modified nostril retainers manufactured from soft acrylic were used for the nasal molding. This technique enables the separation of the nasal molding without having to reduce the cleft width to 5 mm. Nasal molding with the modified nostril retainer resulted in the patient and the physician experiencing a more comfortable treatment period.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Male; Nose; Plastic Surgery Procedures; Preoperative Care

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Lip; Nasal Surgical Procedures; Nose; Oral Surgical Procedures; Plastic Surgery Procedures

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Lip; Nose; Otorhinolaryngologic Surgical Procedures

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Humans; Lip; Nose; Otorhinolaryngologic Surgical Procedures; Plastic Surgery Procedures

Bilateral cleft lip/cleft palate is associated with nasal deformities typified by a short columella. The presurgical nasoalveolar molding (NAM) therapy approach includes reduction of the size of the intraoral alveolar cleft as well as positioning of the surrounding deformed soft tissues and cartilages. In a bilateral cleft patient, NAM, along with columellar elongation, eliminates the need for columellar lengthening surgery. Thus the frequent surgical intervention to achieve the desired esthetic results can be avoided. This article proposes a modified activation technique of the nasal stent for a NAM appliance for columellar lengthening in bilateral cleft lip/palate patients. The design highlights relining of the columellar portion of the nasal stent and the wire-bending of the nasal stent to achieve desirable results within the limited span of plasticity of the nasal cartilages. With this technique the vertical taping of the premaxilla to the oral plate can be avoided.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Plastic Surgery Procedures; Stents; Tissue Expansion

To develop a reliable and easy-to-use method to assess the nasolabial appearance of 18-year-old patients with unilateral cleft lip and palate (CLP).. Retrospective analysis of nasolabial aesthetics using a 5-point ordinal scale and newly developed photographic reference scale: the Cleft Aesthetic Rating Scale (CARS). Three cleft surgeons and 20 medical students scored the nasolabial appearance on standardized frontal photographs.. VU University Medical Center, Amsterdam.. Inclusion criteria: 18-year-old patients, unilateral cleft lip and palate, available photograph of the frontal view.. history of facial trauma, congenital syndromes affecting facial appearance. Eighty photographs were available for scoring.. The interobserver and intraobserver reliability of the CARS for 18-year-old patients when used by cleft surgeons and medical students.. The interobserver reliability for the nose and lip together was 0.64 for the cleft surgeons and 0.61 for the medical students. There was an intraobserver reliability of 0.75 and 0.78 from the surgeons and students, respectively, on the nose and lip together. No significant difference was found between the cleft surgeons and medical students in the way they scored the nose ( P = 0.22) and lip ( P = 0.72).. The Cleft Aesthetic Rating Scale for 18-year-old patients has a substantial overall estimated reliability when the average score is taken from three or more cleft surgeons or medical students assessing the nasolabial aesthetics of CLP patients.

Topics: Adolescent; Attitude of Health Personnel; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Male; Netherlands; Nose; Outcome Assessment, Health Care; Photography; Reproducibility of Results; Retrospective Studies; Students, Medical; Surgeons

The present study aimed to evaluate the potential correlations between objective measurements of nasal function and self-assessed nasal symptoms or clinical findings at nasal examination among adults treated for unilateral cleft lip and palate (UCLP), respectively.. All UCLP patients born between 1960 and 1987 (n = 109) treated at a tertiary referring center were invited. Participation rate was 76% (n = 83) at a mean of 37 years after the initial surgery. All participants completed the same study protocol including acoustic rhinometry (AR), rhinomanometry (RM), anterior rhinoscopy, and questionnaires regarding self-experienced nasal symptoms.. A reduced volume of the anterior nasal cavity on the operated side (measured by AR) correlated to an expressed wish by the patient to change the function of the nose. A similar correlation was seen for the minimal cross-sectional area of anterior nasal cavity on the operated side. Furthermore, correlations were found between smaller volume and area of nasal cavity and a greater frequency of nasal obstruction. No further correlations were found.. Objective measurements partly correlate to the clinical picture among adults treated for UCLP. However, these need to be combined with findings at clinical examination and patient self-assessment to represent the complete clinical picture.

Topics: Adult; Aftercare; Cleft Lip; Cleft Palate; Female; Humans; Male; Middle Aged; Nose; Nose Diseases; Postoperative Complications; Rhinomanometry; Rhinometry, Acoustic; Self Care; Young Adult

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Rhinoplasty

For the assessment of the nasolabial appearance in cleft patients, a widely accepted, reliable scoring system is not available. In this study four different methods of assessment are compared, including 2D and 3D asymmetry and aesthetic assessments.. The data and ratings from an earlier study using the Asher-McDade aesthetic index on 3D photographs and the outcomes of 3D facial distance mapping were compared to a 2D aesthetic assessment, the Cleft Aesthetic Rating Scale, and to SymNose, a computerized 2D asymmetry assessment technique. The reliability and correlation between the four assessment techniques were tested using a sample of 79 patients.. The 3D asymmetry assessment had the highest reliability and could be performed by just one observer (Intraclass correlation coefficient (ICC): 0.99). The 2D asymmetry assessment of the nose was highly reliable when performed by just one observer (ICC: 0.89). However, for the 2D asymmetry assessment of the lip more observers were needed. For the 2D aesthetic assessments 3 observers were needed. The 3D aesthetic assessment had the lowest single-observer reliability (ICC: 0.38-0.56) of all four techniques. The agreement between the different assessment methods is poor to very poor. The highest correlation (R: 0.48) was found between 2D and 3D aesthetic assessments. Remarkably, the lowest correlations were found between 2D and 3D asymmetry assessments (0.08-0.17).. Different assessment methods are not in agreement and seem to measure different nasolabial aspects. More research is needed to establish exactly what each assessment technique measures and which measurements or outcomes are relevant for the patients.

Topics: Child; Cleft Lip; Cleft Palate; Esthetics; Humans; Imaging, Three-Dimensional; Lip; Nose; Reproducibility of Results; Treatment Outcome

There are limited numbers of studies comparing the preoperative and postoperative facial features of infants with unilateral cleft lip and palate (UCLP) using three-dimensional (3D) stereophotogrammetry. The authors attempted an anthropometric analysis of nasolabial asymmetry 1 year after primary lip repair using a handheld 3D imaging system. Five different nasolabial dimensions in 24 infants with UCLP were measured using 3D images captured during primary lip repair and again, 1 year after the repair. The nasal and upper-lip elements of the cleft side were significantly changed after primary lip repair, and nasolabial asymmetry was anthropometrically improved. This is a preliminary longitudinal observation of nasolabial growth in individuals with UCLP using 3D stereophotogrammetric technique. The authors would like to follow these children until adulthood, capturing 3D images at every intervention.

Topics: Anthropometry; Cleft Lip; Cleft Palate; Female; Humans; Imaging, Three-Dimensional; Infant; Lip; Longitudinal Studies; Male; Nose; Photogrammetry

In the evolution of cleft lip repair, there have been continuous attempts to minimize local trauma and to improve lip and nasal appearances. In order to obtain an aesthetically balanced development of midface, the primary surgical correction of the nasolabial area is of paramount importance. In this study, the importance of a back-cut extending cephalically above the inferior turbinate at the mucocutaneous junction which elevates the nostril floor on the cleft side for the purpose of achieving symmetry of the alar bases are analyzed by pre and postoperative photographic anthropometry. This study comprised of fifty cases of the unilateral complete cleft lip. At the time of surgery, the patient age ranged from 3-9 months. The surgeries, performed by a single surgeon, employed the standard Millard technique, incorporating Mohler modifications of lip repair. Anthropometric analysis revealed that the preoperative mean difference between the normal side and the cleft side was 0.2056 with a standard deviation of 0.133. In the postoperative analysis, the mean difference was reduced to 0.0174 with a standard deviation of 0.141. The paired t-test showed that the p-value is <0.001, indicating high statistical significance. To conclude, in complete unilateral cleft lip and palate, the geometrically placed nasal back-cut incision has a definite role in the correction of the alar base symmetry during primary surgery.

Topics: Cephalometry; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Infant; Male; Nose; Plastic Surgery Procedures; Postoperative Period; Prospective Studies

This study aimed to present a new technique for presurgical orthopedic treatment of patients with unilateral cleft lip with or without cleft palate (UCL±P) by means of modified nostril retainers manufactured using a special mold with soft acrylic or orthodontic acrylics material. Nasal molding with the modified nostril retainer is considerably effective and comfortable for the patient.

Topics: Acrylic Resins; Cleft Lip; Cleft Palate; Dental Materials; Humans; Nose; Preoperative Care

Topics: Cleft Lip; Cleft Palate; Continuous Positive Airway Pressure; Craniofacial Abnormalities; Head Protective Devices; Humans; Infant, Newborn; Male; Nose; Respiratory Insufficiency

Nonsyndromic orofacial clefts (OFCs) are complex traits characterized by multifactorial inheritance and wide phenotypic variability. Numerous studies have shown subtle differences in the faces of unaffected relatives from cleft families compared to controls, the implication being that such outward differences are an incomplete expression reflecting an underlying genetic predisposition. Twins discordant for OFCs provide a unique opportunity to further test this idea, as the unaffected co-twin shares on average 50% (for dizygotic twins) and 100% (for monozygotic twins) of the genetic risk factors as the affected twin. We used 3D surface imaging and spatially-dense morphometry to compare facial shape in a sample of 44 unaffected co-twins and age- and sex-matched unaffected controls (n = 241). Unaffected co-twins showed statistically significant differences in the midface, lateral upper face, and forehead regions, compared to controls. Furthermore, co-twins were characterized by a distinct pattern of midfacial retrusion, broader upper faces, and greater protrusion of the mandible and brow ridges. This same general facial pattern was shown in both unaffected monozygotic and dizygotic co-twin subsets. These results provide additional support that altered facial shape is a phenotypic marker for OFC susceptibility.

Topics: Adolescent; Adult; Aged; Brain; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Face; Female; Humans; Imaging, Three-Dimensional; Male; Mandible; Middle Aged; Nose; Phenotype; Risk Factors; Twins, Dizygotic; Twins, Monozygotic; Young Adult

The purpose of this study was to investigate ways to improve rater reliability and satisfaction in nasolabial esthetic evaluations of patients with complete unilateral cleft lip and palate (UCLP), by modifying the Asher-McDade method with use of Q-sort methodology. Blinded ratings of cropped photographs of one hundred forty-nine 5- to 7-year-old consecutively treated patients with complete UCLP from 4 different centers were used in a rating of frontal and profile nasolabial esthetic outcomes by 6 judges involved in the Americleft Project's intercenter outcome comparisons. Four judges rated in previous studies using the original Asher-McDade approach. For the Q-sort modification, rather than projection of images, each judge had cards with frontal and profile photographs of each patient and rated them on a scale of 1 to 5 for vermillion border, nasolabial frontal, and profile, using the Q-sort method with placement of cards into categories 1 to 5. Inter- and intrarater reliabilities were calculated using the Weighted Kappa (95% confidence interval). For 4 raters, the reliabilities were compared with those in previous studies. There was no significant improvement in inter-rater reliabilities using the new method. Intrarater reliability consistently improved. All raters preferred the Q-sort method with rating cards rather than a PowerPoint of photos, which improved internal consistency in rating compared to previous studies using the original Asher-McDade method. All raters preferred this method because of the ability to continuously compare photos and adjust relative ratings between patients.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Esthetics; Humans; Lip; Nose; Observer Variation; Photography; Q-Sort; Reproducibility of Results; Treatment Outcome

Cleft Lip and Palate (CLP) - a common facial malformation in newborns - is typically corrected by surgical intervention to allow for normal speech development, psychosocial adjustment, and facial attractiveness. The long term treatment outcome can be evaluated after a number of years, possibly in adulthood. We investigated the aesthetics of the nasolabial region by subjective ratings. To compare various surgical approaches we recruited 12 raters to evaluate 429 patients. Expert and lay raters judged photographs from patients, who have completed treatment with one of three different surgical strategies performed in our institution over 50 years. Facial photographs were cropped, presented to the raters in a randomized sequence, and judged by the raters on a 5 point Likert scale. The subjective ratings between the raters revealed a fair to substantial inter-rater reliability. The average ratings of the surgical outcome improved continuously over the investigated 5 decades. Despite possible differences between raters and rater groups this overall result was consistently seen in the gender groups (male/female), or expertise related groups (expert/lay). Our analysis revealed that patients with bilateral CLP scored worse than patients with unilateral CLP when treated in the fifties; more recently treated patients of both groups scored similarly.

Topics: Cleft Lip; Cleft Palate; Esthetics; Face; Female; Humans; Male; Nose; Palate; Young Adult

Primary surgical repair of the bilateral cleft lip and palate (BCLP) deformity is challenging. Infant Orthopedic (IO) procedures are often used to assist surgical reconstruction of normal anatomy. Nasoalveolar molding (NAM) is a presurgical infant orthopedic procedure that attempts to reduce the cleft nasal deformity, in addition to the lip and alveolus, leading to an esthetic primary surgical repair.. NAM provides the surgical team with a better foundation for an easier and more esthetic single stage repair at the level of nose in addition to the lip and alveolus.. Infant nasal cartilages are amenable to correction with NAM in the first few weeks of infancy when they retain their plasticity. NAM-assisted surgical repair of a complete BCLP infant is discussed. Postoperatively nasal stents were used to retain results and minimize relapse.. NAM helped correct premaxillary deviation and protrusion, reduce alveolar cleft width and improve the nasal morphology prior to surgery in the BCLP infant.. NAM helped reduce the severity of the cleft deformity in the BCLP infant and facilitated an easier and esthetic single stage primary surgical repair.

Topics: Alveolar Process; Alveoloplasty; Cleft Lip; Cleft Palate; Esthetics; Humans; Infant, Newborn; Nose; Orthopedic Procedures; Preoperative Care; Stents

This study aimed to evaluate cephalometric soft tissue characteristics in individuals with unilateral complete cleft lip and palate (UCCLP) both with and without missing teeth.. A retrospective investigation of patient records, who are being treated at the cleft lip and palate (CLP) clinics at the College of Dentistry. Ninety-six consecutive records of nonsyndromic UCCLP subjects were recruited (33 subjects without missing teeth and 63 subjects with missing teeth). Linear and angular soft tissue measurements obtained from lateral cephalometric radiographs were evaluated and compared among the studied samples.. Lower lip was significantly retruded and shorter (. In subjects with a UCCLP anomaly, missing teeth have an effect on lower lip position and length, which influenced the mentolabial sulcus. Lower lip position and length differ between cleft patients who present with either multiple missing teeth or with no missing teeth, and this needs to be considered during orthodontic treatment planning and surgical management for the cleft defect.

Topics: Anodontia; Cephalometry; Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Mandible; Maxilla; Nose; Tooth

To apply rapid prototyping (RP) technology on pre-fabricating nasoalveolar molding (NAM) appliances, and compare clinical outcomes and complications with traditional NAM appliances.. Between June 2014 and September 2016, 39 children with unilateral cleft lip and palate were included in study. Seventeen children (test group) had received novel NAM protocol by pre-fabricating NAM appliances using RP technology, and the other 22 children (control group) had received traditional NAM protocol. There was no significant difference in gender, age, the side of cleft lip and palate, and the width of the alveolar cleft gap before treatment between 2 groups (. The number of clinic visit was less in test group than in control group (. Clinical outcome of novel approach was equivalent to traditional protocol; however, the number of clinic visit decreased. With improving of RP technology, it would provide a more consistency and convenient way for sequential treatment with cleft lip and palate.. 探讨快速成型技术用于制备唇腭裂矫形术前鼻齿槽矫治器的可行性及效果。.. 以 2014 年 6 月—2016 年 9 月收治的 17 例单侧完全性唇腭裂患儿作为试验组，通过数字化模拟唇腭裂矫治过程，设计数字化模型，并采用快速成型技术制备不同治疗阶段的鼻齿槽矫治器，进行术前矫形。与同期采用传统鼻齿槽矫治器及方法治疗的 22 例患儿（对照组）进行比较。两组患儿性别、年龄、唇腭裂侧别、初始裂隙宽度比较，差异无统计学意义（. 矫治期间，试验组门诊次数显著少于对照组（. 将快速成型技术制作的鼻齿槽矫治器用于唇腭裂术前矫形，其疗效与传统鼻齿槽矫治器相似，但可减少门诊次数，为唇腭裂序列治疗提供一种更可靠和简便的方法。.

Topics: Child; Cleft Lip; Cleft Palate; Humans; Nose; Prosthesis Design; Treatment Outcome

To compare effects of secondary cleft procedures on alar base position and nostril morphology.. Retrospective review.. Multidisciplinary cleft clinic at tertiary center.. Seventy consecutive patients with unilateral clefts were grouped according to secondary procedure.. Alveolar bone graft versus total lip takedown with anatomic muscle repair versus single-stage total lip with cleft septorhinoplasty (nose-lip) versus rhinoplasty alone.. Anthropometric measurements were recorded from pre- and postoperative photographs. Ratios of cleft to noncleft side were compared within and across groups pre- and postoperatively using parametric and nonparametric tests.. Within the bone graft group, no differences were seen postoperatively in alar base position in long-term follow-up. The total lip group demonstrated greater symmetry at the alar base (P < .001), increased vertical lip dimension (P < .001), and decreased nostril height (P = .004) postoperatively. Within the nose-lip group, increased vertical dimension and alar base support (P < .001) were also seen postoperatively. Across groups, the single-stage nose-lip group demonstrated greatest alar base symmetry on worm's-eye view (P < .04).. Alar base asymmetry in patients with unilateral clefts may be related to soft tissue deficiency and was not affected by alveolar bone grafting. Total lip takedown with anatomic muscle reapproximation was associated with increased alar base symmetry and vertical lip dimension on cleft to noncleft side. Greatest symmetry at the alar base was seen following single-stage nose-lip reconstruction, which may be an effective technique for correcting the secondary cleft lip nasal deformity.

Topics: Adolescent; Alveolar Bone Grafting; Anthropometry; Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Photography; Reoperation; Retrospective Studies; Rhinoplasty; Treatment Outcome; Young Adult

To evaluate patient satisfaction and quality of life following secondary cleft rhinoplasty.. Prospective consecutive patient, single unit, single surgeon study.. Spires Cleft Centre, Salisbury, Wilshire, United Kingdom, and private practice.. 56 (27 secondary cleft rhinoplasty) patients completed evaluation forms preoperatively and 3 to 6 months postoperatively.. Subjective assessment was performed using a validated Rhinoplasty Outcomes Evaluation (ROE) questionnaire. This instrument comprises six questions that capture three quality-of-life domains: physical, mental/emotional, and social.. Rhinoplasty outcomes evaluation scores were calculated (range = 0 to 100) to indication satisfaction with rhinoplasty outcomes.. Average age was 28 years (range = 18 to 59 years). There was a significant subjective improvement in the total ROE evaluation scores from 28 ± 10 to 80 ± 11 (P < .01) in secondary cleft rhinoplasty. Similar results were achieved in noncleft rhinoplasty 34 ± 9 to 84 ± 9 (P < .01). Specific scores for nasal aesthetic appearance improved from 0.3 ± 0.2 to 3.2 ± 0.3 (P < .01) in secondary cleft rhinoplasty. No significant change was seen in breathing capacity in secondary cleft rhinoplasty (from 2.7 ± 0.3 to 3.2 ± 0.2; P = .29). All patients said they would undergo the procedure again.. Our results demonstrate high patient satisfaction after cleft rhinoplasty with particular regard to cosmetic appearance. These results are similar to those for noncleft rhinoplasty. We would recommend the use of this simple and quick validated outcome tool with all rhinoplasty patients.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Male; Middle Aged; Nose; Patient Satisfaction; Prospective Studies; Quality of Life; Rhinoplasty; Surveys and Questionnaires; Treatment Outcome

To evaluate nasal symmetry using three-dimensional photogrammetry following primary tip rhinoplasty with or without an internal splint in patients with unilateral complete cleft lip/palate.. We captured three-dimensional images of patients with unilateral complete cleft lip/palate who underwent nasolabial repair by rotation-advancement of the lip and primary tip rhinoplasty, either with or without an internal resorbable splint, and normal control subjects. We assessed nasal symmetry by identifying the plane of maximum symmetry and the root-mean-square deviation between native and reflected surfaces.. We imaged 38 controls and 38 subjects with repaired unilateral complete cleft lip/palate (20 with, 18 without an internal splint).. Nasal asymmetry root-mean-square deviation clustered between 0.19 and 0.50 mm (median = 0.24 ± 0.08 mm) for controls; whereas, those with repaired unilateral complete cleft lip/palate ranged from 0.4 to 1.5 mm (median = 0.75 ± 0.40 mm). Although root-mean-square deviation ranges overlapped, patients with repaired unilateral complete cleft lip/palate had significantly greater asymmetry than controls (P < .001). We found no difference in asymmetry between patients with or without an internal splint (P = .5).. Three-dimensional photogrammetry was used to successfully compare symmetry among different patient and control groups. Although "normal" nasal symmetry was attained in some patients following cleft lip/nasal repair, most had persistent asymmetry compared with normal controls. Placement of a resorbable internal splint did not improve symmetry in patients with unilateral complete cleft lip/palate.

Topics: Absorbable Implants; Case-Control Studies; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Imaging, Three-Dimensional; Infant; Male; Nose; Photogrammetry; Prospective Studies; Rhinoplasty; Splints; Treatment Outcome

Topics: Cleft Lip; Cleft Palate; Esthetics; Esthetics, Dental; Humans; Judgment; Nose

To investigate which of three methods of rating nasolabial appearance-esthetic index, visual analogue scale (VAS), or numerical scale with reference photographs-is optimal.. Experimental study.. Radboud University Medical Centre, The Netherlands and University of Bern, Switzerland.. Cropped photographs of 60 patients with complete unilateral cleft lip and palate (mean age = 10.8 years) were used for rating. A panel of eight raters rated four components of nasolabial morphology (nasal shape, nose deviation, vermillion border, and profile view) using three methods: 5-point esthetic index, 100 mm VAS, and 0 to 200 numerical scale with reference photographs (reference scores method). Method reliability was assessed by re-evaluation of 20 images after >1 month. Intraclass correlation coefficients were calculated to evaluate consistency of each method.. Overall reference scores method always produced more reproducible results (i.e., higher ICCs) than did VAS or the esthetic index. However, statistically significant differences were found between reference scores and esthetic index in rating nasal shape, nose deviation, and vermillion border only (P < 0.001, <0.001, and 0.012, respectively) and between reference scores and VAS in rating nose deviation and vermillion border (P < 0.001 and 0.017, respectively).. We recommend the use of reference photographs along with the VAS or numerical (from 0 to 200) semi-continuous scale. The esthetic index, based on a Likert-type scale, seems to produce the most variable results and, therefore, is not preferred.

Topics: Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Male; Nose; Photography; Plastic Surgery Procedures; Visual Analog Scale

Maxillary hypoplasia is a major issue in cleft lip and palate patients, and predictable surgical maxillary advancement is required. In the present study, the changes and stability of the maxilla and soft tissue profile achieved after the application of anterior maxillary distraction osteogenesis (AMDO) using intraoral expander in unilateral cleft lip and palate and isolated cleft palate patients were investigated by comparing to the Le Fort I osteotomy (LFI) and maxillary distraction osteogenesis (DO) with rigid external distraction (RED) system.Ten patients who underwent orthognathic treatment with AMDO were examined (AMDO group). Changes in the positions of soft and hard tissue landmarks were calculated from the lateral cephalograms taken before the distraction, at the end of the distraction, and 1 year after the surgery. They were compared with the changes in 7 other unilateral cleft lip and palate patients who underwent LFI (LFI group) and 6 others who underwent DO with RED (RED group).The mean maxillary advancement of the AMDO group was similar to that of the RED group, judged by the change of point A. During DO, the AMDO group showed less clockwise rotation of mandible compared to the RED group. The soft tissue advancement of the upper lip and nose in the AMDO group was similar to that in the RED group, which was significantly larger than that in the LFI group.Our results indicate that AMDO can be surgical option to cleft lip and palate patients with less invasive but excellent improvement in both midfacial skeletal and soft tissue similar to DO-RED.

Topics: Adolescent; Adult; Cephalometry; Cleft Lip; Cleft Palate; Female; Humans; Lip; Male; Mandible; Maxilla; Nose; Osteogenesis, Distraction; Osteotomy, Le Fort; Treatment Outcome; Young Adult

The depression of alar base in affected side in patients with unilateral complete cleft lip/palate (CL/P) is one of common clinical features. In this study, the authors try to explore the effect of subcutaneous C shape muscular flap for correcting the depression of alar base in affected side in patients with unilateral complete CL/P during primary surgery.. A total of 30 patients with unilateral complete CL/P who received primary correction of the lip nose deformity were included in this study. The C flap was used to drop and lengthen the height of upper lip in unaffected side, and the subcutaneous muscular flap was dissected from the C flap and positioned at the alar base in the affected side of upper lip to correct the depression. Then the surgical effect was evaluated based on clinical examination during follow-up.. Alar base symmetry was obtained in 26 patients of this case series, and 4 patients showed slight improvement in alar base symmetry. No major complications such as flap necrosis, infection, or hypertrophic scars were observed during surgery and follow-up. No additional incisions and operative time were necessary.. The subcutaneous C shape muscular flap described in this article could offer enough muscular support and markedly correct the depression of nostril and alar base in affected side in primary lip nose repair with no additional incisions and operative time for patients with unilateral complete CL/P.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Infant; Lip; Male; Nose; Physical Examination; Plastic Surgery Procedures; Surgical Flaps; Suture Techniques

The need for a widely accepted method suitable for a multicentre quantitative evaluation of facial aesthetics after surgical treatment of cleft lip and palate (CLP) has been emphasized for years. The aim of this study was to validate a novel computer system 'Analyse It Doc' (A.I.D.) as a tool for objective anthropometric analysis of the nasolabial region.. An indirect anthropometric analysis of facial photographs was conducted with the A.I.D. system and Adobe Photoshop/ImageJ software. Intra-rater and inter-rater reliability and the time required for the analysis were estimated separately for each method and compared.. Analysis with A.I.D. system was nearly 10-fold faster than that with the reference evaluation method. The A.I.D. system provided strong inter-rater and intra-rater correlations for linear, angular and area measurements of the nasolabial region, as well as a significantly higher accuracy and reproducibility of angular measurements in submental view. No statistically significant inter-method differences were found for other measurements.. The hereby presented novel computer system is suitable for simple, time-efficient and reliable multicenter photogrammetric analyses of the nasolabial region in CLP patients and healthy subjects.

Topics: Adolescent; Body Weights and Measures; Cleft Lip; Cleft Palate; Computer Systems; Esthetics; Female; Humans; Image Interpretation, Computer-Assisted; Lip; Male; Nose; Young Adult

The aim of this study was to use a novel system, 'Analyse It Doc' (A.I.D.) for a complex anthropometric analysis of the nasolabial region in patients with repaired unilateral complete cleft lip and palate and in healthy individuals.. A set of standardized facial photographs in frontal, lateral and submental view have been taken in 50 non-cleft controls (mean age 20.6 years) and 42 patients with repaired unilateral complete cleft and palate (mean age 19.57 years). Then, based on linear, angular and area measurements taken from the digital photographs with the aid of the A.I.D. system, a photogrammetric analysis of intergroup differences in nasolabial morphology and symmetry was conducted.. Patients with cleft lip and palate differed from the controls in terms of more than half of analysed angular measurements and proportion indices derived from linear and area measurements of the nasolabial region.. The findings presented herein imply that despite primary surgical repair, patients with unilateral complete cleft lip and palate still show some degree of nasolabial dysmorphology. Furthermore, the study demonstrated that the novel computer system is suitable for a reliable, simple and time-efficient anthropometric analysis in a clinical setting.

Topics: Adolescent; Adult; Body Weights and Measures; Cleft Lip; Cleft Palate; Computer Systems; Esthetics; Female; Humans; Image Processing, Computer-Assisted; Lip; Male; Nose; Photogrammetry; Young Adult

Due to the multidimensional nature of resonance disorders, multivariate diagnostic assessment is advisable. The nasality severity index (NSI) is based on this point of view. Because of the influence of personal and environmental variables on the current NSI, this study aims to refine this index.. Prospective case-control study.. Tertiary university hospital.. Forty-two patients with cleft lip and palate and 50 children without resonance disorders were tested.. Resonance was investigated by perceptual as well as objective measurements. A Nasometer was used to score nasalance, and spectral speech characteristics of a sustained sound /i:/ were determined, among which the voice low tone to high tone ratio (VLHR). Binary logistic regression analysis was performed to calculate the optimal index to discriminate patients from control children. Additionally, the validity of the index was determined based on data from an independent patient and control group.. The NSI 2.0, a weighted linear combination of three variables, can be obtained using the equation NSI 2.0 = 13.20 - (.0824 × nasalance /u:/ [%]) - (.260 × nasalance oral text [%]) - (.242 × VLHR 4.47*F0 [dB]). The NSI has a sensitivity of 92% and a specificity of 100%. Moreover, it has excellent validity (sensitivity 88%, specificity 89%).. The NSI 2.0 discriminates patients from control children with high sensitivity, specificity, and validity. This multiparametric method can offer a more powerful approach in the assessment and treatment planning of individuals with hypernasality.

Topics: Adolescent; Case-Control Studies; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Prospective Studies; Speech Acoustics; Speech Production Measurement; Voice Disorders; Voice Quality

To prevent the occurrence of postoperative long lip, longitudinal postoperative changes in nasolabial forms of patients with unilateral cleft lip who underwent primary lip repair with or without upward advancement of the nasolabial components were compared.. Forty-three subjects (24 unilateral cleft lip and palate [UCLP] and 19 unilateral cleft lip solely, and cleft lip and alveolus [UCL/UCLA]) who underwent primary lip repair with upward advancement of the nasolabial components (NA group) and 30 subjects (16 UCLP and 14 UCL/UCLA) without upward advancement (LA group) were enrolled.. Postoperative photos taken at 1 and 6 months and at 1, 2, and 3 years were used for measuring the heights of the nasal alar base (NBH), the columellar base (CBH), Cupid's peak (CPH), and the upper lip (ULH). The ratios of these measurements between the affected and unaffected sides were calculated in both groups.. In the LA group, the 3-year postoperative all-items ratios of UCLP were significantly larger than those at 1 month postoperatively, demonstrating drooping of the nasolabial tissues in the affected side (all P < .01). Furthermore, the 3-year postoperative CPH and ULH ratio of UCL/UCLA was significantly larger than that at 1 month postoperatively, demonstrating the long lip (P < .01). In the NA group, the NBH, CBH, and CPH ratios of both UCLP and UCL/UCLA did not show significant differences between 1 month and 3 years postoperatively.. Upward advancement of the nasolabial components prevents postoperative long lip.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Humans; Infant; Lip; Nasal Septum; Nose; Plastic Surgery Procedures

Judgement of nasolabial aesthetics in cleft lip and palate (CLP) is a vital component of assessment of treatment outcome. It is usually performed based on two-dimensional (2D) facial photographs. An increasing use of three-dimensional (3D) imaging warrants an assessment if 3D images can substitute 2D photographs during aesthetic evaluation. The aim of this study was to compare reliability of rating nasolabial appearance on 3D images and standard 2D photographs in prepubertal children.. Forty subjects (age: 8.8-12) with unilateral CLP treated according to a standardized protocol, who had 2D and 3D facial images were selected. Eight lay raters assessed nasal form, nasal deviation, vermilion border, and nasolabial profile on cropped 2D and 3D images using a 100-mm visual analogue scale (VAS). Additionally, raters answer two questions: 1. Do 2D or 3D images provide more information on nasolabial aesthetics? and 2. Is aesthetic evaluation easier on 2D or 3D images?. Intrarater agreement demonstrated a better reliability of ratings performed on 3D images than 2D images (correlation coefficients for 3D images ranged from 0.733 to 0.857; for 2D images from 0.151 to 0.611). The mean scores showed, however, no difference between 2D and 3D formats (>0.05). 3D images were regarded more informative than 2D images (P = 0.001) but probably more difficult to evaluate (P = 0.06).. Basal view of the nose was not assessed.. 3D images seem better than 2D images for rating nasolabial aesthetics but raters should familiarize themselves with them prior to rating.

Topics: Adult; Child; Cleft Lip; Cleft Palate; Esthetics; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Nose; Nose Deformities, Acquired; Photogrammetry; Photography; Plastic Surgery Procedures; Reproducibility of Results; Treatment Outcome; Visual Analog Scale

To determine whether judgment of nasolabial esthetics in cleft lip and palate (CLP) is influenced by overall facial attractiveness.. Experimental study.. University of Bern, Switzerland.. Seventy-two fused images (36 of boys, 36 of girls) were constructed. Each image comprised (1) the nasolabial region of a treated child with complete unilateral CLP (UCLP) and (2) the external facial features, i.e., the face with masked nasolabial region, of a noncleft child. Photographs of the nasolabial region of six boys and six girls with UCLP representing a wide range of esthetic outcomes, i.e., from very good to very poor appearance, were randomly chosen from a sample of 60 consecutively treated patients in whom nasolabial esthetics had been rated in a previous study. Photographs of external facial features of six boys and six girls without UCLP with various esthetics were randomly selected from patients' files. Eight lay raters evaluated the fused images using a 100-mm visual analogue scale. Method reliability was assessed by reevaluation of fused images after >1 month. A regression model was used to analyze which elements of facial esthetics influenced the perception of nasolabial appearance.. Method reliability was good. A regression analysis demonstrated that only the appearance of the nasolabial area affected the esthetic scores of fused images (coefficient = -11.44; P < .001; R(2) = 0.464). The appearance of the external facial features did not influence perceptions of fused images.. Cropping facial images for assessment of nasolabial appearance in CLP seems unnecessary. Instead, esthetic evaluation can be performed on images of full faces.

Topics: Child; Cleft Lip; Cleft Palate; Esthetics; Face; Female; Humans; Judgment; Lip; Male; Nose; Reproducibility of Results

To identify the oral and nasal microbial profile of cleft palate children and control children and to reveal interrelationships between the microbiome and the high prevalence of infectious diseases.. Saliva and nasal samples of 10 cleft palate children and 10 age-matched control children were analyzed. Total microbial genomic DNA was isolated, polymerase chain reaction-denaturing gradient gel electrophoresis was applied to obtain fingerprints, and selected bands on fingerprints were sequenced.. The results revealed a significantly lower saliva microbial diversity in cleft children and a different microbial component in both saliva and nares in children with cleft palate. A higher component similarity between the oral and nasal samples was found in the cleft group than in the control group. Lautropia species and Bacillus species were significantly less present among the saliva samples of cleft group. Dolosigranulum species and Bacillus species were significantly fewer in the nasal cavity of cleft group. Streptococcus species became much more predominant in the nasal cavity of the cleft group than in that of the control group.. A disturbed ecological ecosystem is found in oral and nasal microbiome of children with cleft palate as a consequence of the abnormal communication between the two cavities. Further studies are needed to explore the relationship between the disturbed microbiome and diseases.

Topics: Case-Control Studies; Child, Preschool; Cleft Palate; Female; Humans; Infant; Male; Microbiota; Mouth; Nose; Saliva

Acoustic studies of oral-nasal balance disorders to date have focused on hypernasality. However, in patients with cleft palate, nasal obstruction may also be present, so that hypernasality and hyponasality co-occur. In this study, normal speakers simulated different disorders of oral-nasal balance. Linear discriminant analysis was used to create a tentative diagnostic formula based on the long-term averaged spectra (LTAS) of the speech stimuli.. Eleven female participants were recorded while reading nonnasal and nasal speech stimuli. LTASs of the recordings were run for their normal oral-nasal balance and their simulations of hyponasal, hypernasal, and mixed oral-nasal balance. The amplitude values (in decibels) were extracted in 100-Hz intervals over a range of 4 kHz.. A repeated-measures analysis of variance of the normalized amplitudes revealed a resonance condition-frequency band amplitude interaction effect (P < .001). A linear discriminant analysis of the participants' LTAS led to formulas correctly classifying 80.7% of the oral-nasal balance conditions.. The simulations produced distinctive spectra enabling the creation of formulas that predicted the oral-nasal balance above chance level. Future research with speakers with oral-nasal balance disorders will be needed to investigate the potential of this approach for the clinical diagnosis of disorders of oral-nasal balance.

Topics: Adult; Cleft Palate; Discriminant Analysis; Female; Humans; Nose; Speech Production Measurement; Voice Quality; Young Adult

The Symnose semiautomated assessment of outcome of the appearance of the repaired cleft lip and nose was developed to measure asymmetry. Symnose 2 has been further developed to include quantification of the extent of scar color, intensity, and contour and midline dehiscence, underexpressed in the measurement of asymmetry.

Topics: Child; Cicatrix; Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Lip; Nose; Software

With the recent advances of surgical adjuncts including presurgical naso-alveolar molding and postoperative nasal stenting, information on the anthropometric evaluation of cleft lip nasal symmetry after primary rhinoplasty is lacking.. Twenty-nine nonsyndromic patients with complete unilateral cleft lip and palate undergoing modified rotation advancement cheiloplasty with synchronous primary rhinoplasty in our center were prospectively recruited in our study. All of them received our center's peri-operative management protocol, including presurgical naso-alveolar molding and postoperative nasal stenting. Direct anthropometric measurements of their nasal configuration were documented when they were anesthetized for primary lip repair at 3 months of age and for the primary palate repair at 12 months of age. Their nasal configurations were analyzed before primary rhinoplasty and at 9 months after rhinoplasty.. There is a statistically significant change in nasal symmetry at 9 months after the primary rhinoplasty. There is no significant correlation between the nasal configuration before and at 9 months after the primary rhinoplasty.. With significant relapse of nasal deformity at 9 months after the primary rhinoplasty despite the use of presurgical naso-alveolar molding and postoperative nasal stenting, overcorrection of the nasal configuration at primary rhinoplasty should be considered for optimal long-term nasal symmetrical outcome.

Topics: Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Nose; Rhinoplasty; Treatment Outcome

Patients with unilateral complete cleft lip and palate (UCLP) have a characteristic bilateral septal deformity, and septal deviation can be associated with turbinate hyperplasia, leading to paradoxical nasal obstruction. The purpose of the present study was to measure and compare the bony and mucosal dimensions of the inferior turbinate on the cleft and non-cleft sides in patients with UCLP.. We implemented a retrospective cohort study of patients with UCLP who had undergone computed tomography (CT) scan between 2002 to 2013. Subjects who had undergone nasal revision, septoplasty, turbinectomy, or Le Fort I osteotomy before the imaging date were excluded. The primary predictor variable was the subject side (cleft vs noncleft side), and the primary outcome variable was the turbinate cross-sectional area. The secondary predictor variables included the site of measurement along the sagittal axis of the turbinate (anterior, middle, posterior) and tissue type (turbinate whole, bone, mucosa). The Wilcoxon signed rank test for paired samples compared the turbinate dimensions on the cleft and noncleft sides, with statistical significance set at P ≤ .05.. The sample included 53 patients (32 females and 21 males). The inferior turbinates were measured bilaterally on CT images obtained at a mean age of 12.2 ± 0.8 years. The inferior turbinate on the noncleft side was significantly larger in both bone and mucosa (P = .003). This relationship did not change when controlling for age and gender.. The results of the present study have confirmed bony and mucosal enlargement of the inferior turbinate on the noncleft side in patients with UCLP. This might contribute to bilateral nasal obstruction and should be considered during treatment planning for nasopharyngeal and orthognathic surgery.

Topics: Adolescent; Anatomy, Cross-Sectional; Cephalometry; Child; Cleft Lip; Cleft Palate; Cohort Studies; Female; Follow-Up Studies; Humans; Hyperplasia; Hypertrophy; Male; Nasal Bone; Nasal Mucosa; Nasal Septum; Nose; Retrospective Studies; Tomography, X-Ray Computed; Turbinates

The primary objective of this study was to investigate whether growth impairment in children with cleft lip is caused by reconstructing the nostril floor using lateral nasal and premaxillary mucoperiosteal flaps. The effects on growth and symmetry of tip rhinoplasty at the time of initial repair, as well as cleft sidedness are similarly investigated.. An Institutional Review Board approved, retrospective, single-center study at an academic children's hospital from July 2005 to 2010 was designed. Seventy-four patients with unilateral cleft lip ± palate were followed postsurgical repair of the cleft lip deformity. Serial digital photographs from clinical encounters were analyzed. Anthropometric measurements of 10 soft tissue landmarks were extracted from anteroposterior and submental vertex views at serial visits; growth velocities, defined as c = Δd/Δt, were generated using linear mixed models on selected measurements to study time-related changes on growth. The effects on growth and symmetry of primary tip rhinoplasty on perinasal landmarks and nostril floor reconstruction with medial and lateral nasal mucoperiosteal flaps on perioral and perinasal landmarks were analyzed. Proxies for midfacial height (en-al) and maxillary height (al-ch) were used to evaluate the effect of mucoperiosteal dissection, whereas nostril width, height, and angle were used as proxies to evaluate the effects of tip rhinoplasty.. Seventy-four patients met the inclusion criteria. Midface height (En-Al) growth velocity was 0.014 mm/month and maxillary height (Al-Ch) was relatively stable at -0.0059 mm/month with no difference between the subgroups. Nostril height growth was -0.0046 mm/month, nostril width was 0.03 mm/mo, and nostril angle -0.09 °/mo showed no difference between patient with or without primary tip rhinoplasty. Patients with complete cleft showed more asymmetry than those with incomplete clefts in lip and maxillary landmarks at T0 (P < 0.001).. Mucoperiosteal reconstruction of the nostril floor at the time of lip repair does not affect anthropometric growth velocities over a 5-year follow-up. Within the limitations of the selected landmarks, primary tip rhinoplasty did not significantly improve symmetry at 5 years, but also did not affect the growth of the nose. Patients with complete clefts display more postoperative asymmetry than those with incomplete clefts.

Topics: Anatomic Landmarks; Cephalometry; Child, Preschool; Cleft Lip; Cleft Palate; Cohort Studies; Facial Asymmetry; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Infant; Lip; Male; Maxilla; Nasal Cartilages; Nasal Mucosa; Nose; Periosteum; Photogrammetry; Retrospective Studies; Rhinoplasty; Surgical Flaps; Treatment Outcome; Vertical Dimension

Topics: Anthropometry; Cleft Lip; Cleft Palate; Humans; Lip; Nose

The first part of this study validated an automated computer-based method of identifying the three-dimensional midfacial plane in children with unrepaired cleft lip. The purpose of this second part is to develop computer-based methods to quantify symmetry and to determine the correlation of these measures to clinical expectations.. A total of 35 infants with unrepaired unilateral cleft lip and 14 infant controls.. Six computer-based methods of quantifying symmetry were developed and applied to the three-dimensional images of infants with unilateral cleft lip before and after cleft lip repair and to those of controls.. Symmetry scores for cleft type, changes with surgery, and individual subjects ranked according to cleft severity were assessed.. Significant differences in symmetry scores were found between cleft types and found before and after surgery. Symmetry scores for infants with unilateral cleft lip approached those of controls after surgery, and there was a strong correlation with ranked cleft severity.. Our computer-based three-dimensional analysis of nasolabial symmetry correlated with clinical expectations. Automated processing made measurement convenient. Use of these measures may help to objectively measure cleft severity and treatment outcome.

Topics: Cleft Lip; Cleft Palate; Face; Facial Asymmetry; Female; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Infant; Lip; Male; Nose; Prospective Studies; Treatment Outcome

Presurgical correction of severe nasal deformities before cheiloplasty is often recommended for infants with cleft lip and palate. This article describes an approach for the computer-aided design and fabrication of a nasal molding stent. A 3-dimensional photogrammetric system was used to obtain the shape information of the nosewing that was then built as the nostril support for the nasal molding stent. The stent was fabricated automatically with a rapid prototyping machine. This technique may be an alternative approach to presurgical nasal molding in the clinic. Moreover, the patient's nasal morphology can be saved as clinical data for future study.

Topics: Cleft Lip; Cleft Palate; Computer-Aided Design; Humans; Imaging, Three-Dimensional; Infant; Nose; Prosthesis Design; Stents

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Preoperative Care

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Preoperative Care

Because primary nasal correction by the time of lip repair has been incorporated into the treatment approach, many patients have benefitted from this combined procedure. However, primary nasal correction cannot guarantee an excellent result. Although overcorrection has been mentioned as a treatment rationale of the unilateral cleft lip nasal deformity, a detailed approach and quantitative evidence of the rationale are rare. This study evaluates whether overcorrection in the primary repair results in a quantitative improvement in nasal appearance.. In this retrospective study, the inclusion criteria were patients with complete unilateral cleft lip and palate who underwent primary lip and nose repair by the age of 3 to 4 months. Primary nasal overcorrection was achieved by application of muscle to septal base suture, alar cinching suture and Tajima reversed U incision method. Patients were further divided into an overcorrected (n = 19) and nonovercorrected group (n = 19). The following parameters were identified on basilar photos of all patients taken at least 12 months after repair, ratios of cleft to noncleft side in each patient were taken and the mean for each parameter calculated: Ac angle (ACA/ACA'), alar height (AH/AH'), alar width (AW/AW'), nostril height (NH/NH`), nostril width (NW/NW'), and columellar deviation from the midline (CD/NW). The means of the overcorrected and nonovercorrected groups were then compared using the t test.. From all investigated measuremens, Alar height (AH/AH': overcorrected, 0.983 to nonovercorrected, 0.941; P = 0.03) and nostril height ratio (NH/NH') (NH/NH': covercorrected, 0.897 to nonovercorrected, 0.680; P = 0.003) showed statistically significant differences favoring the overcorrected group at least 12 months after surgery.. Primary nasal overcorrection including muscle to columella base suture, alar cinch suture, and Tajima method resulted in quantitatively more long-term symmetric alae and nostril height compared to nonovercorrected patients.

Topics: Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Nose; Retrospective Studies; Rhinoplasty; Treatment Outcome

The paper presents the analysis of clinical case of endoscopic nasal breath restoration and elimination of the secondary cleft lip nasal deformity in 27 years old patient with unilateral choanal atresia and secondary nasal deformity after rhinocheiloplasty. Preoperative examination revealed the absence of nasal breathing on collateral side due to complete bone choanal atresia. Surgical treatment included endoscopic choanal repair, elimination of the secondary nasal deformity, septoplasty, conchotomy and lateroposition of the inferior conchae. The treatment resulted in nasal breath restoration and elimination of nasal deformity. Long-term follow-up at 1 and 12 months post-operatively proved stable positive aesthetic and functional results.. Представлен анализ эндоскопического восстановления носового дыхания и устранения деформации костно-хрящевого отдела носа у пациента 27 лет, перенесшего ринохейлопластику по поводу врожденной левосторонней расщелины губы и неба. На этапе предоперационной подготовки было выявлено отсутствие носового дыхания на здоровой стороне вследствие полной костной атрезии хоаны (АХ). Проведено хирургическое лечение в объеме эндоскопического устранения АХ справа, устранения деформации костно-хрящевого отдела носа, септопластики, конхотомии и латеропозиции нижних носовых раковин. В результате проведенного лечения восстановлено носовое дыхание и устранена деформация костно-хрящевого отдела носа. Контрольное обследование через 1 и 12 мес подтвердило стойкий положительный эстетический и функциональный отдаленные результаты.

Topics: Adult; Choanal Atresia; Cleft Lip; Cleft Palate; Endoscopy; Humans; Male; Nose; Recovery of Function; Respiration; Rhinoplasty; Treatment Outcome

Bilateral cleft lip and palate repair usually requires secondary corrective intentions. Abbe flap is a useful option and has many modifications for revision surgeries of cleft lip nose deformities. Study evaluated a 23-year-old woman for secondary cleft lip nose correction. The authors performed a composite Abbe flap, which included mental bone for repairing the upper lip harmony, maintaining the columellar elongation and bridging central alveolar bone cleft. No complications were observed and aesthetic and functional improvement was maintained. Presented new modification of Abbe flap maintains not only upper lip relaxation (additional skin soft tissue replacement) and columellar lengthening (extended designed flap) but also alveolar cleft reconstruction (vascularized mental bone) by a composite flap. Also, this modification prevents additional surgeries for alveolar cleft repair in cleft lip nose patients.

Topics: Alveolar Bone Grafting; Bone Transplantation; Cleft Lip; Cleft Palate; Esthetics; Female; Follow-Up Studies; Humans; Lip; Nose; Plastic Surgery Procedures; Reoperation; Surgical Flaps; Young Adult

Secondary cleft rhinoplasty represents a particular surgical challenge. The authors have identified the deficit in skeletal projection of the cleft-sided piriform rim as an important contributor to the pathology. A graft is described to augment the piriform crest on the cleft side. This foundation graft is suture fixated to the piriform crest after complete release of all soft tissue attachments to the alar base. The foundation graft is articulated with a long alar strut graft, which allows for powerful projection of the cleft-sided nasal tip. An advancement flap of vestibular skin is described to correct the vestibular stenosis. A transplant of diced cartilage in fascia is added to augment maxillary soft tissue volume. Subjective and objective measures of form and function are presented in a retrospective series of five cases, illustrating the efficacy of the techniques described.

Topics: Adult; Cartilage; Cleft Lip; Cleft Palate; Fascia; Humans; Male; Nose; Reoperation; Retrospective Studies; Rhinoplasty; Ribs

The stigma of nasal deformity due to a congenital cleft lip-palate has an undeniable influence on the affected patient's life. It is therefore of interest to investigate if efforts to reduce esthetic and functional impairments by rhinoplasty (single or multiple) can result in an increased satisfaction with appearance and a self-perception similar to the noncleft population. Retrospective scoring before and after rhinoplasty using the validated Derriford Appearance Scale (DAS-59) and subsequent statistical evaluation and comparison to datasets available in the literature for further classification was used. Of the 61 patients who underwent at least one rhinoplasty, 26 responded to all questions. The mean age of responders was approximately 30 years of age and the male:female ratio was 1:1.2. The scale showed a significant overall improvement after surgery. The full scale and all subscale scores of the DAS-59 were significantly reduced after surgery demonstrating an improvement in the respective categories. Most importantly, if postoperative results were compared with a population concerned and unconcerned about appearance, no difference "facial self-consciousness" of appearance was apparent. Also postoperative subscores for "general self-consciousness" (GSC) and "social self-consciousness" of appearance (SSC) showed no difference from those obtained from the population concerned about appearance. The postoperative subscore for "sexual and bodily self-consciousness" of appearance (SBSC) indicated improvement beyond the level found in the concerned control population. Due to only a low improvement in the difference compared with the subscore representing a "negative self-concept," a statistically significant difference to the concerned population remained, possibly indicating that therapy beyond surgery is needed for improvement. After rhinoplasty, the investigated group of cleft lip-palate patients with nasal deformities showed an improvement in their self-conceived appearance as measured by the DAS-59. Their assessment of self-appearance was comparable to that of a group of noncleft persons with concern about their appearance. Taken together, rhinoplasties, primary and revision, add to the psychosocial well-being and an improved self-perception enhancing quality of life and enabling a more normal life. Further research is needed to clarify how the low reduction found in the "negative self-concept" may be addressed successfully.

Topics: Adult; Cleft Lip; Cleft Palate; Esthetics; Female; Follow-Up Studies; Humans; Male; Nose; Rhinoplasty; Self Concept; Time Factors; Treatment Outcome

The purpose of this study was to compare professional rating and patient satisfaction of nasal appearance after secondary cleft rhinoplasty.. We used a cross-sectional study design and enrolled German adults with nonsyndromic unilateral or bilateral cleft lip and/or palate (UCLP and BCLP, respectively) undergoing secondary cleft rhinoplasty from January 2001 to December 2013. The predictor variable was professional rating. The outcome variable was patient satisfaction with postoperative nasal aesthetics. Other study variables included patient age and gender, type of surgery, and patient rating of nasal function. Appropriate descriptive and univariate statistics were computed, and a P value of <0.05 was regarded as statistically significant. Inter-rater reliability was assessed by the use of Cohen's kappa coefficient.. The study sample consisted of 242 adult cleft patients of mean age of 22.1 ± 9.2 years (range 14-64), including 97 females (40 %) and 176 unilateral clefts (73 %). Most of the patients reported good function (82 %) and good aesthetics (74 %). The main professional rating was good aesthetics (65 %). Analysis of inter-observer reliability revealed significant differences between patient satisfaction and professional assessment (κ = 0.385; P < 0.0001).. Although most of the patients were satisfied with the functional and aesthetic results of secondary cleft rhinoplasty, patient self-assessment of nasal appearance differed from professional assessment.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Esthetics; Female; Humans; Male; Middle Aged; Nose; Observer Variation; Patient Satisfaction; Reoperation; Rhinoplasty; Young Adult

A surgical strategy for definitive cleft lip-nasal correction that stably provides symmetric and natural nasal forms has not been established to date. The purpose of this study was to describe our surgical techniques and 3-dimensional (3D) assessment results after the definitive correction of cleft lip-nose deformity using an extended spreader cartilage graft with a cross-lap joint technique to achieve a rigid strut for lower lateral cartilage repositioning to obtain a desirable nasal tip projection.. This study enrolled 14 patients with unilateral cleft lip (UCL) with or without cleft palate and 8 patients with bilateral cleft lip (BCL) with or without cleft palate who underwent definitive nose correction and were followed for 1 to 3 years. All patients were treated by open rhinoplasty, repositioning of the lower lateral cartilage, use of an extended spreader cartilage graft with a cross-lap joint technique for nasal tip support, and medial-upward advancement of nasolabial components with vestibular expansion by a free mucosal graft. For the BCL nose, pedicle flaps from rim skin were used for columella lengthening. Preoperative and postoperative nasal forms were 3-dimensionally analyzed by use of 3D images serially obtained in 12 patients.. The postoperative nasal forms were satisfactorily improved in all patients, without any serious postoperative complications. Preoperative and postoperative 3D analyses showed a significantly projected nasal tip in the postoperative noses of patients in both the UCL group and the BCL group (P < .01 and P < .05, respectively) and a sharper nasal tip angle in the BCL group (P < .05). Lateral deviation of the nasal tip was significantly improved in the center of the face in patients in the UCL group (P < .01).. The results of this study suggest that the extended spreader cartilage graft using the cross-lap joint graft technique is useful to provide a desirable projection of the nasal tip in the center of the face on definitive correction of both UCL and BCL nose deformities.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Male; Nasal Cartilages; Nasal Mucosa; Nose; Rhinoplasty; Surgical Flaps; Treatment Outcome

The aim of this study was to explore the experience of parents caring for an infant with a cleft lip and palate receiving nasoalveolar moulding.. Nasoalveoral moulding is a pre-surgical orthopedic appliance used to approximate an infant's cleft lip and palate, mould the nose and reduce surgical correction. Use of nasoalveolar moulding can be intensive, costly and lengthy requiring parental commitment to the process since it involves several months of weekly visits for appliance adjustment. Although extensive research has been conducted on surgical outcomes after use, little evidence exists pertaining to parental experiences caring for an infant undergoing the nasoalveolar moulding treatment process.. The qualitative design phenomenology was used to best capture parents' lived experiences.. Eight mothers and four fathers participated in informal, semi-structured interviews during the months of April-May 2010.. Four themes were identified: (1) You do what you have to do; (2) We weren't left alone in the dark; (3) It's just amazing to see the difference; and (4) It's like nothing ever happened. Findings indicated that despite some difficulties, parents' were dedicated to the treatment process and expressed the benefits exceeded any additional work nasoalveolar moulding required.. Multiple recommendations to assist parents with the nasoalveolar moulding treatment process were identified. Improving nasoalveolar moulding education and providing support can substantially improve challenges that are experienced by parents throughout this process - strengthening the importance of their role for successful nasoalveolar moulding outcomes.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Parent-Child Relations

The aim of this study was to propose a classification for unilateral cleft lip and palate (UCLP) malformations based on cone beam computed tomography (CBCT) images, as well as to estimate the amount of bone necessary for grafting, and to evaluate the relationship of this volume with scores obtained using the classification. CBCT images of 33 subjects with UCLP were evaluated according to gap, arch, nasal, and dental parameters (GAND classification). Additionally, these defects were segmented and the amount of graft needed for alveolar bone grafting was estimated. The reproducibility of GAND classification was analyzed by weighted kappa test. The association of volume assessment with the classification (gap and nasal parameters) was verified using analysis of variance, while the intra-observer agreement was analyzed using the intra-class correlation coefficient. The intra-observer reproducibility of the classification ranged from 0.29 to 0.92 and the inter-observer agreement ranged from 0.29 to 0.91. There were no statistically significant values when evaluating the association of the volume with the classification (P>0.05). The GAND classification is a novel system that allows the quick estimation of the extent and complexity of the cleft. It is not possible to estimate the amount of bone needed for alveolar bone grafting based on the classification; individualized surgical planning should be done for each patient specifically.

Topics: Cleft Lip; Cleft Palate; Cone-Beam Computed Tomography; Dental Arch; Humans; Nose; Observer Variation; Reproducibility of Results; Tooth Abnormalities

High-quality aesthetic outcomes are of paramount importance to children growing up after cleft lip and palate surgery. Establishing a validated and reliable assessment tool for cleft professionals and families will facilitate cleft units, surgeons, techniques, and protocols to be audited and compared with greater confidence. This study used exemplar images across a five-point aesthetic scale, identified in a pilot project, to score lips and noses as separate units and compared these human scores with computer-based SymNose symmetry scores.. Forty-five assessors (17 cleft surgeons nationally and 28 other cleft professionals from the UK South West Tri-centre units), scored 25 standardized photographs, uploaded randomly onto a Web-based platform, twice. Each photograph was shown in three forms: lip and nose together, and separately cropped images of nose only and lip only. The same images were analyzed using the SymNose software program.. Scoring lips gave the best intrarater and interrater reliabilities. Nose scores were more variable. Lip scoring associated most closely with the whole-image score. SymNose ranking of the lip images related highly to the same ranking by humans (p = 0.001). The exemplar images maintained their established previous ranking.. Images illustrating the aesthetic outcome grades are confirmed. The lip score is reliable and seems to dominate in the whole-image score. Noses are much harder to score reliably. It appears that SymNose can score lip images very effectively by symmetry. Further use of SymNose will be investigated, and families of children with cleft will trial the scoring system.. Therapeutic, III.

Topics: Cleft Lip; Cleft Palate; Esthetics; Humans; Image Processing, Computer-Assisted; Lip; Nose; Observer Variation; Outcome Assessment, Health Care; Photography; Software

It is essential to have a reliable assessment method in order to compare the results of cleft lip and palate surgery. In this study the computer-based program SymNose, a method for quantitative assessment of the nose and lip, will be assessed on usability and reliability.. The symmetry of the nose and lip was measured twice in 50 six-year-old complete and incomplete unilateral cleft lip and palate patients by four observers. For the frontal view the asymmetry level of the nose and upper lip were evaluated and for the basal view the asymmetry level of the nose and nostrils were evaluated.. A mean inter-observer reliability when tracing each image once or twice was 0.70 and 0.75, respectively. Tracing the photographs with 2 observers and 4 observers gave a mean inter-observer score of 0.86 and 0.92, respectively. The mean intra-observer reliability varied between 0.80 and 0.84.. SymNose is a practical and reliable tool for the retrospective assessment of large caseloads of 2D photographs of cleft patients for research purposes. Moderate to high single inter-observer reliability was found. For future research with SymNose reliable outcomes can be achieved by using the average outcomes of single tracings of two observers.

Topics: Child; Cleft Lip; Cleft Palate; Diagnosis, Computer-Assisted; Female; Humans; Imaging, Three-Dimensional; Lip; Male; Nose; Observer Variation; Photography; Reproducibility of Results

Oblique facial clefts are extremely rare and cause significant morbidity. Treatment of these clefts is complex and requires a fundamental understanding of cleft classification and techniques used for treatment of clefts.. We describe a novel single-staged technique to repair the Tessier no. 4 soft tissue cleft and reconstruct the buccal sulcus and bilaminar lower eyelid by preserving normally excised tissue combined with standard procedures. We also present a case report demonstrating the technique in an adolescent female. The procedure incorporates turnover flaps from soft tissue preservation within the cleft, a Mustarde cheek advancement flap, an anatomical subunit lip repair, a dorsal nasal Rieger flap for ala repositioning, and a lateral nasal flag flap.. The single-staged soft tissue repair eliminated the Tessier no. 4 cleft while simultaneously reconstructing the bilaminar lower eyelid and buccal lining. Our patient had no complications within the perioperative period.. This novel single-staged technique for the treatment of the soft tissue Tessier no. 4 cleft not only repairs the cleft but also reconstructs the buccal sulcus and bilaminar lower eyelid with turnover flaps preserved from the normally discarded excess soft tissue within the cleft. The novel repair allows for the creation of a deeper fornix to aid with placement of an orbital prosthesis and is ideal for use in underserved or remote locations.

Topics: Adolescent; Cleft Palate; Craniofacial Dysostosis; Eye Abnormalities; Eyelids; Female; Humans; Maxillofacial Abnormalities; Nose; Plastic Surgery Procedures; Surgical Flaps

This article describes the development and initial validation of an objective measure of nasal air emission (NAE) using nasal accelerometry.. Nasal acceleration and nasal airflow signals were simultaneously recorded while an expert speech language pathologist modeled NAEs at a variety of severity levels. In addition, microphone and nasal accelerometer signals were collected during the production of /pɑpɑpɑpɑ/ speech utterances by 25 children with and without cleft palate. Fourteen inexperienced raters listened to the microphone signals from the pediatric speakers and rated the samples for the severity of NAE using direct magnitude estimation. Mean listener ratings were compared to a novel quantitative measurement of NAE derived from the nasal acceleration signals.. Correlation between the nasal acceleration energy measure and the measured nasal airflow was high (r = .87). Correlation between the measure and auditory-perceptual ratings was moderate (r = .49).. The measure presented here is quantitative and noninvasive, and the required hardware is inexpensive ($150). Future studies will include speakers with a wider range of NAE severity and etiology, including cleft palate, hearing impairment, or dysarthria. Further development will also involve validation of the measure against airflow measures across subjects.

Topics: Accelerometry; Air; Child; Cleft Palate; Female; Humans; Male; Nose; Reproducibility of Results; Severity of Illness Index; Speech

Nasal deformity associated with cleft lip and palate is a highly challenging reconstructive problem in rhinoplasty. In the literature, several operative solutions and evaluation methods have been described, however these do not offer a standard procedure for the surgeon. Our aim was to standardize our surgical technique-as much as the uniqueness of each case allowed it-based on the most frequent deformities we had faced; and to evaluate our results via a postoperative patient satisfaction questionnaire. Between 2012 and 2014 12 consecutive patients with combined cleft lip and palate deformities underwent secondary nasal and septal correction surgery with the same method by the same surgeon. The indications of surgery were, on one hand, difficult nasal breathing and altered nasal function (tendency for chronic rhinosinusitis) and on the other hand the aesthetic look of the nose. No exclusion criteria were stated. In our follow-up study we evaluated our results by using a modified Rhinoplasty Outcome Evaluation (ROE) questionnaire: patients answered the same four questions pre- and postoperatively. Data were statistically analyzed by t-test.. Based on the questionnaire, all patients experienced improvement of nasal breathing function, improved appearance of the nose and less stigmatization from the society. According to the t-test, all scores of the four questions improved significantly in the postoperative 4-6 months, compared with the preoperative scores.. In our opinion with our standardized surgical steps satisfactory aesthetic and functional results can be achieved. We think the modified ROE questionnaire is an adequate and simple method for the evaluation of our surgical results.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Cohort Studies; Esthetics; Female; Follow-Up Studies; Humans; Male; Nasal Septum; Nose; Patient Satisfaction; Retrospective Studies; Rhinoplasty; Risk Assessment; Surveys and Questionnaires; Treatment Outcome; Young Adult

The aim of this study is to assess the esthetic and morphologic outcomes before surgery using nasoalveolar molding (NAM) therapy in children with unilateral cleft lip and palate.. A prospective analysis was performed.. The study was carried out in the Congenital Malformations Craniofacial and Cleft Lip and Palate Unit, Hospital Virgen de las Nieves, Andalusian Health Service, Granada (Spain).. Twenty consecutively enrolled infants ranging in age from 7 to 30 days with nonsyndromic unilateral cleft lip and palate treated from 2008 to 2012.. All patients were treated with NAM appliances to align the alveolar segments and reduce severity of the nasal deformity.. The extraoral nasal measurements were performed on casts and nasal photographs. The measurements consisted of bialar width (BAW), columellar deviation (CD), cleft nostril height (CNH), cleft nostril width (CNW), non-CNH, non-CNW, and the deviation of the columella to the horizontal line represented by bilateral pupil line (BIA). The authors have made the measurements following Barilla method. Also 2 intraoral measurements were taken.. Following NAM the extraoral records showed a statistically significant decrease in CD (P < 0.0001), CNW (P < 0.0001), and BAW (P < 0.001). Furthermore, statistically significant increases in CNH (P < 0.05) and BIA (P < 0.0001) were observed.Following Barilla measurements, the authors have found a high percentage of symmetry in all the nasal measurements after the NAM therapy.Intraoral results showed a statistically significant decrease in the gap between the greater and lesser alveolar segments and a statistically significant increase in maxillary arch width.. Nasoalveolar molding improves nasal symmetry and achieves an improvement of all maxillary alveolar dimensions, increasing alveolar rim width, reducing the size of alveolar cleft gap, and improving shape of the maxillary dental arch. As a consequence of reducing the alveolar and nasal deformities before surgery, it is expected that the primary repair will be easier for the surgeon and more successful.

Topics: Alveolar Process; Child; Cleft Lip; Cleft Palate; Dental Arch; Esthetics; Female; Humans; Infant; Male; Maxilla; Nasal Septum; Nose; Preoperative Care; Prospective Studies; Rhinoplasty; Splints; Treatment Outcome

Secondary cleft lip nasal deformities corrective procedures are still a major concern for the maxillofacial surgeons.

Topics: Adult; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Lip; Male; Nose; Nose Deformities, Acquired; Rhinoplasty; Surgical Flaps; Treatment Outcome; Young Adult

This article presents a technique for fabricating a modified nasoalveolar molding appliance using 0.032-inch titanium-molybdenum alloy wire for nasal stents incorporating a double loop. The nasal stents are included in the acrylic molding plate at the time the appliance is inserted. The acrylic retention button used in a conventional appliance is replaced by a simple retention hook fabricated using titanium-molybdenum alloy wire. This technique is an effective alternative to a conventional appliance, and it simplifies the appliance-modification process during follow-up visits.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Molybdenum; Nose; Palatal Obturators; Prosthesis Design; Stents; Titanium

To measure cross-sectional areas of the main nasal constrictions as a function of the distance into the nose in children with repaired unilateral cleft lip and palate, as compared with children without cleft, by acoustic rhinometry.. Prospective analysis.. Craniofacial anomalies hospital.. A total of 39 children with repaired unilateral cleft lip and palate and 34 healthy controls without cleft, of both genders, aged 6 to 9 years. Interventions/Variables : Nasal cross-sectional areas measured at the three main deflections of the rhinogram (CSA1, CSA2, CSA3) and distances from the nares (dCSA1, dCSA2, dCSA3) were assessed by means of an Eccovision Acoustic Rhinometer, before and after nasal decongestion. Differences were analyzed at a significance level of 5%.. At the cleft side, mean CSA1, CSA2, and CSA3 values ± standard deviation obtained before nasal decongestion were 0.17 ± 0.12, 0.29 ± 0.20, and 0.40 ± 0.28 cm(2), respectively, and dCSA1, dCSA2, and dCSA3 values ± standard deviation were 2.02 ± 0.40, 3.74 ± 0.51, and 5.50 ± 0.44 cm, respectively. At the noncleft side, these were 0.33 ± 0.11, 0.65 ± 0.28, and 0.90 ± 0.43 cm(2), respectively, and 1.69 ± 0.48, 3.67 ± 0.53, and 5.60 ± 0.70 cm, respectively. Increased cross-sectional area means were seen after nasal decongestion in the control and cleft groups. Mean cross-sectional area values at the cleft side were significantly smaller than noncleft side and control values, and the mean dCSA1 value was smaller at the noncleft side before and after decongestion.. Objective assessment of internal nasal dimensions has shown that children with unilateral cleft lip and palate have a significant impairment of nasal patency due to the reduced cross-sectional areas seen at the cleft side.

Topics: Case-Control Studies; Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Prospective Studies; Rhinometry, Acoustic

To present a conceptual framework of caregiver coping and adaptation to early cleft care using nasoalveolar molding.. In-depth interviews were conducted at three time points with caregivers of infants with cleft lip or cleft lip and palate whose children had nasoalveolar molding to treat their cleft. Qualitative data were analyzed using modified grounded theory.. Most caregivers expressed initial apprehension and anxiety about the responsibilities of care associated with nasoalveolar molding (e.g., changing and positioning tapes, cleaning the appliance). In subsequent interviews, caregivers often reported positive feelings related to their active participation in their child's treatment for cleft. These positive feelings were associated with increased self-esteem and feelings of empowerment for the caregivers. Although caregivers also identified burdens associated with nasoalveolar molding (e.g., stress related to lip taping, concerns about the appliance causing sores in their child's mouth, travel to weekly appointments), they tended to minimize the impact of these issues in comparison with the perceived benefits of nasoalveolar molding.. Despite the increased burden of care, many caregivers of infants with cleft used nasoalveolar molding as a problem-focused coping strategy to deal with their child's cleft. Completing nasoalveolar molding was often associated with positive factors such as increased empowerment, self-esteem, and bonding with their infant.

Topics: Adaptation, Psychological; Adult; Alveolar Process; Caregivers; Cleft Lip; Cleft Palate; Female; Humans; Infant; Interviews as Topic; Male; Nose; Orthodontic Appliances; Power, Psychological; United States

A 19-year-old woman was referred for nasal breathing and aesthetic concerns regarding her nose. A computed tomography scan revealed a massive osseous shield anterior to the piriform aperture. Furthermore, there was a submucosal median alveolar cleft, and the posterior arch of C1 was missing. The magnetic resonance imaging brain scan revealed a curvilinear lipoma of corpus callosum. The ectopic nasal bone was removed by open rhinoplast,y and nasal function and aesthetics were restored. The described features defy conventional clinical diagnosis and severity classifications and present a diagnostic conundrum somewhere between a mild form of frontonasal dysplasia, oculoauriculofrontonasal syndrome, and Pai syndrome.

Topics: Abnormalities, Multiple; Adolescent; Cervical Vertebrae; Cleft Palate; Corpus Callosum; Diagnosis, Differential; Female; Humans; Lipoma; Magnetic Resonance Imaging; Nose; Phenotype; Tomography, X-Ray Computed

Bilateral cleft lip and palate with a severe hypoplastic and backward rotated premaxilla and lack of soft tissues is a rare congenital facial deformity. No treatment protocol for this type of cleft is widely accepted. In patient with bilateral cleft lip and palate, the premaxilla was protracted by nasoalveolar molding before lip surgery. The nasal tip was elevated and the columella lengthened by nasal components incorporated into the palatal guidance plate. After 4 months of nasoalveolar molding, surgery could be performed without complications. Postoperative use of a guidance plate prevented relapse of the premaxillary segment, the nasal conformers maintained the nostril form.

Topics: Cleft Lip; Cleft Palate; Humans; Infant, Newborn; Maxilla; Nose; Palatal Obturators; Plastic Surgery Procedures

To assess the facial esthetics of patients with complete bilateral cleft lip and palate, and to compare the judgment of raters related and unrelated to cleft care.. The sample comprised 23 adult patients (7 women and 16 men) with a mean age of 26.1 years, rehabilitated at a single center. Standardized photographs of the right and left facial profile were taken of each patient and subjectively evaluated by 25 examiners: 5 orthodontists and 5 plastic surgeons with expertise in oral cleft rehabilitation, 5 orthodontists and 5 plastic surgeons without expertise in oral cleft rehabilitation, and 5 laypersons. The facial profiles were classified into 3 categories: esthetically unpleasant, esthetically acceptable, and esthetically pleasant. Intraexaminer and interexaminer agreements were evaluated with the Spearman correlation coefficient and Kendall coefficient of concordance. The differences between rater categories were analyzed using the Student-Newman-Keuls test (with P < .05 indicating a statistically significant difference).. Most of the sample was classified as esthetically acceptable. Orthodontists and plastic surgeons related to oral cleft rehabilitation gave the best scores to the facial profiles, followed by layperson examiners and by orthodontists and plastic surgeons unrelated to oral cleft rehabilitation. The middle third of the face, the nose, and the upper lip were frequently pointed out as contributors to the esthetic impairment.. The facial profile of rehabilitated adult patients with complete bilateral cleft lip and palate was considered esthetically acceptable because of morphologic limitations in the structures affected by the cleft. Laypersons and professionals unrelated to oral cleft rehabilitation seem to be more critical regarding facial esthetics than professionals involved with cleft rehabilitation.

Topics: Adult; Age Factors; Attitude of Health Personnel; Attitude to Health; Cleft Lip; Cleft Palate; Esthetics; Face; Female; Humans; Lip; Male; Maxilla; Nose; Observer Variation; Orthodontics; Orthodontics, Corrective; Orthognathic Surgical Procedures; Photography; Surgery, Plastic; Young Adult

Obtaining an esthetic and functional primary surgical repair in patients with complete cleft lip and palate (CLP) can be challenging because of tissue deficiencies and alveolar ridge displacement. This study aimed to describe surgeons' assessments of presurgical deformity and predicted surgical outcomes in patients with complete unilateral and bilateral CLP (UCLP and BCLP, respectively) treated with and without nasoalveolar molding (NAM). Cleft surgeon members of the American Cleft Palate-Craniofacial Association completed online surveys to evaluate 20 presurgical photograph sets (frontal and basal views) of patients with UCLP (n = 10) and BCLP (n = 10) for severity of cleft deformity, quality of predicted surgical outcome, and likelihood of early surgical revision. Five patients in each group (UCLP and BCLP) received NAM, and 5 patients did not receive NAM. Surgeons were masked to patient group. Twenty-four percent (176/731) of surgeons with valid e-mail addresses responded to the survey. For patients with UCLP, surgeons reported that, for NAM-prepared patients, 53.3% had minimum severity clefts, 58.9% were anticipated to be among their best surgical outcomes, and 82.9% were unlikely to need revision surgery. For patients with BCLP, these percentages were 29.8%, 38.6%, and 59.9%, respectively. Comparing NAM-prepared with non-NAM-prepared patients showed statistically significant differences (P < 0.001), favoring NAM-prepared patients. This study suggests that cleft surgeons assess NAM-prepared patients as more likely to have less severe clefts, to be among the best of their surgical outcomes, and to be less likely to need revision surgery when compared with patients not prepared with NAM.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Female; Health Care Surveys; Humans; Male; Nose; Orthotic Devices; Plastic Surgery Procedures; Prognosis

Orthognathic surgery alters the position of maxilla and mandible, and consequently changes the nasal shape. The nasal change remains a concern to Asian patients. The aim of this study was to measure the nasal changes using a novel three-dimensional photographic imaging method.. A total of 38 patients with Class III malocclusion and prognathism were enrolled. All patients underwent two-jaw surgery with the standard technique. A nasal alar cinching suture was included at the end of procedure. Facial landmarks and nasal morphology were defined and measured from pre- and postoperative three-dimensional photographic images. Intra-rater errors on landmark identification were controlled. Patient's reports of perceptual nasal changes were recorded.. The average width of the alar base and subalare remained similar after surgery. Alar width was increased by 0.74 mm. Nasal height and length remained the same. Nasolabial angle increased significantly. The area of nostril show revealed a significant increase and was correlated with a decrease of columella inclination. Nasal tip projection decreased significantly, by 1.99 mm. Preoperative nasal morphology was different between patients with and without cleft lip/palate, but most nasal changes were concordant. In the self-perception, 37% of patients reported improved nasal appearance, 58% reported no change, and 5% were not satisfied with the nasal changes.. After the surgery, characteristic nasal changes occurred with an increase of nasolabial angle and nostril show, but a preserved nasal width. The majority of patients did not perceive adverse nasal changes.

Topics: Adolescent; Adult; Body Image; Cleft Palate; Female; Humans; Imaging, Three-Dimensional; Male; Malocclusion, Angle Class III; Mandible; Maxilla; Nose; Orthognathic Surgical Procedures; Photogrammetry; Postoperative Complications; Prognathism; Retrospective Studies; Taiwan; Young Adult

To analyze, using 3-dimensional photogrammetric data, midfacial soft tissue and volumetric changes in the cleft maxilla after 1- or 2-piece Le Fort I (LF1) advancement.. This was a retrospective study of patients with cleft and maxillary hypoplasia who underwent LF1 advancement. The primary predictor variable was the type of advancement (1 piece vs 2 pieces). Outcome measurements were changes in soft tissue linear measurements (subnasale [Sn], labium superius [LS], and stomion [SO]) and midfacial volume after maxillary advancement.. Eleven patients (7 male, 4 female) underwent LF1 advancements (4 underwent 2-piece advancement). The mean maxillary advancement was 6.2 ± 1.7 mm. Soft tissue changes at the Sn, LS, and SO were 5.2 ± 2.0, 5.8 ± 2.5, and 5.2 ± 1.8 mm, respectively. The average volume change was 12.2 ± 5.7 cm(3). The mean ratios of soft tissue change to the amount of maxillary advancement (millimeters per millimeter) at the Sn, LS, and SO were 0.89 ± 0.49, 0.97 ± 0.44, and 0.89 ± 0.34, respectively. Volume increased by 2.1 ± 1.3 cm(3)/mm. Patients undergoing 1-piece advancement had greater mean advancement and greater soft tissue changes at the LS and SO (P < .03). After controlling for the amount of advancement, 1-piece LF1 osteotomy showed significantly greater improvements at the LS and SO (P < .04).. Midface advancement at the LF1 level in patients with cleft consistently expands upper lip soft tissue and midfacial volume. Greater changes at the LS and SO were seen with 1-piece than with 2-piece osteotomy.

Topics: Adolescent; Cephalometry; Cleft Lip; Cleft Palate; Cohort Studies; Face; Female; Follow-Up Studies; Humans; Imaging, Three-Dimensional; Incisor; Lip; Male; Malocclusion, Angle Class III; Mandible; Maxilla; Nasal Bone; Nose; Osteotomy, Le Fort; Photogrammetry; Retrospective Studies; Sella Turcica; Treatment Outcome

Assess facial asymmetry in subjects with unilateral cleft lip (UCL), unilateral cleft lip and alveolus (UCLA), and unilateral cleft lip, alveolus, and palate (UCLP), and to evaluate which area of the face is most asymmetrical.. Standardized three-dimensional facial images of 58 patients (9 UCL, 21 UCLA, and 28 UCLP; age range: 8.6-12.3 years) and 121 controls (age range 9-12 years) were mirrored and distance maps were created. Absolute mean asymmetry values were calculated for the whole face, cheek, nose, lips, and chin. One-way analysis of variance, Kruskal-Wallis, and t-test were used to assess the differences between clefts and controls for the whole face and separate areas.. Clefts and controls differ significantly for the whole face as well as in all areas. Asymmetry is distributed differently over the face for all groups. In UCLA, the nose was significantly more asymmetric compared with chin and cheek (P = 0.038 and 0.024, respectively). For UCL, significant differences in asymmetry between nose and chin and chin and cheek were present (P = 0.038 and 0.046, respectively). In the control group, the chin was the most asymmetric area compared to lip and nose (P = 0.002 and P = 0.001, respectively) followed by the nose (P = 0.004). In UCLP, the nose, followed by the lips, was the most asymmetric area compared to chin, cheek (P < 0.001 and P = 0.016, respectively).. Despite division into regional areas, the method may still exclude or underrate smaller local areas in the face, which are better visualized in a facial colour coded distance map than quantified by distance numbers. The UCL subsample is small.. Each type of cleft has its own distinct asymmetry pattern. Children with unilateral clefts show more facial asymmetry than children without clefts.

Topics: Alveolar Process; Anatomic Landmarks; Cephalometry; Cheek; Child; Chin; Cleft Lip; Cleft Palate; Face; Facial Asymmetry; Female; Humans; Imaging, Three-Dimensional; Lip; Male; Nose; Photogrammetry

We report an oblique lip-alveolar band, a rare banding of soft tissue that involves the lip and alveolus, which we have found in five patients with cleft lip and palate (0.2%), compared with an incidence of the Simonartz lip-lip band of 5.7%). To our knowledge this has not been reported previously. In two patients the bands affected the cleft lip and alveolus bilaterally, with or without the palatal cleft, and in three the bands were unilateral cleft lip and alveolus with or without the palatal cleft.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Lip; Mouth Mucosa; Nose

Nasoalveolar molding (NAM) has gained wide acceptance and evidence in cleft therapy. However, standardized treatment protocols and experiences recorded from European centres are lacking. The results of 40 infants with cleft lip and palate treated with presurgical NAM according to the Grayson technique were analyzed. Standardized parameters of cleft width and nasal symmetry were measured in pre- and posttreatment plaster casts and in digitalized 3-dimensional STL models. Statistical analyses were performed by using Student's t-test in a per-protocol manner. 27 out of 40 infants completed NAM and were analyzed. In 13 patients NAM was either temporarily interrupted or terminated prematurely due to skin irritations or lack of parental support. These cases were excluded from statistical analysis, resulting in a drop-out rate of 32.5%. Intersegmental alveolar distance (ISAD), intersegmental lip distance (ISLD), nostril height (NH), nostril width (NW) and columella deviation angle (CDA) were significantly changed in unilateral cleft lip and palate (UCLP) (n = 8). In unilateral cleft lip (UCL) (n = 9), only ISLD, NH and CDA were significantly changed. ISAD of the right and left side, ISLD of the right and left side, premaxilla deviation angle, nostril height and columella length were changed significantly in bilateral cleft lip and palate (BCLP) cases (n = 10). NAM is a suitable presurgical treatment modality. A positive effect has been seen in UCLP and BCLP infants, as compared with their birth status.

Topics: Anthropometry; Cleft Lip; Cleft Palate; Female; Humans; Infant; Lip; Male; Nose; Plastic Surgery Procedures; Preoperative Care; Treatment Outcome

Facial clefts involve complex abnormalities. The therapy is elaborate, and a critical evaluation of therapeutic outcome is required. Our study analyzed the lip and nose deformities associated with unilateral clefts in a prospective longitudinal study.. A total of 33 patients with a cleft lip or cleft lip and alveolus (UCL) and 46 with a cleft lip and palate (UCLP) were treated using a similar concept. Standardized photographs were taken preoperatively (age 0.4-0.52 years) and again aged 4.04-4.59 years. Anthropometric analyses were performed and compared with age-matched normal values.. Nostril width (UCL = 1.01, UCLP = 1.03) and nostril floor width (UCL = 1.02, UCLP = 1.04) were almost symmetric. Nasal tip angles were normalized by surgery. Upper labial height improved, but remained slightly reduced (-4% to -6%). Upper vermillion length was increased (15-17%), and vermillion width was reduced (-12% to -13%) postoperatively. A significantly flatter nostril axis inclination persisted, especially on the affected side (UCL: 37.5°; UCLP: 38.5°), when compared with normal values (53.8°).. Most cleft irregularities were almost eliminated by therapy; however, the outcome is still not satisfactory for some parameters. The rehabilitation of patients with clefts remains a considerable surgical challenge. Facial anthropometric assessment must play an important role in order to detect and overcome therapeutic shortcomings.

Topics: Anatomic Landmarks; Case-Control Studies; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Infant; Lip; Longitudinal Studies; Male; Nasal Cartilages; Nose; Photography; Prospective Studies; Rhinoplasty; Treatment Outcome

Holoprosencephaly (HPE) presents with a spectrum of severity, but in its totality is the most common malformation of the embryonic forebrain occurring 1 in 10,000 to 1 in 20,000 live births. Due to the poor prognosis, treatment of mid-face clefts in HPE patients have classically been addressed in a delayed fashion after 1-year of age. Improvements in the ability to manage medical complications associated with HPE along with an increased understanding and lower mortality rates in less severe forms have challenged these previous practiced routines. Accompanied by advances in understanding of HPE and identification of genes responsible for sporadic forms, we are able to better guide timing of surgical intervention. We present a patient with lobar HPE and a type IV facial deformity treated with early repair of the median facial cleft. We believe this treatment strategy was safe, given her relatively good prognosis. We propose that patients with HPE displaying less severe neural non-cleavage may be good candidates for earlier two-stage intervention.. The historically poor prognosis of patients with holoprosencephaly (HPE) has led to midline facial clefts have being addressed in a delayed fashion after 1-year of age. Improvements in the ability to manage medical complications associated with HPE and lower mortality rates in less severe forms have challenged these previous practiced routines. Additionally, the identification of genes responsible for sporadic forms of HPE can better guide timing of surgical intervention and improve developmental outcomes. We present a patient with lobar HPE and a type IV facial deformity treated with an early two-stage repair of the median facial cleft. We propose patients with HPE displaying less severe neural non-cleavage may be good candidates for earlier intervention.

Topics: Agenesis of Corpus Callosum; Cleft Lip; Cleft Palate; Dura Mater; Female; Holoprosencephaly; Humans; Infant, Newborn; Nasal Cavity; Nose; Palate, Hard; Palate, Soft; Plastic Surgery Procedures; Rhinoplasty; Tomography, X-Ray Computed

Residual deformity of the nose, not lip, continues to be the greater challenge in UCCLP rehabilitation. Platform distortions often re-emerge following primary reconstruction revealing the stereotypical cleft-nose. Nasal alveolar molding reduces nose asymmetry. However, this study applies directional mechanics to the underlying platform distortions and soft tissue nose, introducing a novel device addressing the distorted septo-premaxillary junction.. Retrospective assessment of 47 UCCLP patients by 2-dimensional photographic analysis with 24 subjects treated by dento-maxillary advancement (DMA) and nasal septum button-head pin (NSBP), 17 having nasal molding (NM), compared to 23 subjects without nose treatment, 16 with DMA and 7 with passive plates. Measurements were assessed by t tests, ≤ 05 confidence.. Frontal view: nose-treatment sample achieved ideal ala-bases vertical symmetry (p = 0.00065 & 0.00073); significantly improved ala-rims "slump" angle (p = 0.0071). Both samples had nose positioning within the facial frame like non-cleft population. Sub-nasal view: significant differences were for columella angle (p = 0.0015), nares "offset" (p = 0.002), and columella symmetry (p = 0.022) with nose-treatment achieving near ideal columella symmetry score (0.92) vs. (0.81).. NM and the novel NSBP procedures integrated with the platform correction effect of the DMA successfully treated at three distorted anatomic-levels native to UCCLP to improve nasal aesthetics.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Cohort Studies; Esthetics; Female; Humans; Infant; Male; Nasal Cartilages; Nasal Septum; Nose; Orthopedic Procedures; Palatal Obturators; Photography; Plastic Surgery Procedures; Preoperative Care; Retrospective Studies; Rhinoplasty

The authors present a novel nasoalveolar molding protocol by prefabricating sets of nasoalveolar molding appliances using three-dimensional technology.. Prospectively, 17 infants with unilateral complete cleft lip and palate underwent the authors' protocol before primary cheiloplasty. An initial nasoalveolar molding appliance was created based on the patient's first and only in-person maxillary cast, produced from a traditional intraoral dental impression. Thereafter, each patient's molding course was simulated using computer software that aimed to narrow the alveolar gap by 1 mm each week by rotating the greater alveolar segment. A maxillary cast of each predicted molding stage was created using three-dimensional printing. Subsequent appliances were constructed in advance, based on the series of computer-generated casts. Each patient had a total three clinic visits spaced 1 month apart. Anthropometric measurements and bony segment volumes were recorded before and after treatment.. Alveolar cleft widths narrowed significantly (p < 0.01), soft-tissue volume of each segment expanded (p < 0.01), and the arc of the alveolus became more contiguous across the cleft (p < 0.01). One patient required a new appliance at the second visit because of bleeding and discomfort. Eleven patients had mucosal irritation and two experienced minor mucosal ulceration.. Three-dimensional technology can precisely represent anatomic structures in pediatric clefts. Results from the authors' algorithm are equivalent to those of traditional nasoalveolar molding therapies; however, the number of required clinic visits and appliance adjustments decreased. As three-dimensional technology costs decrease, multidisciplinary teams may design customized nasoalveolar molding treatment with improved efficiency and less burden to medical staff, patients, and families.. Therapeutic, IV.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Computer-Aided Design; Dental Impression Technique; Female; Follow-Up Studies; Humans; Infant; Male; Nose; Orthodontics, Corrective; Preoperative Care; Prospective Studies; Radiographic Image Enhancement; Treatment Outcome

The aim of the study was to evaluate the soft tissue thickness of the patients affected by unilateral cleft lip and palate (UCLP) and to compare the findings with a matched control group without cleft using cone beam computed tomography (CBCT).. The study sample consisted of 66 patients (31 women and 35 men) divided into 2 groups as UCLP group (34 patients; 23 men and 11 women; 9 right sided and 25 left sided; mean age: 14.11 ± 3.48 years) and control group (32 patients; 12 men and 20 women; mean age: 15.10 ± 3.13 years) without any cleft. Angular angle between Nasion-A line and Nasion-B line (ANB), angle between Sella-Nasion line and Gonion-Menton line (SN-MP) and linear (glabella, nasion, rhinion, subnasale, labrale superius, stomion, labrale inferius, labiomentale, pogonion, and gnathion) measurements were done using CBCT. Student t test was performed to compare the variables between the groups.. Soft tissue thickness values for men were higher in both groups, except for rhinion and glabella. Subnasale for women (P = 0.000), men (P = 0.006), and total samples (P = 0.000) and the variable of the labrale superius for men (P = 0.047) and total samples (P = 0.040) were found to be statistically significantly thinner in the UCLP group. SN-MP had significant affect on subnasale thickness (R = 15.8; Beta = -0.397; P = 0.001).. Thickness of the subnasale and the labrale superius were found to be statistically significantly thinner in the UCLP group compared with the controls.

Topics: Adolescent; Case-Control Studies; Cephalometry; Child; Chin; Cleft Lip; Cleft Palate; Cone-Beam Computed Tomography; Face; Female; Forehead; Humans; Lip; Male; Mandible; Maxilla; Nasal Bone; Nose; Sella Turcica; Sex Factors; Young Adult

The Asher-McDade system is a 5-point ordinal scale frequently used to rate the components of nasolabial appearance, including nasal form and nasal symmetry, in unilateral cleft lip and palate. Although reference photographs illustrating this scale have been identified for the frontal and right profile view, no reference photographs exist for the basal view. The aim of this study was to identify reference photographs for nasal form and nasal symmetry from the basal view to illustrate this scale and facilitate its use. Four raters assessed nasolabial appearance (form and symmetry) on basal view photographs of 50 children (average age 8 years) with a repaired cleft lip. Intraclass correlation coefficients show fair to moderate inter-rater reliability. Cronbach α indicated strong agreement between raters (0.77 nasal form; 0.78 nasal symmetry; 0.80 overall), along with low duplicate measurement error and strong internal consistency between the measures. The photographs with the highest agreement among raters were selected to illustrate each point on the 5-point scale for nasal form and for nasal symmetry, resulting in the selection of 10 reference photographs. The basal view reference photograph set developed from this study may complement existing reference photograph sets for other views and facilitate rating tasks.

Topics: Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Reproducibility of Results

Unilateral cleft lip and palate (UCLP) occurs when the maxillary and nasal facial prominences fail to fuse correctly during development, resulting in a palatal cleft and clefted soft and hard tissues of the dentoalveolus. The UCLP deformity may compromise an individual's ability to eat, chew, and speak. In this retrospective cross-sectional study, cone beam computed tomography (CBCT) images of 7-17-year-old individuals born with UCLP (n = 24) and age- and sex-matched controls (n = 24) were assessed. Coordinate values of three-dimensional anatomical landmarks (n = 32) were recorded from each CBCT image. Data were evaluated using principal coordinates analysis (PCOORD) and Euclidean distance matrix analysis (EDMA). Approximately 40% of morphometric variation is captured by PCOORD axes 1-3, and the negative and positive ends of each axis are associated with specific patterns of morphological differences. Approximately 36% of facial skeletal measures significantly differ by confidence interval testing (α = 0.10) between samples. Although significant form differences occur across the facial skeleton, strong patterns of morphological differences were localized to the lateral and superioinferior aspects of the nasal aperture, particularly on the clefted side of the face. The UCLP deformity strongly influences facial skeletal morphology of the midface and oronasal facial regions, and to a lesser extent the upper and lower facial skeletons. The pattern of strong morphological differences in the oronasal region combined with differences across the facial complex suggests that craniofacial bones are integrated and covary, despite influences from the congenital cleft.

Topics: Adolescent; Anatomic Landmarks; Case-Control Studies; Cephalometry; Child; Cleft Lip; Cleft Palate; Cone-Beam Computed Tomography; Cross-Sectional Studies; Facial Bones; Female; Humans; Imaging, Three-Dimensional; Male; Multivariate Analysis; Nose; Retrospective Studies; Skull

Maxillary hypoplasia is a common sequela of cleft lip and palate. Its surgical treatment consists in a maxillary advancement by distraction or by conventional orthognathic surgery but morphological results are unpredictable. Our goal in this study was to see if the esthetical results (on the lip and the nose) of maxillary advancement were correlated to the preservation of lateral incisor space of the cleft side.. This retrospective study included 38 patients operated between 2002 and 2013. Unilateral clefts were studied independently from bilateral clefts. Profile aesthetics was evaluated independently and subjectively by two surgeons and scored on an 8-point scale. The result was classified as "good" if the score was superior or equal to 6. The score was correlated to the following parameters: amount of maxillary advancement, upper incisor axis, preservation of the missing lateral incisor space.. In the "good result" group, the space of the lateral incisor was less often preserved. The nasolabial angle was more open and the upper central incisor axis more vertical. These results were more pronounced in bilateral clefts, but also found in unilateral clefts.. Under reservation of the subjective evaluation and of the small number of patients, it seemed that lateral incisor space closure improved the profile of patients treated by maxillary advancement for cleft lip and palate sequelae.

Topics: Adolescent; Adult; Child; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Lip; Male; Malocclusion; Maxilla; Maxillary Osteotomy; Nose; Orthognathic Surgical Procedures; Plastic Surgery Procedures; Retrospective Studies; Young Adult

Secondary rhinoplasty in cleft lip and palate (CLP) is commonly the last step in a set of surgical procedures that result in a variable but typically intensive change in facial appearance. However, there is evidence that the sentiment about the aesthetic and functional outcomes between patients and surgeons is different. The present study aimed to evaluate the subjective and objective outcomes of secondary rhinoplasty in patients with CLP.. Secondary rhinoplasty was performed in 10 patients with repaired unilateral CLP via a standardized open approach. For the subjective evaluation, the patients completed the rhinoplasty outcome evaluation (ROE) questionnaire. Pre- and postoperative photographic documentation served as the basis for the objective evaluation, which included the following: (1) assessment by five specialists at craniofacial malformation consultation appointments and by three doctors in continuing education using the Asher-McDade aesthetic index (AMAI) rating, and (2) metric facial analysis to determine the nasofrontal angle and the nasolabial angle.. Patient satisfaction was high, based on the evaluation of the ROE questionnaire. The analysis of the AMAI rating questionnaire showed no significant differences between the positive ratings of the 'experienced' and 'inexperienced' doctors. In contrast, there was an obvious and significant difference between the 'preoperative' and 'postoperative' time points for questions 1-3. The metric analysis showed statistically significant improvements of the nasolabial angle and the nasofrontal angle. The subjective and objective outcome evaluations were descriptively congruent.. The data suggest that standardized secondary rhinoplasty in CLP leads to both a subjective and a statistically significant objective improvement of facial appearance and thus may support the psychosocial rehabilitation of affected patients. Furthermore, our results showed that the subjective and objective outcome evaluations of secondary rhinoplasty were largely compatible.

Topics: Adolescent; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Male; Nose; Patient Satisfaction; Reoperation; Rhinoplasty; Surveys and Questionnaires; Treatment Outcome; Young Adult

Nasal aesthetic changes after cleft orthognathic surgery remain understudied. Previous scarring associated with prior cleft surgery may affect the predictability of outcomes after jaw surgery. This study evaluates changes in nasal aesthetics using three-dimensional photography after Le Fort I advancement in patients with nonsyndromic cleft-related maxillary hypoplasia. Cephalometric parameters were recorded pre- and postoperatively. Three-dimensional photogrammetric imaging analyzed changes in interalar width (IAW), internostril width (INW), nasal tip projection (NTP), collumelar length (CL), nasal labial angle (NLA), and nasal length (NL). Statistical significance between pre- and postoperative data was determined using T-tests for each parameter. Eleven patients underwent either single piece Le Fort I osteotomy and advancement, (3 bilateral, 4 unilateral cleft lip, and palate), or 2-piece advancement (2 bilateral, 2 unilateral). Average nasal soft tissue changes were IAW 1.9 mm (0.4-4.2), INW -0.2 mm (-2.8 to 1.6), NTP -1.0 mm (-4.0 to 2.0), CL -0.7 mm (-2.9 to 1.5), NLA -0.2° (-13.9 to 15.1), and NL -0.7 mm (-4.3 to 1.5), (P = 0.001, 0.6, 0.08, 0.01, 0.9, 0.2). For single-piece osteotomy alone changes were IAW 2.1 mm (0.6-4.1), INW -0.6 mm (-2.8 to 1.7), NTP -1.9 mm (-4.0 to 0.3), CL -1.2 mm (-2.9 to 0.03), NLA -1.3° (-13.9 to 15.0), and NL -1.1 mm (-4.3 to 0.7), (P = 0.007, 0.3, 0.009, 0.0002, 0.7, 0.2). For 2-piece osteotomy alone changes were IAW 1.6 mm (-0.4 to 3.3), INW 0.5 mm (0.4-1.6), NTP 0.5 mm (-1.1-2.0), CL 0.2 mm (-1.4 to 1.5), NLA 2.8° (-7.6 to 10.1), and NL -0.1 mm (-1.4 to 1.5), (P = 0.2, 0.4, 0.5, 0.6, 0.5, 0.9). Cleft-related scarring and malposition affect changes in nasal aesthetics following maxillary advancement that are different to the noncleft population. Two-piece Le Fort I increases variability of changes in nasal aesthetics compared with single-piece advancement.

Topics: Adolescent; Cephalometry; Cicatrix; Cleft Lip; Cleft Palate; Esthetics; Female; Follow-Up Studies; Humans; Imaging, Three-Dimensional; Lip; Male; Malocclusion, Angle Class III; Maxilla; Nose; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Photogrammetry; Retrospective Studies

Cleft lip repair is performed in the supine position, tilting the head back under general anesthesia. However, postoperative results are evaluated in the upright position while patients are awake. The purpose of this study was to anthropometrically assess whether nasolabial features of infants with unilateral cleft lip are influenced by posture and anesthesia.. Three-dimensional facial images in a preoperative upright position and operating supine position under general anesthesia were captured from 51 consecutive infants with unilateral cleft lip. Twenty-four indirect anthropometric measurements (11 for the nose and 13 for the lip elements) were considered on each infant.. In the supine position under general anesthesia, alar surface distance was significantly shorter (p < 0.001). Regarding lip measurements, medial lip height of the cleft side and philtrum height were significantly smaller (p < 0.05 and p < 0.05, respectively), whereas vermilion height was greater (p < 0.01). In addition, the cleft width and lip width were significantly broader (p < 0.001 and p < 0.001, respectively) after general anesthesia.. Several nasolabial alteration patterns are found after general anesthesia that are presumably attributable to cessation of nasal breathing and the action of muscle relaxation. Surgeons should take these nasolabial changes into account during preoperative planning and postoperative assessment.

Topics: Cleft Lip; Cleft Palate; Humans; Imaging, Three-Dimensional; Infant; Lip; Nose; Photogrammetry; Supine Position

Cleft surgery is marked by all the controversies and the multiplication of protocols, as it has been shown by the Eurocleft study. The objective of this pilot study is to start a comparison and analyzing procedure between primary surgical protocols in French centers.. Four French centers with different primary surgical protocols for cleft lip and palate repair, have accepted to be involved in this retrospective study. In each center, 20 consecutive patients with complete cleft lip and palate (10 UCLP and 10 BCLP per center), non syndromic, have been evaluated at a mean age of 5 [4,6]. In this first part, the aesthetic results of nose and lip repair were assessed based on the scale established by Mortier et al. (1997).. Considering nose outcome, primary cleft repair surgery including a nasal dissection gives a statistically significant benefit in terms of septum deviation. Considering lip result, muscular dehiscence rate is significantly higher in BCLP patients with a two-stage lip closure. The centers using Millard one-stage lip closure do not have uniform results. For UCLP patients, the quality of scar is not statistically different between Skoog and Millard techniques.. Primary results based on a simple, reproducible evaluation protocol. Extension to other centers required.. Therapeutic study. Level III/retrospective multicenter comparative study.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Lip; Male; Nose; Pilot Projects; Retrospective Studies

Traditional Figueroa nasoalveolar molding (NAM) requires weekly or biweekly adjustments to remove acrylic from the palatal plate to narrow the alveolar gap. These frequent adjustments create a burden for patients living far from a hospital. To minimize this burden, we developed a modified NAM technique using simplified lip taping and a passive palatal plate. Herein we present our clinical experience and outcomes using the traditional and modified methods.. In this blinded, retrospective study of 66 patients with complete unilateral cleft lip and palate, 33 received the traditional NAM and 33 received the modified NAM. Pretreatment and posttreatment facial photographs and clinical charts were used to compare efficacy (nostril height ratio, nostril width ratio, columellar angle, nasal base angle), efficiency (molding frequency), incidence of complications (facial irritation, mucosal ulceration), and medical cost.. Traditional and modified NAM did not differ in treatment efficacy for nostril height ratio (0.88 ± 0.14 vs. 0.90 ± 0.12), nostril width ratio (2.22 ± 0.39 vs. 2.38 ± 0.50), columellar angle (73.5 ± 9.1 degrees vs. 71.3 ± 11.8 degrees), nasal base angle (5.1 ± 2.4 degrees vs. 5.9 ± 2.7 degrees), or alveolar gap width (2.0 ± 2.0 mm vs. 2.0 ± 1.7 mm) (all p > 0.05). Traditional NAM was less efficient, i.e., required more adjustments (8.6 ± 2.0 vs. 6.7 ± 1.1), and cost more (22016.4 ± 2012.7 New Taiwan dollars vs. 20137.6 ± 1173.4 New Taiwan dollars) (both p < 0.001).. Both NAM techniques similarly improved nasal deformities and reduced alveolar gaps, but the modified technique was more efficient and cost less in terms of insurance reimbursement and supplies (labial tapes).

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Face; Humans; Nose; Plastic Surgery Procedures; Retrospective Studies; Rhinoplasty; Treatment Outcome

Patients with complete cleft lip and palate may benefit from cleft lip adhesion or nasoalveolar molding before formal cleft lip repair. The authors compared the relative costs to insurers of these two treatment modalities and the burden of care to families.. A retrospective analysis was performed of cleft lip and palate patients treated with nasoalveolar molding or cleft lip adhesion at The Children's Hospital of Philadelphia between January of 2007 and June of 2012. Demographic, appointment, and surgical data were reviewed; surgical, inpatient hospital, and orthodontic charges and costs were obtained. Multivariate linear regression and two-sample, two-tailed independent t tests were performed to compare cost and appointment data between groups.. Forty-two cleft adhesion and 35 nasoalveolar molding patients met inclusion criteria. Mean costs for nasoalveolar molding were $3550.24 ± $667.27. Cleft adhesion costs, consisting of both hospital and surgical costs, were $9370.55 ± $1691.79. Analysis of log costs demonstrated a significant difference between the groups, with the mean total cost for nasoalveolar molding significantly lower than that for adhesion (p < 0.0001). Nasoalveolar molding patients had significantly more made, cancelled, no-show, and missed visits and a higher missed percentage than adhesion patients (p < 0.0001) for all except no-show appointments, (p = 0.0199), indicating a higher burden of care to families.. Nasoalveolar molding may cost less before formal cleft lip repair treatment than cleft lip adhesion. Third-party payers who cover adhesion and not nasoalveolar molding may not be acting in their own best interest. Nasoalveolar molding places a higher burden of care on families, and this fact should be considered in planning treatment.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Combined Modality Therapy; Cost of Illness; Costs and Cost Analysis; Female; Humans; Infant; Male; Nose; Orthodontics, Corrective; Orthognathic Surgical Procedures; Plastic Surgery Procedures; Retrospective Studies

To develop a new method of presurgical nasoalveolar molding based on computer-aided design technique.. Twenty patients(16 boys, 4 girls) with complete unilateral cleft lip and palate(UCLP) who received presurgical nasoalveolar molding were recruited as the treatment group. Twenty patients(15 boys, 5 girls) with complete UCLP who did not receive presurgical orthopedic treatment were selected as the control group. All parameters of the digital maxillary model were measured using the Rapidform XOR3 software. The statistical analysis was performed with SPSS 15.0.. A'-X and B-Il were reduced significantly after presurgical nasoalveolar molding. However, the mean alveolar height [F- hight (3.7 ± 1.1) mm, F'-height (4.6 ± 0.9) mm] decreased significantly after treatment(P <0.05). There were significant differences between the treatment group and the control group(P<0.05).. Maxillary alveolar morphology could be improved in UCLP infants treated with computer-aided presurgical nasoalveolar molding. The width of the cleft could be reduced and the maxillary midline corrected effectively. However, the alveolar height decreased significantly after the treatment.

Topics: Alveolar Process; Case-Control Studies; Cleft Lip; Cleft Palate; Computer-Aided Design; Female; Humans; Infant; Male; Maxilla; Models, Anatomic; Nose; Software

We have recently presented the Old Spanish Pointer dog, with a 15-20% spontaneous congenital cleft palate rate, as a unique experimental model of this disease. This study aimed to describe the cleft palate of these dogs for surgical research purposes and to determine whether congenital cleft palate influences maxillofacial growth. Seven newborn Old Spanish Pointer dogs of both sexes, comprising a cleft palate group (n = 4) and a normal palate group (n = 3), were fed using the same technique. Macroscopic photographs and plaster casts from the palate, lateral radiographs and computer tomograms of the skull were taken sequentially over 41 weeks, starting at week 5. The cleft morphology, the size and the tissue characteristics in these dogs resembled the human cleft better than current available animal models. During growth, the cleft width varies. Most of the transverse and longitudinal measures of the palate were statistically lower in the cleft palate group. The cleft palate group showed hypoplasia of the naso-maxillary complex. This model of congenital cleft palate seems suitable for surgical research purposes. A reduced maxillofacial pre- and post-natal development is associated to the congenital cleft palate in the Old Spanish Pointer dog.

Topics: Anatomic Landmarks; Animals; Animals, Newborn; Cephalometry; Cleft Palate; Dental Arch; Disease Models, Animal; Dogs; Female; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Mandible; Maxilla; Maxillofacial Development; Models, Dental; Nasal Bone; Nose; Palate; Photography; Time Factors; Tomography, Spiral Computed

The SymNose computer program has been proposed as an objective method for the quantitative assessment of lip symmetry following unilateral cleft lip repair. This study aims to demonstrate the use of SymNose in patients with complete bilateral cleft lip and palate (BCLP), a group previously excluded from computer-based analysis.. A retrospective cohort study compared several parameters of lip symmetry between BCLP cases and non-cleft controls. 15 BCLP cases aged 10 (±1 year) who had undergone primary repair were recruited from the patient database at the South West Cleft Unit, Frenchay Hospital. Frontal facial photographs were selected for measurement. 15 age-matched controls were recruited from a local school. Lip symmetry was expressed as: percentage mismatch of left vermillion border and upper lip area over the right, horizontal lip tilt and lateral deviation of the lip.. A significant increase in lip asymmetry was found in the BCLP group expressed as upper vermillion border mismatch across computer-defined and user-defined midlines (mean difference was 16.4% (p < 0.01) and 17.5% (p < 0.01) respectively).. The results suggest that a significant degree of lip asymmetry remains in BCLP patients even after primary repair. This challenges previous assumptions that those with bilateral defects would be relatively symmetrical.

Topics: Case-Control Studies; Cephalometry; Child; Cleft Lip; Cleft Palate; Cohort Studies; Eyelids; Humans; Image Processing, Computer-Assisted; Lip; Nose; Photography; Retrospective Studies; Software

To explore three-dimensional (3D) facial asymmetry differences in operated children with oral clefts and to compare the results with a control group.. The sample comprised one hundred and three 8- to 12-year-old children: 40 with unilateral cleft lip and palate (UCLP); 23 with unilateral cleft lip and alveolus (UCLA); 19 with bilateral cleft lip and palate (BCLP); 21 with cleft palate (CP) and 80 sex- and age-matched controls living in the North East of England.. 3D stereophotogrammetric facial scans were recorded for each participant at rest. Thirty-nine landmarks were recorded for each scan. The x, y and z coordinates for each landmark were extracted. Kruskal-Wallis and Mann-Whitney tests were conducted to identify 3D landmark asymmetry differences between the groups.. Statistically significant differences were observed between all the groups. The UCLP and UCLA patients displayed the greatest asymmetry, followed by the BCLP group. The CP group was the least asymmetric among the cleft groups. Asymmetry was present to a lesser extent in the control group.. Shape analysis indicates the possible differences in the aetiology and growth pattern of the CP group compared to UCLA or UCLP and BCLP groups.

Topics: Anatomic Landmarks; Case-Control Studies; Cephalometry; Child; Chin; Cleft Lip; Cleft Palate; Ear, External; Facial Asymmetry; Humans; Imaging, Three-Dimensional; Lip; Nasal Cartilages; Nose; Orbit; Photogrammetry

Objective : To elucidate the various effects on maxillary growth following different procedures for vestibular expansion at the time of primary lip repair for unilateral cleft lip and palate (UCLP). Participants : Thirty patients with complete UCLP who underwent primary lip repair using a triangular-flap technique with nasal vestibular expansion (NVE; the NVE group) and 30 patients who underwent the same lip repair with closure of the nasal floor (non-NVE group) were enrolled in this study. Interventions : Serial dental casts on lip and palatal repair were scanned with a laser scanner. The three-dimensional coordinates of seven anatomical landmarks and their growth changes, the curvature radius rate between major/minor segments, and the collapse rates were compared between the two groups. Results : At the time of lip repair, the incisal point was located slightly anteriorly in the non-NVE group. At the time of palatal repair, the cleft edge of the alveolar process in the minor segment was located significantly anteriorly and laterally in the NVE group, showing the significantly forward change of the minor segment. The minor segment collapsed in the non-NVE group. The collapse rate of the NVE group (3.3%) was significantly lower than that of the non-NVE group (40.0%). Conclusions : NVE following simultaneous advancement of nasolabial components on the affected side at the time of primary lip repair for UCLP facilitates the forward molding of the maxilla, resulting in a more symmetrical alveolar arch form.

Topics: Anatomic Landmarks; Cleft Lip; Cleft Palate; Dental Prosthesis Design; Female; Humans; Imaging, Three-Dimensional; Infant; Male; Maxillofacial Development; Models, Dental; Nose; Palatal Obturators; Plastic Surgery Procedures; Rhinoplasty; Treatment Outcome

Bilateral cleft nose deformity is increasingly being treated before primary repair with nasoalveolar molding. With the Grayson technique, nasal molding is started when the alveolar gap is reduced to 5 mm, whereas with the Figueroa technique, nasal molding and alveolar molding are performed at the same time. Both techniques significantly lengthen the columella, but their comparative efficacy, efficiency, and incidence of complications have not been investigated.. In this blinded, retrospective study of 58 patients with complete bilateral cleft lip-cleft palate, 27 underwent Grayson nasoalveolar molding and 31 underwent Figueroa nasoalveolar molding. Outcomes were compared by analyzing pretreatment and posttreatment facial photographs and clinical charts for efficacy (i.e., columella length ratio, alar width ratio, alar base width ratio, nostril shape, nasal tip angle, nasolabial angle, and nasal base angle), efficiency (i.e., molding frequency), and incidence of complications (e.g., facial irritation and oral mucosal ulceration).. Grayson and Figueroa nasoalveolar molding did not differ in treatment efficacy for columellar length ratio, alar width ratio, alar base width ratio, nostril shape, nasal tip angle, nasolabial angle, or nasal base angle (all p > 0.05). Grayson nasoalveolar molding was less efficient (i.e., required more adjustments) (10.8 ± 4.1 versus 7.6 ± 1.5; p = 0.001) and had a higher incidence of oral mucosal ulceration (26 percent versus 3 percent; p < 0.05).. Both Grayson and Figueroa nasoalveolar molding similarly improve nasal deformities and reduce alveolar gaps; however, the Figueroa technique is associated with fewer oral mucosal complications and more efficiency.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Female; Humans; Infant; Infant, Newborn; Male; Nose; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies; Rhinoplasty; Treatment Outcome

The aims of this study were to assess the quantitative values of measurements using proportion indices in the craniofacial region in patients with repaired, non-syndromic, complete unilateral cleft lip and palate (UCLP), and compare them with a control group who did not have clefts using the non-invasive systems of 3-dimensional technology. Three-dimensional measurements of the facial surfaces of 15 Malay patients who had UCLP repaired and 100 Malay control patients aged 18-25 years were analysed. The 3-dimensional images of the respondents' faces were captured using the VECTRA-3D Stereophotogrammetry System. Eleven craniofacial proportions were assessed using a combination of 18 linear measurements obtained from 21 anthropometric soft tissue landmarks. These measurements were used to produce proportion indices to find the differences in the morphological features between the groups, and assessed using the independent sample t test and z scores. There were significant differences between the groups in 7 out of 11 craniofacial proportion indices (p=0.001-0.044). Z scores of 2 indices were disproportionate. They were nasal index (which was severely supernormal) and upper lip index (which was moderately supernormal). Patients with UCLP had higher mean z scores, indicating that patients with UCLP tended to have larger faces than the control group. There were clinically important differences mainly in the nasolabial area, where the nose and the upper lip were wider, larger, or flatter in patients with UCLP.

Topics: Adolescent; Adult; Age Factors; Anatomic Landmarks; Cephalometry; Cleft Lip; Cleft Palate; Face; Female; Humans; Imaging, Three-Dimensional; Lip; Male; Nasal Bone; Nasal Cartilages; Nose; Orbit; Photogrammetry; Skin; Vertical Dimension; Young Adult

The purpose of this study was to cephalometrically evaluate the facial soft-tissue characteristics of adolescent patients with bilateral cleft lip and palate (BCLP) and to compare them with a noncleft control group. Lateral cephalometric radiographs obtained from 56 adolescents with nonsyndromic BCLP (29 boys and 27 girls) were analyzed and compared with 67 control subjects (29 boys and 38 girls) who were matched for sex, age, and ethnicity. All patients had been operated on before the age of 2 years for the surgical repair of cleft lip and palate. None had received any orthopedic or orthodontic treatment. Independent-samples t test revealed that patients with BCLP significantly differed from the control group by having a flatter facial profile, thinner and more retruded nasal base, flatter nasal tip (in males), and reduced upper-lip length. Furthermore, thicker lower-lip pit, shallower mentolabial sulcus, and increased inclination angles of the upper and lower lips relative to the horizontal plane were observed in female patients compared with the normal group. The findings of the current study suggested that adolescent patients with BCLP showed several facial soft-tissue deformities when compared with normal individuals with the same age, sex, and ethnic origin. This study provides objective measures that could lead to better treatment planning and prediction of the need for corrective surgeries in patients with BCLP.

Topics: Adolescent; Anatomic Landmarks; Brain; Case-Control Studies; Cephalometry; Chin; Cleft Lip; Cleft Palate; Face; Female; Humans; Iran; Lip; Male; Nose; Sex Factors; Young Adult

Facial appearance is important for normal psychosocial development in children with cleft lip and palate (CLP). There is conflicting evidence on how deficient maxillary growth may affect nasolabial esthetics.. We retrospectively investigated nasolabial appearance in two groups, the Langenback (35 children; mean age 11.1 years; range: 7.9-13.6) and Vomerplasty (58 children; mean age 10.8 years; range: 7.8-14), who received unilateral CLP surgery by the same surgeon. The hard palate repair technique differed between the two groups. In the Langenback group, palatal bone on the non-cleft side only was left denuded, inducing scar formation and inhibiting maxillary growth. In the Vomerplasty group, a vomerplasty with tight closure of the soft tissues on the palate was applied. Thirteen lay judges rated nasolabial esthetics on photographs using a modified Asher-McDade's index.. Nasolabial esthetics in both groups was comparable (p > 0.1 for each nasolabial component). Inferior view was judged as the least esthetic component and demonstrated mean scores 3.18 (SD = 0.63) and 3.13 (SD = 0.47) in the Langenback and Vomerplasty groups, respectively. Mean scores for other components were from 2.52 (SD = 0.63) to 2.81 (SD = 0.62). Regression analysis showed that vomerplasty is related with slight improvement in the nasal profile only (coefficient B = -0.287; p = 0.043; R(2 ) = 0.096).. This study demonstrates that the use of vomerplasty instead of the Langenbeck technique is weakly associated with the nasolabial appearance among pre-adolescent patients with UCLP.

Topics: Adolescent; Alveolar Bone Grafting; Child; Cleft Lip; Cleft Palate; Esthetics; Female; Follow-Up Studies; Humans; Lip; Male; Maxilla; Nose; Nose Deformities, Acquired; Palatal Muscles; Palate; Palate, Hard; Palate, Soft; Photography; Plastic Surgery Procedures; Retrospective Studies; Vomer

Strategies to address severe anteroposterior palatal shortening with velopharyngeal insufficiency include palatal lengthening or manipulation of posterior pharyngeal tissue as a flap or sphincter. In some cases, a single procedure alone is not sufficient to achieve dynamic velopharyngeal closure. The objective of this study was to determine whether double-opposing Z-plasty coupled with a posterior pharyngeal flap would achieve adequate palatal length in severe velopharyngeal dysfunction.. Six patients, 3 with previously unrepaired cleft palate and 3 children with previous straight-line repairs and significant anteroposterior shortening, were included. Demographic and perioperative information was tabulated. Subjective and objective speech data were gathered, if available. Complications, follow-ups, and postoperative nasometric results were compiled. Statistical analysis involved the paired t test.. There were no perioperative complications. Follow-up was at least 1 year. No postoperative fistulas or nasal obstruction developed. Hypernasal speech and nasal emission were subjectively improved in all patients. Nasometric data showed a statistically significant improvement in nasal air escape with speech.. Simultaneous double-opposing Z-plasty and posterior pharyngeal flap can be performed effectively. This strategy is useful for severe velopharyngeal dysfunction secondary to anteroposterior palatal shortening or a previously unrepaired cleft palate, and the technique optimizes palatal function and creates a mechanical blockade to nasal air escape.

Topics: Child; Cleft Palate; Deglutition; Female; Follow-Up Studies; Humans; Male; Nose; Palate, Soft; Pharynx; Plastic Surgery Procedures; Speech; Surgical Flaps; Velopharyngeal Insufficiency; Voice

To explore how improvement in facial appearance is related to patients' perception and satisfaction following cleft rhinoplasty.. A cross-sectional survey.. 35 cleft rhinoplasty patients treated between 2005 and 2010. 45 observers comprised of healthcare professionals.. Evaluation of patient satisfaction including Rhinoplasty Outcome Evaluation (ROE) questionnaire, Preoperative and Postoperative Semi-quantitative Ordinal Scale Rating (PPSOSR) and a specifically designed semi-structured questionnaire. Evaluation by panel of observers using Asher-McDade Aesthetic Index (AMAI) Rating and PPSOSR.. Patient satisfaction was high, based on the ROE questionnaire (score 76.1). 91% of patients rated their appearance as improved, 3% remained 'uncertain' and 6% felt 'different but not improved.' Teenage females (score 94.1) showed statistically higher satisfaction, when compared to older females (score 75.5), or their male counterparts (score 69.8). The preoperative appearance ratings were not statistically different between patients and panel members but postoperatively, patients' rating of their appearance was statistically higher. All components of the AMAI were scored between 'good' to 'fair' (score 9.3). Seventy percent of the panel rated the postoperative appearance as improved. Interestingly, 10% rated the postoperative appearance as 'unchanged', while 3% reported a 'worsened' appearance. There was no correlation between panel assessment of aesthetic outcome and patient satisfaction.. Cleft rhinoplasty contributes to subjective patient satisfaction as a result of their perceived improvement in appearance and function, even though this was not correlated to objective aesthetic rating by panel members.

Topics: Adolescent; Adult; Age Factors; Attitude of Health Personnel; Attitude to Health; Cleft Lip; Cleft Palate; Cohort Studies; Cross-Sectional Studies; Esthetics; Female; Humans; Male; Middle Aged; Nasal Cartilages; Nose; Nose Deformities, Acquired; Osteotomy; Patient Satisfaction; Respiration; Rhinoplasty; Sex Factors; Treatment Outcome; Young Adult

In this retrospective longitudinal study, we aimed to study differences in the soft-tissue profiles in growing children with clefts in comparison with controls through the period of facial growth from 7 to 18 years.. Lateral cephalometric measurements made at 7 years (T1), 11.1 years (T2), and 17.9 years (T3) of age of 70 white children (35 boys, 35 girls) with complete unilateral cleft lip and palate (UCLP) who received primary lip and palate repair surgeries at The Hospital for Sick Children, Toronto, were compared with those of a control group of similar ages, sexes, and racial backgrounds, and having skeletal Class I facial growth, selected from the Burlington Growth Study. None of the included subjects had received any surgeries other than the primary lip and palate repairs, and none had undergone nasal septum surgery or nasal molding during infancy. Between-group comparisons were made at each time point using generalized linear models adjusted for age and sex effects. Longitudinal comparisons across all time points were conducted using the mixed model approach, adjusting for these effects and their interactions with time.. Bimaxillary retrognathism, progressive maxillary retrognathism, and increasing lower anterior face height with downward and backward growth rotation of the mandible in the UCLP group were seen. Unlike the hard-tissue face height ratio, their soft-tissue face height ratio was not affected. The upper lips in the UCLP group were shorter by 1.81 mm at T2 (P <0.001) and by 1.16 mm at T3 (P = 0.018), whereas their lower lips were 2.21 mm longer at T3 (P = 0.003). A reduced upper lip to lower lip length ratio at T2 and T3 (P <0.001) resulted. Their upper lips were relatively retruded by 1.44 mm at T1, 1.66 mm at T2, and 1.86 mm at T3 (all, P <0.001), and their lower lips were relatively protruded by 1.07 mm at T1 (P = 0.003), 1.40 mm at T2 (P <0.001), and 1.62 mm at T3 (P <0.001). Nose depths in the UCLP group were shallower by at least 1 mm from T1 to T3, and columellar length was shorter by almost 2 mm (all, P <0.001). Their columellae and nose tips rotated downward with growth, with the most significant rotations experienced from T2 to T3, and progressive reductions in their soft-tissue profile convexity were seen from T1 to T3 (P <0.001).. Key attributes of the imbalance in the soft-tissue profile in children with repaired UCLP were identified in the lip and nose regions. Although many profile differences were visible as early as 7 years of age, they became more apparent by 11 years of age and increased in severity thereafter. The short upper lip combined with a long lower lip resulted in the characteristic lip length imbalance, whereas the progressively retruding upper lip and protruding lower lip led to developing a step relationship in the sagittal lip profile during the adolescent growth period. Their columellae and nose tips rotated downward during this time.

Topics: Adolescent; Cephalometry; Child; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Incisor; Lip; Longitudinal Studies; Male; Mandible; Maxilla; Maxillofacial Development; Nose; Plastic Surgery Procedures; Retrognathia; Retrospective Studies; Rotation; Skull Base; Vertical Dimension

A cleft lip and palate consists of fissures of the upper lip and/or palate, and is the most commonly seen orofacial anomaly that involves the middle third of the face. Early treatment of patients with a cleft lip and palate is important because of esthetic, functional, and psychological concerns. Nasoalveolar molding provides excellent results when started immediately after birth. This clinical report describes the presurgical management of an infant with a complete unilateral cleft of the soft palate, hard palate, alveolar ridge, and lip.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Dental Prosthesis Design; Humans; Infant, Newborn; Nose; Nose Diseases; Oral Fistula; Palatal Obturators; Palate, Hard; Palate, Soft; Preoperative Care; Respiratory Tract Fistula; Stents

Patients with operated cleft lip and palate present with a problem of midface hypoplasia, and such patients have been traditionally treated with orthognathic surgery. Such a procedure has its own limitations of relapse and hence a newer modality of distraction osteogenesis with histiogenesis can be chosen to overcome such limitations for midfacial advancement. The purpose of this study is to evaluate an alternative technique and its postoperative stability in maxillary distraction osteogenesis in patients of cleft lip and cleft palate using a rigid external device (RED).. Nine patients with midface bone stock deficiency were selected for maxillary advancement. At the first surgery under general anesthesia, after Le Fort I osteotomy, RED system was used with the alternative technique. After distraction, evaluation was done for ease of the procedure, stability, and complications. Lateral cephalograms were evaluated at 3 stages: T1, pre-distraction; T2, post-distraction; and T3, 1 year post-distraction.. A mean 13.4-mm midface advancement was shown with bone formation at the pterygomaxillary region without losing the vector and having a standby mode in case the wire broke during distraction The results were stable even at 1 year of follow-up.. Maxillary position improved in relation to the cranial base. This study showed that the RED was versatile in midface advancement.

Topics: Adolescent; Cephalometry; Cleft Lip; Cleft Palate; External Fixators; Extraoral Traction Appliances; Female; Follow-Up Studies; Humans; Lip; Male; Mandible; Maxilla; Nose; Orthodontics, Corrective; Osteogenesis; Osteogenesis, Distraction; Osteotomy, Le Fort; Pterygopalatine Fossa; Retrospective Studies; Treatment Outcome; Young Adult

The aim of this publication is to offer teams specializing in the primary and secondary treatment of labio-alveolar-palatal clefts a prosthetic evaluation for more rational management of the dental sequellae of clefts for patients who, when they reach adulthood, often wish to improve their facial esthetics, in which the dental element plays a significant part. The reorganization and restoration of the upper anterior teeth, and their esthetic integration with respect to the face and lips, would then be less of a problem for plastic surgeons or orthodontists. In this respect, the installation in this sector of implants, following ambitious bone surgery involving the sacrifice, in bilateral forms, of the teeth of the medial process is a protocol that could usefully be taken into account.

Topics: Anodontia; Bone Transplantation; Cleft Lip; Cleft Palate; Cooperative Behavior; Dental Implants; Dental Prosthesis, Implant-Supported; Esthetics, Dental; Humans; Incisor; Lip; Nose; Nose Diseases; Oral Fistula; Orthodontics, Interceptive; Palate, Soft; Patient Care Planning; Patient Care Team; Plastic Surgery Procedures; Respiratory Tract Fistula; Tooth Abnormalities; Tooth Extraction; Wound Healing

1) To determine the concordance among surgeons on subjective assessments of nasolabial esthetics in children with repaired cleft lip; and 2) to evaluate longitudinal changes in nasolabial esthetics in relation to cleft lip revision surgery.. School of Dentistry at University of North Carolina, Chapel Hill. Children with repaired unilateral cleft lip: 32 had lip revision surgery and 27 did not have surgery.. Retrospective observational study from a non-randomized clinical trial. Ratings of nasolabial esthetics performed by six surgeons using the Asher-McDade scale at baseline and 12-month follow-up.. Concordance among surgeons ranged from poor to acceptable. Nasolabial ratings at follow-up were better in the Revision group than in the Non-Revision group, although differences were small. The most prevalent change in the Revision Group was improvement in one or more units on the scale, while 'no change' was most prevalent in the Non-Revision group. Participants in the Revision group were more likely to receive a 'no' in relation to the need for lip or nose revision at the follow-up visit.. There were mild esthetic improvements observed in relation to lip revision surgery, which should be interpreted with caution given the subjectivity of the rating method used.

Topics: Adolescent; Attitude of Health Personnel; Attitude to Health; Child; Cleft Lip; Cleft Palate; Esthetics; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Lip; Longitudinal Studies; Male; Non-Randomized Controlled Trials as Topic; Nose; Photography; Reoperation; Retrospective Studies; Treatment Outcome

To evaluate the orthopedic effect of presurgical nasoalveolar molding (PNAM) devices on the palatal deformities in unilateral complete cleft lip and palate (UCCLP) patients.. Three groups with 19 patients each were studied. All samples in groups A and B were non-syndromic UCCLP children. Group A was treated with PNAM prior to operation. Group B was untreated prior to operation. Samples in group C were normally developed nose and lip palate infants aged three months. The orthotopic palate photos before and after PNAM treatment for group A, as well as pre-operative photos of groups B and group C, were taken and measured. All statistics were analyzed using SPSS 21.0.. PNAM treatment significantly increased the AW, AC, and PA of UCCLP patients (P < 0.05), whereas CPW, CWA, CWAS, CWAH, PMD, and CA significantly decreased (P < 0.05). However, no significant difference was observed with the cases in group C (P < 0.05). The AW, CPW, CA, and PA of the patients in group B significantly increased compared with the cases in group A before PNAM treatment (P < 0.05). Multivariate analysis of variance indicated that TW had no statistically significant difference among the three groups (P > 0.05).. PNAM treatment is a non-surgical early treatment for the effective improvement of palatal primary deformities in UCCLP patients.

Topics: Alveolar Process; Child; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Plastic Surgery Procedures; Preoperative Care

Topics: Cleft Palate; Congenital Abnormalities; Heart Septal Defects, Ventricular; Holoprosencephaly; Humans; Infant, Newborn; Male; Microcephaly; Nose; Syndrome

Cleft lip and palate (CLP) affects the dentoalveolar and nasolabial facial regions. Internal and external nasal dysmorphology may persist in individuals born with CLP despite surgical interventions. 7-18 year old individuals born with unilateral and bilateral CLP (n = 50) were retrospectively assessed using cone beam computed tomography. Anterior, middle, and posterior nasal airway volumes were measured on each facial side. Septal deviation was measured at the anterior and posterior nasal spine, and the midpoint between these two locations. Data were evaluated using principal components analysis (PCA), multivariate analysis of variance (MANOVA), and post-hoc ANOVA tests. PCA results show partial separation in high dimensional space along PC1 (48.5% variance) based on age groups and partial separation along PC2 (29.8% variance) based on CLP type and septal deviation patterns. MANOVA results indicate that age (P = 0.007) and CLP type (P ≤ 0.001) significantly affect nasal airway volume and septal deviation. ANOVA results indicate that anterior nasal volume is significantly affected by age (P ≤ 0.001), whereas septal deviation patterns are significantly affected by CLP type (P ≤ 0.001). Age and CLP type affect nasal airway volume and septal deviation patterns. Nasal airway volumes tend to be reduced on the clefted sides of the face relative to non-clefted sides of the face. Nasal airway volumes tend to strongly increase with age, whereas septal deviation values tend to increase only slightly with age. These results suggest that functional nasal breathing may be impaired in individuals born with the unilateral and bilateral CLP deformity.

Topics: Adolescent; Child; Cleft Lip; Cleft Palate; Cone-Beam Computed Tomography; Female; Humans; Imaging, Three-Dimensional; Male; Nasal Cavity; Nasal Obstruction; Nasal Septum; Nose; Retrospective Studies

Orofacial clefts (cleft lip/palate; CL/P) are among the most common congenital anomalies, with prevalence that varies among different ethnic groups. Craniofacial shape differences between individuals with CL/P and healthy controls have been widely reported in non-African populations. Knowledge of craniofacial shape among individuals with non-syndromic CL/P in African populations will provide further understanding of the ethnic and phenotypic variation present in non-syndromic orofacial clefts.. A descriptive cross-sectional study was carried out at Bugando Medical Centre, Tanzania, comparing individuals with unrepaired non-syndromic CL/P and normal individuals without orofacial clefts. Three-dimensional (3D) facial surfaces were captured using a non-invasive 3D camera. The corresponding 3D coordinates for 26 soft tissue landmarks were used to characterize facial shape. Facial shape variation within and between groups, based on Procrustes superimposed data, was studied using geometric morphometric methods.. Facial shape of children with cleft lip differed significantly from the control group, beyond the cleft itself. The CL/P group exhibited increased nasal and mouth width, increased interorbital distance, and more prognathic premaxillary region. Within the CL/P group, PCA showed that facial shape variation is associated with facial height, nasal cavity width, interorbital distance and midfacial prognathism. The isolated cleft lip (CL) and combined cleft lip and palate (CLP) groups did not differ significantly from one another (Procrustes distance = 0.0416, p = 0.50). Procrustes distance permutation tests within the CL/P group showed a significant shape difference between unilateral clefts and bilateral clefts (Procrustes distance = 0.0728, p = 0.0001). Our findings indicate the morphological variation is similar to those of studies of CL/P patients and their unaffected close relatives in non-African populations.. The mean facial shape in African children with non-syndromic CL/P differs significantly from children without orofacial clefts. The main differences involve interorbital width, facial width and midface prognathism. The axes of facial shape differences we observed are similar to the patterns seen in Caucasian populations, despite apparent differences in cleft prevalence and cleft type distribution. Similar facial morphology in individuals with CL/P in African and Caucasian populations suggests a similar aetiology.

Topics: Age Factors; Anatomic Landmarks; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Face; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Mandible; Maxilla; Mouth; Nasal Cavity; Nose; Orbit; Photogrammetry; Principal Component Analysis; Sex Factors; Tanzania; Vertical Dimension

Esthetic evaluation of cleft lip and palate rehabilitation outcomes may assist in the determination of new surgical interventions and aid in reevaluation of treatment protocols. Our objective was to compare esthetics assessments of the nasolabial region in children with a unilateral cleft lip and palate between healthcare professionals who were experienced in the treatment of cleft lip and palate and those who were inexperienced. The study group included 55 patients between 6 and 12 years of age who had already undergone primary reconstructive surgery for unilateral cleft lip. Standardized digital photographs were obtained, and the esthetic features of the nose, lip, and nasolabial region were evaluated. We used only cropped photographic images in the assessments of healthcare professionals with and without experience in cleft lip and palate. Interrater analysis revealed highly reliable assessments made by both the experienced and inexperienced professionals. There was no statistically significant difference in the esthetic attractiveness of the lip and nose between the experienced and inexperienced professionals. Compared with the inexperienced professionals, the experienced professional evaluators showed higher satisfaction with the esthetic appearance of the nasolabial region; however, no difference was observed in the analysis of the lip or nose alone.

Topics: Brain; Child; Child, Preschool; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Infant; Male; Nose; Plastic Surgery Procedures; Treatment Outcome

A novel, modified presurgical nasoalveolar molding (MPNAM) device with retraction screw was designed and used in patients with bilateral complete cleft lip and palate (BCCLP) to rapidly retract and centralize the protuberant and malpositioned premaxilla and correct the nasolabial and palatal deformities. The orthopedic effects and possible complications were evaluated.. Nine patients with BCCLP who met the inclusion criteria were selected. After the maxillary model was obtained, the new MPNAM device with retraction screw was designed and worn until cheilorrhaphy. Changes in local deformities and complications were observed continuously, and the orthopedic effect was evaluated.. All patients quickly adapted to the MPNAM appliance, and the treatment was finished after 5-8 return visits. The columella was significantly prolonged, the nasal tip was elevated, and the collapsed nasal dome was obviously improved. Simultaneously, the premaxilla was rapidly retracted and rotated, and gradually centralized; the clefts were gradually reduced and closed, and a nearly normal dental arch was formed. Although there were some complications, the orthopedic treatment was continued until cheiloplasty.. The MPNAM device with retraction screw can simultaneously correct nasolabial and palatal deformities and also rapidly retract and centralize the premaxilla.

Topics: Acrylic Resins; Biocompatible Materials; Cleft Lip; Cleft Palate; Dental Arch; Equipment Design; Female; Humans; Infant, Newborn; Male; Maxilla; Nose; Orthotic Devices; Palate; Rotation; Stainless Steel; Stents

Tessier cleft types 3 and 4 are both rare craniofacial anomalies. Here we present the first case of a girl born with a combined anomaly of Tessier clefts 3 and 4 with severe bilateral cleft lip, a displaced premaxilla, and three-dimensional underdevelopment of the hard and soft tissues of the maxilla and zygoma. This type of rare facial cleft poses a major operative challenge. Over a period of years, presurgical alveolar molding with an active appliance was followed by seven operations. A satisfactory esthetic outcome was obtained. A multidisciplinary approach to treatment with a plastic surgeon in charge of the operations and an orthodontist in charge of the cleft deformity is essential.

Topics: Activator Appliances; Alveolar Process; Bone Transplantation; Cleft Lip; Cleft Palate; Craniofacial Abnormalities; Esthetics, Dental; Female; Follow-Up Studies; Humans; Infant, Newborn; Maxilla; Nose; Orbit; Palatal Obturators; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome; Zygoma

Oculoauriculovertebral spectrum (OAVS) is a rare congenital malformation consisting of epibulbar dermoids, lid colobomas, auricular deformities, hypoplasia of the soft and bony tissues of the face, associated oral deformities and vertebral anomalies. This report presents a child with a choroid of the right eye, coloboma of the upper eyelid, epibulbar dermoid of the left eye, mandibular hypoplasia, facial asymmetry, bilateral complete cleft lip and palate, hypoplasia of the left alar cartilage, appendage of the left nose, butterfly vertebral defects of Th-1, Th-2 and abnormality of rib XI. Widened sulci of frontal and parietal lobes, bilateral white matter density decrease and calcifications of falx cerebelli were noted. Axial hypotony and delayed psycho-motor development were apparent. This rare case presents a range of severe clinical manifestations of oculoauriculovertebral spectrum. Despite a normal cervical vertebral column, tracheostenosis was present. It caused difficulties in tracheal intubation, creating the need for a tracheostomy, and death after a failed attempt at decannulation. This case indicates that in patients with clinical manifestations including cerebral anomalies, a risk of respiratory insufficiency should be always taken under consideration, when planning surgery.

Topics: Cleft Lip; Cleft Palate; Coloboma; Dermoid Cyst; Eye Neoplasms; Facial Asymmetry; Fatal Outcome; Follow-Up Studies; Goldenhar Syndrome; Humans; Infant, Newborn; Male; Mandible; Nose; Psychomotor Performance; Ribs; Thoracic Vertebrae; Tracheal Stenosis

This prospective cross-sectional, case-controlled morphometric study assessed three dimensional (3D) facial morphological differences between average faces of 103 children aged 8-12 years; 40 with unilateral cleft lip and palate (UCLP), 23 with unilateral cleft lip and alveolus (UCLA), 19 with bilateral cleft lip and palate (BCLP), 21 with isolated cleft palate (ICP), and 80 gender and age-matched controls. 3D stereophotogrammetric facial scans were recorded for each participant at rest. Thirty-nine landmarks were digitized for each scan, and x-, y-, z-coordinates for each landmark were extracted. A 3D photorealistic average face was constructed for each participating group and subjective and objective comparisons were carried out between each cleft and control average faces. Marked differences were observed between all groups. The most severely affected were groups where the lip and palate were affected and repaired (UCLP and UCLA). The group with midsagittal palatal deformity and repair (ICP) was the most similar to the control group. The results revealed that 3D shape analysis allows morphometric discrimination between subjects with craniofacial anomalies and the control group, and underlines the potential value of statistical shape analysis in assessing the outcomes of cleft lip and palate surgery, and orthodontic treatment.

Topics: Anatomic Landmarks; Case-Control Studies; Cephalometry; Cheek; Child; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Face; Facial Asymmetry; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Male; Nose; Photogrammetry; Prospective Studies; Zygoma

The Tessier 3 cleft is one of the rarest congenital craniofacial clefts, which often extends through the upper lip, the alar groove and the medial canthus. Only a few cases have been reported. There is no standardized method for the surgical treatment for this condition in the literature, and to obtain an acceptable outcome is difficult. A Uighur girl with severe bilateral Tessier 3 clefts and associated orofacial deformities is described here, and a novel protocol for clefts of this severity and rarity is presented. This study focuses particularly on describing the surgical procedures and techniques. Further treatments required for the cleft-associated deformities during later growth and developmental stages are also discussed in detail.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Craniofacial Abnormalities; Esthetics; Eyelids; Facial Muscles; Female; Follow-Up Studies; Humans; Infant; Nose; Orbit; Patient Care Team; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome

We describe our experience with various silicone materials for making one-step and two-step impressions of the cleft-lip-palate-nose complex during nasoalveolar moulding. Our technique is superior to common alginate-based impression techniques, as it provides precise reproduction of the complex anatomy of the cleft, and is compatible with the latest available methods of planning treatment with nasoalveolar moulding, such as computer-aided reverse engineering and rapid prototyping.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Computer-Aided Design; Dental Impression Materials; Dental Impression Technique; Dimethylpolysiloxanes; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Infant; Lasers; Models, Dental; Nose; Orthopedic Procedures; Patient Care Planning; Silicone Elastomers; Stents; User-Computer Interface

The aim of this study was to analyze the accurate three-dimensional positions and positional changes of the lip and nose in patients with unilateral cleft lip and palate.. Sixty-three patients with unilateral complete cleft lip and palate (UCLP) and 96 patients with isolated cleft palate were retrospectively enrolled. Facial casts of all subjects taken immediately before and after cheiloplasty and before palatoplasty were used. Three-dimensional values of 12 landmarks were measured by electronic caliper and parallel milling machine. Independent-samples t test was used in analyzing positional differences between UCLP and control, and 2-way analysis of variance was selected in analyzing positional changes among UCLP groups. The threshold of significance was set at 0.05.. Superiorly dislocated christa philtri (Cph) (P < 0.001), subalae (Sa) (P < 0.001), and nostril tip (Nt) (P < 0.001) were partially corrected and still dislocated (P < 0.05, P < 0.001, P < 0.001) immediately after operation, but Cph (P = 0.322) and Cph' (P = 0.081) developed caudally to normal about 10 months after primary surgery. In sagittal dimension, lip and nose, especially Cph' (P < 0.001), Sa' (P < 0.001), and Nt' (P < 0.001) on the cleft side, dislocated dorsally before operation. Immediately after operation, Sa' (P = 0.456) and Nt' (P = 0.067) were normal in sagittal projection, but Cph' was corrected partially and still insufficient (P < 0.001). Unfortunately, sagittal projections of all nasolabial structures, Cph (P < 0.001), Sa' (P < 0.001), Nt (P < 0.001), Cph' (P < 0.001), Sa' (P < 0.05), and Nt' (P < 0.001), decreased significantly and were insufficient after operation.. In vertical dimension, nasolabial displacements were corrected partially by primary surgery, and catching-up growth happened since then. Insufficient sagittal projections of the lip and nose were corrected successfully by lip repair, but lip repair itself had adverse effects on nasolabial sagittal growth.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Face; Female; Humans; Imaging, Three-Dimensional; Infant; Lip; Male; Nose; Retrospective Studies

We describe a new technique for the reconstruction of the nasal floor at the same time as cheiloplasty in patients with complete unilateral cleft lip and palate. We operated on patients aged between 3 and 36 months in public secondary and tertiary level institutions. None of these patients had had a previous operation for the correction of the cleft lip or palate. The operation required the design of two mucous flaps, one lateral and one medial to the defect, to reposition the tissues anatomically and repair the congenital deficiency. Three hundred and fifty-eight patients have been treated using this technique, most of whom (n = 233, 65%) were boys, and 288 (80%) presented with a right complete unilateral cleft. Postoperative evaluation showed that 22 patients (6%) had asymmetry of the nasal base equal to or less than 1 mm, 18 (5%) had nasovestibular fistulas, and 5 (1%) required revision. We conclude that this technique greatly reduces the number of asymmetrical nasal floors and the incidence of nasovestibular fistulas.

Topics: Cleft Lip; Cleft Palate; Female; Humans; Infant; Lip; Male; Nose; Oral Surgical Procedures; Plastic Surgery Procedures; Surgical Flaps

Three-dimensional (3D) imaging is a relatively new method of objectively evaluating surgical results, allowing the surgeon to accurately measure postsurgical changes with little inconvenience to the patient. Its accuracy and reliability has been consistently demonstrated in the literature. This article describes updated methods that we use with 3D imaging software to assess rhinoplasty results at our institution. The measurements described include the assessment of symmetry, tip projection, rotation, volume, width, and topographic width. We also apply these techniques to assess the surgical changes of patients with unilateral clefts who underwent secondary rhinoplasty performed by the senior author.

Topics: Adult; Cleft Palate; Female; Humans; Imaging, Three-Dimensional; Male; Nose; Outcome Assessment, Health Care; Photogrammetry; Reproducibility of Results; Rhinoplasty; Software

Oronasal fistulas are a frequent complication after cleft palate surgery. Numerous repair methods have been described, but wound-healing problems occur often. The authors investigated, for the first time, the suitability of multilayered amniotic membrane allograft for fistula repair in a laboratory experiment (part A), a swine model (part B), and an initial patient series (part C).. In part A, one-, two-, and four-layer porcine and human amniotic membranes (n = 20 each) were fixed in a digital towing device and the force needed for rupture was determined. In part B, iatrogenic oronasal fistulas in 18 piglets were repaired with amniotic membrane allograft, autofetal amniotic membrane, or small intestinal submucosa (n = 6 each). Healing was evaluated by probing and visual inflammation control (no/moderate/strong) on postoperative days 3, 7, 10, and 76. Histological analysis was performed to visualize tissue architecture. In part C, four patients (two women and two men, ages 21 to 51 years) were treated with multilayered amniotic membrane allograft.. In part A, forces needed for amniotic membrane rupture increased with additional layers (p < 0.001). Human amniotic membrane was stronger than porcine membrane (p < 0.001). In part B, fistula closure succeeded in all animals treated with amniotic membrane with less inflammation than in the small intestinal submucosa group. One fistula remained persistent in the small intestinal submucosa group. In part C, all fistulas healed completely without inflammation.. Amniotic membrane is an easily available biomaterial and can be used successfully for oronasal fistula repair. The multilayer technique and protective plates should be utilized to prevent membrane ruptures.. Therapeutic, V.

Topics: Animals; Biological Dressings; Cleft Palate; Female; Fistula; Humans; Male; Nose; Nose Diseases; Oral Fistula; Oral Surgical Procedures; Plastic Surgery Procedures; Postoperative Complications; Swine; Transplantation, Homologous; Treatment Outcome; Wound Healing

Defects such as cleft lip with or without cleft palate (CL/P) are among the most common craniofacial birth defects in humans. In many cases, the underlying molecular and cellular mechanisms that result in these debilitating anomalies remain largely unknown. Perturbed hedgehog (HH) signalling plays a major role in craniofacial development, and mutations in a number of pathway constituents underlie craniofacial disease. In particular, mutations in the gene encoding the major HH receptor and negative regulator, patched1 (PTCH1), are associated with both sporadic and familial forms of clefting, yet relatively little is known about how PTCH1 functions during craniofacial morphogenesis. To address this, we analysed the consequences of conditional loss of Ptch1 in mouse neural crest cell-derived facial mesenchyme. Using scanning electron microscopy (SEM) and live imaging of explanted facial primordia, we captured defective nasal pit invagination and CL in mouse embryos conditionally lacking Ptch1. Our analysis demonstrates interactions between HH and FGF signalling in the development of the upper lip, and reveals cell-autonomous and non-autonomous roles mediated by Ptch1. In particular, we show that deletion of Ptch1 in the facial mesenchyme alters cell morphology, specifically in the invaginating nasal pit epithelium. These findings highlight a critical link between the neural crest cells and olfactory epithelium in directing the morphogenesis of the mammalian lip and nose primordia. Importantly, these interactions are critically dependent on Ptch1 function for the prevention of orofacial clefts.

Topics: Animals; Brain; Cell Death; Cell Proliferation; Cell Shape; Cleft Lip; Cleft Palate; Disease Models, Animal; Epithelial Cells; Fibroblast Growth Factors; Genetic Association Studies; Hedgehog Proteins; Mesoderm; Mice; Mice, Knockout; Morphogenesis; Nasal Mucosa; Neural Crest; Nose; Patched Receptors; Patched-1 Receptor; Phenotype; Receptors, Cell Surface; Signal Transduction; Wnt1 Protein

This paper reviewed the outcome of cantilevered costochondral grafts used for dorsal nasal augmentation in the management of patients treated at the Australian Craniofacial Unit (ACFU), Adelaide over a 29-year period.. All patients undergoing dorsal nasal augmentation with costochondral grafts as part of their craniofacial management between 1981 and 2009 were identified using the ACFU database, and their medical notes were reviewed.. 107 patients (50 M, 57 F), with a mean age of 12.3 years (range: 2-62 years) and requiring a total of 150 costochondral grafts, were identified from the departmental database. Mean follow-up after nasal augmentation was 5.6 years (1 month-31.5 years). 46% of the patients were diagnosed with Binder syndrome/Chondrodysplasia punctata; other diagnoses included Tessier midline clefts, cleft lip and palate and frontonasal dysplasia. A dorsal midline incision (49%) was the commonest method of access, with 84% of patients having mini-screw fixation for graft stabilisation. Complications included screw palpability, infection, skin necrosis and graft fracture. The commonest reasons for a replacement graft were graft atrophy and fracture, infection and persistent deformity.. Cantilevered nasal costochondral grafting is an excellent technique for improving nasal contour and function in a wide variety of clinical situations.

Topics: Adolescent; Adult; Atrophy; Cartilage; Child; Child, Preschool; Cleft Lip; Cleft Palate; Craniofacial Abnormalities; Face; Female; Humans; Male; Maxilla; Maxillofacial Abnormalities; Middle Aged; Nose; Reoperation; Rhinoplasty; Ribs; Time Factors; Young Adult

This study evaluated the effectiveness of computer-aided design-nasoalveolar molding (CAD-NAM) on maxillary alveolar morphology in infants with unilateral cleft lip and palate (UCLP).. 15 infants with UCLP treated by CAD-NAM therapy composed the treatment group, and the control group consisted of 15 infants with non-presurgically treated UCLP. The maxillary morphology was analyzed by Rapidform XOR3 software. Differences in all variables pre- and post-CAD-NAM were discussed.. Significant difference was found in arch length, cleft gap, labial frenum deviation, A-X, A'-X, and alveolus height on both sides pre- and post-CAD-NAM.. This study suggests a trend toward morphological improvement in maxillary alveoli of infants with UCLP treated with CAD-NAM. The CAD-NAM effectively reduced the cleft gap, corrected the maxilla midline, and improved the sagittal length of the maxilla. The alveolar height decreased significantly after the treatment, which indicated that the traction force of the appliance may have obstructive effects on the vertical growth of the alveolar bone.

Topics: Alveolar Process; Anatomic Landmarks; Case-Control Studies; Cleft Lip; Cleft Palate; Computer-Aided Design; Female; Humans; Imaging, Three-Dimensional; Infant; Male; Maxilla; Nose; Orthognathic Surgical Procedures; Palatal Obturators; Software

The cleft alveolus component of the oral cleft deformity is addressed with a separate surgical stage. Several host and operator related factors affect the surgical outcome. When factors that increase the likelihood of secondary alveolar bone graft failure are identified, alterative methods like dentoalveolar distraction (DAD) may be employed. In infants, molding of the alveolar segments is possible and when a synergistic surgical approach is used, the possibility of successful alveolar cleft repair is increased. The authors present two case reports wherein the use of nasoalveolar molding (NAM) and DAD helped to tackle the alveolar cleft deformity.

Topics: Alveolar Bone Grafting; Alveolar Process; Child; Cleft Palate; Humans; Infant; Nose; Orthopedic Procedures; Osteogenesis, Distraction; Plastic Surgery Procedures; Preoperative Care; Prone Position; Treatment Outcome

Objective : Objective measure of scarring and three-dimensional (3D) facial asymmetry after surgical correction of unilateral cleft lip (UCL) and unilateral cleft lip (UCLP). It was hypothesized that the degree of scarring or asymmetry would be correlated with poorer psychological function. Design : In a cross-sectional design, children underwent 3D imaging of the face and completed standardized assessments of self-esteem, depression, and state and trait anxiety. Parents rated children's adjustment with a standard scale. Setting : Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences. Patients : Fifty-one children aged 10 years with UCLP and 43 with UCL were recruited from the cohort treated with the surgical protocol of the CLEFTSIS managed clinical network in Scotland. Methods : Objective assessment to determine the luminance and redness of the scar and facial asymmetry. Depression, anxiety, and a self-esteem assessment battery were used for the psychological analysis. Results : Cleft cases showed superior psychological adjustment when compared with normative data. Prevalence of depression matched the population norm. The visibility of the scar (luminance ratio) was significantly correlated with lower self-esteem and higher trait anxiety in UCLP children (P  =  .004). Similar but nonsignificant trends were seen in the UCL group. Parental ratings of poorer adjustment also correlated with greater luminance of the scar. Conclusions : The objectively defined degree of postoperative cleft scarring was associated with subclinical symptoms of anxiety, depression, and low self-esteem.

Topics: Case-Control Studies; Cephalometry; Cicatrix; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Facial Asymmetry; Humans; Nose

Cocaine is a potent vasoconstrictor, and long-standing use can result in an acquired palatal cleft. Similar to congenital cases, this palatal defect can cause nasal emission and hypernasal speech. The goals of palate repair include optimizing palatal function for speech and feeding while avoiding dehiscence or postoperative fistulae. The modified double-opposing Z-plasty is an effective technique for cleft palate repair. We describe the first reported case using this technique to repair a palatal defect resulting from chronic cocaine use. Recommended requirements for using this technique include absence of future or ongoing ischemic insults to the tissue (cocaine abstinence) for at least 1 year, an intact vascular pedicle demonstrated by greater palatine dimples, presence of sufficient vascularized soft tissue with preserved pharyngeal arches, small to medium defect sizes within 10 cm(2), and extensive flap mobilization with tension-free closure. The advantages of this technique include preservation and reorientation of functional muscle, single-stage repair, and obviated requirement for distant donor sites.

Topics: Cleft Palate; Cocaine; Humans; Nose; Palate, Soft; Surgical Flaps

Objective : To compare nasoalveolar molding (NAM) effect employing a nasal elevator plus DynaCleft® and NAM-Grayson system in patients with complete unilateral cleft lip and palate. Method : Prospective study in two groups. Group A included 20 consecutive patients treated with DynaCleft® and a nasal elevator before lip surgery. Group B included 20 patients treated with NAM-Grayson system. Maxillary casts and standard view photographs were done before and after treatment. Columella deviation angle, soft tissue distance of the cleft, intercommisural distance, and nostril height and width were traced and measured on the printed photos; a ratio was obtained and compared before and after treatment. Cleft width, anterior width, and anteroposterior distances were measured on the maxillary cast. Results : Group A began treatment at an average age of 14.3 days and group B at an average age of 16.9 days; no complications were observed. For group A, the initial average alveolar cleft within the cast was 10.7 mm, and after treatment it was 6.6 mm. For group B, pretreatment width was 11.2 mm, and after treatment it was 5.9 mm. No differences were found on the anterior and posterior width, and A-P distance of both groups. The initial mean columellar angle in group A was 38.1°, and after treatment it was 61.5°; for group B the initial mean columellar angle was 33.6°, and after treatment it was 59.5°. Results of Mann-Whitney U and Student's t tests showed no differences (P > .05). Width and height dimensions of the nostril showed minor differences. Conclusions : Both methods significantly reduced the cleft width and improved the nasal asymmetry. Our findings show that both methods produced similar results.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nose; Prospective Studies; Treatment Outcome

The aim of this study was to assess the nostril symmetry following primary cleft rhinoplasty done with either a dorsal onlay or columellar strut graft in patients with non-syndromic complete unilateral cleft lip and palate. In this retrospective study 30 consecutive patients treated with autogenous or alloplastic dorsal onlay grafts and 30 consecutive patients treated with autogenous or alloplastic columellar strut grafts for complete unilateral cleft nose reconstruction were analyzed for nasal symmetry. The autogenous grafts used were costo-chondral or septal cartilage and the alloplastic graft used was high density polyethylene (Medpore(®)). Assessment of the nostril symmetry was done using a two-dimensional nasal analysis 24-30 months postoperatively. Ratios between cleft and noncleft side nostril for three parameters were used to assess symmetry namely nostril width, nostril height and nostril gap area. None of the three parameters showed statistically significant changes. A satisfactory, though not statistically significant, difference in symmetrical outcome could be achieved in both the groups with the exception of nostril width symmetry in group treated with dorsal onlay graft.

Topics: Adolescent; Adult; Biocompatible Materials; Cartilage; Cephalometry; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Male; Nasal Cartilages; Nasal Septum; Nose; Patient Satisfaction; Photography; Polyethylenes; Prostheses and Implants; Retrospective Studies; Rhinoplasty; Transplantation, Autologous; Treatment Outcome; Young Adult

Severe bilateral cleft-lip/palate patients are difficult to manage even if nasoalveolar molding therapy is advocated before surgical repair. A 5-day-old male infant with bilateral cleft-lip-palate was managed with the nasoalveolar molding technique. Periodic adjustments of the appliance were continued every week to mold the nasoalveolar complex into the desired shape for the 5 months of infancy. The cleft width of 12 mm on the right and 14 mm on the left side was completely reduced, and the absent columella was lengthened to 6 mm with the active molding appliance. The horizontal bar of the nasal stent of the appliance was modified by adding an additional 1 mm layer of resilient liner on the tissue surface to achieve rapid columellar lengthening. In severe bilateral cleft-lip/palate cases, simple modifications in the appliance can achieve rapid results.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Equipment Design; Follow-Up Studies; Humans; Infant, Newborn; Male; Nose; Orthopedic Procedures; Plastic Surgery Procedures; Stents; Surface Properties; Tissue Expansion

To evaluate the correlation between symmetry of the craniofacial skeleton and aesthetics of the nose and upper lip in children with complete unilateral cleft lip and palate (CUCLP).. Craniofacial symmetry was evaluated on postero-anterior (PA) cephalograms of 54 children (37 boys and 17 girls; mean age = 11.0 years, SD 1.6) with CUCLP repaired with a one-stage closure (Cleft group). Treated subjects were age- and gender-matched with 54 untreated subjects taken from the University of Michigan Growth Study (Control group). Fourteen coefficients of asymmetry (CAs) were calculated and four angles were measured. Four raters assessed the nasolabial appearance on cropped facial and profile photographs with the 5-grade aesthetic index of Asher-McDade (grade 1 means the most aesthetic and grade 5 the least aesthetical outcome) in the Cleft group only. Independent t-tests were used to evaluate the inter-group differences for CAs. Pearson's correlation coefficients were calculated to examine a relationship between particular components of the aesthetical index and CAs. Multiple regression analyses were carried out to explain the nasolabial aesthetics on the basis of craniofacial symmetry.. In the Cleft group, most cephalometric variables demonstrated asymmetry not exceeding 10%. The Cleft and Control groups differed regarding three angular measurements (Se, Ism, and ANS) and 1 CA (Mo-V). Three of the four nasolabial components demonstrated correlation with some cephalometric variables. However, the correlation coefficients were low (range: -0.309 to 0.305).. There is a weak correlation between craniofacial skeletal symmetry and aesthetics of the nose and upper lip in children with CUCLP.

Topics: Cephalometry; Child; Cleft Lip; Cleft Palate; Esthetics; Facial Asymmetry; Facial Bones; Female; Humans; Lip; Male; Nose; Statistics, Nonparametric; Treatment Outcome

We assessed the postoperative nasal form and symmetry after presurgical use of a Hotz plate (HP) in patients with unilateral complete cleft lip and palate (UCLP). The subjects were 28 infants with UCLP who underwent cheiloplasty. Of these subjects, 14 underwent presurgical orthopedic treatment using the HP (HP group) and 14 underwent the same treatment without the HP (non-HP group). Photographic records were obtained 1 and 6 months after cheiloplasty, and the results of anthropometric analysis were compared between the 2 groups. The nasal inclination and the ratio of the width of the nasal base to the total width of the nose were significantly improved in the HP group compared with the non-HP group at both postoperative time points. Thus, presurgical use of the HP significantly improved the nasal asymmetry and deformity in UCLP patients after primary cheiloplasty and nasal repair.

Topics: Cleft Lip; Cleft Palate; Combined Modality Therapy; Female; Humans; Infant; Infant, Newborn; Male; Nose; Orthopedic Procedures; Orthotic Devices; Photography; Plastic Surgery Procedures; Rhinoplasty; Treatment Outcome

We describe an effective technique for anchorage of transnasal traction in the management of maxillary rotation during external distraction.

Topics: Bone Plates; Bone Wires; Cephalometry; Cleft Lip; Cleft Palate; Cleidocranial Dysplasia; External Fixators; Humans; Maxilla; Nose; Osteogenesis, Distraction; Osteotomy, Le Fort; Pycnodysostosis; Rotation; Traction

Topics: Adolescent; Alveolar Process; Bone Transplantation; Cleft Lip; Cleft Palate; Female; Humans; Maxilla; Nasal Surgical Procedures; Nose; Osteogenesis, Distraction

Topics: Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Nose; Orthopedic Procedures

Topics: Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Nose; Orthopedic Procedures

The aesthetic outcome of cleft treatment is of great importance due to its complex management and the psychosocial consequences of this defect. The aim of the study was to assess the aesthetic evaluations of patients following cleft surgery by various groups and investigate potential associations of the assessments with life quality parameters. Head photos of 12 adult patients with treated unilateral cleft lip and palate were evaluated by laypeople and professionals. A questionnaire was distributed and answered by the patients and their parents. Intra-panel agreement was high (α > 0.8) for laypeople and professionals. Between-groups agreement was high for both laypeople and professionals, but not when patients and/or parents were tested. Professionals, parents, and patients were more satisfied with patients' appearance than laypeople, although in general all groups were not highly satisfied. Low satisfaction with aesthetics correlated with increased self-reported influence of the cleft in the patients' social activity and professional life (0.56 < rho < 0.74, p < 0.05). These findings highlight the observed negative influence of the cleft on the patient's social activity and professional life and underline the need for the highest quality of surgical outcome for this group of patients.

Topics: Adolescent; Adult; Attitude to Health; Case-Control Studies; Cleft Lip; Cleft Palate; Dentists; Esthetics, Dental; Face; Female; Humans; Interpersonal Relations; Lip; Male; Maxilla; Nose; Orthodontics; Parents; Personal Satisfaction; Psychological Distance; Self Concept; Surgery, Oral; Surveys and Questionnaires; Treatment Outcome; Young Adult

Objectives : (1) To compare oral pressure and nasal airflow in 3- to 5-year-olds versus older children and adults; (2) to describe stability of these measures in 3- to 5-year-olds at two recording times; and (3) to report participation rates of 3- to 5-year-olds for the aerodynamic protocol. Design : Prospective, nonrandomized, convenience samples in four age groups. Setting : University clinic. Participants : A total of 105 individuals without cleft palate and with normal speech for their age who were 3 to 5 (n  =  45), 7 to 9 (n  =  20), 11 to 13 (n  =  20), or 20 to 30 years old (n  =  20). All had normal nasal resonance and absence of nasally obstructive conditions on the testing day. Main Outcome Measures : Oral pressure and nasal airflow on /p/ and /m/ in syllable series and the word "hamper." Results : Oral pressure was significantly higher on /p/ for 3- to 5-year-olds versus the two oldest groups. Nasal airflow on /p/ occurred infrequently across groups. Oral pressure on /m/ was significantly higher for 3- to 5-year-olds versus adults. Nasal airflow on /m/ increased significantly with age. Oral pressure and nasal flow did not differ at two measurement times for the 3- to 5-year-olds. Of the 3- to 5-year-olds, 88% completed the protocol. Conclusions : Oral pressure decreased on /p/ and nasal airflow increased on /m/ from early childhood into adulthood. Nasal air escape on /p/ occurred rarely for speakers of any age; when it did occur, the magnitude was limited. Most preschool-aged children should be able to complete a velopharyngeal aerodynamic protocol, and measures are stable even for these young speakers.

Topics: Child; Cleft Palate; Humans; Nose; Pharynx; Prospective Studies; Speech

The Le Fort II midfacial advancement appears to be an effective surgical method for the treatment of severe midfacial-nose hypoplasia with a skeletal class III malocclusion, which is usually combined with syndromic midfacial anomalies. However, the conventional surgical method requires the coronal approach, including a coronal incision, together with other surgical approaches, such as an intraoral incision. Therefore, surgeons often hesitate to propose this type of osteotomy, even for patients who develop severe nonsyndromic midfacial-nose hypoplasia. This report presents a new surgical approach for performing a safe Le Fort II osteotomy for nasomaxillary, midfacial corrective advancement via a solely intraoral approach.. Surgery was performed with endoscopically assisted piezoelectric surgery. The osteotomized nasomaxillary Le Fort II segment was successfully protracted without aggressive down-fracture procedures with the sole intraoperative use of a rigid external distraction (RED) system, followed by internal rigid fixation, and the subsequent removal of the RED system. Seven patients (all patients were nonsyndromic, but 2 had cleft lip and palate, and an average age of 19.9 years) were included in this study.. The degrees of midfacial advancement at the base of nasal bone (the top edge of the modified Le Fort II segment) that was osteotomized and at maxillary point A was 8.3 mm (range 5.8 mm to 10.5mm) and 8.5 mm (range 5.9 mm to 9.8 mm), respectively.. This new method less invasively facilitates safe, secure, and ideal nasomaxillary midfacial protraction to yield a satisfactory resultant facial profile and favorable occlusion in patients with severe midfacial-nose hypoplasia and skeletal class III malocclusions.

Topics: Adolescent; Adult; Cephalometry; Cleft Lip; Cleft Palate; Endoscopes; Endoscopy; Female; Follow-Up Studies; Fracture Fixation, Internal; Humans; Jaw Fixation Techniques; Male; Malocclusion, Angle Class III; Mandibular Osteotomy; Maxilla; Maxillary Osteotomy; Minimally Invasive Surgical Procedures; Nasal Bone; Nasal Cavity; Nose; Osteotomy, Le Fort; Patient Care Planning; Piezosurgery; Surgery, Computer-Assisted; Traction; Young Adult

Comparison of nasal asymmetry between unilateral cleft lip and palate (UCLP) patients with and without nasal correction at primary repair. Assessment of the value of Symnose as a routine research tool.. 75 ten-year-old UCLP patients who underwent primary lip repair by one of two techniques: classical Millard with primary nasal correction (n = 30) or modified Millard without nasal correction (n = 45). Control group of ten-year-old school children (n = 45).. Nasal asymmetry of participants was measured from facial photographs taken in two views: frontal and basal. The Symnose computer program was used to calculate asymmetry for three parameters: front perimeter (FP), base perimeter (BP) and nostrils (N). Total asymmetry was also calculated. Each image was traced on three separate occasions and a mean of the three measurements was calculated.. BP, N and total asymmetry were significantly greater in UCLP patients without nasal correction compared to both controls and patients with correction (BP = 12.73% v 4.90% v 6.75%, N = 47.73% v 15.83% v 30.75%, total = 81.87% v 46.43% v 54.68%, p ≤ 0.001). FP asymmetry was significantly greater in controls than all UCLP patients (22.87% v. 18.18% and 15.07%, p = 0.001 and p = 0.008). BP measurements have a higher degree of repeatability than FP and N (Coefficient of repeatability = 5.99, 17.02 and 16.47, respectively).. Primary nasal correction produces greater nasal symmetry during childhood from the basal view. Symnose is a simple method of objectively measuring asymmetry in UCLP, however improvements are required before it can be considered a useful research tool.

Topics: Cephalometry; Child; Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Humans; Image Processing, Computer-Assisted; Male; Nose; Oral Surgical Procedures; Quality of Life; Retrospective Studies

To determine relationship between screening perceptual assessment for resonance disorders and nasalance scores.. Screening perceptual assessment of 115 children with cleft palate with or without lip was performed to determine its relationship to nasalance sores. The perceptual assessment 3-scale (-1: hyponasality; 0: normal; +1: hypernasality) was compared to nasalance scores based on nasometry. To find the weight of Kappa, nasalance scores were converted to a 3-ordinal scale with 3 criteria for cut-off points (-1: nasalance score -1, -1.5 and-2 SD lower than the mean, 0: nasalance score +/- 1 SD, +/- 1.5 and +/- 2 SD of the mean; and + 1: nasalance score + 1 SD, + 1.5, and + 2 SD greater that the mean).. Correlations between screening perceptual assessment and nasalance scores were good to excellent. The percentage of agreement was good, the Kappa reliability was fair to moderate in passages of a mixture of oral and nasal consonants (My House) and devoid of nasal consonants (Laying Hen). A weak relationship was found for the nasal passage (Winter).. The relationship of speech assessments in the present study varied, as it depended on the different variables and analysis. To ensure a strong relationship, further prospective study is needed.

Topics: Adolescent; Child; Child, Preschool; Cleft Palate; Cross-Sectional Studies; Female; Humans; Infant; Male; Nose; Retrospective Studies; Speech Articulation Tests; Speech Disorders

The goal of this study was to compare perioperative outcomes for the anterior versus posterior approach to the iliac crest for alveolar bone grafting in patients with cleft lip and palate (CLP).. A retrospective cohort study of patients with CLP who had an anterior or posterior iliac crest bone graft during a 10-year period was performed. Available medical records were reviewed and the outcome variables documented included the operation site for bone graft procurement (anterior or posterior), estimated blood loss, duration of operation, concurrent procedures, and length of hospital stay. The 2 groups were compared by t test, Fisher exact test, and multivariate regression to show differences.. There were 239 patients with CLP who had an iliac crest bone graft to the alveolar cleft; 133 had an anterior and 106 a posterior approach for bone graft procurement. The mean estimated blood loss was significantly less with the posterior approach (85 vs 177 mL; P < .0001). The mean operation duration with the posterior approach was longer (4.6 vs 3.5 hours; P < .0001). Most patients in this group (67%), however, had 2 or more additional procedures during the same anesthetic, whereas only 16% of patients in the anterior group had 2 or more additional procedures. The mean length of stay was significantly shorter for the posterior approach (1.7 vs 2.2 days; P < .0001).. These results suggest that patients having a bone graft from the posterior iliac crest have a smaller estimated blood loss and a shorter length of stay. In addition, this approach permits repair of the alveolar cleft and additional procedures, including augmentation of the median tubercle and correction of nasolabial distortions, which are often present in patients with CLP.

Topics: Alveoloplasty; Blood Loss, Surgical; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Cohort Studies; Female; Humans; Ilium; Length of Stay; Lip; Male; Nose; Retrospective Studies; Time Factors; Tissue and Organ Harvesting; Treatment Outcome

Nasoalveolar molding (NAM) is a treatment option available for early cleft care. Despite the growing debate about the efficacy of nasoalveolar molding, questions remain regarding its prevalence and the demographic characteristics of families undergoing this technique prior to traditional cleft surgery.. To determine the number of teams currently offering nasoalveolar molding and to identify salient clinical and sociodemographic variables in infants and families who choose nasoalveolar molding compared with those who choose traditional cleft care across three well-established cleft centers.. Via phone surveys, 89% of the U.S. cleft teams contacted revealed that nasoalveolar molding is available at 37% of these centers. Chart reviews and phone correspondence with caregivers indicate that the average distance to the cleft center was 65.5 miles and caregiver age averaged 30.9 ± 5.7 years. Of families who chose nasoalveolar molding, 85% received total or partial insurance coverage. No difference in caregiver education, income, or distance to the clinic between treatment groups was found. On average, infants receiving nasoalveolar molding and cleft surgery had larger clefts and had more clinic visits than infants receiving traditional cleft surgery. Infants who were firstborn and those who did not have other siblings were more likely to receive nasoalveolar molding than were infants who were residing with other siblings.. Currently more than one-third of U.S. cleft centers offer nasoalveolar molding. Although the cleft size was larger in the nasoalveolar molding group, no treatment group differences in education, income, and distance to the clinic were found.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Patient Care Team; Plastic Surgery Procedures; Practice Patterns, Physicians'; United States

A 2 month-old infant with unilateral cleft lip, alveolus and palate was presented with wide alveolar defect, soft-tissue deformity and a markedly sunken nasal wing at the cleft side.. The patient was treated with a moulding plate and additionally with a nasal stent. The device consisted of an acrylic plate with an attached nasal stent that lifted the nasal dome.. Under this pre-surgical treatment, the cleft edges moved closer by 9 mm and 6 mm at the alveolar ridge and palate, respectively. The nasal wing was lifted considerably.. Pre-surgical nasoalveolar moulding helped to reduce the cleft gap, improve the arch form, approximate lip segments and distinctly improve the morphology of the nose by correcting flattened nasal wings.

Topics: Abnormalities, Multiple; Alveolar Process; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Infant; Male; Nose; Orthodontics, Corrective; Plastic Surgery Procedures; Preoperative Care; Recovery of Function; Risk Assessment; Treatment Outcome

Surgical correction for submucous cleft palate is generally indicated in the presence of velopharyngeal inadequacy. Clinical assessment of velopharyngeal inadequacy requires that the child is able to produce a connected speech sample, which can yield a delay in treatment decisions that extends through a critical period of speech and language development. A perceptual speech assessment and intraoral examination are traditionally the most important methods of establishing a diagnosis of submucous cleft palate. The purpose of this case report is to demonstrate the use of magnetic resonance imaging as a diagnostic tool to provide early identification and an indication of surgical treatment for an individual born with a submucous cleft palate. The magnetic resonance images indicated a discontinuous levator veli palatini muscle sling arrangement with attachment of the muscle bundles onto the hard palate. Surgery was performed at 16 months and postsurgical speech evaluations demonstrated normal resonance and age-appropriate speech.

Topics: Cleft Palate; Humans; Infant, Newborn; Language Development; Magnetic Resonance Imaging; Male; Nose; Palate, Soft

Topics: Biocompatible Materials; Cleft Lip; Cleft Palate; Elastic Modulus; Humans; Infant; Nasal Cartilages; Nose; Pliability; Prosthesis Design; Prosthesis Fitting; Prosthesis Retention; Stents; Surface Properties; Surgical Tape

In this longitudinal study, the craniofacial morphology and evaluated soft tissue profile changes, at 6 and 12 years of age in patients with complete bilateral cleft lip and palate (CBCLP) were compared. Lateral cephalograms from 148 patients with CBCLP, treated consecutively at three European cleft centers, Gothenburg (n (A) = 37), Nijmegen (n (B) = 26), and Oslo (n (C) = 85), were evaluated. Eighteen hard tissue and ten soft tissue landmarks were digitized. Paired t test, Pearson's correlation coefficients, and multiple regression models were applied for statistical analysis. ANOVA and Tukey-B, as a post hoc test, were used to evaluate the increments and compare centers. Hard and soft tissue data were superimposed using the generalized Procrustes analysis. For Nijmegen, the increments of the variables SNA, ANB, SN-NL, SN-ML, NL-ML, Snss, and Snpg were significantly different than the two other centers (p = 0.041 to <0.001). SNPg increments were significantly different between Nijmegen and Oslo (p = 0.002). The three cleft centers followed different treatment protocols, but the main differences in craniofacial morphology until 12 years of age were the growth pattern and the maxillary and upper incisor variables. Follow-up of these patients until facial growth has ceased, which may elucidate components for improving treatment outcome.

Topics: Age Factors; Cephalometry; Child; Chin; Cleft Lip; Cleft Palate; Clinical Protocols; Facial Bones; Female; Follow-Up Studies; Humans; Incisor; Lip; Longitudinal Studies; Male; Mandible; Maxilla; Maxillofacial Development; Nasal Bone; Nose; Osteotomy; Palate, Hard; Palate, Soft; Sella Turcica; Skull; Treatment Outcome

(1) To evaluate quantitative differences in presurgical presentations of alveolar alignment and nostril anatomy of infants with BCLP treated with nasoalveolar molding (NAM) from those treated with maxillary infant orthopedics only (IO) and (2) to detect interrelationships between presurgical nasoalveolar anatomy, age at lip surgery, age of commencing, and durations of alveolar and nasal molding.. A retrospective analysis was conducted on nasal-alveolar measurements and presurgical treatment records of infants with BCLP who received lip repair by a single surgeon in a tertiary-care, referral teaching hospital consecutively from 2000 to 2009 after undergoing NAM (n  =  29; 51 nostrils) or IO (n  =  17; 32 nostrils). Paired t tests analyzed nostril and alveolar symmetry in each group. Intergroup comparisons were made by linear mixed-model regression analyses. Pearson's correlation tests were conducted to detect significant interrelationships within groups.. Significant between-group differences were noted in alveolar irregularity (NAM: 3.58 ± 1.02 mm; IO: 7.31 ± 1.28 mm; p < .01), columellar length (NAM: 2.88 ± 0.27 mm; IO: 1.48 ± 0.34 mm; p < .001), columellar width (NAM: 6.10 ± 0.21 mm; IO: 6.88 ± 0.26 mm; p < .01), columellar length/width ratio (NAM: 0.48 ± 0.05; IO: 0.20 ± 0.07; p < .05), and columellar angle (NAM: 0.98 ± 1.1°; IO: 3.69 ± 1.37°; p < .05). Differences in age of commencing presurgical orthopedics, lip surgery, and treatment durations were not significant. Better-aligned alveolar segments in the NAM group did not statistically correlate with nostril dimensions. Alveolar irregularity and nostril height in the IO group strongly correlated.. Infants who received NAM had longer columellae and better-aligned alveolar segments than those who received only IO. Other nostril dimensions were not significantly different.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Female; Humans; Infant; Infant, Newborn; Male; Nose; Preoperative Care; Prostheses and Implants; Retrospective Studies; Rhinoplasty; Treatment Outcome

The purpose of this controlled study is to determine satisfaction with speech and facial appearance in Flemish pre-pubescent children with unilateral cleft lip and palate. Forty-three subjects with unilateral cleft lip and palate and 43 age and gender matched controls participated in this study. The Cleft Evaluation Profile was used to assess the perceived satisfaction for individual features related to cleft care. Both the cleft palate subjects and their parents were satisfied with the speech and facial appearance. The Pearson χ(2) test revealed significant difference between the cleft palate and the control group regarding hearing, nasal aesthetics and function, and the appearance of the lip. An in depth analysis of well specified speech characteristics revealed that children with clefts and their parents significantly more often reported the presence of an articulation, voice and resonance disorder and experienced /s/ /r/ /t/ and /d/ as the most difficult consonants. To what extent the incorporation of specific motor oriented oral speech techniques regarding the realisation of specific consonants, attention to vocal and ear care, and the recommendation of secondary velopharyngeal surgery, with the incorporation of primary correction of the cleft nose deformity simultaneously with primary lip closure, will aid these patients are future research subjects.

Topics: Adolescent; Articulation Disorders; Attitude to Health; Case-Control Studies; Child; Cleft Lip; Cleft Palate; Esthetics; Esthetics, Dental; Face; Female; Finland; Hearing; Humans; Interpersonal Relations; Lip; Male; Nose; Parents; Patient Satisfaction; Personal Satisfaction; Phonetics; Respiration; Self Concept; Speech; Speech Intelligibility; Speech Therapy; Voice Disorders

Children with unoperated cleft lip/palate have nearly normal facial growth, whereas patients who have had labiopalatal repair often exhibit midfacial retrusion. The aim of this study was to compare cephalometric data in patients with repaired unilateral or bilateral complete cleft lip/alveolus (UCCLA or BCCLA) with patients with repaired unilateral or bilateral complete cleft lip/palate (UCCLP or BCCLP). This study might provide insight into the etiology of impaired facial growth in patients with repaired cleft lip/palate.. This was a retrospective, cross-sectional analysis of nonsyndromic patients with UCCLA, BCCLA, UCCLP, and BCCLP. Angular and linear measurements of the midfacial region were made on traced lateral cephalograms. Paired t tests were used to compare each group with normative controls from the Michigan Growth Study. Multivariate analysis of variance was used to determine possible differences among the groups.. There were 77 patients (38 male and 39 female) with a mean age of 11.2 years (range, 6 to 16 years; UCCLA, n = 25; BCCLA, n = 7; UCCLP, n = 18; and BCCLP, n = 27). There was no significant difference in midfacial position between the UCCLA and BCCLA groups and noncleft age-matched controls. In contrast, the maxilla in patients with UCCLP and BCCLP was significantly smaller and more retruded (P < .05) compared with patients with UCCLA and BCCLA and controls.. Children with UCCLA and BCCLA appear to have normal midfacial growth, whereas the maxilla in children with UCCLP and BCCLP is small and retrusive. This study suggests that the presence and/or repair of the secondary palate is responsible for midfacial hypoplasia in these patients.

Topics: Adolescent; Age Factors; Alveoloplasty; Bone Transplantation; Case-Control Studies; Cephalometry; Child; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Lip; Male; Mandible; Maxilla; Maxillofacial Development; Nose; Palatal Muscles; Palate; Retrospective Studies; Surgical Flaps

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.

Topics: Adolescent; Cephalometry; Child; Cleft Lip; Cleft Palate; Esthetics; Facial Asymmetry; Female; Humans; Male; Nose; Regression Analysis

Tessier clefts type 3 and 4 are rare. In this paper the authors report on the management of a wide Tessier 3 cleft. There is no standardized protocol or timing of the surgical procedures in this rare disfiguring condition. Generally speaking, the aim is to preserve the function of important anatomical structures (e.g., a seeing eye.) and reconstruct, as best as possible, harmonic facial features. The authors present a "step by step" solution of the malformation pointing out the limitations of the surgical procedures they used and the goals they wanted to obtain. Despite of the uniqueness and the complexity of the pathology, the authors think they obtained reasonable results both in term of function and aesthetics, permitting the patient to be accepted in the social environment.

Topics: Anophthalmos; Cheek; Cleft Lip; Cleft Palate; Esthetics; Female; Follow-Up Studies; Humans; Infant, Newborn; Maxillary Sinus; Maxillofacial Abnormalities; Nose; Orbit; Plastic Surgery Procedures; Treatment Outcome

To identify the nasolabial soft tissue changes that occur after Le Fort I advancement.. A prospective study of patients who had Le Fort I advancement at the Children's Hospital Boston from 2005 to 2007. The pre- and postoperative anthropometeric nasolabial measurements were recorded by a single examiner.. A total of 37 patients with a mean age of 18.6 years at the time of operation and a mean follow-up of 12.6 months were recruited. Nearly one half of the study sample (16 of 37) had cleft lip/palate. Direct anthropometry showed a reduction of the nasal length by 1.3 mm while the nasal tip protrusion increased by 1.1 mm. The nasofrontal angle decreased by 9.8° and the upper lip moved forward by 4.15 mm, reflecting the advancement in the maxilla. The height of the cutaneous upper lip increased by 0.4 mm. No significant differences were found in the soft tissue response observed between the cleft and noncleft subjects.. Le Fort I advancement produces elevation of the nasal tip, as seen by a reduction in the nasal length, an increase in the nasal tip protrusion, and a concomitant reduction in the nasofrontal angle. Additionally, the cutaneous lip height increased, most likely due to an unfurling of the upper lip.

Topics: Adolescent; Adult; Cephalometry; Cleft Lip; Cleft Palate; Cohort Studies; Eyelids; Female; Follow-Up Studies; Frontal Bone; Humans; Image Processing, Computer-Assisted; Incisor; Lip; Male; Mandible; Maxilla; Nasal Bone; Nose; Orthopedic Fixation Devices; Osteotomy, Le Fort; Overbite; Prospective Studies; Sella Turcica; Sex Factors; Young Adult

Topics: Attitude of Health Personnel; Burns; Cleft Lip; Cleft Palate; Decision Making; Humans; Nose; Patient Care Planning; Plastic Surgery Procedures; Surgery, Plastic

This article focuses on current practices and controversy in the area of presurgical infant orthopedics in patients born with cleft lip and palate.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Health Care Costs; Humans; Infant; Maxillofacial Development; Nose; Orthodontic Appliance Design; Orthodontics, Corrective; Orthotic Devices; Palatal Obturators; Patient Care Team; Pediatric Dentistry; Preoperative Care; Standard of Care; Stents; Tissue Expansion; Treatment Outcome

The senior author routinely performs primary nasal reconstruction with every cleft lip repair. This addresses the nasal tip asymmetry and simplifies the definitive secondary rhinoplasty in adolescence.. A retrospective chart review was completed of all unilateral cleft secondary rhinoplasties performed by the senior author. The indications for secondary rhinoplasty were examined, anatomical features of the nose at the time of operation were documented, and the reconstructive techniques used were recorded.. From 2001 to 2009, the senior author performed 116 secondary rhinoplasties in patients with a previously repaired unilateral cleft lip. The senior author performed 44 of the initial cleft lip repairs (group A). A Dibbell rhinoplasty was required in 26 percent, a Potter rhinoplasty was required in 5 percent, a Tajima inverted-U incision was required in 70 percent, and an alar base resection was required in 53 percent. For those patients who did not undergo cleft lip repair with primary rhinoplasty by the senior author, 60 percent required a Dibbell rhinoplasty, Potter rhinoplasty was not used, 76 percent required a Tajima inverted-U incision, and 64 percent required an alar base resection. Group A had significantly greater dome symmetry when comparing the cleft side to the noncleft side (p = 0.001). Nostril apex height was also more symmetrical in group A (p = 0.105).. Primary nasal reconstruction performed with cleft lip repair as described by the senior author makes the nasal tip more symmetric and requires less complex intervention at the time of definitive secondary rhinoplasty.. Therapeutic, IV.

Topics: Adolescent; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Reoperation; Retrospective Studies; Rhinoplasty; Time Factors; Young Adult

This comparative cross-sectional study assessed the facial surface dimensions of a group of Malay children with unilateral cleft lip and palate (UCLP) and compared them with a control group. 30 Malay children with UCLP aged 8-10 years and 30 unaffected age-matched children were voluntarily recruited from the Orthodontic Specialist Clinic in Hospital Universiti Sains Malaysia (HUSM). For the cleft group, lip and palate were repaired and assessment was performed prior to alveolar bone grafting and orthodontic treatment. The investigation was carried out using 3D digital stereophotogrammetry. 23 variables and two ratios were compared three-dimensionally between both groups. Statistically significant dimensional differences (P<0.05) were found between the UCLP Malay group and the control group mainly in the nasolabial region. These include increased alar base and alar base root width, shorter upper lip length, and increased nose base/mouth width ratio in the UCLP group. There were significant differences between the facial surface morphology of UCLP Malay children and control subjects. Particular surgical procedures performed during primary surgeries may contribute to these differences and negatively affect the surgical outcome.

Topics: Age Factors; Anatomic Landmarks; Case-Control Studies; Cephalometry; Child; Chin; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Ear, External; Eye; Face; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Malaysia; Male; Mouth; Nasal Cartilages; Nose; Orbit; Photogrammetry; Plastic Surgery Procedures; Zygoma

Outgrowth and fusion of the lateral and medial nasal processes and of the maxillary process of the first branchial arch are integral to lip and primary palate development. Wnt9b mutations are associated with cleft lip and cleft palate in mice; however, the cause of these defects remains unknown. Here, we report that Wnt9b(-/-) mice show significantly retarded outgrowth of the nasal and maxillary processes due to reduced proliferation of mesenchymal cells, which subsequently results in a failure of physical contact between the facial processes that leads to cleft lip and cleft palate. These cellular defects in Wnt9b(-/-) mice are mainly caused by reduced FGF family gene expression and FGF signaling activity resulting from compromised canonical WNT/β-catenin signaling. Our study has identified a previously unknown regulatory link between WNT9B and FGF signaling during lip and upper jaw development.

Topics: Animals; Apoptosis; beta Catenin; Blotting, Western; Cell Movement; Cell Proliferation; Cells, Cultured; Cleft Lip; Cleft Palate; Fibroblast Growth Factors; In Situ Hybridization; Jaw; Lip; Maxilla; Mice; Mice, Knockout; Microscopy, Electron, Scanning; Nasal Mucosa; Nose; Organ Culture Techniques; Palate; Real-Time Polymerase Chain Reaction; Wnt Proteins

To evaluate the facial morphology characteristics of patients with complete unilateral cleft lip and palate (UCCLPs) who had undergone cleft palate repair at different times.. This study included 46 nonsyndromic UCCLPs and 38 age and sex matched non-cleft patients. 35 cephalometric measurements were used to evaluate the facial morphology. Student's t-test, one-way ANOVA and rank sum tests were used for comparison. Significant difference was defined at 95% level.. The data showed that UCCLPs who had palatoplasty between 7 and 12 years had greater PMP-A, PMP-ANS, Ba-ANS, Ba-A, Ba-N-ANS than those operated on before 4 years of age, and UCCLPs who had palatoplasty at 4-12 years had smaller Y-axis angle than those operated on before 4 years of age.. The maxillary sagittal length increased gradually as von Langenbeck repair was delayed. UCCLPs who underwent palate repair using von Langenbeck technique at 4-12 years had a more protrusive maxilla and less clockwise rotated mandible than those repaired before 4 years. UCCLPs operated using the von Langenbeck technique at 4-12 years had better head-face morphology than those operated on before 4 years. There was no difference in facial morphology among UCCLPs with palate repair at 4-12 years.

Topics: Adolescent; Age Factors; Case-Control Studies; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Dental Occlusion; Face; Female; Humans; Male; Mandible; Mandibular Condyle; Maxilla; Maxillofacial Development; Nasal Bone; Nose; Orbit; Palate; Rotation; Sella Turcica

Cleft lip nasal deformity reconstruction is one of the difficult points of cleft palate sequence treatment. Treatment principle and method of cleft nasal deformity is mainly from the western scholars' point of view and technology. In this paper, according to the differences of typical form of east and west, we proposed the reconstructive theory and method corresponding to the Chinese. We hope that can deepen our understanding to the nasal deformity and the characteristics of cleft lip in order to improve reconstructive method.

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Plastic Surgery Procedures; Rhinoplasty

To establish a new method of presurgical alveolar molding using computer aided design(CAD) in infants with complete unilateral cleft lip and palate (UCLP).. Ten infants with complete UCLP were recruited. A maxillary impression was taken at the first examination after birth. The study model was scanned by a non-contact three-dimensional laser scanner and a digital model was constructed and analyzed to simulate the alveolar molding procedure with reverse engineering software (RapidForm 2006). The digital geometrical data were exported to produce a scale model using rapid prototyping technology. The whole set of appliances was fabricated based on these solid models.. The digital model could be viewed and measured from any direction by the software. By the end of the NAM treatment before surgical lip repair, the cleft was narrowed and the malformation of alveolar segments was aligned normally, significantly improving nasal symmetry and nostril shape.. Presurgical NAM using CAD could simplify the treatment procedure and estimate the treatment objective, which enabled precise control of the force and direction of the alveolar segments movement.

Topics: Cleft Lip; Cleft Palate; Computer-Aided Design; Humans; Infant; Maxilla; Nose

The aim of this study was to compare nostril height, width, collumelar length, interalar distance and nostril symetry between unilateral complete cleft lip/palate patients undergoing nasoalveolar moulding (NAM) and incomplete cleft lip patients/palate with no need of presurgical moulding before and after cheiloplasty with primary nasal correction. Our study group included 18 patients from whom 9 were NAM cleft lip/palate nasal deformity cases and 9 incomplete cleft lip/palate cases. All measurements were obtained by two independent investigators and averaged, standard deviations and symetry ratios were calculated, and paired and unpaired t-test was performed to compare the groups.. Our study results showed no statistically significant difference in nostril height, width, collumelar lenght, interalar distance in unilateral cases in preoperative and postoperative measurements between these two groups. Symetry measurements included nostril width on the affected and nonaffected side, nostril height on the affected and nonaffected side before (T1) and after (T2) cheiloplasty. The nostril height ratio was 1.2 and 1.03 for T1 to T2 and the nostril width revealed a ratio of 0.5 and 0.8 for T1 to T2 in unilateral NAM cases. In the incomplete cleft lip group the height ratio was 1.04 and 1.03 for T1 to T2 and the width ratio was 0.59/0.93 in pre-/postoperative measurements. These symetry values showed also no statistical significance between NAM and incomplete cleft lip cases.. Our study results showed no statistical significant difference in nostril height, width, collumelar lenght, interalar distance and nostril symetry between unilateral complete cleft lip/palate patients undergoing NAM and incomplete cleft lip patients/palate with no need of presurgical moulding, proving NAM combined with primary nasal correction is a very efficient management for cleft lip/palate children with outstanding results (Tab. 5, Fig. 4, Ref. 25).. nasoalveolar molding, complete cleft lip nasal deformity, cleft lip, nostril height, width, collumelar lenght, interalar distance, nostril symetry.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nose; Preoperative Care; Rhinoplasty; Splints

The aim of this study was to explore the bone-soft tissue relationships around the nasolabial area in uncorrected secondary unilateral cleft nose deformities.. Measurements taken from photographs and cone-beam computerized tomography (CBCT) results were derived and paired up to represent the deformity features of bone and soft tissue, respectively.. All soft tissue measurements were significantly smaller than the corresponding bone measurements. Various bone-soft tissue correlation patterns were observed in different measurement pairs.. The adopted photography-CBCT combined measurement method appeared to be reliable in evaluating the hard-soft tissue relationships in the nasolabial area. In unoperated unilateral cleft nose deformities, bony deformities would decide the soft tissue contours, and soft tissue in turn could camouflage the underlying bone deformities in various patterns and scale, making the external configuration less deformed than its bone basis.

Topics: Cephalometry; Child; Cleft Lip; Cleft Palate; Cone-Beam Computed Tomography; Dimensional Measurement Accuracy; Female; Humans; Male; Nasal Bone; Nasal Cartilages; Nasal Septum; Nose; Nose Diseases; Photography; Statistics, Nonparametric

The cleft lip nose is a complex 3-dimensional (3D) midfacial soft tissue and bony deformity. The contribution of maxillary hypoplasia to the etiology of this deformity has often been implicated for the suboptimal results of surgical treatment. The dimensions of the maxilla in unilateral cleft lip and palate (UCLP) have not been studied especially in relation to the volumetric and other asymmetries on the either side in unilateral clefts. The purpose of this article is to assess the relevant maxillary parameters of length, width, height, depth, and volume in patients with UCLP and compare the parameters of the cleft and noncleft sides.. Fifteen patients with UCLP were treated by a standard protocol by a single surgeon and orthodontist. The measurements of maxilla were taken using a combination of axial, coronal, lateral, and 3D reconstructed images. The volume of each maxilla was calculated on 3D reconstructions using the technique of manual segmentation, which allowed complete reconstruction of the right and left maxilla individually.. In general, the cleft maxillary length, width, height, depth, and volume have been found to be reduced when compared with the normal sides with significant P values (Wilcoxon signed rank test Z, P < 0.001).. The study demonstrates the anatomy of the maxillary asymmetry existing in UCLP and underlines the importance of correcting the bony deficiency by appropriate techniques to harmonize the results of rhinoplasty in unilateral cleft lip nose deformity. Augmentation of the deficient maxilla by specific contoured bone grafts allows restoration of the symmetry of the nasal platform in unilateral cleft lip nose deformity.

Topics: Case-Control Studies; Child; Child, Preschool; Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Humans; Imaging, Three-Dimensional; Infant; Male; Maxilla; Nose; Reproducibility of Results; Rhinoplasty; Statistics, Nonparametric; Tomography, X-Ray Computed; Treatment Outcome

Cleft lip repair aims to normalize the disturbed anatomy and function. The authors determined whether normalization of blood circulation is achieved.. The authors measured the microcirculatory flow, oxygen saturation, and hemoglobin level in the lip and nose of controls (n = 22) and in patients with unilateral and bilateral cleft lip-cleft palate. The authors measured these parameters before lip repair (n = 29 and n = 11, respectively), at the end of lip repair (n = 27 and 10, respectively), and in the late postoperative period (n = 33 and n = 20, respectively). The arterial flow velocity was measured in unilateral groups at the same time points (n = 13, n = 11, and n = 12, respectively). Statistical differences were determined using analysis of variance.. Before surgery, the arterial flow velocities and microcirculation values were similar on each side of the face and between groups. The microcirculatory flow was significantly higher in the prolabium of bilateral patients than in the philtrum of controls. All circulation values in unilateral and bilateral patients in the late postoperative period were within the range of controls and of those before surgery. Intraoperatively, the authors consistently found a perforating artery on the superficial side of the transverse nasalis muscle.. There appears to be no intrinsic circulatory deficit in unilateral and bilateral cleft lip-cleft palate patients. The increased flow in the prolabium indicates a strong hemodynamic need in this territory, compelling its vascular preservation. Whether surgical preservation of the nasalis perforator artery is of long-term benefit should be addressed in future studies.. Therapeutic, V.

Topics: Blood Flow Velocity; Cleft Lip; Cleft Palate; Hemoglobins; Humans; Intraoperative Period; Lip; Microcirculation; Nose

We evaluated the effects of presurgical nasoalveolar molding (NAM) with an orthopedic appliance and compared them with a passive orthopedic method (Hotz plate, HP), focusing on the naris morphology and width of the alveolar and palate cleft gap. The subjects were 28 unilateral complete cleft lip and palate patients treated with primary cheiloplasty at Tsukuba University Hospital from 2004 to 2011. Thirteen patients were treated preoperatively with NAM (NAM group), and 15 with HP (HP group). The surgical outcome was assessed according to left-right naris symmetry, as measured by the area ratio, perimeter ratio, aspect a/u ratio (aspect ratio of the affected side/aspect ratio of the unaffected side), and Hausdorff distance. In addition, the alveolar and palate cleft width was measured at the times of orthopedic plate setting and primary cheiloplasty. The aspect ratio was significantly smaller in the NAM group than in the HP group before the operation. In both groups, the aspect ratio, perimeter ratio, and Hausdorff distance were significantly smaller after the operation than before. The width of the alveolar and palate cleft gap was significantly narrowed in the NAM group, and the cleft gap at the initiation of NAM correlated significantly with the Hausdorff distance after cheiloplasty. We found that NAM improved the form of the naris after primary cheiloplasty and decreased the palate cleft gap more effectively than HP and that the width of the palate cleft gap was correlated with the surgical outcome of the naris.

Topics: Alveolar Process; Case-Control Studies; Cleft Lip; Cleft Palate; Female; Humans; Infant; Infant, Newborn; Male; Nose; Orthopedic Procedures; Preoperative Care; Treatment Outcome

Topics: Cleft Lip; Cleft Palate; Factor XI Deficiency; Female; Humans; Nose; Plastic Surgery Procedures; Young Adult

Nasoalveolar molding is increasingly being used to treat unilateral cleft nose deformity before primary repair. The Grayson technique starts nasal molding when an alveolar gap is reduced to 5 mm, whereas the Figueroa technique performs nasal and alveolar molding at the same time. The authors investigated the comparative efficacy, efficiency, and incidence of complications of the two techniques.. A blinded, retrospective study was conducted on 63 patients with complete unilateral cleft lip-cleft palate; 31 underwent the Grayson nasoalveolar molding and 32 underwent the Figueroa nasoalveolar molding. Pretreatment and posttreatment facial photographs and clinical charts were used to compare efficacy (nostril height ratio, nostril width ratio, columellar angle), efficiency (molding frequency), and incidence of complications (facial irritation, mucosal ulceration).. The Grayson and Figueroa techniques did not differ in treatment efficacy for nostril height ratio (0.86 ± 0.09 versus 0.85 ± 0.09; p > 0.05) and columellar angle (84.0 ± 4.5 degrees versus 85.3 ± 2.6 degrees; p > 0.05). Although the Grayson technique was more effective for reducing nostril width ratio (1.21 ± 0.29 versus 1.27 ± 0.19, p = 0.05), it was less efficient (i.e., required more adjustments) (10.9 ± 2.5 versus 8.8 ± 1.9; p < 0.001) and had a higher incidence of mucosal ulceration (23 percent versus 3 percent; p < 0.05).. The two nasoalveolar molding techniques differed in efficacy, efficiency, and incidence of complications in patients with complete unilateral cleft lip-cleft and palate. Understanding these differences may help surgeons and orthodontists improve outcome expectations and consultations with patients' families.. Therapeutic, III.

Topics: Cleft Lip; Cleft Palate; Female; Humans; Infant; Infant, Newborn; Male; Nose; Orthodontic Appliances, Removable; Photography; Retrospective Studies; Single-Blind Method; Treatment Outcome

Physiologic and developmental role of mastoid pneumatisation in children with otitis media with effusion (OME) is still controversial. For measuring mastoid pneumatisation and examine developmental characteristics, we used children with orofacial malformation of high risk for long term negative pressure in the middle ear and are expected to have lower rate of size and growth of pneumatisation. Mastoid were measured on Schuller's mastoid X-ray pictures planimetrically in study group of 146 children with bilateral (BCLP), unilateral (UCLP) and isolated (ICP) cleft palate, and control group of non-cleft 52 children, both groups with confirmed otitis media with effusion and no previous otological surgery. The lowest pneumatisation found in BCLE, BCLP and UCLP showed no growth of mastoid with age and lower mastoid size than OME controls. ICP is the only cleft type with growth of mastoid with aging. OME patients has the highest size of mastoid and growth rate with aging.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Mastoid; Nose; Otitis Media with Effusion; Radiography; Retrospective Studies

To evaluate nasal morphology, symmetry, and nostril shape in patients with unilateral cleft lip and palate following mixed-dentition alveolar bone grafting.. Prospective stereophotogrammetric study.. Hospital-based.. Thirty-nine patients with a history of repaired unilateral cleft lip and palate who received an iliac crest alveolar bone graft were recruited prospectively to participate in the study. Each patient served as his/her own control.. Partial facial impressions of all patients were acquired before and a minimum of 6 months after the alveolar bone grafting procedure. Image acquisition and analysis of the casts constructed from these models were carried out using three-dimensional stereophotogrammetry.. Surface-based registrations and linear measurements were performed to assess nasal morphology and nostril shape. A modified Procrustes technique was used to determine the change in nasal symmetry. A two-tailed, paired t test and an analysis of covariance were used to assess statistical significance.. Significant side-to-side asymmetry exists in the nasal region of patients with unilateral cleft lip and palate, both before and after alveolar bone grafting. No significant changes were observed between pre-alveolar bone graft and post-alveolar bone graft images based on linear measurements, asymmetry scores, and registrations. Gender and surgeon were not significant factors.. Under the conditions of this study, mixed-dentition alveolar bone grafting appears to have no significant long-term effect on nasal morphology, symmetry, or nostril shape.

Topics: Adolescent; Alveolar Bone Grafting; Child; Cleft Lip; Cleft Palate; Facial Asymmetry; Facial Expression; Female; Humans; Ilium; Imaging, Three-Dimensional; Male; Nose; Photogrammetry; Pilot Projects; Prospective Studies; Rhinoplasty; Treatment Outcome

A definitive correction of nasal deformity is best performed by creating symmetry and addressing the nostril/tip/columella complex, which is more easily handled by direct vision. The main objective is to evaluate the nasal changes along with function and also to evaluate the satisfaction outcome of the patients following secondary rhinoplasty.. Ten patients who were admitted to our unit for secondary rhinoplasty procedure involving the cleft lip-palate defects associated with nasal deformities were considered for the study. All the patients were evaluated pre- and postoperatively for aesthetics and function along with patient satisfaction and perception.. All the operated cases of cleft nasal deformity had a significant improvement in the facial aesthetics and function postoperatively. Clinical evaluation revealed that the post-nasal changes were significant with no nasal obstruction. Statistically, the results were significant (p<0.05).. Although our sample is small, this study would assist in some preliminary conclusions. From our present study, in the view of a distinct deformity of the internal and external nose associated with cleft lip/nose/palate in adolescents or adults, septal rhinoplasty or rhinoplasty alone provides good aesthetics and functional results.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Esthetics; Female; Follow-Up Studies; Humans; India; Male; Nose; Patient Satisfaction; Plastic Surgery Procedures; Reoperation; Rhinoplasty; Risk Assessment; Sampling Studies; Treatment Outcome; Young Adult

There is a difference between complete and incomplete cleft lip with regard to the nasal shape. Severe nasal deformity is found in almost all cases of complete cleft lip. This problem has been approached by preoperative nasoalveolar moulding, primary nasal correction and the use of a nostril retainer. We corrected the nasal deformity associated with complete cleft lip by using the combination of a nostril suspender and lip adhesion before cleft lip repair. The present article outlines this treatment strategy and assesses the effects of our treatment on nasal deformity.. Fourteen patients with complete cleft lip and palate were assigned to two groups for retrospective analysis: group A comprised seven patients, who underwent cleft lip repair after a combination of nostril suspension and lip adhesion, while group B had seven patients, who received cleft lip repair alone. In group A, a nostril suspender was fabricated and fitted to each patient at the initial visit, while lip adhesion was done at 1 month of life. At 1 year postoperatively, four parameters (nostril symmetry, alar cartilage slump, alar base level and columellar tilt) were scored on a scale of 1-4 to compare nasal shape between the two groups.. With respect to nostril symmetry, alar cartilage slump and columellar tilt, group A showed less deformity compared with group B and the difference between the two groups was statistically significant.. The use of a nostril suspender and lip adhesion can achieve dynamic correction of the nasal deformity associated with complete cleft lip.

Topics: Cleft Lip; Cleft Palate; Female; Humans; Infant; Lip; Male; Nose; Plastic Surgery Procedures; Rhinoplasty

Presentation of a technique to determine objectively the degree of symmetry in the area of nose and lip in cleft patients based on analysis of photographs. To compare the objective measurements with the subjective impression.. This was a retrospective study using a predefined photo documentation standard to capture images of the area of nose and lip.. Department of Oral and Maxillofacial Surgery, University of Jena, Germany.. Unilateral cleft patients following primary lip repair (group 1; n  =  36) or secondary correction (group 2; n  =  23).. Measurements were taken on standardized photographs of three dimensions in the area of the nose and two dimensions in the upper lip region. Sign tests were used to ascertain differences between the cleft and unaffected sides separately for each group. Subjective impressions regarding symmetry were gathered and quantified by means of a visual analog scale (VAS). The Mann-Whitney U test was employed to compare the observers' impressions between the two groups.. While significant side differences were found for all distances in group 1, only the side differences in the height of the nostril remained significant in group 2. Subjective evaluation of the nostril area improved significantly following corrective surgery. However, no such change in the area of the upper lip was recognized by the observers.. We were able to demonstrate that the measurable symmetry of the nostril area, as well as the upper lip, was significantly enhanced by corrective surgery. However, only the subjective impression of the nostril was improved.

Topics: Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Esthetics; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Nasal Cartilages; Nose; Photography; Retrospective Studies; Visual Analog Scale

The purpose of this study was to describe the clinical and three-dimensional (3D) outcomes following secondary correction of bilateral cleft lip and nose by reverse-U incision, nasal tip cartilage graft, and medial-upward advancement of bilateral nasolabial components with vestibular expansion with a free mucosal graft.. Secondary correction of the bilateral cleft lip and nose deformity was performed on 11 patients with complete bilateral cleft lip, alveolus and palate (BCLP). In four patients with an extremely short columella, an inferiorly based small pedicle flap from rim skin rotating into the columella base was included to elongate the columella length. Pre- and postoperative nasal forms were recorded using photos and 3D data taken serially.. The nasal forms and lateral profiles were improved in all patients postoperatively. The pre- and postoperative 3D colour images demonstrated satisfactorily elongated columella length, symmetrically increased nasal tip projection, and enlarged alar groove. No serious complications were observed postoperatively.. Our secondary correction technique of the bilateral cleft lip and nose will provide successful results producing an adequate nasal tip projection and alar forms without damaging the upper lip tissue in patients with BCLP.

Topics: Adolescent; Cartilage; Cleft Lip; Cleft Palate; Female; Humans; Imaging, Three-Dimensional; Lasers; Male; Nasal Cartilages; Nasal Mucosa; Nose; Photography; Rhinoplasty; Skin Transplantation; Surgical Flaps; Treatment Outcome; Young Adult

The aim of this study was to assess the 3-dimensional facial surface changes after cleft alveolar bone grafting with digital surface photogrammetry.. In a prospective study, 22 patients with cleft lip and palate underwent alveolar bone grafting. Before the procedure and 6 weeks postoperatively and before the continuation of orthodontic treatment, 3-dimensional images were taken with digital surface photogrammetry. Seven standard craniofacial landmarks on the nose and the upper lip were identified. Their spatial change because of bone grafting was assessed. Statistical analysis was performed with analysis of variance and t test.. A significant increase in anterior projection on the operative side (P < .05) was found for the labial insertion points of the alar base (subalare). No significant changes were detected for the position of the labial landmarks.. Our results show 3-dimensionally that there is a positive influence of the alveolar bone graft on the projection of the alar base on the cleft side.

Topics: Adolescent; Alveolar Process; Alveoloplasty; Bone Transplantation; Cephalometry; Child; Cleft Lip; Cleft Palate; Face; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Longitudinal Studies; Nasal Cartilages; Nose; Orthodontics, Corrective; Photogrammetry; Prospective Studies; Young Adult

To evaluate three-dimensional nasal morphology following primary reconstruction in children with unilateral cleft lip and palate relative to contemporaneous noncleft data.. Prospective, cross-sectional, controlled study.. Glasgow Dental Hospital and School, Faculty of Medicine, Glasgow University.. Two groups of 3-year-old children (21 with unilateral cleft lip and palate and 96 controls) with facial images taken using a three-dimensional, vision-based capture technique.. Three-dimensional images of the face were reflected so the cleft was on the left side to create a homogeneous group for statistical analysis. Three-dimensional coordinates of anthropometric landmarks were extracted from facial images by a single operator. A set of linear measurements was used to compare cleft and control subjects on right and left sides, adjusting for sex differences.. The mean nasal base width and the width of the nostril floor on right and left sides differed significantly between control and unilateral cleft lip and palate groups. The measurements were greater in children with unilateral cleft lip and palate. The differences in the mean nasal height and mean nasal projection between the groups were not statistically significant. Mean columellar lengths were different between the left and right sides in children with unilateral cleft lip and palate.. There were significant nasal deformities following the surgical repair of unilateral cleft lip and palate.

Topics: Anthropometry; Case-Control Studies; Child, Preschool; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Female; Humans; Imaging, Three-Dimensional; Male; Nose; Prospective Studies; Treatment Outcome

We investigated the effect of the bacterial flora of the nose and throat on the outcome of the initial repairs of the cleft palate in the presence of prophylactic antibiotics.. A retrospective review of 90 procedures in 66 patients who had cleft palate repair between April 2005 and June 2007 was conducted at Booth Hall Children's Hospital, Manchester, U.K. Both isolated cleft palate and cleft lip and palate patients were included. Exclusion criteria included syndromic cases, other medical disorders, and revisions of previous cleft palate repairs. Nose and throat swabs were taken on admission. Benzyl penicillin and flucloxacillin were given perioperatively. The occurrence of oronasal fistulas was correlated with the bacteria grown on culture.. The oronasal fistula rate was 15.9%. The highest fistula rate in procedures with positive swabs was seen with Moraxella catarrhalis.. M. catarrhalis has not been previously recognized as a pathogen in cleft palate repairs. This study demonstrates a higher fistula rate in procedures positive for M. catarrhalis. Other factors that may have contributed to the fistula formation include the severity of the initial cleft and technical factors. Further study is required before a definitive link can be established.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Cleft Lip; Cleft Palate; Floxacillin; Follow-Up Studies; Humans; Moraxella catarrhalis; Moraxellaceae Infections; Nose; Nose Diseases; Oral Fistula; Penicillin G; Pharynx; Postoperative Complications; Respiratory Tract Fistula; Retrospective Studies; Staphylococcus aureus; Streptococcus; Treatment Outcome

Cleft-lip nasal deformity alters patient's self-image, as well as posing unique challenges for the rhinoplastic surgeon.. The main purpose of this study was to compare the panel perceptions of nasal aesthetics following secondary cleft rhinoplasty with versus without caudal septal extension grafting (columella grafting). We also investigated whether patient's self-assessment and satisfaction correlated with 4 other variables: (1) rhinoplasty techniques; (2) patients' age; (3) patients' gender; and (4) panel perceptions.. Using a cross-sectional study design, we enrolled a sample of adult laypersons and medical experts. The predictor variable was the rhinoplasty techniques (with/without columellar grafting). The outcome variable was the panel rankings of nasal aesthetics based on the photographs of 50 nonsyndromic cleft patients before and after the rhinoplasty. Other variables included the patient's subjective assessment and satisfaction, demographic and anatomic variables. Appropriate descriptive, uni- and bivariate statistics were calculated. The significance level was set at P≤0.05 and <0.05 for single- and two-tailed tests of hypothesis, respectively.. The sample consisted of 507 laypersons and 51 professionals who gave comparative ratings (P>0.05). Columellar grafting was associated with higher rankings of postoperative nasal aesthetics (P =0.04). Most of the patients (90%) rated positive outcomes. Surgical techniques, patients' age and gender, and panel perceptions were not individually significantly associated with subjective measures and satisfaction.. Our results suggest that caudal septal extension grafting improves the nasal aesthetics of the cleft patients, as judged by the panel. Patient's self-assessment seems unreliable to be used as an outcome measure.

Topics: Adolescent; Adult; Age Factors; Analysis of Variance; Attitude of Health Personnel; Cartilage; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Esthetics; Female; Humans; Male; Middle Aged; Nasal Cartilages; Nose; Outcome Assessment, Health Care; Patient Satisfaction; Photography; Rhinoplasty; Sex Factors; Statistics, Nonparametric; Young Adult

The purpose of this study was to assess and compare nasal symmetry in patients who underwent correction of a complete unilateral cleft lip using the Afroze incision without and with primary septoplasty using a standardized two-dimensional photographic analysis.. A prospective cohort study of 190 consecutive patients with complete unilateral cleft lip and alveolus with cleft palate treated with or without septoplasty using the Afroze incision technique was conducted at a high-volume center. Eighty-two patients operated on without primary septoplasty and 76 patients operated on with primary septoplasty were evaluated. Nasal symmetry was compared between patients using two-dimensional photographic analysis. Ratios between the cleft side and the non–cleft side for five parameters were used to assess symmetry: alar base–to–interpupillary line distance, columella-to–Cupid's bow distance, nostril gap area, nostril width, and nostril height. The Mann-Whitney U test was used to calculate differences between the two groups.. Patients operated on with primary septoplasty showed more nasal symmetry compared with patients operated on without septoplasty. This difference was statistically significant for columella-to–Cupid's bow distance, nostril gap area, and nostril height (p = 0.008, p < 0.001, and p < 0.001, respectively) and for the distance between alar base and the alar base–to–interpupillary line distance (p = 0.145) the difference was present but not statistically significant. For nostril width, no difference was found (p = 0.850).. Patients treated with primary septoplasty showed better results in terms of nasal symmetry when analyzed using two-dimensional photographic analyses.

Topics: Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Nasal Septum; Nose; Photography; Prospective Studies; Rhinoplasty; Treatment Outcome

The purpose of this study was to compare the efficacy of presurgical nasoalveolar molding in treating unilateral versus bilateral cleft lip–cleft palate patients.. A blinded, retrospective study was conducted with 16 unilateral and 13 bilateral cleft lip–cleft palate patients. Pretreatment and posttreatment facial and intraoral impressions were used to compare soft- and hard-tissue changes.. Nasoalveolar molding therapy improves nasal angle in unilateral (p = 0.010) and bilateral cleft lip–cleft palate (p = 0.001) patients, and improves nostril width in unilateral (p = 0.005) and bilateral cleft lip–cleft palate (p = 0.028) patients. Treatment significantly improves nostril breadth only in unilateral cleft lip–cleft palate patients (p = 0.005). Compared with bilateral cleft lip–cleft palate patients, unilaterally affected patients were more asymmetric before and after nasoalveolar molding therapy. Nasoalveolar molding more effectively increases columellar height (p = 0.002) and columellar width (p = 0.002) in the bilateral cleft lip–cleft palate group. Although starting bialar widths did not significantly differ between the two groups, nasoalveolar molding significantly decreased bialar width only in unilateral cleft lip–cleft palate patients (p = 0.032). When the intersegment alveolar cleft distances of the bilateral cleft lip–cleft palate patients were summed, an improvement similar to that in unilateral cleft lip–cleft palate patients was observed. Furthermore, nasoalveolar molding appeared to prevent alveolar width widening as patients continued to grow.. There are differences in efficacy between unilateral and bilateral cleft lip–cleft palate patients undergoing nasoalveolar molding. Understanding these differences may help physicians and dentists better shape expectations.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Infant; Infant, Newborn; Nose; Orthodontics, Corrective; Preoperative Care; Retrospective Studies; Treatment Outcome

To analyze the 3-dimensional nasal forms after secondary treatment of unilateral cleft lip nose deformity.. Thirteen Japanese adolescents with severe nose deformity associated with unilateral complete cleft lip with/without palate underwent definitive nose correction at the Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, and were followed for 1 to 3 years. Twenty healthy Japanese age-matched adolescents were included as controls. All patients were treated by open rhinoplasty through bilateral reverse-U incision and transcolumellar incision, correction of the columellar base with/without septoplasty, columellar strut graft, and medial-upward advancement of nasolabial components with vestibular expansion using a free mucosal graft. Pre- and postoperative nasal forms were measured using a 3-dimensional noncontact laser scanner. Angular and linear measurements, symmetry of the alar groove arch, and deviation of the nasal midline were analyzed.. Comparison of pre- with postoperative 3-dimensional nasal forms showed that postoperative nasal height was significantly increased (P < .01) but still shorter than that of controls. The significant preoperative differences in the nasal dorsal angle (P < .05) and bilateral alar groove arch (P < .01) disappeared after the operation. The deviation of the nasal midline was improved in the lower half of the nose (P < .05) postoperatively. There were no serious complications in any patients.. These surgical procedures can provide a symmetric and protruded nasal form, but there remain some differences between postoperative patients and healthy Japanese subjects.

Topics: Adolescent; Adult; Case-Control Studies; Cephalometry; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Imaging, Three-Dimensional; Lasers; Male; Nasal Cartilages; Nasal Septum; Nose; Plastic Surgery Procedures; Rhinoplasty; Treatment Outcome; Young Adult

Topics: Abnormalities, Multiple; Adult; Child; Cleft Lip; Cleft Palate; Ear, External; Eye Abnormalities; Genetic Association Studies; Heart Septal Defects, Atrial; Humans; Infant; Male; Maxilla; Micrognathism; Nose; Syndrome; Thumb

To compare the nasolabial aesthetics for individuals with nonsyndromic complete unilateral cleft lip and palate between the ages of 5 and 12 years.. Retrospective cross-sectional study.. Four cleft centers in North America.. A total of 124 subjects with repaired complete unilateral cleft lip and palate who were treated at the four centers.. After ethics approval was obtained, 124 preorthodontic frontal and profile patient images were scanned, cropped to show the nose and upper lip, and coded. Using the coded images, four nasolabial features that reflect aesthetics (i.e., nasal symmetry, nasal form, vermilion border, and nasolabial profile) were rated by five examiners using the rating system reported by Asher-McDade et al. (1991) . Intrarater and interrater reliabilities were determined using weighted kappa statistics. Mean ratings, by center, were compared using analysis of variance.. Intrarater reliability scores were good to very good and interrater reliability scores were moderate to good. Total nasolabial scores were Center B = 2.98, Center C = 3.02, Center D = 2.80, and Center E = 2.87. No statistically significant differences among centers were detected for both total aesthetic scores and for any of the individual aesthetic components.. There were no significant differences in nasolabial aesthetics among the centers evaluated. Overall good to fair nasolabial aesthetic results were achieved using the different treatment protocols in the four North American centers.

Topics: Child; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Esthetics; Facial Asymmetry; Female; Humans; Lip; Male; North America; Nose; Outcome Assessment, Health Care; Research Design; Retrospective Studies

Repairs of the cleft nose, lip, and palatal deformity remain challenging endeavors for reconstructive surgeons. Postsurgical nasomaxillary hypoplasia is a common finding in patients with extensive clefts. This complex deformity has a pronounced impact on the social behavior and self image of the subject. Esthetic and functional rehabilitation of this postsurgical defect is scarcely reported in the literature. Support in the form of prostheses or stents to prevent tissue collapse is usually required in these patients following surgery. This clinical case presentation discusses the fabrication of an internal nasal stent for a cleft nose, lip, and palate patient following surgical reconstruction. Two prostheses using two prosthetic materials (Polymethyl methacrylate, flexible resin) were prepared to compare their efficacy. The final prostheses improved the patient's appearance, making the postsurgical defect less conspicuous.

Topics: Adolescent; Biocompatible Materials; Cleft Lip; Cleft Palate; Dental Prosthesis Design; Denture Design; Denture, Partial; Female; Humans; Maxilla; Nose; Nose Diseases; Oral Fistula; Palatal Obturators; Plastic Surgery Procedures; Polymethyl Methacrylate; Postoperative Complications; Prostheses and Implants; Prosthesis Design; Respiratory Tract Fistula; Stents; Treatment Outcome

Patients with bilateral cleft lip-cleft palate have nasal deformities including reduced nasal tip projection, widened ala base, and a deficient or absent columella. The authors compare the nasal morphology of patients treated with presurgical nasoalveolar molding followed by primary lip/nasal reconstruction with age-matched noncleft controls.. A longitudinal, retrospective review of 77 nonsyndromic patients with bilateral cleft lip-cleft palate was performed. Nasal tip protrusion, alar base width, alar width, columella length, and columella width were measured at five time points spanning 12.5 years. A one-sample t test was used for statistical comparison to an age-matched noncleft population published by Farkas.. All five measurements demonstrated parallel, proportional growth in the treatment group relative to the noncleft group. The nasal tip protrusion, alar base width, alar width, columella length, and columella width were not statistically different from those of the noncleft, age-matched control group at age 12.5 years. The nasal tip protrusion also showed no difference in length at 7 and 12.5 years. The alar width and alar base width were significantly wider at the first four time points.. This is the first study to describe nasal morphology following nasoalveolar molding and primary surgical repair in patients with bilateral cleft lip-cleft palate through the age of 12.5 years. In this investigation, the authors have shown that patients with bilateral cleft lip-cleft palate treated at their institution with nasoalveolar molding and primary nasal reconstruction, performed at the time of their lip repair, attained nearly normal nasal morphology through 12.5 years of age.

Topics: Adolescent; Alveolar Process; Anthropometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Infant; Infant, Newborn; Nose; Orthotic Devices; Palatal Obturators; Preoperative Care; Rhinoplasty; Stents

The aim of this study was to compare craniofacial morphology and soft tissue profiles in patients with complete bilateral cleft lip and palate at 9 years of age, treated in two European cleft centres with delayed hard palate closure but different treatment protocols. The cephalometric data of 83 consecutively treated patients were compared (Gothenburg, N=44; Nijmegen, N=39). In total, 18 hard tissue and 10 soft tissue landmarks were digitized by one operator. To determine the intra-observer reliability 20 cephalograms were digitized twice with a monthly interval. Paired t-test, Pearson correlation coefficients and multiple regression models were applied for statistical analysis. Hard and soft tissue data were superimposed using the Generalized Procrustes Analysis. In Nijmegen, the maxilla was protrusive for hard and soft tissue values (P=0.001, P=0.030, respectively) and the maxillary incisors were retroclined (P<0.001), influencing the nasolabial angle, which was increased in comparison with Gothenburg (P=0.004). In conclusion, both centres showed a favourable craniofacial form at 9-10 years of age, although there were significant differences in the maxillary prominence, the incisor inclination and soft tissue cephalometric values. Follow-up of these patients until facial growth has ceased, may elucidate components for outcome improvement.

Topics: Age Factors; Alveoloplasty; Bone Transplantation; Cephalometry; Cleft Lip; Cleft Palate; Clinical Protocols; Face; Facial Bones; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Incisor; Lip; Male; Maxilla; Maxillofacial Development; Nose; Osteotomy; Palatal Obturators; Palate, Hard; Palate, Soft; Treatment Outcome

The purpose of the study was to provide quantitative information about the facial soft-tissue characteristics of operated unilateral complete cleft lip and palate (UCCLP) children compared with healthy children during mixed dentition.. Lateral cephalometric radiographs of 48 children with UCCLP who had been operated on before the age of 2 years were analyzed and compared with those of a control group of 60 healthy children with the same age, sex, and ethnic characteristics.. The children with operated UCCLP differed from the control group by having a more concave profile, flatter nasal tip, more retrognathic basis nasi, shorter upper lip, thicker upper and lower lip, reduced upper-lip projection, and increased lower-lip projection.. The facial soft-tissue morphology in operated UCCLP patients differed from normal controls of the same age, sex, and ethnic group. It may be necessary for children with UCCLP operated before 2 years of age to have some preventive treatment.

Topics: Age Factors; Cephalometry; Child; Chin; Cleft Lip; Cleft Palate; Dentition, Mixed; Face; Female; Forehead; Humans; Image Processing, Computer-Assisted; Lip; Male; Mandible; Nose; Treatment Outcome; Vertical Dimension

To study the changes of palate cleft gap of complete unilateral cleft lip and palate (UCLP) infants before and after presurgical orthodontic and cheiloplasty.. The sample consisted of 18 complete UCLP infants who were treated using presurgical nasoalveolar molding (PNAM) appliance and cheiloplasty. The maxillary models were obtained at the initial visit, after PNAM treatment 1 month before cheiloplasty, and 2 months after cheiloplasty. The change of palate cleft gap were compared.. After PNAM treatment and cheiloplasty, the lip profile was obviously improved, cleft gap was reduced, and the height of ala nasi fornix was recovered.. PNAM treatment can improve the lip shape and nasal deformity degree of UCLP patient. The cleft gap and upper lip tension are reduced.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Lip; Nose; Preoperative Care

To 3-dimensionally analyze outcomes after the secondary treatment of bilateral cleft lip-nose deformity at the Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, Kagoshima, Japan.. Ten Japanese male young adults with bilateral cleft lip with or without palate (BCL±P) who had undergone definitive nose correction and were followed up for 1 to 4 years were enrolled in this study. Ten unaffected race- and gender-matched young adults were used as controls. All patients underwent secondary correction of the nose by open rhinoplasty through a bilateral reverse-U incision, columellar strut graft, and medial-upward advancement of the nasolabial components with vestibular expansion by use of a free mucosal graft. In 3 patients with an extremely short columella, an inferiorly based small pedicle flap from rim skin rotated into the columellar base was added for columella lengthening. Nasal forms were periodically measured by use of a 3-dimensional noncontact laser scanner. The angular and linear measurements and the curvature of the alar groove arch were compared between patients and control subjects.. Comparison of the preoperative and postoperative nasal forms showed significant improvements in the nasal dorsum and tip angles, as well as nasal height. The size of the nasal alar grooves was also increased to the same size range as the control subjects. There were persistent differences between postoperative columellar angle and nasal width in patients and those in the control subjects.. Our surgical procedures can provide an acceptably protruded nasal form for patients with BCL±P without damaging the upper lip tissue, but further improvement to prevent nasal tip overprojection may be useful.

Topics: Adolescent; Cartilage; Case-Control Studies; Cephalometry; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lasers; Lip; Male; Mouth Mucosa; Nasal Cartilages; Nasal Mucosa; Nose; Nose Deformities, Acquired; Photography; Postoperative Complications; Rhinoplasty; Skin Transplantation; Surgical Flaps; Treatment Outcome; Young Adult

Amniotic band syndrome is an uncommon congenital pathological condition that may lead to malformations and foetal-infant death. We report an autoptic case. The patient was a male preterm infant. At 14 weeks of gestation, a routine ultrasonography showed severe craniofacial anomalies and a close contiguity of the foetal head with the amnios. The neonate survived three days, after which an autopsy was carried out. The infant had a frontoparietal meningoencephalocele; a fibrous band was attached to the skin, close to the meningoencephalocele base. Cleft lip and palate, nose deformation and agenesis of the right eye were also present. At the opening of the cranial cavity, occipital hyperostosis was observed. The herniated brain showed anatomical abnormalities that made identification of normal structures difficult. Microscopically, the nervous parenchyma had architectural disorganization and immaturity, and the fibrous band consisted of amniotic membranes. As evident from this case report, amniotic band syndrome may cause severe malformations and foetal-infant death.

Topics: Amniotic Band Syndrome; Autopsy; Cleft Palate; Encephalocele; Eye Abnormalities; Humans; Infant, Newborn; Male; Nose

To observe the effective of presurgical nasoalveolar molding (PNAM) therapy in the treatment of complete cleft lip and palate infant.. PNAM was performed as presurgical orthodontic treatment in 45 infants (aged 18.33 d) with nonsyndromic complete cleft lip and palate. The columella deviation, columella length, nostril width, nostril height and width of alveolar cleft were measured before and after treatment. The data were analyzed by SPSS 10.0.. After PNAM treatment, the columella deviation, columella length, nostril width and width of alveolar cleft obviously decreased, while the nostril height increased. Except for smaller cleft nostril width of bilateral complete cleft lip and palate infant, other measurement items had statistics difference (P<0.05).. PNAM can improve nasal profile of complete cleft lip and palate infant and decrease the width of alveolar cleft, and make it easy for the operation of cleft lip and palate.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nose; Preoperative Care; Tyrphostins

A 2-year-old girl was referred to our hospital because of a pulsating mass in the roof of the mouth. On examination, a mass measuring 4 × 5 cm was found in the roof of the mouth and nose with a secondary palatal cleft. She had hypertelorism, a bifid nose, and a visible cleft over the dorsum and skin of the nose. In 1 stage, the mass was opened, reduced, and repositioned into the cranial cavity, and the defect was repaired with 2 parallel bridges of split costal bone grafts. The bone grafts were placed between 2 layers of soft tissue and the mucosa repaired over it. Palatal cleft was repaired with the Veau-Wardill-Kilner method 1 year later. Fourteen years later, the bifid nose was corrected using a flying-bird incision and a costal cartilage graft for the dorsum of the nose. On follow-up, minimal scar remained on the tip of the nose. There was neither obliteration nor reduction in the size of the bony defect. There were no operative complications, and the shape of the nose improved. The patient and her parents were highly satisfied with the result.

Topics: Abnormalities, Multiple; Bone Transplantation; Child, Preschool; Cleft Palate; Encephalocele; Esthetics; Ethmoid Bone; Female; Follow-Up Studies; Humans; Hypertelorism; Nose; Plastic Surgery Procedures; Ribs; Sphenoid Bone

To compare landmark vs surface-shape measurements in a sample of patients with cleft lips and palates following secondary alveolar bone grafting.. The faces of 10 patients (4 males and 6 females) with an unilateral cleft lip and palate were captured using a 3D surface camera system before and 6 weeks after alveolar bone grafting. In each face, six coordinates were registered. The pre- and postoperative images were superimposed on areas that were not affected by the surgery. Using 3D modeling software landmarks, nasal symmetry, and surface-to-surface deviation, analysis was performed. All data were subjected to standard statistical analyses.. Color map surface-to-surface comparison revealed a significant anteroposterior elevation in the nasal region of the cleft side after surgery.. The ala, alar base, and paranasal areas are increased anteroposteriorly after secondary bone grafting. This surgery tends to diminish the asymmetry in nasal morphology typically seen in patients with unilateral cleft lip and palate. Overall, 3D surface-to-surface analysis allows for a better quantification of treatment changes.

Topics: Adolescent; Analysis of Variance; Anatomic Landmarks; Bone Transplantation; Cephalometry; Child; Cleft Lip; Cleft Palate; Female; Humans; Imaging, Three-Dimensional; Male; Nose; Photogrammetry; Photography, Dental; Young Adult

Topics: Abnormalities, Multiple; Alveolar Process; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Infant, Newborn; Male; Nose; Orthodontics, Corrective; Palatal Obturators; Prosthesis Design; Time Factors

The aim of this study was to evaluate symmetry of the lip and nose in patients with CUCLP after primary cheiloseptoplasty (Afroze technique), in comparison to non-cleft controls.. In this prospective study, forty-four patients with operated non-syndromic CUCLP were included. The control group consisted of 44 volunteers without cleft defects of approximately the same age and sex. Primary septoplasty was performed in conjunction with the cleft lip (CL) repair using the Afroze incision. 3D facial images were acquired using 3D stereophotogrammetry. After a 3D cephalometric analysis of the lip and nose was performed in both groups, linear and volumetric data were acquired. Lip and nose symmetry were calculated and compared using Student`s t-tests as well as the Chi square test.. For all measurements, the control group was up to 36% closer to perfect symmetry compared to the CUCLP group after primary surgery. This difference was statistically significant.. After primary cheiloseptoplasty according to the Afroze technique in patients with CUCLP, asymmetry in the nose and lip area still exists as compared to non-cleft controls. Although non-cleft individuals also show some degree of asymmetry, the results of this study stress the difficulty in obtaining near normal symmetrical relations.

Topics: Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Imaging, Three-Dimensional; Infant; Lip; Male; Nose; Orthognathic Surgical Procedures; Photogrammetry

The objective of this study was to treat the cleft lip and alveolus, nasal deformity with presurgical nasoalveolar molding (PNAM), to elucidate the problems and treatment methods, which may be helpful for the use of PNAM in clinic.. Twenty nine infants with cleft lip and palate (CLP) were treated with PNAM in our center. There were 19 unilateral and 10 bilateral CLP patients. The initial visit time was 3 to 150 days after birth. Treatment time ranged from 2.5 to 3 months. The appliance was modified at 2-week interval.. According to the evaluation standards, 17 infants were treated successfully with the closure of cleft lip and alveolar processes, reposition of the deformed nasal cartilages, and increased length of columella. The lip and nasal deformities of 9 infants were corrected partly, which were helpful for surgery. There were 3 infants giving up PNAM.. There were five important facts for the successful treatment, including initial visit time, impression of the intraoral cleft defect, modification of the plate and the nasal stent, and use of nasal splints. Orthodontics and plastic surgeons should have the same views for PNAM in infants, which will advance the treatment level for cleft lip and palate.

Topics: Alveolar Process; Bone Plates; Cleft Lip; Cleft Palate; Dental Care; Humans; Infant; Infant, Newborn; Nose; Plastic Surgery Procedures; Preoperative Care; Stents

To report surgical repair of a bifid nose combined with a cleft of the primary palate.. Clinical report.. A 1-year-old, male castrated Springer spaniel dog.. With the dog in sternal recumbency, an extraoral (dorsal) approach to the nose was performed, and after surgical margins were outlined, a Y-shaped skin incision was made to remove redundant tissue and expose the bifid nasal cartilages. The cartilages were opposed and sutured together and the skin closed in 2 layers. The dog was repositioned in dorsal recumbency, and the 2 maxillary first incisor teeth were extracted. After tangential incision and undermining of the cleft defect, the mucosa was sutured in 1 layer.. Healing was uneventful and there was an immediate return to normal function. At 2 weeks, 3 and 6 months function was excellent without further clinical signs.. Bifid nose associated with a cleft of the primary palate can be surgically corrected.

Topics: Animals; Cleft Palate; Dog Diseases; Dogs; Male; Nose; Nose Diseases

The presurgical nasoalveolar molding plate appliance with stent (PNAM) extended from the palatal molding plate; to correct the nostril shape of infants with cleft lip and palate is well known. The PNAM appliance is based on the finding that a high degree of plasticity is maintained in the cartilage of infants during the first 6 weeks after birth. However, on the current PNAM protocol described by Grayson et al. the nasal stent is supposed to be an adjunct to the palatal molding plate after reducing the severity of the alveolar cleft width. We have used the modified Hotz's plate from the setup model and built up the nasal stent even before reducing the severity of the alveolar deformity. In this study we assess the effects of the modified Hotz's plate and the modified PNAM appliance for the alveolar and palatal form. The lateral deviation of the incisal point, the width of the palatal cleft, and the degree of curvature of the palatal vault were first evaluated on plaster models. The PNAM group is smaller on the lateral deviation of the incisal point than the modified Hotz's group. The decreased average width of the palatal cleft and curvature of the palate, was almost the same in both the modified Hotz's and PNAM groups. In comparison with the modified Hotz's plate, the modified PNAM appliance also improves the molding of the alveolar segments and reduces cleft width.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nose; Palatal Obturators; Preoperative Care

Despite recent developments in cleft surgery, a surgical method for secondary correction of unilateral cleft lip-nose deformity has not yet been established. The purpose of this study was to describe the surgical techniques for secondary correction of unilateral cleft lip-nose deformity with 3-dimensional (3D) observations of preoperative and postoperative nasal forms.. Secondary corrections of unilateral cleft lip-nose deformity were performed on 13 patients with a complete unilateral cleft lip and palate, and these patients were followed up for 1 year to more than 3 years. All patients were treated by open rhinoplasty through a bilateral reverse-U incision and transcolumellar incision, correction of the columella base with/without septoplasty, nasal tip cartilage graft, and medial-upward advancement of nasolabial components with vestibular expansion by free mucosal graft. Preoperative and postoperative nasal forms were observed by use of photos and 3D data obtained serially.. The postoperative nasal forms were improved in all patients. The preoperative 3D color images indicated asymmetry of the alar groove and nasal tip visually. The top of the alar groove on the cleft side was dislocated distally and downwardly, resulting in a small snub ala. The postoperative 3D color images showed symmetric nasal forms with the adequately recovered nasal tip projection and the appropriate circle of the nasal ala groove on the cleft side. There were no serious postoperative complications.. Repositioning of the nasalis muscle and sufficient expansion of the nasal vestibule as well as reconstruction of nasal cartilages are important for correction of unilateral cleft lip-nose deformity.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lasers; Male; Nasal Cartilages; Nasal Mucosa; Nasal Septum; Nose; Photography; Rhinoplasty; Treatment Outcome; Young Adult

This study compared craniofacial morphology between three groups of children with complete unilateral cleft lip and palate, treated with different surgical protocols. The study included 66 10-year-old children (42 boys and 20 girls) with a complete unilateral cleft lip and palate (22 patients in each of the three groups). Children aged 7 months underwent one-stage surgery, performed by a single surgeon. During surgery, the soft and hard palate and the lip underwent correction. The difference between the groups depended on the hard palate closure. Group I patients had the mucoperiosteal flap elevated on both sides of the cleft. Group II patients had the mucoperiosteal flap elevated on the non-cleft side, and had only a minimal 2-3mm mucoperiosteal flap elevated on the cleft side. Group III patients had mucoperiostium elevated from the septum vomer to create a single-layered caudally pedicled flap, and had only a minimal 2-3mm palatal flap elevated on the cleft side. Craniofacial morphology was defined using lateral cephalometric analysis. Significant craniofacial morphological differences were identified between groups I, II and III. Group III demonstrated the most favourable morphology. This indicates that the technique of hard palate closure has significant influence on craniofacial growth and development.

Topics: Age Factors; Case-Control Studies; Cephalometry; Child; Cleft Lip; Cleft Palate; Facial Bones; Female; Humans; Image Processing, Computer-Assisted; Lip; Male; Mandible; Maxilla; Mouth Mucosa; Nose; Palate, Hard; Palate, Soft; Periosteum; Plastic Surgery Procedures; Sella Turcica; Surgical Flaps; Tissue and Organ Harvesting; Treatment Outcome; Vertical Dimension; Vomer

In cleft lip and palate patients the shape of the nose invariably changes in three dimensions (3D) due to rhinoplastic surgery. The purpose of this study was to evaluate stereophotogrammetry as a 3D method to document volumetric changes of the nose in patients with a cleft lip (CL) or cleft lip and palate (CLP) after secondary open rhinoplasty. 12 patients with unilateral CL or CLP were enrolled in the study prospectively. 3D facial images were acquired using 3D stereophotogrammetry preoperatively and 3 months postoperatively. A 3D cephalometric analysis of the nose was performed and volumetric data were acquired. The reliability of the method was tested by performing an intra- and inter-observer analysis. Left, right and total nasal volumes and symmetry were compared. No statistically significant differences (p<0.05) were found within and between observers for the measured volumes and symmetry. Postoperatively, the total volume of the nose increased significantly, especially the volume at the cleft side. No significant volume difference pre- and postoperatively was found for the non-cleft side. The symmetry of the nose improved significantly. 3D stereophotogrammetry is a sensitive, quick, non-invasive method for evaluating volumetric changes of the nose in patients with cleft lip or cleft lip and palate.

Topics: Adolescent; Adult; Cartilage; Cephalometry; Cleft Lip; Cleft Palate; Female; Humans; Imaging, Three-Dimensional; Male; Nose; Photogrammetry; Rhinoplasty; Statistics, Nonparametric; Treatment Outcome; Young Adult

The aim of this retrospective study was to correlate the width of the cleft lip with the severity of the nasal deformity in unilateral cleft lip and palate (UCLP) patients before primary lip repair. Preoperative impression casts were made. Measurements were taken of the width of the cleft lip (CW), nose (NW), and nasal floor (NFW), alar base height (ABH), columella length (CL), nasal length (NL) and nasal tip protrusion (NTP). The ratio of the non-cleft side (NFW) to the cleft side (NFWR), the ratio of the non-cleft side (ABH) to the cleft side (ABHR), and the ratio of the cleft side (CL) to the non-cleft side (CLR) were calculated. The average NW, NL and CW were higher in the group with complete clefts. There was a negative linear relationship between CW and NFWR, and a positive linear relationship between CW and ABHR in the complete group. In the incomplete group, negative correlations were obtained between CW and NFWR and between CW and ABHR. These findings show that there are correlations between CW and the transverse and vertical imbalance of nose in both groups but not between CW and anteroposterior imbalance of nose.

Topics: Cephalometry; Cleft Lip; Cleft Palate; Functional Laterality; Humans; Infant; Lip; Nose; Plastic Surgery Procedures; Reference Standards; Retrospective Studies; Severity of Illness Index

Having read the paper written by Dr. Ezzat et al. (2007) concerning the quantifying appraisal of the effects of presurgical nasoalveolar molding treatment on nasal symmetry and intraoral dimensions in patients with unilateral cleft lip and palate, we would like to share a different approach.

Topics: Alginates; Alveolar Process; Calcium Sulfate; Cleft Lip; Cleft Palate; Dental Impression Materials; Face; Humans; Infant; Models, Anatomic; Models, Dental; Nose; Preoperative Care

A very rare case of proboscis lateralis is reported. This case is different from previously reported cases due to proboscis lateralis, single nostril, loss of columella, and median cleft lip without holoprosencephaly. In addition, this is considered the first surviving individual with proboscis lateralis accompanied by median cleft lip.

Topics: Cleft Lip; Cleft Palate; Craniofacial Abnormalities; Female; Follow-Up Studies; Humans; Infant; Nasal Bone; Nasal Septum; Nose; Plastic Surgery Procedures; Rhinoplasty; Surgical Flaps; Turbinates

Stickler syndrome is an autosomal dominant disease characterized by various disorders of the eyes and the connective tissues throughout the body. It can arise from a mutation in the collagen associated gene. We present a case of Stickler syndrome with rhegmatogenous retinal detachment.. A 10-years-old boy was referred to us with rhegmatogenous retinal detachment of the right eye. His family history included eye disease and a cleft palate. He had high myopia, vitreous liquefaction and lattice degeneration in the both eye. He also had a cleft palate and a broad nasal bridge. His condition was diagnosed as Stickler syndrome. We performed vitrectomy, scleral buckling and encircling, and silicone oil injection in the right eye. We also did a reattachment of the retina in the right eye.. Pediatric retinal detachment may indicate the presence of Stickler syndrome and a complete examination of the eye as well as a full family history must be obtained in such cases.

Topics: Child; Cleft Palate; Eye Diseases; Fibrillar Collagens; Genes, Dominant; Humans; Injections, Intraocular; Male; Mutation; Myopia; Nose; Retinal Detachment; Scleral Buckling; Silicone Oils; Syndrome; Vitrectomy; Vitreous Body

Various methods have been described for the primary surgical reconstruction of the unilateral cleft lip and palate deformity (UCLP) in infants. There have been several attempts at restoring the normal anatomy of the nose at the time of lip repair in the affected individuals with varying degrees of success. Presurgical nasoalveolar molding (PNAM) is a presurgical infant orthopedic procedure that attempts to target the nasal deformity leading to a more esthetic surgical repair.. At our center we aimed to use PNAM to help in providing the surgical team with a better foundation for an easier and more esthetic single stage repair at the level of nose in addition to the lip and alveolus.. The infant nasal cartilages are amenable to correction in the first few weeks of life when they retain their plasticity. Three infants with complete unilateral cleft lip palate (CUCLP) were operated upon after a course of PNAM. No nasal stents were use after repair to retain the results.. PNAM reduced the extent of the cleft deformity and improved the anatomic relationship between the affected structures. Postoperative recovery was uneventful. Subjective evaluation immediate post surgery and at the time of palate repair reveals adequate nasolabial esthetics. Long-term results of PNAM assisted repair are to be ascertained.. The use of PNAM enables in reducing the severity of the deformity the surgical team has to tackle thereby enabling in a better and esthetic primary repair.

Topics: Alveolar Process; Alveoloplasty; Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Lip; Male; Nasal Cartilages; Nose; Orthopedic Procedures; Palatal Obturators; Plastic Surgery Procedures; Preoperative Care; Stents; Surgical Flaps

Premaxillary augmentation is a widely adopted procedure used as an independent facial contouring operation or as an adjunct to rhinoplasty. Insufficient projection of the praemaxilla is a relatively common deformity, especially in the Asian population. We performed two cases of premaxillary augmentation using autologous costal cartilage as an adjunct to rhinoplasty. The first case was a 17-year-old man, who had had an underprojected and over-rotated nose with a bulbous tip since birth. He underwent bilateral premaxillary augmentation using autologous costal cartilage and a rhinoplasty with unilateral extended spreader graft in conjunction with columella strut insertion and dorsal augmentation with Goretex. The second case was a 22-year-old male, who had a repaired left cleft lip and palate. He underwent a revision unilateral premaxillary augmentation and rhinoplasty with columella strut insertion, nasal tip cap graft and dorsal augmentation using autologous costal cartilage. The two patients were satisfied with the results of both the premaxillary augmentations and the rhinoplasties. In both patients, we performed a correction of the acute nasolabial angle and the midface was augmented, which resulted in a more pronounced nasal tip augmentation and a more natural appearance of the midface. We suggest that autologous costal cartilage block could be satisfactory graft material for premaxillary augmentation.

Topics: Adolescent; Cartilage; Cleft Lip; Cleft Palate; Esthetics; Humans; Male; Nose; Polytetrafluoroethylene; Prostheses and Implants; Rhinoplasty; Young Adult

To evaluate the efficacy of nasal endoscopic-assisted surgery for adults cleft palate repair.. We designed and made two suitable nasal mucoperiosteal flaps in nasal cavities, then released the nasal mucoperiosteal flaps to the level of hard palate and sewed up two flaps on the midline of oral cavity to repair the nasal side of cleft palate.. Nine of 11 patients were healed after three months following-up. The bilateral palatal mucoperiosteal flap were separated in the front of hard palate in 2 patients, however they were not perforated due to well-healing of nasal mucoperiosteal flaps and second stage surgery was not necessary.. The cleft palate could be repaired using the tensionless nasal mucoperiosteal flap with good blood supply, and'procedures could be carried out under nasal endoscopy. Endoscopic-assisted surgery for cleft palate repair was simple to perform, and its effect was satisfactory.

Topics: Adolescent; Adult; Cleft Palate; Endoscopy; Female; Humans; Male; Nasal Mucosa; Nose; Periosteum; Plastic Surgery Procedures; Surgical Flaps; Young Adult

The objective of this study was to review the outcome of surgical rehabilitation of nasoalveolar complex in patients with alveolar clefts.. Twenty-seven patients (13 female, 14 male) with 4 bilateral and 23 unilateral alveolar clefts who were treated in our clinic during the period between 2002 and 2009 were included in the study.. All the patients had oronasal fistulas, and all of them were closed successfully except one. Recurrence of the oronasal fistula was seen in 1 patient. Alar base was supported by onlay cortical bone in most of the patients. Eleven of the canines at the cleft site erupted after the operation in to the grafted area. Seventy-six percent (n = 16) of the 21 patients could be assigned to the successful groups 1 and 2, whereas 24% (n = 5) were assigned to the unfavorable group. There was not any insufficient result.. Bone graft placed along the piriform margin and alar wings during alveolar bone grafting improves the results of nasal correction. Late grafting should be performed at least to support the alar base for nasal symmetry.

Topics: Adolescent; Adult; Alveolar Process; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Postoperative Complications; Rhinoplasty; Surgical Flaps; Treatment Outcome

Secondary bone grafting plays an important role in the multimodal therapy of patients with cleft lips, alveoli, or palates. Through a comparative study of the nasal profile before and after alveolar bone grafting, this article aimed to determine the appropriate timing of operation and keys to success.. In the study, 38 cases (23 boys and 15 girls aged 9-13 years, with an average of 11.4 years) were examined of patients with unilateral cleft lips or palates, upon whom secondary bone grafting was performed under general anesthesia. Comparative studies are conducted on their nostril widths and heights in both the cleft side and the noncleft side as well as the widths and angles of the alar bases measured in the preoperative, postoperative, and follow-up (6 months) periods respectively.. Of the 29 cases examined 6 months after the operation, 4 indicate failure as the amount of bone loss exceeds 50%, whereas in the other 25 cases, both the nostril widths of the cleft side have increased, and the nostril heights of the cleft side have decreased significantly (P < 0.01).. As shown in the study, the nasal profile after alveolar bone grafting is changed obviously; thus, it is recommended that patients not receive rhinoplasty before bone grafting or have both operations at the same time.

Topics: Adolescent; Alveolar Bone Loss; Alveoloplasty; Bone Transplantation; Cephalometry; Child; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Male; Nasal Cartilages; Nasal Cavity; Nose; Postoperative Complications; Rhinoplasty; Time Factors; Treatment Outcome

To investigate the craniofacial morphology of Malay children with repaired UCLP and compare the data with non-cleft Malay children.. Twenty Malay children with repaired UCLP (12 boys, 8 girls; Mean age: 10.5 years) and 20 normal Malay children (8 boys, 12 girls; Mean age: 9.72 years) were recruited from the Combined Cleft Lip and Palate Clinic and the Department of Children's Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, Malaysia. Lateral cephalometric radiographs were taken with the head orientated parallel to the floor. Thirty-one linear and angular variables were measured on the lateral cephalometric radiographs with Dolphin Imaging Software Version 10.0 (Dolphin Imaging, Chatsworth, CA, USA). The data were analysed with the Mann-Whitney U test and the level of significance was set at p < 0.05.. In the UCLP group, the girls had deeper overbites than the boys (p = 0.011), and in the Control group the girls had a significantly more acute cranial base angle (NSBa, p = 0.017) and a less protrusive lower lip (LL-E line, p = 0.21). The data for the boys and girls were combined. Subjects in the UCLP group had a more acute cranial base angle, shorter and more retruded maxillae and were more skeletal III than the subjects in the Control group. In the UCLP group, the upper and lower incisors were less proclined than in the Control group, the interincisal angle was more obtuse and the overjet reduced by 6 mm. There were no significant facial height differences. The nasolabial angle (Col-Sn-UL) was significantly more obtuse and the upper lip relative to the E line more retrusive in the UCLP group. There was no significant difference between the groups in facial heights or the maxillo-mandibular planes angle.. Malay children with repaired UCLP have small, retrusive maxillae. The mandible in this group of children was of normal size and position, relative to the cranial base. Pressure from the repaired upper lip may be responsible for the retruded maxillae, retroclined incisors and obtuse nasolabial angle.

Topics: Adolescent; Cephalometry; Child; Chin; Cleft Lip; Cleft Palate; Dental Occlusion; Face; Female; Humans; Incisor; Lip; Malaysia; Male; Mandible; Maxilla; Nose; Sex Factors; Skull Base; Software; Vertical Dimension

Genoa syndrome was first described by Camera et al in 1993 in two patients with semilobar holoprosencephaly (HPE), craniosynostosis and abnormal small hands with cone-shaped epiphyses and hypoplastic terminal phalanges of fingers (OMIM: 601370). In 2001, Lapunzina et al reported a case of craniosynostosis and HPE associated with several other malformations and suggested that these findings could be attributed to a severe form of Genoa syndrome or to a newly recognized syndrome. Endocrinopathies in association with HPE are frequently reported in the literature. Diabetes insipidus, hypothyroidism, hypocortisolism, and growth hormone deficiency are frequently associated with HPE. We here report a case of semilobar HPE, craniosynostosis and cleft lip/palate, possibly a case of Genoa syndrome, associated with central diabetes insipidus.

Topics: Abnormalities, Multiple; Cleft Lip; Cleft Palate; Craniosynostoses; Diabetes Insipidus, Neurogenic; Holoprosencephaly; Humans; Infant; Male; Nose; Syndrome

The repair of a bilateral cleft is more difficult than a unilateral repair because of numerous anatomical challenges, such as difficulty of repairing the skin and muscle overlying the protruded premaxilla and bilateral nasal reconstruction with shortening of the columella. An optimum outcome is achieved when all of the deformities of the primary cleft palate, the problems of scar and secondary deformities have been addressed.. To propose an integrated and functional reconstruction of the primary bilateral cleft lip-nose repair and to present the preliminary outcomes of this technique and its advantages.. An integrated, functional reconstruction process includes: 1) analysis of the bilateral cleft deformities; 2) interdisciplinary management and use of Tawanchai Center's protocol for cleft lip and palate care; 3) pre-surgical orthopedic treatments; and, 4) integrated primary cleft lip-nose repair and post-operative management. This approach to repair includes: 1) design of a prolabial flap and a modified, rotation advancement technique for skin surgery; 2) functional muscle reconstruction; 3) correction of nasal deformities and columella lengthening; 4) reconstruction of the vermillion; and, 5) final skin closure.. Between 2002 and 2010, this technique was performed and evaluated on 42 patients who received primary bilateral cleft lip-nose repair, including 31complete, 6 incomplete and 5 right complete and left incomplete, 27 males and 15 females. Six parameters (scar, Cupid's bow symmetry, vermillion border symmetry, philtrum anatomic fidelity, muscle function and nasal symmetry) were used for evaluating the results, based on 4 scales (0-3) by 2 plastic surgeons. Among the mean scores better rating scales were achieved in philtrum anatomic fidelity (0.69) and Cupid' bow symmetry (0.76) while the mean of the less satisfactory rating scale was found in scar (1.13) and nasal asymmetry (0.96). These preliminary outcomes showed satisfactory results. Secondary reconstruction is less difficult and may be performed at the age of 4-6 years if indicated.. The authors introduced the Tawanchai Center's integrated concepts and functional reconstruction technique for bilateral cleft lip-nose repair. The technique offers the advantages of an integrated assessment for all of the deformities of the primary cleft palate, the design of an integrated technique together with proper peri-operative care, presurgical orthodontic treatment, and a well-coordinated, holistic, interdisciplinary management. A satisfactory preliminary outcome was demonstrated but more improvement of the outcome can be achieved by: 1) continuing assessment of this group of patients until they reach maturity; 2) refining techniques; 3) improving interdisciplinary care; and, 4) setting benchmarks for the outcome.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Delivery of Health Care, Integrated; Female; Hospitals, Teaching; Humans; Infant; Lip; Male; Nose; Patient Care Planning; Patient Care Team; Plastic Surgery Procedures; Postoperative Period; Rhinoplasty; Surgical Flaps; Thailand; Treatment Outcome

The functional and aesthetic result from secondary cleft rhinoplasty is commonly impaired by a bulge in the lateral nasal vestibule, which can relapse in the postoperative period despite careful intraoperative correction. We aim to improve our results by using a foam ear defender as a postoperative splint to prevent relapse.. Case series of 10 patients with photographs of a typical clinical case.. The postoperative nasal pack was exchanged with a foam ear defender on day 5. The splint was worn continuously for 3 to 4 weeks, then nightly for 3 months. The splint was changed daily by the patient.. The results were assessed clinically by the senior author.. The patients had little or no recurrence of the lateral vestibular bulge following nasal splintage.. Foam ear defenders are a simple, cheap, and comfortable method to provide splintage to the nasal vestibule following secondary cleft rhinoplasty.

Topics: Cleft Palate; Ear Protective Devices; Humans; Nose; Postoperative Care; Rhinoplasty; Secondary Prevention; Splints

Nasal aplasia, including hemi aplasia of the nose, is a rare congenital anomaly of the nose. Since the ipsilateral side tends to be affected more frequently than the contralateral side of the face in half nose anomalies, only reports concerning the ipsilateral defect are numerous. This report presents an unusual case of hemi aplasia of the nose with complete cleft lip and palate of the contralateral side. A local flap on the nasal dorsum was used for nasal reconstruction, where correction of the elongation of the inner canthal distance and the shape of the inner canthus was performed.

Topics: Cleft Lip; Cleft Palate; Eyelids; Humans; Male; Nose; Plastic Surgery Procedures; Surgical Flaps

Hypernasality in velocardiofacial syndrome (VCFS) is more severe, persistent, and difficult to manage compared to other populations with cleft palate or velopharyngeal (VP) dysfunction. This pilot study investigated why children with VCFS have more severe hypernasality.. Pressure-flow methodology indirectly measured VP orifice size and VP closure timing during speech in a group of 5 children with VCFS, 5 children with cleft palate, and 6 normal children.. Children with VCFS demonstrated significant differences in VP closure timing and hypernasality. There were no significant group differences in VP orifice size. Duration of nasal airflow was the strongest predictor of judgments of hypernasality.. This study provides preliminary evidence that VP closure timing may account for the more severe hypernasality in children with VCFS, compared to structural factors alone.

Topics: Air Pressure; Child; Cleft Palate; DiGeorge Syndrome; Female; Humans; Linear Models; Male; Nose; Pilot Projects; Sound Spectrography; Speech; Speech Production Measurement; Transducers, Pressure; Velopharyngeal Sphincter; Voice Disorders; Voice Quality

The aim of this study was to evaluate a modified surgical technique for premaxilla repositioning with concomitant autogenous bone grafting in bilateral trans-foramen cleft lip and palate patients.. The study included 50 bilateral trans-foramen cleft lip and palate patients. Bone graft was harvested from the mandibular symphysis in 24 patients. Whenever more grafting was necessary, the iliac crest bone was used as the donor site (26 patients). The premaxilla was displaced by rupturing the bone and the palatine mucosa, and repositioned in a more adequate position using a surgical guide. The premaxilla and the grafts were fixed with miniplates and screws or screws only. The surgical guide was kept in place for 2 months, whereas the miniplates and screws were removed after 6 months, together with the complete bilateral lip and nose repair. Follow-up examinations were performed at 3, 6, and 12 months by means of periapical and occlusal radiographs, and by clinical examination. Thereafter, the patients were referred for completion of the orthodontic treatment.. Overall, in 48 cases (96%) the treatment achieved total graft integration, with complete closure of the bucconasal and palatal fistulas, and premaxilla stability (either at first surgery or after reoperation). In the remaining 2 patients (4%), the treatment failed, due to necrosis of the premaxilla.. The procedure is complex and involves risk. However, the patient's social inclusion, especially at the addressed age group, is the best benefit achieved.

Topics: Bone Plates; Bone Screws; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Graft Survival; Humans; Male; Maxilla; Nasal Cavity; Necrosis; Nose; Nose Diseases; Oral Fistula; Osteotomy; Palate; Periosteum; Postoperative Complications; Respiratory Tract Fistula; Surgical Flaps

Nasoalveolar molding was developed to improve dentoalveolar, septal, and lower lateral cartilage position before cleft lip repair. Previous studies have documented the long-term maintenance of columella length and nasal dome form and projection. The purpose of the present study was to determine the effect of presurgical nasoalveolar molding on long-term unilateral complete cleft nasal symmetry.. A retrospective review of 25 consecutively presenting nonsyndromic complete unilateral cleft lip-cleft palate patients was conducted. Fifteen patients were treated with presurgical nasoalveolar molding for 3 months before surgical correction, and 10 patients were treated by surgical correction alone. The average age at the time of follow-up was 9 years. Four nasal anthropometric distances and two angular relationships were measured to assess nasal symmetry.. All six measurements demonstrated a greater degree of nasal symmetry in nasoalveolar molding patients compared with the patients treated with surgery alone. Five symmetry measurements were significantly more symmetric in the nasoalveolar molding patients and one measurement demonstrated a nonsignificant but greater degree of symmetry compared with the patients treated with surgery alone.. The data demonstrate that the lower lateral and septal cartilages are more symmetric in the nasoalveolar molding patients compared with the surgery-alone patients. Furthermore, the improved symmetry observed in nasoalveolar molding-treated noses during the time of the primary surgery is maintained at 9 years of age.

Topics: Child; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Infant; Nose; Plastic Surgery Procedures; Retrospective Studies; Time Factors

Topics: Anthropometry; Child; Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Infant; Nose; Photography; Plastic Surgery Procedures; Reproducibility of Results; Treatment Outcome

Diagnosis and treatment of rhinolalia are some of the most important elements in the follow-up of patients presenting with a cleft palate. In order to quantify the nasal airflow, speech therapists use either nasalance-measuring devices or devices related to aerophonoscopy. At the Maxillofacial Surgery Department in the Nantes University Hospital, we are currently trying to evaluate the inter- and intra-individual reproducibility of quantitative values provided by the aerophonoscope. We intend to use this device, originally designed in our department 25 years ago, as a reference tool for the measurement of nasal airflow after cleft surgery.

Topics: Cleft Palate; Deafness; Equipment Design; Humans; Nose; Phonation; Pulmonary Ventilation; Respiration; Rhinomanometry; Speech Acoustics; Speech Disorders; Speech Production Measurement; Speech Therapy; Speech, Esophageal; Velopharyngeal Sphincter

Facial disfigurement in children with congenital craniofacial defects can lead to decreased self-esteem and poor self-perception. Traditional methods of reconstruction can fail to achieve a normal appearance in patients with severe disfigurements. Composite tissue allotransplantation (CTA) in children could offer a unique reconstructive opportunity. A discussion of the usage of CTA for congenital craniofacial defects is thus warranted. Treatment of severe craniofacial clefts, Treacher-Collins syndrome, hemifacial microsomia, and some vascular anomalies can yield unsatisfactory results, even after multiple surgeries. CTA provides the advantage of intact vascularized bone that would not need to be reshaped to fit the defect, with the correct donor match. CTA also provides reconstruction with similar tissue type in regions of the central midface such as the nose, lips, and eyelids. With advances in transplant immunology to devise mechanisms to decrease immunosuppression and induce donor antigen-specific tolerance, CTA may be a future reality in the pediatric population.

Topics: Child; Cleft Lip; Cleft Palate; Craniofacial Abnormalities; Craniosynostoses; Facial Asymmetry; Facial Transplantation; Humans; Immune Tolerance; Immunosuppression Therapy; Mandibulofacial Dysostosis; Nose; Plastic Surgery Procedures; Tissue Transplantation; Transplantation, Homologous

To investigate individualized one-staged correction of alveolar cleft and lip and nasal deformities secondary to lip cleft.. The alveolar cleft and lip and nasal deformities secondary to lip cleft were corrected in one stage.. From 2004 to 2007, 37 cases were treated. 33 patients were treated successfully with primary healing in bony recipient area. Cancellous bone exposure happened in 3 cases. The wounds healed after debridement and drainage. The cosmetic results were satisfactory.. One-staged correction of alveolar cleft and the lip and nasal deformities secondary to lip cleft can achieve good results.

Topics: Adolescent; Alveolar Process; Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Nose Deformities, Acquired

Facial esthetics play an important role in social interactions. However, children with a repaired complete unilateral cleft lip and palate usually show some disfigurement of the nasolabial area. To date, few studies have assessed the nasolabial appearance after different treatment protocols. The aim of the present study was to compare the nasolabial esthetics after 1- and 3-stage treatment protocols.. Four components of the nasolabial appearance (nasal form, nasal deviation, mucocutaneous junction, and profile view) were assessed by 4 raters in 108 consecutively treated children who had undergone either 1-stage closure (Warsaw group, 41 boys and 19 girls, mean age 10.8 years, SD 2.0) or 3-stage (Nijmegen group, 30 boys and 18 girls, mean age 8.9 years, SD 0.7). A 5-grade esthetic index of Asher-McDade was used, in which grade 1 indicates the most esthetic and grade 5 the least esthetic outcome.. The nasal form was judged the least esthetic in both groups and graded 3.1 (SD 1.1) and 3.2 (SD 1.1). The nasal deviation, mucocutaneous junction, and profile view were scored from 2.1 (SD 0.8) to 2.3 (SD 1.0) in both groups. The treatment outcome after the Warsaw and Nijmegen protocols was comparable. Neither overall nor any of the 4 components of the nasolabial appearance showed intercenter differences (P > .1).. The nasolabial appearance after the Warsaw (1-stage) and Nijmegen (3-stage) protocols was comparable. The technique of lip repair (triangular flap in Warsaw and Millard rotation advancement in Nijmegen) gave comparable results for the esthetics of the nasolabial area.

Topics: Age Factors; Child; Cleft Lip; Cleft Palate; Clinical Protocols; Esthetics; Female; Humans; Lip; Male; Nose; Palatal Muscles; Palatal Obturators; Palate, Hard; Palate, Soft; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome

Children with repaired cleft lip/palate require secondary closure of the alveolar cleft and, often, nasolabial revision. We describe a technique performed in 61 patients for harvesting bone for the alveolar defect and dermis for augmentation of the median tubercle, taking both from the posterior iliac region. The advantages of the posterior approach are as follows: (1) the same donor site is used for cancellous bone and dermal graft and (2) the child's appearance is improved along with alveolar cleft grafting.

Topics: Alveolar Process; Alveoloplasty; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Curettage; Humans; Ilium; Lip; Nose; Osteotomy; Skin Transplantation; Tissue and Organ Harvesting

The purpose of this study was to determine if there were correlations between anthropometric nasolabial measurements and subjective assessments of nasal esthetics in individuals with repaired complete unilateral cleft lip and palate (CUCLP).. The sample consisted of 28 individuals with repaired CUCLP and 20 age- and gender-matched individuals without clefts.. Nasolabial morphology was assessed using 2D and 3D measurements made on frontal photographs, lateral cephalometric radiographs, and plaster nose casts. A panel of orthodontists rated nasal esthetics from frontal, lateral, three-quarter, and basal view photographs and plaster nose casts using visual analog scales, and they also order ranked the nose casts. Based on the nasal esthetics ratings and rankings, two groups that had the best and the worst esthetics representing the extremes of nasolabial esthetics were statistically identified. Measurements were compared between the cleft and noncleft and the best and worst groups using t tests and analysis of variance.. Differences in anthropometric measurements between the groups were identified. The columellar width and nose base and nasolabial angles significantly differed between the best and worst groups (p < .05). Differences in panel ratings of nasolabial esthetics between the best and worst groups were statistically detected using lateral and three-quarter view photographs (p < .05).. Although morphologic differences between the cleft and noncleft and between the best and worst groups were identified, the slight morphologic differences noted were not sufficient to explain the subjective esthetic evaluation by the panel.

Topics: Adolescent; Case-Control Studies; Cephalometry; Child; Cleft Lip; Cleft Palate; Esthetics; Face; Female; Humans; Imaging, Three-Dimensional; Lip; Male; Models, Anatomic; Nasal Cartilages; Nose; Photography; Young Adult

The current classification diagrams for cleft lip and palate are descriptions of the components involved in the cleft, but they do not consider in detail the severity of distortion. We sought to establish a new diagram (the Clock Diagram) for cleft lip and palate, which describes the pathology according to the severity of distortion of the nose, lip, and primary and secondary palate, and to apply this classification scheme toward treatment selection.. The method is based on surgical results obtained from 1043 cleft lip and palate patients operated by the author between 1996 and 2007, under the protocol based on our classification. To further illustrate the classification and diagram method, two types of clefts are described, using the proposed diagram and compared with Kernahan's diagram.. This new diagram describes the cleft's severity using terminology from our clinic's classification of cleft severity. In comparison with Kernahan's diagram, the Clock Diagram more effectively demonstrates a cleft's severity. I have observed a higher incidence of lip and palate revision in severe clefts.. The Outreach Program Lima Clock Diagram classifies the severity of the cleft and affords an individualized description of cleft morphology. I have observed a direct relation between cleft severity and the number of poor outcomes in our patients.

Topics: Cleft Lip; Cleft Palate; Humans; Lip; Nose; Palate, Hard; Palate, Soft; Patient Care Planning; Severity of Illness Index; Terminology as Topic

Topics: Cleft Palate; Female; Foreign Bodies; Household Articles; Humans; Infant; Nose

To evaluate the feasibility of anterior maxillary segmental distraction (AMSD) to correct maxillary hypoplasia and severe dental crowding in cleft lip and palate (CLP) patients, 7 patients (average age 16.4 years) with maxillary hypoplasia, shortened maxillary dental arch length and severe anterior dental crowding secondary to CLP were selected for this study. After anterior maxillary segmental osteotomy, 3 patients were treated using bilateral internal distraction devices, and 4 patients were treated using rigid external distraction devices. Photographs and radiographs were taken to review the improvement in facial profile and occlusion after distraction. An average 10.25 mm anterior maxillary advancement was obtained in all patients after 10-23 days of distraction and 9-16 weeks of consolidation. The sella-nasion-point A (SNA) angle increased from 69.5 degrees to 79.6 degrees. Midface convexity was greatly improved and velopharyngeal competence was preserved. The maxillary dental arch length was greatly increased by 10.1 mm (P<0.01). Dental crowding and malocclusion were corrected by orthodontic treatment. These results show that AMSD can effectively correct the hypoplastic maxilla and severe dental crowding associated with CLP by increasing the midface convexity and dental arch length while preserving velopharyngeal function, and dental crowding can be corrected without requiring tooth extraction.

Topics: Adolescent; Cephalometry; Cleft Lip; Cleft Palate; Dental Arch; External Fixators; Feasibility Studies; Female; Humans; Internal Fixators; Male; Malocclusion; Mandible; Maxilla; Nasal Cavity; Nose; Osteogenesis, Distraction; Osteotomy; Osteotomy, Le Fort; Photography, Dental; Sella Turcica; Tooth Movement Techniques; Velopharyngeal Sphincter; Young Adult

The management for primary unilateral cleft lip nose deformities has not yet been established. In this study, short-term postoperative nasal forms after presurgical nasoalveolar molding (NAM) followed by primary lip repair for children with complete unilateral cleft lip and palate (UCLP) were evaluated and compared with the nasal forms achieved by treatment without nose correction.. Fifteen patients with complete UCLP who were treated in our department and followed up for more than 1 year (range 1 to 5 yrs) were enrolled. All subjects underwent presurgical orthopedic treatment with NAM, followed by lip repair using Cronin's triangular flap method with medial-upward advancement of nasolabial components with vestibular expansion. Postoperative nasal forms including nostril height and width ratio, ratio of the height of the top of the alar groove, and curvature of the appropriate circle of the nasal ala were evaluated using color photographs. Fifteen patients with complete UCLP who underwent presurgical orthopedic treatment using a Hotz plate followed by lip repair without nose correction served as controls.. The comparison of postoperative nasal forms demonstrated that the nostril height and width ratio and the height of the top of the alar groove in the correction group were significantly superior compared with those of the controls.. Our management of cleft lip nose will provide good nasal forms with minimum invasion in patients with UCLP. Long-term follow-up will be necessary to clarify effects on the growth of nasal tissues reconstructed in infancy.

Topics: Cleft Lip; Cleft Palate; Dental Prosthesis Design; Facial Muscles; Follow-Up Studies; Humans; Infant; Lip; Nasal Cartilages; Nose; Palatal Obturators; Photography; Plastic Surgery Procedures; Retrospective Studies; Rhinoplasty; Stents; Surgical Flaps; Suture Techniques; Treatment Outcome

Topics: Adolescent; Age Factors; Child; Child Development; Child, Preschool; Cleft Lip; Cleft Palate; Facial Muscles; Follow-Up Studies; Hearing; Humans; Infant; Infant, Newborn; Language Development; Longitudinal Studies; Maxillofacial Development; Neurolinguistic Programming; Nose; Palatal Muscles; Plastic Surgery Procedures; Speech; Treatment Outcome

A popular method for nasolabial rating in unilateral cleft lip and palate (UCLP) is the Asher-McDade system consisting of a 5-point ordinal scale assessing nasal form, nasal symmetry, nasal profile, and vermilion border. The aim of the current study was to identify reference photographs illustrating this scale to facilitate its use.Four observers assessed nasolabial appearance on frontal and profile photographs of the nasolabial area of 42 children of Caucasian origin with a repaired UCLP at age 9 years. Cronbachs alpha, based on the individual scores of the 4 observers, ranged from 0.73 to 0.82 for the 4 nasolabial ratings, indicating a good reliability. The reliability of the overall score (mean of the 4 component scores) was also high (Cronbachs alpha, 0.83). Both for the nasolabial component ratings and for the overall score, duplicate measurement errors were small. The reliability for the mean of the 4 observers' scores was good, Spearman rank correlation coefficients ranging from 0.56 to 0.96.Subsequently, photographs were selected that showed the highest agreement among observers. For each of the 4 components (eg, nasal form, nasal deviation, nasal profile, and shape of the vermilion border), 5 photographs were selected to illustrate the whole range of the scale (score, 1-5), resulting in the selection of 20 pictures.It was concluded that nasolabial appearance rating can be performed reliably using a panel of judges and averaging the scores of all observers. Reference photographs, as developed from this study, may facilitate the rating task.

Topics: Child; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Lip; Male; Nose; Photography; Reference Values; Reproducibility of Results; White People

In contrast to the multitude of investigations regarding aesthetic changes in nasal surgery, few data are available concerning nasal function. This is especially important for cleft patients with a compromised nasal respiration.In this prospective study, 68 cleft patients, who underwent nasal surgery, were evaluated concerning aesthetic and respiratory outcome. To assess nasal respiration, active anterior rhinomanometry, rhinoresistometry, and acoustic rhinometry were performed preoperatively and 6 months postoperatively (without and with nasal decongestion, according to international standards). For analyzing the changes in aesthetic parameters, photographs from 3 directions, which were taken preoperatively and at least 6 months postoperatively, were compared. Thus, 57 angles and relations of lines were created out of 54 anthropometric points. The Wilcoxon test was used to compare preoperative and postoperative data (P < 0.05). Regarding aesthetic outcome, a significant improvement in many parameters was seen. The noses postoperatively proved to be significantly narrower and more symmetric and showed a better projection.Although analysis of functional respiratory data showed a significant increase in nasal volume, no change in nasal airflow and hydraulic diameter could be found.Whereas aesthetic improvement of the cleft nose is a goal, which can be achieved regularly, nasal respiration still seems to be a challenge in cleft patients. This study highlights the necessity of taking functional data to learn more about the effects of surgery. Objective methods to assess nasal respiratory function are important for planning and performing nasal surgery and are a means of quality control.

Topics: Adolescent; Adult; Anthropometry; Child; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Male; Middle Aged; Nose; Prospective Studies; Rhinomanometry; Rhinometry, Acoustic; Rhinoplasty; Statistics, Nonparametric; Treatment Outcome

Presurgical nasoalveolar molding (NAM) in the orofacial orthopedic treatment of unilateral clefts of the lip and palate aims to align and approximate the maxillary hemialveolar segments and simultaneously support and mold the deformed nasal cartilages, correct and center nasal tip projection, and lengthen the deficient cleft-side columella in early infancy, before the primary reparative lip surgery. A number of techniques of achieving these objectives have been described in the literature and are increasingly being practiced by cleft care teams around the world. However, a detailed description of the nasal stent is lacking in the literature and needs to be elucidated to facilitate greater usage of presurgical NAM in contemporary practice. This report fills this void by providing an analytical description of the different parts of the nasal stent; clarifies their desirable design features, anatomic correlations, and clinical importance; and illustrates in a step-by-step manner simple direct and indirect methods of incorporating a nasal stent, improvised by the author in his practice, that can be used with any of the contemporary NAM appliances and techniques. From the simple methods described, clinicians will be enabled to select one that may be most easily adaptable to their preferred appliance and clinical setting.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nose; Palatal Obturators; Prostheses and Implants; Prosthesis Design; Prosthesis Fitting; Stents

The Dallas surgical protocol for primary bilateral cleft lip/nose repair depends on the anatomy of the deformity. In cases of asymmetric bilateral clefts, an extremely small prolabium (<6 mm in vertical high) or a displaced premaxilla, a 2-stage lip repair was performed. At the same time, assessment of the tissue available for the columella determined the approach to the nose. In this part, the technique of 2-stage lip/nose repair of the bilateral cleft lip and palate is reviewed, and the long-term outcomes are presented.

Topics: Cleft Lip; Cleft Palate; Clinical Protocols; Female; Humans; Infant; Male; Nose; Rhinoplasty; Surgical Flaps; Texas; Treatment Outcome

Unilateral primary lip/nose repair, closed approach using the Dallas protocol presents step-by-step technique with 10 completed cases. Adjustments and corrections frequently used in the lip/nose repair are presented. A discussion of various techniques used today with their advantages and disadvantages is reviewed. Ten completed cases are presented with their long-term outcomes. Recommendations for developing countries regarding this and other techniques are made for the care of the unilateral primary cleft lip, nose, alveolus, and palate.

Topics: Adolescent; Adult; Child; Child, Preschool; Cleft Lip; Cleft Palate; Clinical Protocols; Developing Countries; Female; Humans; Infant; Male; Maxillofacial Development; Nose; Orthopedic Procedures; Treatment Outcome

Various lines of evidence suggest that face shape may be a predisposing factor for non-syndromic cleft lip with or without cleft palate (CL/P). In the present study, 3D surface imaging and statistical shape analysis were used to evaluate face shape differences between the unaffected (non-cleft) parents of individuals with CL / P and unrelated controls.. Sixteen facial landmarks were collected from 3D captures of 80 unaffected parents and 80 matched controls. Prior to analysis, each unaffected parent was assigned to a subgroup on the basis of prior family history (positive or negative). A geometric morphometric approach was utilized to scale and superimpose the landmark coordinate data (Procrustes analysis), test for omnibus group differences in face shape, and uncover specific modes of shape variation capable of discriminating unaffected parents from controls.. Significant disparity in face shape was observed between unaffected parents and controls (p < 0.01). Notably, these changes were specific to parents with a positive family history of CL/P. Shape changes associated with CL/P predisposition included marked flattening of the facial profile (midface retrusion), reduced upper facial height, increased lower facial height, and excess interorbital width. Additionally, a sex-specific pattern of parent-control difference was evident in the transverse dimensions of the nasolabial complex.. The faces of unaffected parents from multiplex cleft families displayed meaningful shape differences compared with the general population. Quantitative assessment of the facial phenotype in cleft families may enhance efforts to discover the root causes of CL/P.

Topics: Case-Control Studies; Cephalometry; Cleft Lip; Cleft Palate; Face; Family Health; Female; Genetic Predisposition to Disease; Humans; Imaging, Three-Dimensional; Lip; Male; Maxillofacial Development; Nose; Orbit; Parents; Photogrammetry; Principal Component Analysis; Sex Factors; Vertical Dimension; Zygoma

Cleft palate represents one of the most common congenital birth defects in human. During embryonic development, palatal shelves display oronasal (O-N) and anteroposterior polarity before the onset of fusion, but how the O-N pattern is established and how it relates to the expansion and fusion of the palatal shelves are unknown. Here we address these questions and show that O-N patterning is associated with the expansion and fusion of the palatal shelves and that Dlx5 is required for the O-N patterning of palatal mesenchyme. Loss of Dlx5 results in downregulation of Fgf7 and expanded Shh expression from the oral to the nasal side of the palatal shelf. This expanded Shh signaling is sufficient to restore palatal expansion and fusion in mice with compromised palatal mesenchymal cell proliferation, such as Msx1-null mutants. Exogenous Fgf7 inhibits Shh signaling and reverses the cranial neural crest (CNC) cell proliferation rescue in the Msx1/Dlx5 double knockout palatal mesenchyme. Thus, Dlx5-regulated Fgf7 signaling inhibits the expression of Shh, which in turn controls the fate of CNC cells through tissue-tissue interaction and plays a crucial role during palatogenesis. Our study shows that modulation of Shh signaling may be useful as a potential therapeutic approach for rescuing cleft palate.

Topics: Animals; Body Patterning; Cleft Palate; Fibroblast Growth Factor 7; Gene Expression Regulation, Developmental; Hedgehog Proteins; Homeodomain Proteins; Humans; Mesoderm; Mice; Mice, Knockout; Morphogenesis; MSX1 Transcription Factor; Nose; Palate; Signal Transduction

To evaluate the curative effect of presurgical nasoalveolar molding (NAM) in the treatment of infants with bilateral complete cleft lip and palate (BCLP).. Nine infants with BCLP were included. Presurgical alveolar molding was used to bring the premaxilla back into proper alignment with the lateral segments in the maxilla arch. Presurgical nasal molding produced tissue expansion of the short columella and corrected the nasal tip cartilages. Up to 5 months of active treatment was needed before lip repair. Student's t test was used for data analysis with SPSS 15.0 software package.. After presurgical NAM in 9 infants with BCLP, the posterior lateral alveolar segments were aligned while retracting the premaxilla, the premaxilla had been returned from 37.64mm to 29.94mm within the maxillary arch (P<0.01). The nasal alar base width was significantly reduced following NAM(P<0.05). The columella was nonsurgically lengthened from 1.13mm to 3.78mm(P<0.05).. In order to obtain satisfactory lip-nose configuration for BCLP, presurgical NAM is useful in cleft lip and palate team approach.

Topics: Cartilage; Cleft Lip; Cleft Palate; Humans; Infant; Maxilla; Nose; Preoperative Care

To investigate the long-term effects of pharyngeal flap surgery (PFS) on nasal and nasopharyngeal dimensions of patients with velopharyngeal insufficiency (VPI) and to correlate the findings with the onset of respiratory complaints after surgery.. Prospective study in 58 nonsyndromic patients with repaired cleft palate and VPI, evaluated 2 days before and 5 months (POST1) and 1 year (POST2) after PFS, on average. Patients were divided into two groups: one consisting of patients with postoperative respiratory complaints (RC group) and the other without complaints (NRC group).. Superiorly based PFS.. Respiratory complaints (self reports of mouth breathing, snoring, and other sleep obstructive events) assessed at POST1 and POST2, and minimum nasal (NCSA) and nasopharyngeal (NPA) cross-sectional areas assessed by rhinomanometry at POST2.. Respiratory complaints were reported by 55% and 36% of the patients evaluated at POST1 and POST2, respectively. Posterior rhinomanometry showed a significant postoperative reduction of mean NCSA in the RC and NRC groups (p < .05), to subnormal levels in some of them. The decrease was more pronounced in the RC group. No significant changes in NCSA were observed by anterior rhinomanometry. Similar results were obtained when NPA was assessed by modified anterior rhinomanometry.. In the long-term, PFS yielded a significant reduction in upper airways dimensions beyond what should be expected and associated with persistent respiratory complaints in some cases.

Topics: Adolescent; Adult; Child; Cleft Palate; Female; Humans; Male; Middle Aged; Mouth Breathing; Nasal Obstruction; Nasopharynx; Nose; Oral Surgical Procedures; Plastic Surgery Procedures; Prospective Studies; Rhinomanometry; Snoring; Surgical Flaps; Velopharyngeal Insufficiency

Presurgical Orthopaedics is any treatment that alters the position of the segments of cleft maxilla in infancy prior to lip and palate reconstruction. There are different approaches, with different mechanics, seeking and achieving different end results. This article describes PNAM, a current approach to the traditional method of presurgical infant orthopaedics for patients with unilateral and bilateral clefts of lip and palate. The goal of PNAM is to align and approximate the alveolar cleft segments while at the same time achieving correction of nasal cartilage and soft tissue deformity.

Topics: Alveoloplasty; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Palatal Obturators; Plastic Surgery Procedures; Stents; Treatment Outcome

Thirty-five young adults (22-32 years old, mean 25) born with complete unilateral or bilateral clefts participated in a follow-up of speech, appearance, and teeth after treatment. They completed a questionnaire about their satisfaction with their speech, nose, lip, and teeth on visual analogue scales, and indicated on two overall questions how often they thought about their cleft, and how often they were asked questions about their speech, nose, or lip. Their speech was recorded and assessed blindly and independently by two speech and language pathologists. Participants' satisfaction with their speech did not correlate significantly with the speech assessments. Satisfaction with the nose had the highest correlation with the overall questions. No participant indicated more dissatisfaction with speech than the midpoint of the scale, making conclusions about covariance between satisfaction with speech and the overall questions difficult.

Topics: Adult; Cleft Lip; Cleft Palate; Esthetics; Female; Follow-Up Studies; Humans; Lip; Male; Nose; Patient Satisfaction; Speech; Speech Production Measurement; Young Adult

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Plastic Surgery Procedures

Primary bone grafts in congenital cleft alveolus do not always provide sufficient bulk or height of bone for ideal placement of endosseous implants. Thus, maxillary sinus or nasal floor elevation and inlay bone grafts in previously grafted areas are not exceptions in the daily routine. This case report stresses the need of a detailed treatment plan and careful surgical management of nasal floor elevation with particulate autogenous bone graft to successfully provide the patient with osseointegrated prostheses.

Topics: Alveolar Process; Alveoloplasty; Bone Transplantation; Cleft Lip; Cleft Palate; Dental Implantation, Endosseous; Humans; Incisor; Male; Maxillary Sinus; Nose; Oral Surgical Procedures, Preprosthetic; Time Factors; Young Adult

To determine the presence of Staphylococcus aureus in a nasal flora and oral environment, the correlation between frequency of transmission of S. aureus and oronasal fistula size, and the pattern of methicillin resistance on S. aureus strains in children with cleft lip and palate (CLP).. Thirty-two CLP children with and without oronasal fistulas, ranging in age from 5 to 13 years were examined for oronasal fistula presence and size. Stimulated saliva samples and nasal swab samples were taken and investigated for S. aureus presence. S. aureus presence and counts were correlated with fistula presence and size.. Saliva samples showed statistical differences between the groups with and without oronasal fistulas with an area ranging from 0.80 to 28.26 mm2. The S. aureus counts were significantly higher (r = .535, p = .002) in saliva samples from children with larger oronasal fistula. The S. aureus count was not significantly different (r = -.013, p = .942) in nasal samples compared with oronasal fistula size. Methicillin resistance with disk-diffusion method was recorded as sensitive (> or =13 mm) in all S. aureus strains.. The results of this study indicate a positive correlation between fistula size and S. aureus transmission to one oral environment through oronasal fistulae, and a positive correlation between frequency of S. aureus transmission and fistula size. All S. aureus strains were sensitive to methicillin. These results may have implications for preventive treatment of CLP children.

Topics: Adolescent; Child; Child, Preschool; Cleft Lip; Cleft Palate; Colony Count, Microbial; Disk Diffusion Antimicrobial Tests; Humans; Methicillin-Resistant Staphylococcus aureus; Nose; Nose Diseases; Oral Fistula; Respiratory Tract Fistula; Saliva; Staphylococcus aureus

Bilateral cleft lip-cleft palate is associated with nasal deformities typified by a short columella. The authors compared nasal outcomes of cleft patients treated with banked fork flaps to those of patients who underwent nasoalveolar molding and primary retrograde nasal reconstruction.. A retrospective review of 26 consecutive patients with bilateral cleft lip-cleft palate was performed. Group 1 patients (n = 13) had a cleft lip repair and nasal correction with banked fork flaps. Group 2 patients (n = 13) had nonsurgical columellar elongation with nasoalveolar molding followed by cleft lip closure and primary retrograde nasal correction. Group 3 patients (n = 13) were age-matched controls. Columellar length was measured at presentation and at 3 years of age. The number of nasal operations was recorded to 9 years. The Kruskal-Wallis and Tukey-Kramer tests were used for statistical analysis.. Initial columellar length was 0.49 +/- 0.37 mm in group 1 and 0.42 +/- 0.62 mm in group 2. Post-nasoalveolar molding columellar length was 4.5 +/- 0.76 mm in group 2. By 3 years of age, columellar length was 3.03 +/- 1.47 mm in group 1, 5.98 +/- 1.09 mm in group 2, and 6.35 +/- 0.99 mm in group 3. Group 2 columellar length was significantly greater (p < 0.001) than that of group 1 and not statistically different from that of group 3 (p > 0.05). All group 1 patients (13 of 13) needed secondary nasal surgery. No nasoalveolar molding patients (zero of 13, group 2) required secondary nasal surgery.. Nonsurgical columellar elongation with nasoalveolar molding followed by primary retrograde nasal reconstruction restored columellar length to normal by 3 years and significantly reduced the need for secondary nasal surgery.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Nose; Plastic Surgery Procedures; Prostheses and Implants; Retrospective Studies; Rhinoplasty; Stents; Tissue Expansion

Numerous techniques exist to address poor nasal tip projection in the cleft nose deformity. The authors describe a secondary closed rhinoplasty technique using diced cartilage nasal tip grafting.. Cleft patients who previously underwent lower lateral cartilage repositioning with residual poor nasal tip projection underwent the "stuffy nose" rhinoplasty technique in which diced septal cartilage grafts were placed in a pocket made from a unilateral marginal incision over the lower lateral cartilages. Preoperative and follow-up (1 year) comparative measurements included (1) columellar length, (2) alar base-nasal tip-columellar base angle, and (3) lateral tip projection.. Twenty cleft patients had improvement in nasal form and tip projection from the stuffy nose rhinoplasty. Mean change from preoperatively to follow-up was as follows: columellar length, 11.3 mm to 13.3 mm (17.7 percent); alar base-nasal tip-columellar base angle, 42.0 to 33.5 degrees (8.5 degrees, or 20.2 percent decrease); and lateral tip projection, 7.7 mm preoperatively to 9.0 mm postoperatively (16.9 percent increase). Two patients developed complications (one graft exposure and one infection) but healed with conservative treatment. Two different patients underwent revisionary nasal surgery but for other concerns (alar base asymmetry and internal nasal valve collapse).. The stuffy nose rhinoplasty was shown to objectively improve nasal tip projection in cleft patients with secondary nasal deformities, with minimal complications and decreased need for revisions.

Topics: Adolescent; Cartilage; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Rhinoplasty

The bilateral cleft lip and nasal repair has remained a challenging endeavor. Techniques have evolved to address concerns over unsatisfactory features and stigmata of the surgery. The authors present an approach to this complex clinical problem that modifies traditional repairs described by Millard and Manchester. The senior author (H.S.B.) has developed this technique with over 25 years of surgical experience dealing with the bilateral cleft lip. This staged lip and nasal repair provides excellent nasal projection, lip function, and aesthetic outcomes. Lip repair is performed at 3 months of age. Columellar lengthening is performed at approximately 18 months of age. A key component of this repair focuses on reconstruction of the central tubercle. A triangular prolabial dry vermilion flap is augmented by lateral lip vermilion flaps that include the profundus muscle of the orbicularis oris. This minimizes lateral lip segment sacrifice and provides improved central vermilion fullness, which is often deficient in traditional repairs. The authors present the surgical technique and examples of their clinical results.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Plastic Surgery Procedures

A 10-month-old boy suffering from a rare multiple-deformities with congenital cleft lip, ala nasi cleft, face horizontal cleft, alveolar cleft, accessory ear and inguinal hernia. All of the above-mentioned multiple-deformities have been cured by surgical operations, during which the bleeding was prevented strictly. According to the principle of asepsis, the hernial sac was ligatured firstly, the accessory ears were cut off, the ala nasi cleft, cleft lip and facial transversal cleft were repaired in turn. After the operation, the wound were completely healed up in time and the deformities were corrected.

Topics: Cleft Lip; Cleft Palate; Hernia, Inguinal; Humans; Infant; Male; Nose

The aim of the study was to evaluate the clinical outcomes of secondary functional cheilorhinoplasty of residual lip and nasal deformities caused by muscular deficiency in cleft patients.. During a 4-year period, 31 patients underwent cheilorhinoplasty, including complete reopening of the cleft borders and differentiated mimic muscle reorientation. In 21 patients, remarkable residual clefts of the anterior palate were also closed. Simultaneous alveolar bone grafting was performed in 15 patients. The minimum follow-up was 1 year. Cosmetic features evaluated were spontaneous facial appearance and changes in position of the nasal floor and the philtrum. The width of the alar base was measured. For functional outcomes, deficiency during mimic movements was evaluated, using standardized photographs taken preoperatively and postoperatively. The final results, judged according to defined criteria with several clinical factors, were compared.. Cosmetic and functional improvement was achieved in all patients. In young patients (aged 4 to 9 years), the improvements were noteworthy. There were no differences in outcomes between the groups with and without simultaneous grafting, except for unilateral cases with minor muscular deficiency, in whom bone grafting before cheilorhinoplasty led to better results.. In cases of major muscular deficiency, early cheilorhinoplasty should be performed at age 7 years, without waiting for the usual timing of bone grafting. In minor and moderate cases, the operation can ideally be done in combination with bone grafting.

Topics: Adolescent; Bone Transplantation; Child; Child, Preschool; Cleft Lip; Cleft Palate; Facial Muscles; Female; Graft Survival; Humans; Male; Nasal Cartilages; Nose; Reoperation; Rhinoplasty; Treatment Outcome; Young Adult

Topics: Cleft Lip; Cleft Palate; Female; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Nose; Tissue Expansion; Tissue Expansion Devices

"Do not touch the nose in primary repair of the unilateral cleft lip and palate!" In the past, this dogmatic attitude caused functional and aesthetic (psychological) problems for the child until secondary corrections during adolescence were performed. In the 1950s, surgeons started to correct at least a few features of the nasal deformity and to develop radically corrective measures. Since 1970, a new and very comprehensive concept of correction has been used at the authors' department of plastic and reconstructive surgery.. Methods of primary nasal repair by various surgeons are presented chronologically. The main features of the authors' strategy are special incision lines, extensive mobilization of all dislocated structures, straightening of the deviated septum, correction of the deformed ala and nasal tip, induction of bone growth in hypoplastic areas under the alar base and along the piriform aperture, and a special suture technique of the orbicularis muscle to form a better philtrum.. Improvement of the aesthetic and functional results can be achieved with this type of nasal repair. Since 1970, approximately 500 patients have been operated on with this method at the authors' hospital and elsewhere, with 80 percent showing satisfactory results and 20 percent revealing deficiencies. Severe nasal deformities, which were common when no primary repair was applied, were not observed. This observation period provides evidence that no growth retardation occurs.. Because of the good results of this method and the lack of growth retardation, this approach is to be recommended. It also benefits children in underdeveloped countries, where frequent surgery is not possible.

Topics: Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Infant; Lip; Male; Nose; Plastic Surgery Procedures; Retrospective Studies

The authors conducted the present study to elucidate what elements characterize the nasal profiles of patients with unilateral cleft lips (CLs).. A total of 40 Japanese unilateral CL patients were studied. For each patient, the nasal profile curve was traced on three-dimensional computer tomography image. Then four points were marked on the contour. The points were NAS (Nasion), MAP (the Most Anterior Point on the nasal profile curve), GPRN (the Genuine Pronasale: the point on the nasal curve at which the curve protrudes most), and SBN (Subnasale: the point at the columellar base). Using specially designed software, the distances between these marking points were measured along the nasal profile curve.. In CL patients, the distance between the MAP and GPRN is longer, and the GPRN is located more inferiorly than in non-cleft persons.. The nasal tip tends to become round and to droop in unilateral CL patients. In order to avoid this deformity pattern, the nasal tip should be reshaped to present a sharper curvature and corrected superiorly.

Topics: Adolescent; Adult; Case-Control Studies; Cephalometry; Child; Child, Preschool; Cleft Palate; Female; Humans; Male; Nose; Patient Care Planning; Statistics, Nonparametric

The overall incidence of pathological septal deformity has been found to be significantly higher in unilateral cleft lip/palate (UCLP) children than in control children. Of the seven types of septal deformity according to Mladina's classification, type 6 has been found to be the most frequent in UCLP children, occurring in only 3.7% of the control children.. To investigate the incidence of type 6 septal deformity in the parents of UCLP children.. UCLP children (N=62) and their parents (N=91) were examined for type 6 septal deformities.. Type 6 was found in at least one parent of a UCLP child in 58% of cases. However, it was not found in the parents whose UCLP children did not show a type 6 septal deformity.. Type 6 septal deformity is almost a rule in children suffering from UCLP. Type 6 was not seen in the parents whose UCLP children did not show a type 6 septal deformity. There is a morphogenetic predisposition for the development of CLP in children whose parents carry a type 6 septal deformity.

Topics: Adolescent; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Family Health; Female; Humans; Male; Nose; Parents; Quantitative Trait, Heritable

To evaluate the outcome of presurgical nasoalveolar molding (PNAM) therapy in the treatment of patients with nonsyndromic unilateral cleft and palate (UCLP).. A prospective study with blinded measurements.. Twelve patients with UCLP treated from 1997 to 2003.. The starting age for PNAM therapy was 26 days and the average length of the therapy was 110 days.. Measurements of intraoral and extraoral casts were made, and statistical analyses were used to compare the differences between pre- and posttherapy measurements.. After PNAM therapy, there was a statistically significant decrease in both intersegment alveolar cleft distance and columellar deviation (p < .05). There was also a statistically significant increase in cleft nostril height, maxillary width, and columellar width (p < .05). Moreover, although there was no statistically significant reduction of the affected nostril width, it demonstrated on average 1.7-mm reduction after PNAM therapy. The length of the time the patient utilized the appliance and postmolding nostril height were found to have a statistically significant positive correlation (p < .05).. PNAM therapy decreases intersegment alveolar cleft distance while permitting an increase in posterior maxillary arch width. It also increases nasal symmetry by decreasing columellar deviation, increasing nostril height on the affected side, maintaining bialar width of nose, increasing columellar width, and creating more symmetrical nostril heights and widths. The improvement of the height of the cleft nostril was correlated with the time the appliance was applied.

Topics: Alveolar Process; Cephalometry; Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Infant; Infant, Newborn; Models, Dental; Nose; Orthopedic Procedures; Palatal Obturators; Preoperative Care; Prospective Studies; Single-Blind Method; Stents; Time Factors; Treatment Outcome

The purpose of this study was to assess the progressive changes of columella length and nasal growth after presurgical nasoalveolar molding and primary cheiloplasty in bilateral complete cleft lip-cleft palate infants.. Twenty-two consecutive complete bilateral cleft lip-cleft palate infants were included. All of them underwent nasoalveolar molding for columella lengthening and retraction of the premaxilla for 3 to 4.5 months before primary cheiloplasty. Standard 1:1 basilar photographs were taken before and after nasoalveolar molding, 1 week after cheiloplasty, and yearly for 3 years. Nasal height and width were measured directly on the photographs.. The results revealed that columella length was significantly lengthened after nasoalveolar molding and was further improved after primary cheiloplasty. The columella decreased in length slightly in the first and second years postoperatively and started to increase in length slightly in the third year postoperatively, whereas the rest of the nose grew significantly in height year by year. This consequently appeared as relapse of columella length. The shortage of the columella length was 1.9 mm.. Both presurgical nasoalveolar molding and primary cheiloplasty lengthened the columella in bilateral cleft lip-cleft palate patients. However, there was a relative relapse in columella length because of the differential growth between the columella and the rest of the nose in the first and second years postoperatively.

Topics: Anthropometry; Cleft Lip; Cleft Palate; Face; Follow-Up Studies; Humans; Infant; Infant, Newborn; Maxillofacial Development; Nose

A group of syndromes, consisting of Malpuech syndrome, Michels syndrome, Carnevale syndrome, OSA syndrome, and Mingarelli syndrome share the combination of symptoms of highly arched eyebrows, ptosis, and hypertelorism, and vary in other symptoms such as asymmetry of the skull, eyelid, and anterior chamber anomalies, clefting of lip and palate, umbilical anomalies, and growth and cognitive development. It has been suggested that they are in fact part of the same entity. Here, we describe a brother and sister with the same constellation of symptoms, and compare these with the various entities. We conclude that the present patients resemble most patients with Carnevale and Mingarelli syndrome, and the case reported by Guion-Almeida, and that these patients form together most probably the same entity. We suggest the name Carnevale syndrome as this author described this combination of symptoms for the first time. Malpuech and Michels syndromes are probably separate entities, although they may still be allelic. Pattern of inheritance of Carnevale syndrome is most likely autosomal recessive.

Topics: Abnormalities, Multiple; Blepharoptosis; Bone Diseases; Child, Preschool; Cleft Lip; Cleft Palate; Craniofacial Abnormalities; Craniosynostoses; Eyelids; Face; Female; Genes, Recessive; Humans; Hypertelorism; Male; Nose; Radiography; Skull; Syndrome; Torticollis; Urogenital Abnormalities

Imaging systems for patients with cleft palate typically are not portable, but are essential to obtain an audiovisual record of nasoendoscopy and otoscopy procedures. Practitioners who evaluate patients in rural, remote, or otherwise medically underserved areas are expected to obtain audiovisual recordings of these procedures as part of standard clinical practice. Therefore, patients must travel substantial distances to medical facilities that have standard recording equipment. This project describes the specific components, strengths and weaknesses of an MPEG-4 digital recording system for otoscopy/nasoendoscopy evaluation of patients with cleft palate that is both portable and compatible with store-and-forward telemedicine applications.. Three digital recording configurations (TabletPC, handheld digital video recorder, and an 8-mm digital camcorder) were used to record the audio/ video signal from an analog video scope system.. The handheld digital video recorder was most effective at capturing audio/video and displaying procedures in real time. The system described was particularly easy to use, because it required no postrecording file capture or compression for later review, transfer, and/or archiving.. The handheld digital recording system was assembled from commercially available components. The portability and the telemedicine compatibility of the handheld digital video recorder offers a viable solution for the documentation of nasoendosocopy and otoscopy procedures in remote, rural, or other locations where reduced medical access precludes the use of larger component audio/video systems.

Topics: Cleft Palate; Data Compression; Data Display; Endoscopy; Equipment Design; Humans; Image Processing, Computer-Assisted; Nose; Otoscopy; Radiology Information Systems; Telemedicine; Video Recording

To find out the nasendoscopic changes of velopharyngeal configuration and movement after palatoplasty with or without velopharyngeal muscle reconstruction.. The nasendoscopy was taken in forty-one patients with palatoplasty, 22 repaired by velopharyngeal muscle reconstruction and 19 with modified von Langenbeck's procedure (non-reconstructive group).. In patients with velopharyngeal muscle reconstruction, the velopharyngeal ports are smooth and full with a definite reduction in size than patients without velopharyngeal muscle reconstruction. During phonation, the complete and marginal velopharyngeal competence rate in reconstructive group (90.91%) is higher than the group of non-reconstruction (37.31%) The major velopharyngeal closure is circular movement in reconstructive group, otherwise coronal closure in nonconstructive group.. Based the observation of nasendoscopy, the velopharyngeal muscle reconstruction in palatoplasty has more definite improvement to velopharyngeal closure than non-reconstructive procedure. Palatoplasty with velopharyngeal muscle reconstruction could reduce the size of velopharyngeal port and make the complete velopharyngeal closure easier.

Topics: Adolescent; Child; Child, Preschool; Cleft Palate; Endoscopy; Humans; Infant; Nose; Pharyngeal Muscles; Plastic Surgery Procedures

Morning glory disc anomaly (MGDA) is a rare congenital malformation of the optic disc, which can be associated with midline craniofacial abnormalities, such as basal encephalocele. A female neonate presented with MGDA in the right eye, pendular nystagmus, hypertelorism, a flattened nasal root and cleft lip and palate. MRI revealed a basal encephalocele, agenesis of the corpus callosum and ventricular enlargement. MGDA combined with midline facial clefting should always lead to the suspicion of a basal encephalocele.

Topics: Abnormalities, Multiple; Cleft Lip; Cleft Palate; Craniofacial Abnormalities; Humans; Infant; Male; Nose; Optic Disk

In contrast to the common clefts of the lip, alveolus and palate, the atypical clefts of the face may come in myriad patterns of clinical expression and are often not easy to define.. In this report, a case of median craniofacial dysraphia is described.. At presentation, the 3-month-old male patient had a bilateral complete cleft of the lip, alveolus and palate. The nose was wide and a horn was present on the nasal dorsum. 3-D CT AND MRI REVEALED: Duplication of the metopic suture ending at the wide anterior fontanel; orbital hypertelorism; midline cranial cleft ending just superior to the nasal dorsum; frontoethmoidal encephalocoele and holoprosencephaly. The presence of two metopic sutures was confirmed during surgery.. The presented case carries the characteristics of the median cleft face syndrome. However, it differs from similar cases in two respects. First, the patient had two metopic sutures, one on either side of the cranial extension of the median cleft. Second, the patient had a bilateral cleft lip in contrast to the expected median cleft lip deformity.

Topics: Cerebellum; Cleft Lip; Cleft Palate; Cranial Sutures; Craniofacial Abnormalities; Encephalocele; Holoprosencephaly; Humans; Hypertelorism; Infant; Male; Muscle Spasticity; Nose; Radiography; Syndrome

Continued advancement in the comprehensive care of children with cleft lip and palate has resulted in numerous innovative treatment protocols. The cooperation of numerous specialties has continued to expand the options for difficult cases. A high standard for aesthetic and functional results has been established. Presurgical treatment of a cleft alveolus and its associated soft tissues with presurgical orthopedics is just one of these techniques. Differing opinions of the effectiveness, growth disturbances, and additional costs of presurgical molding are often debated, but the concepts should be understood by any cleft surgeon or orthodontist involved in cleft care.

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Nose; Orthodontics, Interceptive; Palatal Obturators; Preoperative Care; Stents

The aim of this study was to assess the outcome of bone grafting using a corticocancellous block of iliac crest to reconstruct the support for the deformed, volume-deficient alar base in treated patients with unilateral cleft lip and palate (UCLP). The main outcome being measured was nasal symmetry.. This was a prospective study using a noninvasive three-dimensional stereophotogrammetry system (C3D) to assess the position of the alar base. Images were captured immediately preoperatively and at 6 months following the augmentation of the alar base with a block of bone graft. These images were used to calculate facial symmetry scores and were compared using a two sample Student's t test to assess the efficacy of the surgical method in reducing facial/nasal asymmetry.. This investigation was conducted on 18 patients with one patient failing to attend for follow-up. The results for 17 patients are presented.. Facial symmetry scores improved significantly following the insertion of the bone graft at the deficient alar base (p=0.005).. 3D stereophotogrammetry is a noninvasive, accurate, and archiveable method of assessing facial form and surgical change. Nasal symmetry can be quantified and measured reliably with this tool. Bone grafting to the alar base region of treated UCLP patients with volume deficiency produces improvement in nasal symmetry.

Topics: Adolescent; Adult; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Humans; Image Processing, Computer-Assisted; Male; Nose; Photogrammetry; Prospective Studies; Statistics, Nonparametric

To evaluate three-dimensional (3D) facial morphology in patients surgically corrected for unilateral cleft lip and palate (UCLP) following pre-surgical nasoalveolar molding (NAM).. Prospective, longitudinal study. Digital stereophotogrammetry was used to capture 3D facial images, and x, y, and z coordinates of five landmarks were digitized to compute mean morphologies. The sample comprised 15 patients with left UCLP and 10 matched control subjects. Facial form differences at age 37 weeks, using principal components analysis and finite-element scaling analysis (FESA) were assessed.. Using the first two principal components, which accounted for 63% of the total shape-change, UCLP and control groups showed similar distributions in the modal space (p > 0.05). For the UCLP group, the mean 3D facial form was smaller and less protrusive when superimposed on the non-cleft mean. Using FESA, reductions in facial volume were found in the UCLP group, involving the columella (29%), labial tubercle (51%), lower lip (29%) and lateral aspects of the face (19%). The UCLP group also showed increases in size above the tip of the nose (25%) and laterally to the columella directly below the nares (29%).. Following surgical repair of UCLP in patients previously treated with NAM, 3D facial morphology was virtually indistinguishable from the non-cleft mean. Clinically, the apparent improvement in the facial soft tissues may mask dysmorphic skeletal growth, and further studies are required to characterize the underlying bony changes associated with the soft tissue changes reported here.

Topics: Alveolar Process; Case-Control Studies; Cephalometry; Cleft Lip; Cleft Palate; Computer Simulation; Face; Finite Element Analysis; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Infant; Lip; Longitudinal Studies; Nose; Palatal Obturators; Photogrammetry; Preoperative Care; Prospective Studies; Rhinoplasty

Rather than treating nasal, maxillary, and soft tissue deformities as separate problems, the author has approached the deformities as a single aesthetic and functional unit, the nasal-maxillary complex. This complex includes the maxilla, nose, and overlying soft tissues, including the upper lip. Successful reconstruction is based on a thorough knowledge of the underlying anatomy and physiology of these structures. Treatment of nasal-maxillary complex deformities in adolescents represents the final stages in a lifetime of reconstructive procedures. A team approach is preferred that includes a craniofacial surgeon, orthodontist, dentist, prosthodontist, and speech and language pathologist. The author's personal philosophy is based on sequential reconstruction of the underlying nasal-maxillary bony base. This is followed by reconstruction of the internal/external nasal complex and final soft tissue reconstruction. These principles are presented along with case examples.

Topics: Adolescent; Bone Transplantation; Cleft Lip; Cleft Palate; Humans; Maxilla; Nose; Osteotomy, Le Fort; Surgical Fixation Devices

Is the poor potential of growth an ineluctable consequence of mesodermal deficiency? Should we agree with the idea that all protocols are equivalent? Actually, these opinions reflect the empiricism of previous generations. We must now become rational and develop a project without compromise to achieve good functions at primary surgery. 'The normal structures are present on either side of the cleft, only modified by the fact of the cleft...' Victor Veau's hypothesis is the conclusion of rigorous anatomical and embryological research. Our current knowledge of the pathological anatomy allows for a better restoration of the normal anatomy. Anatomy is nothing if it is not functional. Every thing should be done to control the healing process to allow the best expression and interaction of the various functions, especially for those concerning nasal ventilation and masticatory efficiency. To correct the deformity, the cleft surgeon must perform a wide subperiosteal and subperichondrial elevation and must learn the skills of this accurate work to preserve the integrity of very fragile structures. The primary treatment must take into account a rational and uncompromising selection of the age of the first operation, of the successive procedures, and their chronology to benefit from the growth spurt of the maxilla, and to avoid the worse scars resulting from secondary epithelialization. Finally, if nasal breathing is the most important function concerning facial growth, it is essential to restore this normal function at the time of the first operation. The oral breathing pattern set at the time of the first operation leaves a cortical imprint that is very difficult to erase, even after clearing the nasal airways. The results of the functional approach we have used in the last decade are particularly consistent and very convincing. In this ambitious and demanding program, the patient comes first; we decrease the burden for him and his family, and give them the benefit of a good social life before school age.

Topics: Age Factors; Alveolar Process; Child, Preschool; Cicatrix; Cleft Lip; Cleft Palate; Clinical Protocols; Gingivoplasty; Humans; Incisor; Infant; Mastication; Maxilla; Maxillofacial Development; Mouth Breathing; Nose; Palatal Obturators; Palate, Soft; Postoperative Complications; Respiration; Tooth Eruption; Treatment Outcome

Usually, the nasal sequels of unilateral cleft patient are just considered as an esthetic problem to be addressed after the growth spurt of adolescence. This very narrow vision has led the cleft lip and palate treatment to a deadend. Actually, nasal sequels are the worst in terms of consequence on facial growth. 75% of complete unilateral cleft children are more oral than nasal breathers. Today, we know about the bad consequences of oral breathing on facial growth. It is not surprising to observe a high rate of small maxilla with cleft maxilla scars. In the fetus, the unilateral cleft nose deformities are well explained by the rupture of the facial envelope and the ventilatory dynamics of the amniotic fluid. Every step of the primary treatment threatens the nasal air way patency, whether when repairing lip and nose, suturing the hard palate that is the floor of the nose, or closing the alveolar cleft which controls the width of the piriform aperture. The functional and esthetic nasal sequels reflect the initial deformity, but are also the surgeon's skill and protocol choice. Before undertaking treatment, we must analyze the deformity at every level. Usually, the best option is to reopen the cleft completely to perform a combined revision of the lip, nose, and alveolar cleft after an adequate anterior maxillary expansion. If nasal breathing is necessary for an adequate facial growth, 25 years of experience showed us that it was very difficult to erase the cortical imprint of an early oral breathing pattern. So it is essential to establish a normal nasal breathing mode at the initial surgery. When the initial surgery is efficient and/or the secondary repair is successful, the final esthetic rhinoplasty, when indicated, is just performed for the sake of harmonization, with a classic internal approach and a few refinements.

Topics: Adolescent; Child; Cleft Lip; Cleft Palate; Clinical Protocols; Dissection; Esthetics; Humans; Maxillofacial Development; Mouth Breathing; Nasal Bone; Nose; Palatal Expansion Technique; Patient Care Planning; Plastic Surgery Procedures; Respiration; Rhinoplasty; Treatment Outcome

The use of the nasoalveolar molding technique (NAM) aims to reduce passively the width of the alveolar gap, while improving the AP discrepancy but also focusing on the nose. We developed a within-subjects study in which 11 infants with unilateral lip deformity and varying degrees of alveolar gaps were treated by NAM. Patients included in the study presented alveolar gap at the first appointment to configure the molding device. Alveolar gap was then measured again at the time of lip repair to evaluate the impact of the appliance utilization, and the nostril shape was reassessed to verify the benefit relative to nose symmetry. All patients obtained significant reduction of the alveolar gap. The appliance also facilitated primary nasal positioning, significantly improving nasal symmetry and nostril shape. NAM constitutes an important adjunct to ameliorate the results of primary definitive lip repair while also improving the surgeon's ability to provide nasal symmetry.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Congenital Abnormalities; Humans; Infant; Infant, Newborn; Models, Dental; Nose; Orthodontic Appliances; Orthodontics, Preventive; Plastic Surgery Procedures; Preoperative Care; Prosthesis Design; Rhinoplasty

Craniofrontonasal dysplasia is a rare, familial X-linked syndrome with coronal synostosis (brachycephaly or plagiocephaly), hypertelorbitism (frequently asymmetric), and extracranial anomalies. Details of the timing and technique of the craniofacial correction have not been well described. The largest series of patients with craniofrontonasal dysplasia treated at a single institution was used for review.. A review of patients at the University of California, Los Angeles Craniofacial Clinic with the diagnosis of craniofrontonasal dysplasia was performed (n = 21). Data included office, hospital, and operative records; photographs; lateral cephalograms; and three-dimensional computed tomographic scans. Based on surgical outcomes, a treatment algorithm was created.. Fourteen patients were female, seven were male, and five had a family history of craniofrontonasal dysplasia (24 percent). Eight patients had unilateral coronal synostosis (plagiocephaly) and 13 had bilateral coronal synostosis (brachycephaly). Eleven patients had asymmetric hypertelorbitism and 10 had symmetric hypertelorbitism. Patients also had cleft lip-cleft palate (10 percent), ear deformities (19 percent), strabismus or esotropia (81 percent), dry frizzy hair (100 percent), syndactyly (14 percent), and nail (100 percent) or other anomalies. After fronto-orbital advancement, no patients had increased intracranial pressure problems or difficulty related to resynostosis. After hypertelorbitism correction, three patients relapsed. Because of this, correction in later patients was delayed until after eruption of permanent maxillary incisors. The mean anterior interorbital distance was reduced in patients from 184 percent to 98 percent of sex-matched controls.. The phenotypic expression of craniofrontonasal dysplasia is described to recognize patients early. A treatment algorithm for craniofrontonasal dysplasia based on timing and technique is offered to decrease the need for revision and improve outcomes.

Topics: Abnormalities, Multiple; Algorithms; Cleft Lip; Cleft Palate; Craniosynostoses; Eye Abnormalities; Female; Genetic Diseases, X-Linked; Hair; Humans; Hypertelorism; Infant; Limb Deformities, Congenital; Male; Nails, Malformed; Nose; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome

The authors have volunteered their services as plastic surgeons in several countries, such as Nepal and Cambodia. In these programs, the authors saw many adults with cleft lips or palates who could not have primary repair at the proper time. The purpose of this report is to discuss the primary repair of untreated cleft lips or palates in adult patients.. Subjects were older than 17 years. In Nepal, primary repairs were performed in 129 adults with untreated clefts over the past 11 years. Unilateral cleft lips were repaired by rotation advancement with the small triangular flap method or the straight method with a small triangular flap. Bilateral clefts were repaired using a one-stage repair method. Cleft palates were repaired by a mucoperiosteal push-back or Furlow technique.. Differences between primary cleft repair for infants and for adults were as follows: (1) in adults, aggressive correction was possible, as maxillary growth was not a consideration; (2) correction of the anterior part of the nasal deformity was more difficult than in infants, as adults showed less elasticity and a more severe deformity of the nasal cartilages; (3) simultaneous palatoplasty should be chosen judiciously, as it is more invasive and results in higher morbidity; and (4) cheiloplasty under local anesthesia can reduce cost, time, and manpower.. These observations should be useful for the local and foreign surgeons who treat clefts in developing regions.

Topics: Adult; Age Factors; Aged; Cleft Lip; Cleft Palate; Developing Countries; Female; Humans; International Cooperation; Japan; Male; Middle Aged; Nepal; Nerve Block; Nose; Oral Surgical Procedures; Postoperative Complications; Surgery, Oral; Surgical Flaps

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).

Topics: Adolescent; Case-Control Studies; Cephalometry; Child; Cleft Lip; Cleft Palate; Face; Facial Bones; Female; Humans; Lip; Male; Mandible; Maxilla; Maxillofacial Development; Nose; Skull; Skull Base; Vertical Dimension

The current study aimed to determine how nasorespiratory function changes in association with maxillary distraction osteogenesis (DO). Furthermore, with regard to impaired nasorespiratory function, the possibility of a relationship between the cleft side and laterality and any effect of maxillary distraction osteogenesis was investigated.. In this descriptive, prospective clinical report, subjective and objective data regarding nasorespiratory function before and after maxillary distraction osteogenesis were compared.. Data from 13 subjects with cleft lip and palate were used. Subjects had a severe maxillary deficiency and underwent distraction osteogenesis using a rigid external device system.. The subjective measure was the score on a questionnaire regarding nasorespiratory function using a visual analog scale. The objective measure was nasal resistance.. The visual analog scale score for two items significantly decreased just after distraction osteogenesis. Nasal resistance also significantly decreased 1 year after distraction osteogenesis. Moreover, nasal resistance on the cleft side was significantly greater than that on the noncleft side just before and 1 year after distraction osteogenesis. There was a significant positive correlation between changes in the visual analog scale score and nasal resistance.. These results suggest that nasorespiratory function changes in association with maxillary distraction osteogenesis in subjects with cleft lip and palate. Moreover, it appears that nasal obstruction on the cleft side does not change in subjects with unilateral cleft lip and palate.

Topics: Adolescent; Adult; Airway Resistance; Cephalometry; Child; Cleft Lip; Cleft Palate; External Fixators; Female; Follow-Up Studies; Humans; Male; Mandible; Maxilla; Nasal Obstruction; Nose; Osteogenesis, Distraction; Patient Satisfaction; Prospective Studies; Respiration

Cleft palate is a congenital deformity with soft tissue and hard tissue defects. Normal cleft palate repairing surgery only repairs soft tissue defects, whereas bone defects in the hard palate still exist. Therefore, we conducted this study in beagles to observe the influence of bone grafting at primary surgery on craniofacial growth and occlusal relationships in individuals with complete cleft palate and to provide experimental evidence for optimal surgical procedures for cleft palate. Using 60 beagle puppies as subjects, we tested the effects of bone grafting in surgically induced palatal defect. The animals were randomly and equally divided into four groups: (1) unoperated controls; (2) surgically induced unilateral cleft palate, not repaired; (3) two-flap palatoplasty used to close the soft defect of the surgically induced cleft palate; (4) autogenous bone (a piece of rib bone) implanted into the palatal defect before two-flap palatoplasty was performed.Cephalometric roentgenography and plaster casts of the maxillary were taken preoperatively and every 4 weeks after surgery. Sixty metric cranial variables were measured directly from the cleaned skulls after the animals were killed the 34th week postoperatively. The measurement results indicated that bone grafting may reduce the disturbance of maxillary growth caused by the cleft palate and the denuded bone, but it may cause other maxillary deformities. This finding suggests that surgeons should be careful in choosing the method of primary bone grafting in repairing complete cleft palate.

Topics: Animals; Bone Transplantation; Cephalometry; Cleft Palate; Dental Arch; Dental Occlusion; Disease Models, Animal; Dogs; Female; Male; Maxilla; Maxillofacial Development; Nose; Palate, Hard; Periosteum; Plastic Surgery Procedures; Random Allocation; Ribs; Surgical Flaps; Time Factors

1) To compare nasendoscopy (NE) and multiview fluoroscopy (MVF) in assessing velopharyngeal gap size; and 2) to determine the relationship between these assessments and velopharyngeal insufficiency (VPI) severity.. Retrospective review of consecutive patients with VPI at a tertiary care children's hospital, assessed with NE and MVF between 1996 and 2003.. 177 subjects. NE and MVF gap areas were correlated (R = 0.34, 95% CI 0.26-0.41). In adjusted analysis, VPI severity was associated with: 1) NE gap area (OR = 2.78, 95% CI 1.96-3.95), 2) MVF gap area (OR 1.64, 95% CI 1.37-1.95), 3) age <5 years (OR 3.30, 95% CI 1.47-7.38), and 4) previously repaired cleft palate (OR 0.48, 95% CI 0.25-0.94).. NE and MVF assessments provide complementary information and are correlated. Both are associated with VPI severity. However, the "bird's-eye view" provided by NE has a stronger correlation with VPI severity than MVF.. B-2b.

Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Cineradiography; Cleft Palate; Cohort Studies; Endoscopy; Female; Fluoroscopy; Humans; Male; Nose; Palatal Muscles; Palate, Soft; Pharynx; Phonation; Retrospective Studies; Speech Intelligibility; Velopharyngeal Insufficiency

The aim of this study is to present a technique for maxillary distraction osteogenesis using Le Fort I osteotomy without down-fracture. Six cleft-related patients suffering from severe midfacial deficiency were treated with maxillary distraction osteogenesis. The RED II system was chosen as the extraoral device and the Leipzig retention plate system to anchor the maxillary segment. Maxillary distraction osteogenesis was successful in all cases. Cephalometric and clinical evaluation after an average follow-up period of 1 year showed stable results with respect to skeletal and dental relationships. The SNA angle increased from 72.3 degrees to 81.4 degrees and the ANB angle increased by 11.0 degrees immediately after removing the distraction device. After 1 year, the sagittal bone gain remained and the SNA angle had decreased by 0.8 degrees . This technique seems to minimize the risk of the surgical procedure and shorten the operation time. It may become an alternative method for the treatment of patients with severe midfacial hypoplasia.

Topics: Adolescent; Bone Plates; Cephalometry; Chin; Cleft Lip; Cleft Palate; External Fixators; Female; Follow-Up Studies; Humans; Male; Malocclusion, Angle Class III; Mandible; Maxilla; Nose; Osteogenesis, Distraction; Osteotomy, Le Fort; Sella Turcica; Vertical Dimension

We report on the clinical and molecular abnormalities in a 7-month-old girl and her mother with an ectodermal dysplasia disorder that most closely resembles Rapp-Hodgkin syndrome (RHS). At birth, the child had bilateral cleft palate, a narrow pinched nose, small chin, and hypoplastic nipples, and suffered from respiratory distress, feeding difficulties, and poor weight gain, although developmental progress was normal. Her mother had a cleft palate, sparse hair, high forehead, dental anomalies, a narrow nose, dysplastic nails, and reduced sweating. Sequencing of the p63 gene in genomic DNA from both individuals revealed a heterozygous frameshift mutation, 1721delC, in exon 14. This mutation has not been described previously and is the seventh report of a pathogenic p63 gene mutation in RHS. The frameshift results in changes to the tail of p63 with the addition of 90 missense amino acids downstream and a delayed termination codon that extends the protein by 21 amino acids. This mutation is predicted to disrupt the normal repressive function of the transactivation inhibitory domain leading to gain-of-function for at least two isoforms of the p63 transcription factor. The expanding p63 mutation database demonstrates that there is considerable overlap between the molecular pathology of RHS and Hay-Wells syndrome, with identical mutations in some cases, and that these two disorders may in fact be synonymous.

Topics: Adult; Biomarkers; Chin; Cleft Palate; Ectodermal Dysplasia; Female; Frameshift Mutation; Humans; Infant; Membrane Proteins; Nails, Malformed; Nose; Syndrome

To evaluate the outcome of presurgical nasoalveolar molding therapy in the treatment of patients with bilateral cleft lip and palate.. A prospective study with blinded measurements.. The Cleft and Craniofacial Clinic at the University of Texas at Houston Medical School, Houston, Texas.. Eight patients with bilateral cleft lip and palate, treated between 2002 and 2004.. The starting age for presurgical nasoalveolar molding therapy was 34.9 days and the average length of the therapy was 212.5 days.. Measurements of intraoral and extraoral casts were performed, and statistical analyses were used to compare the differences between measurements before and after therapy.. Intraoral measurements demonstrated that there was a statistically significant reduction of the premaxillary protrusion and deviation. There was also a significant reduction in the width of the larger cleft. Extraoral measurements revealed that there was a significant increase in the bi-alar width and in the columellar length and width. Moreover, there was a significant improvement in columellar deviation. Finally, the nostril heights of both sides were increased.. The authors have quantitatively shown that presurgical nasoalveolar molding therapy has significant advantages in the treatment of bilateral cleft lip and palate patients. It improves the nasal asymmetry and deficient nasal tip projection associated with bilateral cleft lip and palate. It also forces the protruded premaxillary segment into alignment with the dental alveolar segments, improving the shape of the maxillary arch. As a result, the changes associated with presurgical nasoalveolar molding therapy help decrease the complexity of subsequent surgeries.

Topics: Acrylic Resins; Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Models, Dental; Nose; Orthodontic Appliances; Preoperative Care; Stents

An anthropometric measurement serves as both an objective assessment and a description of shape and size. Gypsum casts were used for the measurement, along with a statistical evaluation of results, to compare the appearance of patients with a complete unilateral or bilateral cleft lip and palate prior to corrective surgery of their secondary deformity and following this intervention. The evaluated approach was our own modification of rhinoplasty and lip correction, using the remodeling and extension of soft tissues envelope by a skin flap. That is formed from a lip scar after primary reconstruction. Both data of the studied group (n = 49), pre- and postoperative, were compared to a control group of healthy individuals (k = 19), thereby allowing the original severity of the deformity and the morphologic change after surgery to be objectively assessed. Upon correlation to healthy volunteers, we proved that the effect of surgery shifted the monitored parameters into a range found in the normal population. An anthropometric measurement on gypsum casts appeared to be simple, easy to perform, precise, easy to repeat, inexpensive, and yet of a three-dimensional nature with no burden for the patient. It is suitable for verifying the effects of new therapeutic procedures.

Topics: Adolescent; Adult; Anthropometry; Calcium Sulfate; Case-Control Studies; Cephalometry; Cicatrix; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Lip; Lip Diseases; Male; Models, Anatomic; Nose; Nose Deformities, Acquired; Plastic Surgery Procedures; Rhinoplasty; Surgical Flaps; Treatment Outcome

To assess the degree of facial symmetry in patients suffering from unilateral cleft lip, alveolus and palate (UCLAP) by determining differences between the cleft and the non-cleft hemifaces from 3D surface data.. In twenty-two 10-year-old UCLAP patients, who had the lip repaired using the Tennison-Randall technique and did not undergo further revisional surgery, differences were determined between landmarks, surface areas of the upper lip vermilion and nostrils and virtual volumes of midface, nose and upper lip for cleft and non-cleft sides, separately, after having established a plane of symmetry calculated from optical 3D facial surface data.. Statistically significant differences could be found between cleft and non-cleft sides for the nasal landmarks G(lat), G(sup) and La(med), the nostril angle and the virtual volume of the nose (p(Glat)=0.011, p(Gsup)<0.0005, p(Lamed)=0.002, p(nostril angle)=0.036 and p(nose volume)<0.0005, resp.).. Analysis of 3D data shows that complete nasal symmetry is difficult to achieve with Tennison-Randall's lip repair without revisional surgery. Further trials on larger populations of patients will allow a more comprehensive and consistent analysis of the consequence of different methods for cp repair in order to identify the techniques with the best outcome in terms of facial symmetry.

Topics: Cephalometry; Child; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Face; Facial Asymmetry; Humans; Image Processing, Computer-Assisted; Lip; Nose; Statistics, Nonparametric

Hypernasality is associated with various diseases and interferes with speech intelligibility. A recently developed quantitative index called voice low tone to high tone ratio (VLHR) was used to estimate nasalization. The voice spectrum is divided into low-frequency power (LFP) and high-frequency power (HFP) by a specific cutoff frequency (600 Hz). VLHR is defined as the division of LFP into HFP and is expressed in decibels. Voice signals of the sustained vowel [a :] and its nasalization in eight subjects with hypernasality were collected for analysis of nasalance and VLHR. The correlation of VLHR with nasalance scores was significant (r = 0.76, p < 0.01), and so was the correlation between VLHR and perceptual hypernasality scores (r = 0.80, p < 0.01). Simultaneous recordings of nasal airflow temperature with a thermistor and voice signals in another 8 healthy subjects showed a significant correlation between temperature rate of nasal airflow and VLHR (r = 0.76, p < 0.01), as well. We conclude that VLHR may become a potential quantitative index of hypernasal speech and can be applied in either basic or clinical studies.

Topics: Adult; Auscultation; Cleft Palate; Diagnosis, Computer-Assisted; Female; Humans; Male; Middle Aged; Nose; Phonation; Phonetics; Respiratory Sounds; Severity of Illness Index; Sound Spectrography; Speech Acoustics; Speech Production Measurement; Voice Disorders

To study the results 10 years after early surgical cleft lip and nose repair.. We present the outcome of 123 early cleft lip repairs whose condition was managed in a multidisciplinary team according to a strict protocol. We give the observation results of operations of a single surgeon's neonatal surgery over a 10-year period in term of aesthetic assessments and dental arch relationships. One hundred and twenty-three patients were operated on during the first 4 weeks of life; a subgroup of 40 child had been operated on at a week or less of age.. The results show good aesthetic assessments and dental relationships, with facial growth appropriate for the age.. We are currently encouraging early cleft lip and nose repair in the full-term baby as the good method of management of newborns with cleft.

Topics: Cleft Lip; Cleft Palate; Female; Humans; Infant, Newborn; Male; Nose; Treatment Outcome

The Royal College of Surgeons Cleft Steering Group and the Craniofacial Society of Great Britain and Ireland have recommended that, for patients with a cleft of the lip and/or palate, a model is made of the deformity before primary surgery. This provides a record for audit and can be used to compare the results of treatment. There is no standardisation in the way in which a model of the cleft deformity is made, which makes inter-unit comparison difficult. In this paper, we describe our technique for making a composite model of the cleft palate, lip and nose. This method is adaptable and quick to perform, and the models are easy to store.

Topics: Cleft Palate; Dimethylpolysiloxanes; Humans; Lip; Models, Anatomic; Nose; Oral Surgical Procedures; Palate; Plastic Surgery Procedures; Silicone Elastomers; Silicones; United Kingdom

The Crk adaptor protein, which is encoded by two splice variants termed CrkI and CrkII, contains both SH2 and SH3 domains but no catalytic region. It is thought to function in signal transduction processes involved in growth regulation, cell transformation, cell migration, and cell adhesion. Although the function of Crk has been studied in considerable detail in cell culture, its biological role in vivo is still unclear, and no Crk-knockout mouse model has been available. Therefore, we generated a complete null allele of Crk in mice by using the Cre-loxP recombination approach. The majority of Crk-null mice die at late stages of embryonic development, and the remainder succumb shortly after birth. Embryos lacking both CrkI and CrkII exhibited edema, hemorrhage, and cardiac defects. Immunohistochemical examination suggested that defects in vascular smooth muscle caused dilation and rupturing of blood vessels. Problems in nasal development and cleft palate were also observed. These data indicate that Crk is involved in cardiac and craniofacial development and that it plays an essential role in maintaining vascular integrity during embryonic development.

Topics: Animals; Antigens, CD34; Blood Vessels; Cardiovascular Abnormalities; Cleft Palate; Crosses, Genetic; Embryo, Mammalian; Female; Gene Targeting; Genotype; Male; Mice; Mice, Knockout; Muscle, Smooth, Vascular; Myocardium; Nose; Phenotype; Proto-Oncogene Proteins c-crk

The purpose of this study was to apply nasoalveolar molding appliance in infants with cleft lip and plate and to observe the preliminary effects on nasal cartilage and columella.. Ten infants were treated with nasoalveolar molding. The other ten infants without any presurgical orthopedic treatment were chosen as the control group. Each patient was photographed at the initial visit (T0), after nasoalveolar molding (T1), 2 weeks (T2), and half a year (T3) after cheiloplasty. Six measurements were made on the photographs and the nasal symmetry was analyzed with paired t test.. The percentage of the deviation from perfect symmetry was significantly improved at T0-T1, T1-T2 stage (P<0.05), and the improvement relapsed at T2-T3 (P<0.05). There was significant difference between the orthopedic group and the control group with the changes in nasal symmetry in vertical dimension (P<0.01), and there was no significant difference in horizontal dimension (P>0.05).. Nasal asymmetry was significantly improved after nasoalveolar molding. Half a year after the primary cheiloplasty, although there was a relapse tendency of nasal asymmetry, the shape of the nasal dome was ideal.

Topics: Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Infant; Nose; Rhinoplasty

A scar flap is formed with the pedicle at the lateral part of the columella base at the cleft side, that is, in the center of the affected region. It enables flap placement according to individual need. A prospective evaluation was performed in a group of 76 patients with cleft lip and palate, all operated on by the same plastic surgeon. The flap was used to improve the height of the columella and the extent of nasal mucosa on the frontal septum and on the nostril base in the vestibule. In the lip, the flap raised its height and improved proportionality. The average area of flap used in a unilateral deformity was 42 mm. Both flaps in a bilateral deformity were 77 mm. The average follow-up was 22.4 months. Neither local nor general complications were noted apart from a recurrence of the deformity of the nasal septum in 7.9% of patients. The nasal passage was improved in 59.9% of patients and normalized in 19.6% upon follow-up rhinomanometry, but nevertheless, only one third of patients overcame their dynamic stereotype of breathing by the mouth. Anthropometric measurements showed an absence of statistically significant differences between patients after surgery and healthy individuals in crucial parameters (nasal tip projection, length of columella, nasolabial angle, nasal angle, and lip angle). The loss of the stigmatizing deformity is based on rotation of the nasolabial angle in relation to the aesthetic axis of the face. Direct examination proved aesthetic and functional improvement as statistically significant in 92.1% of patients.

Topics: Adolescent; Adult; Anthropometry; Cicatrix; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Nose Deformities, Acquired; Plastic Surgery Procedures; Prospective Studies; Radiography; Surgical Flaps

To examine lateral cephalometric radiographs of adult unoperated cleft lip and palate patients for the purpose of clarifying whether maxillary deficiencies observed in treated cleft patients result from intrinsic defects or surgical intervention early in life.. This retrospective study examined lateral cephalograms of 30 adult patients with nonsyndromic complete unilateral cleft lip and palate (CUCLP). The lateral cephalograms were traced and evaluated for size and position of the cranial base, maxilla, maxillary dentition, mandible, and mandibular dentition as well as for vertical relationships. Comparisons with 30 adult noncleft individuals were made.. In unoperated adult cleft lip and palate patients, the cranial base angle was increased with the anterior cranial base reduced in length. The maxilla was found to be normal in size and somewhat prognathic in position. Both the maxillary and mandibular incisors were relatively upright. The mandible was smaller in size and posteriorly positioned.. The potential for normal growth of the maxilla exists in patients with CUCLP. It is likely that disturbances of maxillary growth in surgically operated cleft patients are related primarily to the surgical intervention.

Topics: Adolescent; Adult; Cephalometry; Chin; Cleft Lip; Cleft Palate; Female; Humans; Incisor; Male; Mandible; Maxilla; Nose; Retrospective Studies; Skull Base; Vertical Dimension

The cleft lip and palate patient is mainly characterized by the presence of an oronasal communication, malformation or agenesis of the teeth close to the cleft, and deficient sagittal and transverse growth of the maxilla. These patients require various treatments involving a multidisciplinary team, which may include a maxillofacial surgeon, an orthodontist, a speech therapist, a paediatrician, a general dentist, a prosthodontist, an ENT specialist, a psychologist and all those professionals who can help provide functional, aesthetic and psychological improvement. This report describes a case of prosthetic rehabilitation in a patient with cleft lip and palate and an oronasal fistula (communication) following surgery. Different prosthetic treatments are described, with emphasis being placed on the approach chosen after to discuss the various limitations which arose.

Topics: Adult; Cleft Lip; Cleft Palate; Dental Prosthesis; Female; Humans; Mouth Abnormalities; Nose

To present technical modifications to the original presurgical nasal remodeling appliance introduced in 1991. The purpose of the modifications is to improve the cleft nasal deformity before unilateral and bilateral cleft lip repair.. The principle behind this technique, known as dynamic presurgical nasal remodeling (DPNR), is the use of the force generated during suction and swallowing. A conventional intraoral plate is built with a nasal extension added to the labial vestibular flange. The nasal extension was modified and consists of three components. The palatal plate is left loose in the mouth to generate a discontinuous but controlled impact directed to the affected nasal structures during suction and swallowing. The principle aim of the DPNR technique in unilateral cases is to improve the deformation of nasal structures by straightening the columella, elevating the nasal tip, and remodeling the depressed cleft side alar cartilages. In bilateral cases, the aims are to elongate the columella and to obtain nasal tip projection.. The modifications introduced in the appliance enhance the original DPNR technique and are effective in ameliorating the initial cleft nasal deformity. This facilitates primary surgical cleft lip and nose correction and improves surgical outcomes in patients with complete unilateral and bilateral cleft lip and palate.

Topics: Biomechanical Phenomena; Cleft Lip; Cleft Palate; Deglutition; Humans; Infant, Newborn; Myofunctional Therapy; Nose; Palatal Obturators; Preoperative Care; Prosthesis Design; Stents; Stress, Mechanical; Sucking Behavior

The aero-acoustic aspects of nasalization that distinguish speakers with velopharyngeal adequacy from those with velopharyngeal inadequacy are well known. Differences in aerodynamic aspects of nasalization also have been demonstrated in normal speakers with cleft palate and their noncleft counterparts. The purpose of this study was to compare the amplitude and temporal patterns of oral-nasal balance in speakers with cleft palate and normal speech to those with normal speech without cleft palate.. Using the Nasal Accelerometric Vibrational Index technique, the time course and amplitude of oral-nasal balance were studied in 10 children with cleft palate and velopharyngeal adequacy and 10 noncleft controls. The speech sample included syllable, word, and sentence contexts, most of which were devoid of nasal consonants.. The results indicate few differences between the two groups in contexts devoid of nasal consonants. However, significant differences were evident with regard to temporal aspects of oral-nasal balance in a nasal-oral consonant word context.. Subtle structural-motor differences that may exist between normal speakers with and without cleft palate may be more evident when the spatiotemporal requirements for velar movement become more complex and result in a greater possible combination of oral-nasal impedance ratios.

Topics: Case-Control Studies; Child; Cleft Palate; Female; Humans; Male; Mouth; Multivariate Analysis; Nose; Palate, Soft; Speech; Speech Production Measurement; Time Factors; Velopharyngeal Insufficiency

Our aim was to develop and validate a new method to assess objectively and quantitatively the morphology of the nostrils after nasal or nasolabial surgery. We used digital analysis using specific mathematical algorithms to assess several geometric measurements, particularly of facial asymmetry, expressed in adimensional units. Forty-five patients with no facial anomalies (control group) were used initially to evaluate the method and to obtain variables for statistical reference. Thirty-five patients operated on for unilateral cleft lip and palate (cleft group) were then analysed and compared with the control group. Individual scores were obtained for each patient, computed, and correlated with those established by a lay panel. Statistical analysis showed good sensitivity and reliability (R>0.8).

Topics: Child; Cleft Lip; Cleft Palate; Female; Humans; Image Processing, Computer-Assisted; Male; Nose; Software

We aimed to evaluate retrospectively changes in the nasal appearance after secondary bone grafting in children with complete unilateral cleft lip and palate in 41 consecutive patients. Basal view photographs were analysed by a software program (ASYMNOS, for asymmetry of nostrils, available on simple request) that computes comparative functions between both nostrils and gives an objective score. These data were compared with those of a control group. The measurements and scores were calculated for each group, and then the global objective scores were correlated with the subjective scores that resulted from an independent external panel that ranked the aesthetic aspects of the nostrils. There was a significant improvement in the nasal symmetry postoperatively that resulted from a decrease in height between the nostrils, and a positive correlation between the objective and subjective scores.

Topics: Bone Transplantation; Cleft Lip; Cleft Palate; Humans; Image Processing, Computer-Assisted; Nose; Plastic Surgery Procedures; Software

Cleft is a developmental malformation, which is defined as a partial or complete lack of anatomic tissues continuity in typical areas of disorders in embryological face development. The reasons for cleft formation are not completely recognised but many hypotheses indicate both environmental and genetic factors as possible sources. The list of the cleft types is the following: cleft lip, cleft lip and alveolus, isolated cleft palate, cleft lip, alveolus and palate, and combined clefts. The malformation may occur unilateral or bilateral. According to World Health Organization cleft lip and palate is classified in the first ten of the most common developmental disorders, however the bilateral form of pathology is the least popular one.. The aim of the study is the anthropometric measurement of a nose of children and adolescents with bilateral cleft lip, alveolus and palate in comparison with data gathered as a result of healthy people measurements. The research was conducted on 26 patients with the malformation: 12 girls and 14 boys at the age range between 7 and 18. The measurements were taken with the use of small bow and slide compasses. For the purpose of the statistical analysis we used formula for standardisation. Both, the arithmetic average and the standard deviation were estimated on the basis of research done on 30 healthy people of same sex and at proper age. Intersexual comparison of these values with the use of t-Student test was done. In order to distinguish homologues features in respect to the comparative group, one-way ANOVA and test post hoc (Duncan) were used.. Malformation was mainly reflected in increased width the base of the nose (sbal-sbal), width of nose (al-al) and its small prominence (sn-prn). Increase in head height values together with underdevelopment in sagittal plane was also observable. The increase of upper face height (n-sto) was recognized as stronger in case of females than males with the same malformation. The middle part of face was characterized by increase of height measurements together with sagittal plane underdevelopment.. It was stated that the patients with bilateral cleft lip, alveolus and palate tended to have flat and wide nose.

Topics: Abnormalities, Multiple; Adolescent; Anthropometry; Cephalometry; Child; Cleft Lip; Cleft Palate; Face; Female; Humans; Male; Maxillofacial Development; Nasal Septum; Nose; Reference Values; Rhinoplasty; Sex Factors; Surgery, Plastic

The technique for primary correction of the cleft lip and nose, as practised by The North Thames Cleft Lip and Palate Centre at Great Ormond Street Hospital/St Andrew's Centre (GOStA) has evolved over 28 years of personal experience. It is an amalgamation of techniques developed by many others with some personal modifications. Patients are routinely audited at 5, 10, 15 and 20 years and outcomes evaluated and compared with other centres where possible. Secondary surgery of lip and nose is based on the same principles of anatomical reconstruction used in the primary surgery.

Topics: Age Factors; Cleft Lip; Cleft Palate; Dental Arch; Dissection; Esthetics; Facial Muscles; Follow-Up Studies; Humans; Infant; Maxilla; Nasal Septum; Nose; Palatal Obturators; Patient Satisfaction; Plastic Surgery Procedures; Treatment Outcome; Velopharyngeal Insufficiency

We describe the way our multidisciplinary team manages cleft lips and palates at our centre at the Catholic University of Louvain. Since 1987, we have opted for the neonatal repair of the cleft lip and nose, and closure of the cleft palate at three months of age. Multidisciplinary follow-up then takes place to detect and correct the sequellae. The children are seen once a year by a plastic surgeon, an otorhinolaryngologist, a maxillofacial surgeon, a speech therapist, an audiologist, and an orthodontist. Secondary corrections are scheduled depending on functional, aesthetic, and psychological requirements.

Topics: Age Factors; Alveoloplasty; Cleft Lip; Cleft Palate; Deglutition Disorders; Follow-Up Studies; Humans; Infant; Infant, Newborn; Lip; Nose; Orthodontics, Corrective; Orthodontics, Interceptive; Otitis Media; Palate, Soft; Patient Care Team; Plastic Surgery Procedures; Speech Disorders; Velopharyngeal Insufficiency

This paper presents an assessment protocol for the evaluation and description of speech, resonance and myofunctional characteristics commonly associated with cleft palate and/or velopharyngeal dysfunction. The protocol is partly based on the GOS.SP.ASS'98 and adapted to Flemish. It focuses on the relevant aspects of cleft type speech necessary to facilitate assessment, adequate diagnosis and management planning in a multi-disciplinary setting of cleft team care.

Topics: Articulation Disorders; Cleft Palate; Facial Expression; Humans; Language Development; Nose; Palatal Muscles; Palate, Soft; Patient Care Planning; Phonetics; Speech; Speech Disorders; Velopharyngeal Insufficiency; Voice; Voice Disorders; Voice Quality

To compare craniofacial morphology and nasolabial appearance up to age 17 in individuals with repaired complete unilateral cleft lip and palate (UCLP) treated at five European centers.. Longitudinal cohort study.. Multidisciplinary cleft services in Northern Europe.. 127 consecutively treated individuals with repaired complete UCLP.. Cephalometric variables, 14 angular and 2 ratio variables, and panel ratings of nasolabial appearance, 4 variables.. The results revealed that at ages 12 and 17, two centers had a flatter profile (gs-sn-pgs) and retrognathic maxilla (sss-ns-sms). Additionally, one of the two centers had increased lower face height. Ratings of nasolabial appearance showed more similarity between the centers.. The results confirm that systematic differences in craniofacial morphology and nasolabial appearance may occur between different cleft centers, but do not allow specific caused factors to be identified.

Topics: Adolescent; Cephalometry; Child; Cleft Lip; Cleft Palate; Dental Occlusion; Europe; Follow-Up Studies; Humans; Lip; Longitudinal Studies; Maxillofacial Development; Nose; Odds Ratio; Oral Surgical Procedures; Outcome Assessment, Health Care; Regression Analysis; Statistics, Nonparametric

Topics: Abnormalities, Multiple; Blepharophimosis; Cleft Palate; Fatal Outcome; Foot Deformities, Congenital; Genes, Recessive; Hand Deformities, Congenital; Humans; Infant, Newborn; Limb Deformities, Congenital; Male; Mandibulofacial Dysostosis; Nose; Syndrome

To observe the clinical effect of presurgical nasoalveolar molding in infants with complete cleft lip and palate.. Presurgical nasoalveolar molding was performed in 38 infants with cleft lip and palate (26 patients with unilateral cleft lip and palate, 12 patients with bilateral cleft lip and palate), aged between 5 and 30 days. The width of alveolar cleft was measured before and after the operation and the effect of treatment was assessed.. After 108 - 152 days of therapy, the average width of alveolar cleft decreased by 5.3 mm in 26 patients with unilateral cleft lip and palate. Nasal profile was improved in 76 percent of cases. In 12 patients with bilateral cleft lip and palate, the average width of left cleft decreased by 4.7 mm and that of the right decreased by 4.2 mm. The distance between right and left cleft increased by 5.1 mm. Nasal profile was improved in 66 percent of cases.. Presurgical nasoalveolar molding in complete cleft lip and palate can improve nasal profile and decrease the width of alveolar cleft.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Female; Humans; Infant, Newborn; Male; Nose; Orthodontics, Corrective; Preoperative Care

Bacterial infections can complicate any surgery. Knowledge of potentially pathogenic bacterial flora in children with cleft lip and palate allows appropriate risk management, including the need for prophylactic antibiotics. This project reviewed the bacteriology of children before primary cleft lip and palate surgery.. A retrospective study of the results of nose, throat, and ear microbiological swabs taken from children, aged 1 to 26 months, before repair of primary cleft lip, cleft palate, or both was carried out. Swabs with Staphylococcus aureus and beta-hemolytic streptococcus were considered positive.. From October 1987 to May 2002, 321 primary cleft lip or palate operations were performed in 250 patients. Results from 326 sets of preoperative swabs were available, including five repeat sets from patients whose operations were postponed. There were 235 (72.1%) negative sets and 91 (27.9%) positive sets. Of the positive swabs, 86 sets grew S. aureus, and 10 sets grew beta-hemolytic streptococcus.. Children with unrepaired cleft lip and palate have a significant risk of carrying S. aureus and a small risk of carrying beta-hemolytic streptococci. These risks need to be considered when deciding on protocols for preoperative bacteriology tests and prophylactic antibiotics.

Topics: Antibiotic Prophylaxis; Child, Preschool; Cleft Lip; Cleft Palate; Colony Count, Microbial; Ear; Humans; Infant; Nose; Oral Surgical Procedures; Pharynx; Preoperative Care; Retrospective Studies; Staphylococcus aureus; Streptococcus

To evaluate three-dimensional changes in nasal morphology in patients with unilateral cleft lip and palate treated with presurgical nasoalveolar molding (NAM) to correct naso-labio-alveolar deformity.. This was a prospective, longitudinal study. Digital stereophotogrammetry was used to capture three-dimensional facial images, and x, y, and z coordinates of 28 nasal landmarks were digitized.. Ten patients with unilateral cleft lip and palate.. Nasal form changes between T1 (age: 28 +/- 2 days, pre-NAM) and T2 (age: 140 +/- 2 days, post-NAM), using conventional measurements and finite-element scaling analysis.. Overall nasal changes were statistically different (p < .01), but no linear or curvilinear changes were found. Specifically, relative size increases were found on the noncleft side, involving the upper nose (30%), alar depth (20%), alar dome (30%), columella height (30%), and lateral wall of the nostril (17%). On the cleft side, the following showed a size increase: upper nose (8%), alar dome (5%), columella height (30%), and lateral wall of the nostril (30%). The cleft-side alar curvature, however, showed a large decrease in size (80%), but no changes on the noncleft side were found. Corresponding shape changes and angular changes were also found.. Using NAM, bilateral nasal symmetry in patients with unilateral cleft lip and palate was improved before surgical repair. Furthermore, slight overcorrection of the alar dome on the cleft side using pressure exerted by the nasal stent is indicated to maintain the NAM result.

Topics: Adolescent; Adult; Alveoloplasty; Case-Control Studies; Cleft Lip; Cleft Palate; Female; Humans; Male; Nasal Obstruction; Nasopharynx; Nose; Postoperative Period; Rhinomanometry; Rhinoplasty; Statistics, Nonparametric

We report an 8-year-old girl presented with a proboscis on the right nasal nostril, right heminasal hypoplasia, hypertelorism, and cleft lip and palate on the other side. After repair of the cleft lip and palate and the hypertelorism, we successfully reconstructed the heminose with a V-Y advancement flap containing the proboscis tube.

Topics: Abnormalities, Multiple; Child; Cleft Lip; Cleft Palate; Female; Humans; Hypertelorism; Nose; Rhinoplasty

We present an audit of primary cleft palate surgery in our unit including rates of two important post-operative complications. Multidisciplinary audit clinics ran from March 1998 to April 2002 to follow up all local patients with a cleft lip or palate who had undergone primary palatal surgery in our unit. One hundred and forty eight patients were studied. Patient ages at follow-up ranged from 3 years and 10 months to 17 years and 4 months. Two surgeons performed the primary surgery. One hundred and twenty eight Wardill-Kilner and 20 Von Langenbeck repairs were performed. We found a 4.7% rate of oro-nasal fistula development requiring surgical closure, and a 26.4% rate of velopharyngeal insufficiency (VPI) requiring subsequent pharyngoplasty. We noted that the type of cleft involved affected the rate of VPI, 16% of patients with unilateral cleft lip and palate versus 29.2% of patients with a solitary cleft palate requiring secondary surgery. Outcome of surgery was determined by a 'Cleft Audit Protocol for Speech' (CAPS) speech therapy assessment at follow-up clinics. Only 14.9% of all patients assessed demonstrated any degree of hypernasality. Our results compare favourably with other recent studies including the Clinical Standards Advisory Group (CSAG) report into treatment of children with cleft lip and palate.

Topics: Adolescent; Child; Child, Preschool; Cleft Palate; Female; Fistula; Humans; Infant; Male; Medical Audit; Mouth; Nose; Nose Diseases; Oral Fistula; Patient Care Team; Pharynx; Plastic Surgery Procedures; Postoperative Complications; Speech; Speech Therapy; Treatment Outcome; Velopharyngeal Insufficiency

The purposes of this study were to analyze the craniofacial growth in women with an isolated cleft palate, to compare their matured craniofacial form with that of women with normal occlusion, and to survey the factors that influenced the matured craniofacial morphology of the adults with cleft palate during their growth process.. Eighteen women with nonsyndromic isolated cleft palate were chosen from patients who received a palatoplasty at the Kyushu University Hospital, Fukuoka, Japan. Their lateral cephalometric radiographs were taken longitudinally from palatoplasty to adolescence. Fifty women with normal occlusion were chosen as controls. From their lateral cephalographs, linear and angular variables were calculated using the x,y coordinates of 20 skeletal landmarks.. Maxillary length was shorter and the nasomaxillary complex was positioned more posteriorly in relation to the anterior cranial base of the adults with isolated cleft palate, compared with the controls. The mandible was shorter and was rotated inferiorly and posteriorly. However, remarkable deviation from the average craniofacial growth pattern was not recognized from palatoplasty to adolescence. The factors that influenced the craniofacial growth in the subjects with cleft palate were the forward growth of the A point from 2 to 5 years of age, the downward growth of the Ba point, the anterior upper facial height N-Ans in puberty, and the vertical position of the point Ba at the time of palatoplasty.. This study provided evidence of the growth tendency and the factors influencing the intermaxillary relationship in subjects with isolated cleft palate. These are significant for orthodontic treatment planning.

Topics: Adolescent; Adult; Age Factors; Cephalometry; Child, Preschool; Cleft Palate; Facial Bones; Female; Follow-Up Studies; Humans; Japan; Longitudinal Studies; Mandible; Maxilla; Maxillofacial Development; Nose; Puberty; Retrospective Studies; Rotation; Skull; Vertical Dimension

The goal of this study was to use three-dimensional (3D) analysis to characterize the primary facial deformities in children with unilateral cleft lip and palate (UCLP) and then serially analyze the relationships between facial deformities and maxillofacial growth from infancy to adolescence.. Twenty-one Japanese subjects with unilateral cleft lip and alveolus (UCLA) and 20 with UCLP who had been operated on and then followed up for more than 15 years were enrolled in this study.. Facial cast models taken at cheiloplasty were scanned with a 3D laser scanner. Lateral cephalographs taken when subjects were 15 years of age or older were traced, and linear and angular measurements were calculated. The correlation between primary facial forms and maxillofacial morphology in adolescence was analyzed.. Three-dimensional analysis showed larger ocular hypertelorism, wider cleft, greater deviation of the columella base, and more severe retruded position of the affected nasal alar base in subjects with UCLP than those with UCLA. Total surface area of the upper lips in subjects with UCLP was significantly smaller than those with UCLA. Correlation analyses revealed that the width of cleft lip, deviation of the columella base, difference of the nose base width, and surface area of the upper lip were statistically correlated with the maxillary length, the anterior position of the maxillary alveolar base, the posterior facial height, and the high angle of the mandible.. The subjects who had less severe facial deformities and more tissue volume of the upper lips at cheiloplasty showed better maxillofacial growth.

Topics: Adolescent; Alveolar Process; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Face; Follow-Up Studies; Humans; Hypertelorism; Imaging, Three-Dimensional; Lasers; Lip; Longitudinal Studies; Mandible; Maxilla; Maxillofacial Development; Nose; Vertical Dimension

To evaluate the long-term three-dimensional stability of Le Fort I maxillary osteotomy in patients with unilateral cleft lip and palate (CLP) who had preceding alveolar bone grafting.. Analysis of prospectively collected data.. University teaching hospital and postgraduate training center.. Thirty consecutive patients with unilateral cleft lip and palate, who underwent the procedure between 1990 and 1999, satisfied the inclusion criteria and had complete records. There were 9 males and 21 females, with an age range of 14 to 28 years (mean, 18 years), and follow-up range of 12 to 66 months (mean, 62 months).. Cephalometric and study cast analyses using pre- and postoperative records (3, 6, 12, 24, and 36 months). Evaluation of surgical movement and postsurgical change at all above time intervals was carried out to determine stability of surgical maxillary movement in the horizontal and vertical planes and to identify rotational and transverse relapse.. Total relapse of surgical movement was 31% in the horizontal plane and 52% in the vertical plane, as well as 30% rotational. Relapse correlated with extent of surgical movement, and most relapse occurred in the first 6 months after surgery. No significant transverse relapse was documented.. Alveolar bone grafting prior to osteotomy stabilizes the transverse dimension of the dental arch, but does not improve horizontal, vertical, or rotational relapse, which remains significant. Correlation of relapse with extent of surgical movement does suggest that planned over-correction is a reasonable option.

Topics: Adolescent; Adult; Alveoloplasty; Bone Plates; Bone Screws; Bone Transplantation; Cephalometry; Cleft Lip; Cleft Palate; Dental Arch; Female; Follow-Up Studies; Humans; Incisor; Longitudinal Studies; Male; Mandible; Maxilla; Nose; Osteotomy, Le Fort; Prospective Studies; Retrospective Studies; Rotation; Time Factors; Vertical Dimension

To assess nostril symmetry and alveolar cleft width in infants with unilateral cleft lip and palate following presurgical nasoalveolar molding (NAM).. Fifty-seven newborn patients underwent presurgical nasoalveolar molding. Magnified basal view facial photos were taken at four different times: initial visit (T1), before cheiloplasty (T2), 1 month after cheiloplasty (T3), and 1 year of age (T4). Direct measurements from the photos included: (1) nostril width on the affected and nonaffected side; (2) nostril height on the affected and nonaffected side; (3) columella-nasal base angle; and (4) width of the alveolar cleft. Nostril width and height data were used to calculate a ratio of affected to nonaffected side.. Effects of nasal symmetry after presurgical nasoalveolar molding were compared between the affected and nonaffected side. The nostril width ratio was 1.7, 1.2, 1.0, and 1.2 for T1 to T4. The nostril height ratio was 0.5, 0.8, 1.0, and 0.9 for T1 to T4. The angle of the columella was 53.3 degrees , 69.9 degrees , 91.2 degrees , and 86.9 degrees for T1 to T4. The average alveolar cleft width was 8.2 mm at T1 and closed down to 2.4 mm before cheiloplasty (T2) in cases with complete cleft.. Infants with presurgical nasoalveolar molding improved symmetry of the nose in width, height, and columella angle, as compared to their presurgical status. There was some relapse of nostril shape in width (10%), height (20%), and angle of columella (4.7%) at 1 year of age.

Topics: Alveolar Process; Cartilage; Cephalometry; Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Follow-Up Studies; Humans; Infant, Newborn; Lip; Male; Nose; Palatal Obturators; Preoperative Care; Prostheses and Implants; Prosthesis Design; Stents

The purpose of this case report is to introduce an extraoral nasal molding appliance (ENMA) and treatment approach for presurgical nasoalveolar molding in newborns with unilateral cleft lip and palate.. A 15-day-old girl presented with complete unilateral cleft lip and palate. A circumferential headband supported the actual nasoalveolar molding device, which consisted of a nasal stent made from a 0.8-mm stainless steel helical spring. The spring was activated at 2-week intervals.. The shape of the cartilaginous septum, alar cartilage tip, medial and lateral crus and alveolar segments were molded to resemble the normal shape of these structures. ENMA can be helpful in any patient with unilateral cleft lip and palate because it is easy to fabricate, practical to activate, and comfortable to wear and use.

Topics: Alveolar Process; Cartilage; Cleft Lip; Cleft Palate; Female; Humans; Infant, Newborn; Nasal Septum; Nose; Patient Care Planning; Preoperative Care; Prostheses and Implants; Prosthesis Design; Stainless Steel; Stents

To characterize the soft tissue features of infants with unilateral cleft lip (UCL) and unilateral complete cleft lip and palate (UCLP) prior to primary surgery and compare with noncleft controls.. Prospective controlled capture of the facial morphology of infants using a noninvasive three-dimensional stereophotogrammetry method.. 23 children with presurgical cleft: 11 UCL (M = 6, F = 5); 12 UCLP (M = 9, F = 3), and 21 noncleft controls (M = 7, F = 14) were imaged at approximately 3 months of age (range 10 to 16 weeks).. Accurate, repeatable quantification of facial soft tissues in infants with clefts prior to surgery.. Significant differences (p <.05) were found between the UCLP group and UCL and control groups in anatomical and soft nose width, cleft-side alar wing length, and nasal tip horizontal displacement. Both cleft groups were significantly different from controls and from each other in cleft-side nostril dimensions, alar wing angulation, columella angle, and alar base to corner of mouth dimension; alar base width; and soft tissue defect in nose and the lip and philtrum length bordering the cleft. Significant differences between clefts and controls were identified in the nostril and philtrum on the noncleft side.. The use of children with UCL as controls for UCLP studies is inappropriate. This technique overcame the limitations of direct measurement of infant faces to aid the surgeon in the planning and subsequent re-evaluation of surgical rationale.

Topics: Analysis of Variance; Case-Control Studies; Cephalometry; Cleft Lip; Cleft Palate; Face; Facies; Female; Humans; Imaging, Three-Dimensional; Infant; Male; Nose; Photogrammetry; Reference Values; Reproducibility of Results

The purpose of this article is to describe a modified appliance and treatment approach for presurgical nasoalveolar molding in infants with unilateral cleft lip and palate.. This approach uses a plate held in with outriggers, which prevents the cleft-widening effect of the tongue, helps with tongue tip placement, and utilizes the functional movements of the facial musculature to guide and relocate the major segment medially to its normal position. Nasal molding is undertaken after most of the lateromedial correction of the alveolar position.. This technique helps to improve alveolar position, nasal septum alignment, nasal symmetry, and nasal tip projection prior to lip repair.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant, Newborn; Maxilla; Myofunctional Therapy; Nose; Orthodontic Appliance Design; Orthodontics, Preventive; Palatal Obturators; Preoperative Care; Stents

In this study, we used the chicken mutant strain known as cleft primary palate (cpp) to study the mechanisms of beak outgrowth. cpp mutants have complete truncation of the upper beak with normal development of the lower beak. Based on structural analysis and grafts of facial prominences, we localized the defect to the frontonasal mass and its derivatives. Several explanations that would account for the outgrowth defect were investigated, including abnormal expression of genes in the frontonasal epithelium, intrinsic defects in epithelium and/or mesenchyme defects in epithelial-mesenchymal signalling, a localized decrease in cell proliferation or a localized increase in programmed cell death. One of the genes expressed in the frontonasal epithelial growth zone, Fgf8, failed to down-regulate and was maintained for at least 48 hr beyond the time when down-regulation normally occurs. Recombination experiments further illustrated that the frontonasal mass epithelium was abnormal in the cpp mutants, whereas mutant mesenchyme was capable of normal outgrowth when combined with wild-type epithelium. Cell proliferation was not decreased in mutant embryos nor was cell death initially increased. Later, at stages 31-32, when the prenasal cartilage begins directed outgrowth, there was an increase in cell death within the mutant upper but not lower beak cartilage. The cpp beak truncation, therefore, is due to an epithelial defect in the frontonasal mass that is coincident with a failure to down-regulate expression of Fgf8.

Topics: Animals; Apoptosis; Avian Proteins; Beak; Cell Proliferation; Chick Embryo; Chickens; Cleft Palate; Down-Regulation; Epithelium; Fibroblast Growth Factor 8; Fibroblast Growth Factors; Gene Expression Regulation, Developmental; Mesoderm; Mutation; Nose; Phenotype; RNA, Messenger; Transplants

Craniofrontonasal syndrome (CFNS) is an X-linked developmental disorder that shows paradoxically greater severity in heterozygous females than in hemizygous males. Females have frontonasal dysplasia and coronal craniosynostosis (fusion of the coronal sutures); in males, hypertelorism is the only typical manifestation. Here, we show that the classical female CFNS phenotype is caused by heterozygous loss-of-function mutations in EFNB1, which encodes a member of the ephrin family of transmembrane ligands for Eph receptor tyrosine kinases. In mice, the orthologous Efnb1 gene is expressed in the frontonasal neural crest and demarcates the position of the future coronal suture. Although EFNB1 is X-inactivated, we did not observe markedly skewed X-inactivation in either blood or cranial periosteum from females with CFNS, indicating that lack of ephrin-B1 does not compromise cell viability in these tissues. We propose that in heterozygous females, patchwork loss of ephrin-B1 disturbs tissue boundary formation at the developing coronal suture, whereas in males deficient in ephrin-B1, an alternative mechanism maintains the normal boundary. This is the only known mutation in the ephrin/Eph receptor signaling system in humans and provides clues to the biogenesis of craniosynostosis.

Topics: Agenesis of Corpus Callosum; Amino Acid Sequence; Animals; Base Sequence; Chromosomes, Human, X; Cleft Lip; Cleft Palate; Cranial Sutures; Craniofacial Abnormalities; DNA; DNA Mutational Analysis; Dosage Compensation, Genetic; Ephrin-B1; Female; Genetic Linkage; Humans; Hypertelorism; Male; Mice; Molecular Sequence Data; Mutation; Nose; Pedigree; Sequence Homology, Amino Acid; Syndrome; Thumb

We report on two patients with a unique constellation of anomalies resembling the Nager acrofacial dysostosis syndrome. Clinical manifestations which differentiate their condition from Nager syndrome include: microcephaly, cleft lip and palate, a peculiar beaked nose, blepharophimosis, microtia, symmetrical involvement of the thumbs, and great toes and developmental delay. We postulate that the inheritance is autosomal recessive on the basis of similarly affected male and female sibs.

Topics: Abnormalities, Multiple; Adolescent; Blepharophimosis; Cleft Lip; Cleft Palate; Diagnosis, Differential; Female; Genes, Recessive; Humans; Male; Mandibulofacial Dysostosis; Microcephaly; Nose; Syndrome

The purpose of this study was to assess the progressive changes of nasal symmetry, growth, and relapse after presurgical nasoalveolar molding and primary cheiloplasty in unilateral complete cleft lip/palate infants. Twenty-five consecutive complete unilateral cleft lip/palate infants were included. All the infants underwent nasoalveolar molding before primary cheiloplasty. Standard 1:1 ratio basilar photographs were taken before and after nasoalveolar molding, 1 week after cheiloplasty, and yearly for 3 years. Linear measurements were made directly on the photographs. The results of this study revealed that the nasal asymmetry was significantly improved after nasoalveolar molding and was further corrected to symmetry after primary cheiloplasty. After the primary cheiloplasty, the nasal asymmetry significantly relapsed in the first year postoperatively and then remained stable and well afterward. The relapse was the result of a significant differential growth between the cleft and noncleft sides in the first year postoperatively. To compensate for relapse and differential growth, the authors recommend (1) narrowing down the alveolar cleft as well as possible by nasoalveolar molding, (2) overcorrecting the nasal vertical dimension surgically, and (3) maintaining the surgical results using a nasal conformer.

Topics: Anthropometry; Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Nose; Rhinoplasty

To identify inherited craniofacial morphologic features in individuals at high risk for cleft of the lip, cleft palate, or both.. Twins without cleft from 33 pairs of monozygotic twins discordant for cleft lip, cleft palate, or both were studied. There were 17 males and 16 females of Caucasian origin, ranging from 3 to 18 years (15 with cleft lip and palate [CLP], 10 with cleft lip [CL], and 8 with cleft palate [CP]), collected from five craniofacial centers (United States and Canada).. The twin without cleft (noncleft) from each set was compared with an age- and sex-matched control individual from the Burlington Growth Centre, Toronto, Ontario. Posteroanterior and lateral cephalograms were traced and digitized using a computer custom analysis. Descriptive statistics, Student's t tests, and analysis of variance were used to test 40 variables in a pilot study comparing the noncleft twin groups with the controls. Preliminary analysis permitted pooling of the CLP and CL groups (n = 25). To minimize false-positive significance, only 14 variables (from the maxillofacial area) were tested.. Using the raw probabilities, eight variables showed significant differences between the pooled noncleft CLP and CL (CL[P]) twin group and the controls. However, when the level of significance was adjusted, only four (nasal width [p < .01], cranial base length [p < .05], cranial base width/length ratio [p < .001], and maxillary width/length ratio [p < .05]) were significantly different. No significant differences were confirmed between the noncleft CP twin group and the controls.. The noncleft member of a discordant monozygotic pair has a number of facial characteristics that differ from the general population. These may predispose to the formation of a cleft lip or palate and may result from a deficiency or distortion of the mesenchyme that forms the craniofacial structures.

Topics: Adolescent; Analysis of Variance; Case-Control Studies; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Genetic Predisposition to Disease; Humans; Male; Maxilla; Nose; Observer Variation; Pilot Projects; Skull Base; Twins, Monozygotic

To investigate the short- and long-term effects of maxillary distraction osteogenesis (DOG) on the upper-airway size and nasal resistance in nine patients with cleft lip and palate (CLP).. Changes in the upper-airway size were measured by using lateral cephalometric radiographs taken immediately before and after DOG, and 1 year later. Nasal resistance was measured with a rhinomanometer. An analysis of variance was used to establish statistical significance. Spearman correlation coefficient was used to evaluate the relationship between changes in the cross-sectional area of the upper airway and nasal resistance in association with DOG.. Immediately after DOG, the anteroposterior dimension of the superior part of the upper airway was significantly increased (p < 0.01) and nasal resistance was significantly decreased (p < 0.05). Moreover, the cross-sectional area of the total upper airway was significantly increased (p < 0.01). There was a significant correlation between the increase in the upper-airway cross-sectional area and the reduction in nasal resistance (p < 0.05). The upper-airway size was significantly augmented (p < 0.05) and nasal resistance was significantly reduced (p < 0.05) at 1 year after DOG compared with immediately before DOG.. An increase in the upper-airway size and a reduction in nasal resistance occurred after maxillary DOG in patients with CLP, and these changes were stable after 1 year.

Topics: Adolescent; Adult; Airway Resistance; Analysis of Variance; Cephalometry; Child; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Maxilla; Nasopharynx; Nose; Oropharynx; Osteogenesis, Distraction; Pharynx; Rhinomanometry; Statistics, Nonparametric

To study a new method of simultaneous repair of alveolar cleft and the deformity of the nose and lip.. 42 patients with cleft of alveolar process were included in this study. We filled the cleft of alveolar process with iliac cancellous bone and covered the depression of piriform aperture and the nasal side with iliac cartilage. Simultaneously, we corrected the nasal deformity using V-Y plasty of a mucosa-cartilage compound flap at the nasal vestibule.. In the patients aged 9 approximately 11 years, the mean height of the repaired alveolar process was 86.7%; the mean thickness was 89.6%; the contour and function of the alveolar process was grade I or II. The canine erupted at the place of bone grafting. The depression of the piriform aperture and alae nasi was repaired. The contour of the nares was symmetrical. In the patients over 12 years, the mean height of the alveolar process was 70.1%; the mean thickness was 71.7%; the contour and function of the alveolar process was grade II or III. The deflexion of nasal dorsum and nasal dome was not ameliorated in 2 patients of 18 years old.. The application of iliac cancellous and chondral bone to simultaneously repair cleft of alveolar process and the nasal deformity is an ideal plastic method. It can recover the height of alveolar process and the continuity of dental arch, ameliorate the nasal deformity, and redress the deflexion of nasal dorsum and nasal end. It can also eliminate the psychological obstacle of the patients at an early stage.

Topics: Adolescent; Alveolar Process; Bone Transplantation; Child; Cleft Palate; Female; Humans; Jaw Abnormalities; Male; Nasal Cavity; Nose; Reproducibility of Results; Surgery, Plastic; Treatment Outcome

Topics: Cleft Lip; Cleft Palate; Equipment Design; Humans; Infant; Nose; Palatal Obturators; Preoperative Care; Rhinoplasty; Stents

Twenty patients with unilateral cleft lip and palate, orthodontically treated from the full primary or early transitional dentition stages until retention and dismissal, were recalled later in adult life to evaluate the status of their occlusion and facial appearance.. Cephalometric radiographs, photographs, and casts were attained as final records. In several instances, final records were obtained by orthodontic colleagues at the patient's current residence. Evaluation of the longitudinal records provided retrospective insight pertinent to the growth and positional relationships of the jaws' contiguous structures and the dentition.. Orthodontic results are linked with observations related to the nasomaxillary complex: the anterior cranial base, tissue deficiency, the maxillary and mandibular dentition, and time modifications in skeletal facial growth. At adult ages, the patients with unilateral cleft lip and palate had acceptable facial profiles and acceptable alignment of the anterior dentition. Variances noted in mandibular pattern of growth explain attainment of acceptable relationships. In many cases, tissue deficiency in the anterior cleft region was compensated for with fixed partial dentures and removable prosthetic appliances. Posterior crossbites, although few in number, were proportionately more prevalent in this unilateral cleft lip and palate patient population than was anticipated; possible reasons are presented, taking into consideration congenital contingencies and therapeutic overlays.

Topics: Adult; Cephalometry; Cleft Lip; Cleft Palate; Dental Occlusion; Denture, Partial, Fixed; Denture, Partial, Removable; Face; Female; Humans; Longitudinal Studies; Male; Malocclusion; Mandible; Maxilla; Maxillofacial Development; Models, Dental; Nose; Orthodontics, Corrective; Photography, Dental; Retrospective Studies; Skull Base

Complete uni-lateral cleft palates resulting from failed union between internal and external nasal buds cause an imbalance of both superficial and deep nasal structures. After summarizing the principles that should guide the care of these anomalies, the authors present their therapeutic procedure, in which orthopaedic and surgical treatments are intimately associated. They conclude their presentation by emphasizing the difficulty of predicting the definitive result because of the extreme diversity of the sequellae that always accompany the treatment of cleft palates.

Topics: Alveolar Process; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Clinical Protocols; Humans; Infant; Nose; Oral Surgical Procedures; Orthodontics, Preventive; Palatal Obturators; Periosteum; Plastic Surgery Procedures; Preoperative Care; Prognosis

To evaluate the impact of orthognathic surgery on acoustic nasalance of subjects with cleft and investigate the causes of possible changes by analyzing velopharyngeal function and nasal patency.. Nasalance was measured in 29 subjects with operated cleft palate +/- lip before (PRE) and 45 days (POST1) and 9 months (POST2) after surgery, on average. In 19 of the patients, the minimum velopharyngeal (VP) and nasal cross-sectional (N) areas were also determined.. Le Fort I osteotomy with maxillary advancement in combination with procedures involving the nose, maxilla, mandible or all three.. Nasalance, VP area, N area.. We observed: (1) a significant (p < .05) increase in mean nasalance at POST1 and POST2, compared with PRE during the reading of oral sentences and nasal sentences; at POST2, high nasalance on the oral sentences was observed in 45% of the patients with normal nasalance at PRE, and 57% of patients with low nasalance on the nasal sentences at PRE no longer presented abnormal nasalance; (2) a significant increase in mean VP area at POST1; two borderline patients demonstrated deterioration of VP closure at POST2, compared with PRE; and (3) a significant increase in mean N area at POST2, with 73% of patients no longer presenting subnormal areas seen at PRE.. On a long-term basis, orthognathic surgery modifies speech nasalance of some subjects with cleft, perhaps because of an increase in internal nose size. This may also improve nasal patency for breathing.

Topics: Acoustics; Adolescent; Adult; Air; Analysis of Variance; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Maxilla; Nasal Obstruction; Nose; Palate, Soft; Pharynx; Respiration; Speech; Speech Acoustics; Statistics as Topic; Velopharyngeal Insufficiency

Assessment of stability of the advanced maxilla after two-jaw surgery and Le Fort I osteotomy in patients with cleft palate based on soft tissue planning.. Between 1995 and 1998, 15 patients with cleft lip and palate deformities underwent advancement of a retruded maxilla, without insertion of additional bone grafts. Eleven patients had bimaxillary osteotomies and four patients only a Le Fort I osteotomy. Relapse of the maxilla in horizontal and vertical dimensions was evaluated by cephalometric analysis after a clinical follow-up of at least 2 years.. In the bimaxillary osteotomies, horizontal advancement was an average 4 mm at point A. After 2 years, there was an additional advancement of point A of an average of 0.7 mm. In the mandible, a relapse of 0.8 mm was seen after an average setback of 3.9 mm. In the four patients with Le Fort I osteotomy, point A was advanced by 3.8 mm and the relapse after 2 years was 0.9 mm. Vertical elongation at point A resulted in relapse in both groups. Impaction of the maxilla led to further impaction as well.. Cephalometric soft tissue analysis demonstrates the need for a two-jaw surgery, not only in severe maxillary hypoplasia. Alteration of soft tissue to functional harmony and three-dimensional correction of the maxillomandibular complex are easier to perform in a two-jaw procedure. It results in a more stable horizontal skeletal position of the maxilla.

Topics: Adolescent; Adult; Cephalometry; Chin; Cleft Lip; Cleft Palate; Face; Facial Bones; Female; Follow-Up Studies; Humans; Male; Malocclusion, Angle Class III; Mandible; Maxilla; Nose; Osteotomy; Osteotomy, Le Fort; Patient Care Planning; Recurrence; Sella Turcica; Statistics, Nonparametric; Vertical Dimension

A national survey was conducted to obtain an overall view of the status, assess changes in trends of cleft management, and study new categories of interest.. Questionnaires were sent to 90 chief residents of all Korean institutes with plastic surgery training programs.. Forty-eight respondents returned completed questionnaires. The results were: (1) the most common unilateral cleft lip repair method used is the rotation-advancement technique (100%); (2) 73% of respondents correct cleft lip nasal deformity at preschool age; (3) the Millard technique is the most common management in bilateral cleft lip repair (65%); (4) in the management of protruding premaxilla, 44% of the respondents choose presurgical orthopedics; (5) the usual cleft palate repairs are the pushback (64%) and double-opposing Z-plasty (43%) in complete cleft palates and the double-opposing Z-plasty (75%) and pushback (36%) comprised the common techniques in incomplete cases; (6) 86% of responding programs perform alveolar cleft repairs during the period of mixed dentition; the most common treatment of velopharyngeal incompetence is pharyngeal flap (71%); and (8) the interdisciplinary team approach is practiced by 64% of respondents.. Many changes were noted since a previous 1995 survey. We hope that this study provides the necessary information needed for the eventual establishment of standard cleft management in Korea.

Topics: Age Factors; Alveoloplasty; Child, Preschool; Cleft Lip; Cleft Palate; Dentition, Mixed; Humans; Korea; Lip; Maxilla; Nose; Orthodontics, Corrective; Palatal Obturators; Palate; Patient Care Team; Surgery, Oral; Surgery, Plastic; Surgical Flaps; Surveys and Questionnaires; Velopharyngeal Insufficiency

Unoperated bilateral complete cleft lip and palate in an adult or elderly patient is seen rarely, and the existence of unoperated clefts is a result of unfavorable economic and social circumstances. We report an unoperated 65-year-old patient with bilateral complete cleft lip and palate and present our preference for the surgical management.. Repair of the bilateral complete cleft lip and palate was successfully carried out using straight-line closure for the bilateral cleft lip and two-flap pushback palatoplasty with superiorly based lateral port control pharyngeal flap for the wide cleft palate at the first stage, and large residual anterior palatal fistulas were closed using bilateral superiorly based (retrograde flow) full-thickness nasolabial island flaps at the second stage.. To our knowledge based on a review of the literature, this is the first report of an elderly patient with bilateral complete cleft lip and palate and the first application of bilateral superiorly based (retrograde flow) full-thickness nasolabial island flaps for closure of large residual anterior palatal fistulas or alveolar clefts. The bilateral superiorly based (retrograde flow) full-thickness nasolabial island flap may be a good solution in large anterior palatal defects using unilaterally or bilaterally in a single stage with minimal donor site morbidity, in which there is not enough tissue for local repair or if previous attempts are unsuccessful.

Topics: Aged; Alveolar Process; Alveoloplasty; Cleft Lip; Cleft Palate; Facial Muscles; Female; Humans; Nose; Palate; Palate, Soft; Pharynx; Skin Transplantation; Surgical Flaps

We report a boy with a nasal deformity, choanal atresia, bifid uvula, severe bilateral microphthalmia and a facial cleft who showed regression of development at the age of 2 years with subsequent improvement. We suggest he represents a further case of the rare Fryns "Anophthalmia-Plus" syndrome.

Topics: Abnormalities, Multiple; Anophthalmos; Child, Preschool; Cleft Lip; Cleft Palate; Developmental Disabilities; Humans; Male; Nose

Topics: Abnormalities, Multiple; Child, Preschool; Cleft Lip; Cleft Palate; Holoprosencephaly; Humans; Male; Nose; Rhinoplasty; Surgical Flaps; Suture Techniques

We present a male infant 2.5-months old with asymmetric skull, anophthalmia, apparent hypertelorism, abnormal nares, unilateral cleft lip and palate, and structural abnormalities of the central nervous system. These findings are similar to cerebro-oculo-nasal syndrome except for the appearance of nose. This case is either a clinical variability in cerebro-oculo-nasal syndrome or a new entity.

Topics: Abnormalities, Multiple; Anophthalmos; Brain; Cleft Lip; Cleft Palate; Eye Abnormalities; Humans; Hypertelorism; Infant; Male; Nose; Syndrome; Tomography, X-Ray Computed

Nasal alveolar molding is used effectively to reshape the nasal cartilage and mold the maxillary arch before cleft lip repair and primary rhinoplasty. It provides aesthetic and functional benefits of nasal tip and alar symmetry and improved dental arch form. At The Craniofacial Center at the University of Illinois at Chicago, the authors have developed a modification of a nasal alveolar molding appliance previously described in the literature. The key modification is the use of an orthodontic wire from the palatal prosthesis with an acrylic bulb positioned inside the nose, underneath the apex of the alar cartilage, as the nasal stent. This modification allows easier adjustment of the position of the bulb during treatment to achieve a more symmetrical relationship between the nasal cartilages, columella, philtrum, and alveolar segments.

Topics: Cleft Lip; Cleft Palate; Equipment Design; Humans; Nose; Orthodontic Wires; Palatal Obturators; Preoperative Care; Stents

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.

Topics: Adult; Cleft Lip; Cleft Palate; Female; Humans; Imaging, Three-Dimensional; Male; Nose

In this study the nasal deformities in patients with cleft lip, alveolus and palate (CLAP) were analysed and the relevant role of the perinasal-perioral muscular balance, and the inborn dislocation of the alar cartilages is presented.. 50 CLAP patients were analysed in whom 29 primary cheiloplasties, 12 lip revisions and 9 rhinoplasties were performed. The lip repair was done by a modification of Millard's technique, the nose by either a closed or open-sky rhinoplasty. The severity of the cleft appearance was evaluated pre- and postoperatively, according to a pre-agreed visual rating scale. There were 4 degrees of severity of the deformity preoperatively (mild, moderate, severe and very severe), and postoperatively 5 categories of outcome (excellent, very good, good, satisfactory and poor) depending on the scores obtained by summing up the points corresponding to different types of deformity. This scale is closely related to the American Cleft Palate classification of clefts.. 17 excellent, 4 very good, 2 good, 5 satisfactory and 1 poor result were obtained in the group of primary cheiloplasty. Eight excellent, 4 very good results were obtained by the lip revisions. Seven excellent and 2 satisfactory results were obtained following rhinoplasty.. During the primary lip repair, it is important to correct the abnormal position of ala nasi, the nasal floor and the base of the columella. When correct insertion of m. transversus nasi to the nasal spine is achieved and a good repair of m. orbicularis oris, symmetry of the alae and normal growth of lip and columella was obtained even in most severe bilateral cases. In cases of diastasis of the orbicularis and transversus nasi muscles, in combination with other soft tissue deformities or scars, a secondary musculo-periosteal revision is recommended. The defect of the soft tissue triangle of the nose is best corrected via an open rhinoplasty.

Topics: Adolescent; Adult; Alveolar Process; Child; Child, Preschool; Cleft Lip; Cleft Palate; Facial Muscles; Humans; Infant; Infant, Newborn; Lip; Lip Diseases; Nose; Nose Deformities, Acquired; Reoperation; Rhinoplasty; Treatment Outcome

The purpose of this study was to assess the three-dimensional (3-D) facial and alveolar morphology of patients with unilateral clefts of lip, alveolus and palate by means of a computer-aided diagnosis system.. Maxillary orthopaedic treatment was performed using soft/hard acrylic plates (Hotz's) within 2 weeks of birth. The nasolabial and alveolar morphology of 15 patients was evaluated before orthopaedic treatment (2 weeks of age) and before cheiloplasty (3 months of age). Nasolabial form was measured using a 3-D optical scanner. Twenty-one landmarks were extracted from the data and analysed linearly and angularly. Alveolar forms were measured with a high-accuracy contact-type 3-D digitizer on plaster casts. Seven landmarks were digitized and analysed linearly and angularly.. Some growth was observed in the intercanthal distance, alar width, intercommissural width, and height of the lip. There was little change in the width of the cleft lip or displacement of the columella base, while the alveolar cleft narrowed.. Presurgical orthopaedics reduces cleft width and makes subsequent surgery easier.

Topics: Acrylic Resins; Alveolar Process; Cephalometry; Cleft Lip; Cleft Palate; Computer-Aided Design; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Infant; Infant, Newborn; Lip; Models, Dental; Nose; Optics and Photonics; Palatal Obturators; Preoperative Care; Prosthesis Design; Statistics, Nonparametric

To determine the degree of facial asymmetry in infants with unilateral cleft lip and/or palate, and quantify improvements following primary surgery, in three dimensions.. The faces of 20 infants with unilateral clefts (10 UCL; 10 UCLP), and 20 age-matched, non-cleft controls, were captured using the C3D stereophotogrammetry system prior to primary lip/nose repair (at 3 months), at 6 months and at age 1 year.. Procrustes techniques were applied to 3D landmark configurations to its mirror image. Mean squared distances between landmarks and their antimeres were calculated and expressed as asymmetry scores for each 3D configuration. Full-face, nose and lip median scores were compared and changes with time evaluated (P < 0.01).. There were no significant changes in asymmetry scores in the control group from 3 months to 1 year. The UCLP group was more asymmetric than the UCL group, displaying greatest improvement in nasal symmetry following primary repair. The lips continued to improve over time. The UCL group had significant nasal asymmetry, which did not appear to improve with primary surgery.. Immediate improvement in asymmetry scores in children with UCLP is related to the production of a more symmetrical nasal form after primary surgery. In contrast, the nasal asymmetry seen in children with UCL is unchanged despite surgery. Full face asymmetry scores may mask subtle changes over time. Nasal and lip asymmetry should be considered individually.

Topics: Case-Control Studies; Cephalometry; Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Infant; Nose; Photogrammetry; Photography, Dental; Prospective Studies; Rhinoplasty; Statistics, Nonparametric

To examine whether the treatment provided by the Mount Vernon Cleft Team produces craniofacial growth outcomes comparable with that of the Oslo Team.. Mount Vernon Hospital, Middlesex, UK.. A retrospective cephalometric investigation.. Seventy-five Mount Vernon children and 150 Oslo children with complete unilateral or bilateral clefts of the lip and palate. The subjects were matched for age, gender, and cleft type, and their radiographs were digitized. The radiographs from each site were grouped according to patient age (9-11 or 14-16) and cleft classification (bilateral/unilateral). Patients with associated craniofacial anomalies were excluded from the study.. Of the four variables studied (SNA, SNPg, NGn, sNANsPG) significant differences in maxillary growth were noted for bilateral and unilateral cleft groups at 14-16 years of age. The soft tissue profile was significantly flatter in bilateral and unilateral Mount Vernon cases at 14-16 years. The craniofacial growth exhibited by the Mount Vernon patients demonstrated 3.9-5.1 degrees reduction in maxillary prominence with respect to the Oslo sample. The bilateral cases from Mount Vernon had greater anterior face heights at 14-16 years.. The treatment provided by the Mount Vernon Cleft team leads to a reduced maxillary prominence in children aged 14-16 years compared with the Oslo sample. This reduction is statistically significant in unilateral cleft lip and palate.

Topics: Adolescent; Alveoloplasty; Bone Transplantation; Case-Control Studies; Cephalometry; Child; Chin; Cleft Lip; Cleft Palate; Confidence Intervals; Female; Humans; Image Processing, Computer-Assisted; Lip; London; Male; Mandible; Maxilla; Maxillofacial Development; Norway; Nose; Palate, Hard; Radiographic Image Enhancement; Retrospective Studies; Sella Turcica; Statistics as Topic; Vertical Dimension

Soft tissue profile analysis from cephalometric radiographs is recognized as an important part of the assessment of treatment outcome in cleft lip and palate (CLP), and has previously been found to discriminate between groups better than conventional hard tissue cephalometric analysis. Cephalometric radiographs of 182 12-14-year-old children from the UK with complete unilateral cleft lip and palate (UCLP) were available for this investigation, which aimed to describe the cephalometric soft tissue findings for this group of UK children. Seven soft tissue profile angular variables were measured using Dentofacial Planner Plus (DFP). Thirty films were re-measured two weeks later to assess the reliability of the method, which was acceptable for most of the variables, although use of landmarks related to the lips increased error. Mean nasolabial angle (97.44 degrees), facial convexity (138.02 degrees), and soft tissue ANB (2.99 degrees) compared unfavourably with previously reported data. These findings support the data given in the Clinical Standards Advisory Group study. Soft tissue profile assessment from cephalometric radiographs has acceptable reliability. The results of treatment show poor outcome in the UK compared with published data.

Topics: Adolescent; Algorithms; Cephalometry; Child; Cleft Lip; Cleft Palate; Confidence Intervals; Face; Humans; Image Processing, Computer-Assisted; Lip; Matched-Pair Analysis; Nose; Radiography; Reproducibility of Results; Statistics as Topic; Statistics, Nonparametric; Treatment Outcome

To evaluate morphological problems for children with complete unilateral cleft lip and palate (UCLP).. A cross-sectional study was performed on 46 patients with complete UCLP at Osaka University Dental Hospital.. The method was applied to three groups of children with UCLP (8 4-month-old infants, 18 1.5-year-old children, and 20 4-year-old children).. The three-dimensional coordinates of facial landmarks were extracted automatically from XYZ data sets and from photo images produced by an optical surface scanner.. The intercanthal distance, nose width, and mouth width were closer to those of normal children in the older group. Deviation of the columella toward the noncleft side was smaller in the 4-year-old group. The angle of the nasal tip was large in all groups. Asymmetry of the ala was conspicuous at the upper part of the nose in the vertical dimension. Asymmetry of the nostril was observed in the vertical dimension and in the anteroposterior dimension in the 4-year-old group. The angle of the Cupid's bow was obtuse on the noncleft side, and the bottom of the Cupid's bow deviated toward the cleft side. The Cupid's bow was longer on the noncleft side. Protrusion of the vermilion was poor in all groups.

Topics: Cephalometry; Child, Preschool; Cleft Lip; Cleft Palate; Eyelids; Facies; Forehead; Humans; Imaging, Three-Dimensional; Infant; Lip; Nose; Oral Surgical Procedures; Surgical Flaps; Treatment Outcome

Topics: Alveoloplasty; Bone Transplantation; Cleft Lip; Cleft Palate; Cost-Benefit Analysis; Gingivoplasty; Humans; Nose; Orthodontics; Periosteum; Tooth Eruption

Patients suffering from unilateral cleft lip, alveolus and palate exhibit a varying degree of asymmetry of the midface. Evaluation of this asymmetry can be carried out by means of 3D-CT, or a laser surface scanner.. In this paper, 3D-CT-scan data of 21 patients with unilateral clefts of lip, alveolus and palate were analysed using three-dimensional models. Evaluations of the 3D-models were carried out with the computer-aided 3D-operation simulator 3D-Cosmos.. Asymmetry was found in the orbital, nasal and maxillary regions. The infraorbital rims were displaced craniocaudally and horizontally as well as laterally of the cleft-sided piriform aperture. This asymmetry corresponded to a dislocation of the maxillary segment on the cleft side. A deficit in volume was not reliably found.

Topics: Alveolar Process; Cephalometry; Cleft Lip; Cleft Palate; Computer-Aided Design; Facial Asymmetry; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Infant; Maxilla; Nasal Cavity; Nose; Orbit; Tomography, X-Ray Computed

Frontonasal malformation includes a spectrum of anomalies involving the eyes, nose, lips, forehead and brain. We present a case in which a fetal labial cleft was initially identified using traditional two-dimensional sonography. Three-dimensional sonography with multiplanar reconstruction and surface-rendering were essential to establish the diagnosis of frontonasal malformation with severe nasal hypoplasia and unilateral complete cleft lip/palate.

Topics: Adult; Cleft Lip; Cleft Palate; Female; Frontal Bone; Humans; Imaging, Three-Dimensional; Nose; Pregnancy; Ultrasonography, Prenatal

To describe the soft tissue profile of children with unilateral cleft lip and palate from profile photographs and assess the reliability of this method.. Retrospective analysis of prospectively collected data.. A national study in the United Kingdom.. Caucasian children born in the United Kingdom between April 1, 1982, and March 31, 1984, and aged between 12 and 14 years at data collection. A cleft side and noncleft side profile photograph was available for each of 175 children.. Seven angular measurements were made using Dentofacial Planner Plus software, and the profile appearance was rated by an expert panel.. Reliability for repeated measurement of the same photograph was acceptable for all but li-sm(s)-pg(s) (labiomental fold). Similar levels of reliability were found when comparing measurements from the cleft side and non-cleft side photograph. Logistic regression showed that the variables nst-sn-ls (nasolabial angle), ss(s)-n(s)-pg(s) (maxillary prominence), and g(s)-prn-pg(s) (facial convexity) were associated with the profile score.. Soft tissue profile analysis from photographs is reliable and robust under a range of conditions. Soft tissue profile measurements are associated with panel ratings of profile.

Topics: Adolescent; Child; Chin; Cleft Lip; Cleft Palate; Confidence Intervals; Face; Humans; Image Processing, Computer-Assisted; Lip; Logistic Models; Maxilla; Normal Distribution; Nose; Photogrammetry; Photography; Prospective Studies; Reproducibility of Results; Retrospective Studies; Software; Statistics as Topic; Statistics, Nonparametric

Analysis of craniofacial morphology and growth in children with untreated isolated cleft palate (ICP) (cleft of the secondary palate only) at 2 and 22 months of age and comparison of the morphology and growth to that of a control group with unilateral incomplete cleft lip (UICL).. A total of 98 cleft children (53 with ICP and 45 with UICL) drawn from a larger group representing all Danish children with cleft born in the period 1976 to 1981 were included in the study. Craniofacial morphology and growth were analyzed using three-projection infant cephalometry.. The ICP group differed significantly from the UICL group. The most striking findings in the ICP group were: short maxilla; reduced posterior maxillary height; increased posterior maxillary width (in the 2-month-old); short mandible; reduced posterior height of the mandible; bimaxillary retrognathia; and reduced pharyngeal depth, height, and area. The facial growth pattern was fairly similar in the two groups except for a somewhat more vertical growth direction in the ICP group.. The facial morphology in ICP children differs significantly from that of children with UICL of the same age. The differences in facial morphology can be ascribed to the difference in the primary anomaly in the ICP group. The facial growth pattern was fairly similar in the ICP and UICL group; however, a somewhat more vertical growth direction was observed in the ICP group.

Topics: Body Height; Body Weight; Case-Control Studies; Cephalometry; Cleft Lip; Cleft Palate; Dental Arch; Face; Facial Bones; Female; Humans; Image Processing, Computer-Assisted; Infant; Lip; Longitudinal Studies; Male; Mandible; Maxilla; Maxillofacial Development; Nose; Orbit; Pharynx; Retrognathia; Skull; Skull Base; Statistics as Topic; Vertical Dimension

There are numerous methods of repairing a cleft lip. In our institution, two methods have been used for primary lip repair, the triangular flap method, and the rotation-advancement plus small triangular flap method. The purpose of this study was to compare postsurgical anthropometric results following these two surgical methods.. Twenty children with a unilateral complete cleft lip, alveolus and palate (UCLAP) were selected for this study. Ten underwent primary lip repair by the triangular flap method (Triangular Group), and the other 10 underwent repair by the rotation-advancement plus small triangular flap method (Rotation Group).. They were documented with a three-dimensional optical scanner, and analysed with computer-aided anthropometric method reported previously (Comput. Methods Programs 58: 159-173, 1999a; J. Cranio-Maxillofac Surg 27: 345-353, 1999b).. The shapes of the nose and nostril were a little better in the Rotation Group. However, in the Rotation Group, differences between good and poor cases were more extreme than in the Triangular Group. The shape of Cupid's bow was good shortly after surgery in the Triangular Group. A good shape of Cupid's bow was also obtained in the Rotation Group, but the improvement was more delayed. On the non-cleft side, the length of Cupid's bow was more extended in the Triangular Group. Certain deformities were common to both groups, such as deviation of the columella and a flattened ala on the cleft side.. Rotation-advancement plus the small triangular flap method was thought to produce somewhat better results, however, further improvements in the technique are needed.

Topics: Alveolar Process; Cephalometry; Cleft Lip; Cleft Palate; Face; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Infant; Lip; Male; Nose; Optics and Photonics; Orbit; Rotation; Statistics as Topic; Surgical Flaps

To describe CT appearances in patients with unilateral cleft lip and palate (CLP) 20 years after bone graft surgery.. Eighteen consecutive patients with unilateral CLP were examined. All patients had been treated with primary closure, both in infancy and early childhood, supplemented with bone grafting at the age of around 10 years. The CT examination of the upper jaw included a dental CT program. The CT appearances of the cleft side were compared with those of the untreated non-cleft side.. Abnormal CT appearances included skew nasal aperture (n=17), nasal septal deviation (n=17), low floor of nasal aperture (n=15) at or towards the cleft side, and deviation of anterior nasal spine towards the non-cleft side (n=18). The posterior part of the bone cleft was visible in all patients, and the dental arch was V-shaped in 8.. Although adherence to the present treatment protocol is considered to give satisfactory functional and cosmetic results, certain abnormalities persist. A knowledge of these is a prerequisite for a complete and final evaluation of the surgical and orthodontic regimen.

Topics: Bone Transplantation; Child; Cleft Palate; Dental Arch; Female; Follow-Up Studies; Humans; Imaging, Three-Dimensional; Male; Maxilla; Nasal Bone; Nasal Cavity; Nasal Septum; Nose; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Alveolar Process; Alveoloplasty; Child; Child, Preschool; Cleft Lip; Cleft Palate; Humans; Infant; Lip; Maxillofacial Development; Nose; Plastic Surgery Procedures

A typical cleft deformity of the central facial area is very frequently associated with impaired patency of the nose. Rhinomanometry makes it possible to assess objectively and quantitatively the patency of these airways. For objective assessment of the disorder this examination was made closely before secondary rhinoplasty in 36 patients with complete unilateral (81%) or bilateral cleft (19%). Using the method of active anterior rhinomanometry, values of nasal flow and nasal resistance were assessed. Subsequently the degree of obstruction of the nasal airways and the lateral ratio of the nasal flow were evaluated. The mean value of the total nasal flow was 239.9 cm3/s, and the mean value of nasal resistance for individual nasal vents was 3.55. The results were compared with normal values according to Bachmann. It was revealed that patients with clefts suffer in 88% of casesfrom significant obstruction of the nasal airways and In the remaining 12% of cases from mild obstruction. The lateral ratio can be evaluated as normal only in 19% and 14% of patients with unilateral and bilateral clefts respectively. Although the great majority of patients ask for secondary correction because they want to improve their appearance, It is an advantage to express objectively the functional disorder of nasal patency before surgery--thus defining the indication more accurately--and to explain to the patient the possible benefit of the operation.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Pulmonary Ventilation; Rhinomanometry

The purpose of this study was to compare the financial impact of two treatment approaches to the unilateral cleft alveolus. The recently advocated nasoalveolar molding (NAM; and gingivoperiosteoplasty (GPP; at the time of lip repair were compared with the traditional approach of secondary alveolar bone graft.. The records of all patients (n = 30) with unilateral cleft lip and alveolus treated by a single surgeon during 1985 through 1988 were examined retrospectively. The patients were divided into two groups: group 1 patients (n = 14) were treated by lip repair, primary nasal repair, and secondary alveolar bone graft prior to eruption of permanent dentition; group 2 patients (n = 16) were treated by NAM, GPP, lip repair, and primary nasal repair. Patients who required secondary alveolar bone graft after GPP were noted. The cost of treatment by each protocol was calculated in 1998 dollars.. The average cost of treatment for a patient treated by lip repair, primary nasal repair, and secondary alveolar bone graft prior to eruption of permanent dentition was $22,744. Of the 16 patients treated by NAM, GPP, lip repair, and primary nasal repair, 10 required no further treatment of the unilateral cleft alveolus; six patients required secondary alveolar bone graft. The average per-patient treatment cost in this group was $19,745. The average cost savings of NAM and GPP, compared with alveolar bone graft is $2999.. The treatment of unilateral cleft alveolus by nasoalveolar molding and gingivoperiosteoplasty results in substantial cost savings, compared with treatment by secondary alveolar bone graft.

Topics: Alveolar Process; Alveoloplasty; Anesthesiology; Bone Transplantation; Cleft Lip; Cleft Palate; Clinical Protocols; Cost Savings; Fees, Medical; General Surgery; Gingivoplasty; Health Care Costs; Hospitalization; Humans; Nose; Operating Rooms; Orthodontics; Palatal Obturators; Periosteum; Recovery Room; Retrospective Studies; Time Factors; Tooth Eruption; Treatment Outcome

The purpose of this study was to investigate the relationship between craniofacial and nasopharyngeal morphology and velopharyngeal function in submucous cleft palate.. 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.. 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.

Topics: Age Factors; Cephalometry; Child; Child, Preschool; Cleft Palate; Female; Forecasting; Humans; Male; Maxilla; Nasopharynx; Nose; Palate, Soft; Pharynx; Prognosis; Sella Turcica; Sex Factors; Skull Base; Speech; Statistics as Topic; Statistics, Nonparametric; Velopharyngeal Insufficiency; Vertical Dimension

The offspring of mothers with untreated or poorly controlled phenylketonuria (PKU) (McKusick 261600) are at risk of having congenital anomalies including microcephaly, congenital heart defects and developmental delay (Rouse et al 1997). We report a child born to a mother with poorly controlled PKU and suggest that the facial abnormalities seen in this child could be part of the specturn of maternal PKU embryopathy.

Topics: Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Maxillofacial Abnormalities; Microcephaly; Nose; Phenylketonurias; Pregnancy

The correlation between the nasalance score and the perceptual rating of several aspects of speech of speakers with velopharyngeal insufficiency (VPI) by six speech-language pathologists was evaluated.. The overall grade of severity, hypernasality, audible nasal emission, misarticulations, and intelligibility were rated on visual analog scales. Speech samples with a normal distribution of phonemes (normal text [NT]) and those free of nasal consonants (denasal text [DT]) of 43 patients with VPI were used. Mean nasalance scores were computed for the speech samples, and Spearman correlation coefficients were computed between the mean nasalance score and the five parameters of the differentiated rating.. The Institute of Phoniatrics, Utrecht University Hospital, The Netherlands.. The correlation coefficient between the mean nasalance and the perceptual rating of hypernasality ranged among judges from .31 to .56 for NT speech samples and .36 to .60 for DT speech samples. Only small differences were found between speech pathologists with and without expertise in cleft palate speech. The rating of the overall grade of severity appeared to correlate quite well with the rating of the intelligibility (r(NT) = .77, r(DT) = .79). Lower correlation coefficients, ranging from .34 to .71, were found between overall grade of severity and hypernasality, audible nasal emission, and misarticulations.. A low correlation between the nasalance and the perceptual rating of hypernasality was found. The parameter overall grade of severity appeared to be determined mainly by the parameter intelligibility. Expertise in rating of cleft palate speech does not guarantee a high correlation between instrumental measurement and perceptual rating.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Articulation Disorders; Child; Child, Preschool; Cleft Palate; Female; Humans; Male; Matched-Pair Analysis; Middle Aged; Netherlands; Nose; Phonetics; Signal Processing, Computer-Assisted; Speech Disorders; Speech Intelligibility; Speech Perception; Speech-Language Pathology; Statistics, Nonparametric; Velopharyngeal Insufficiency

To determine whether palate height and maxillary arch depth are systematically related to the surgical center at which primary repair in unilateral cleft lip and palate (UCLP) was carried out.. A retrospective comparison based on study casts of consecutive cases of UCLP obtained at age 9 years from six different centers. The observer who conducted measurements was blinded to the source of individual records.. The patients whose records were analyzed received all their surgical care in a national health service setting in six different northern European centers and regions.. Patients were consecutively treated Caucasian children with non-syndromic complete UCLP born in the period 1976 to 1979.. The main outcome measures for the original study were craniofacial form, dental arch relationships, nasolabial appearance, and speech. This report focuses on measurements of anterior maxillary arch depth and palate height.. Anterior arch depth and anterior palate height showed some variation among the centers. There was a tendency for anterior arch depth and palate height to also be reduced at centers at which patients showed unfavorable dental arch relationships.. Anterior arch depth and palate height might be considered in future studies of surgical outcome and in their possible relationship to problems of articulation.

Topics: Analysis of Variance; Cephalometry; Child; Cleft Lip; Cleft Palate; Dental Arch; Face; Humans; Image Processing, Computer-Assisted; Lip; Maxilla; Nose; Palate; Retrospective Studies; Single-Blind Method; Skull; Speech; Statistics as Topic; Treatment Outcome

To compare growth, speech, and nasal symmetry outcomes of three methods of hard palate repair.. Consecutive available records of children born with unilateral bony complete cleft lip and palate over the period 1972 to 1992.. Identical management of lip, nose, alveolus, and soft palate. Hard palate repair by Cuthbert Veau (CV) from 1972 to 1981, von Langenbeck (vL) from 1982 to 1989, or medial Langenbeck (ML) from 1989 to 1991.. For growth: GOSLON yardstick or 5-year model index. For speech: articulation test. Nasal anemometry. For nasal symmetry: Coghlan computer-based assessment. All these measures were developed during the period of data collection but not for this project.. There was a strong trend toward more favorable anteroposterior maxillary growth with the change from CV to vL to ML techniques. This fell short of statistical significance because of the small sample size. There was a significant reduction in cleft-related articulation faults (p =.01) considered to be related to improved arch form. In the absence of improved rates of velopharyngeal insufficiency or nasal symmetry, increased surgical experience was discounted as a significant contribution to improved growth and articulation outcomes.. Reduced periosteal undermining and residual exposed palatal shelf from CV to vL to ML improved incisor relationships and articulation.

Topics: Child; Child, Preschool; Cleft Palate; Female; Humans; Infant; Male; Maxilla; Nose; Oral Fistula; Oral Surgical Procedures; Palate, Hard; Plastic Surgery Procedures; Speech Articulation Tests; Surgical Flaps; Treatment Outcome; Velopharyngeal Insufficiency; Voice Quality

The aim was to study the relationship between perceptual evaluation of speech variables related to velopharyngeal function and the pattern of nasal airflow during the velopharyngeal closing phase in speech in children with and without cleft palate.. Fourteen children with cleft lip and palate or cleft palate only and 15 controls aged 7 and 10 years. All were native Swedish speakers.. Three experienced listeners performed a blinded perceptual speech evaluation. Nasal airflow was transduced with a pneumotachograph attached to a nasal mask. The duration from peak to 5% nasal airflow, maximum flow declination rate, and nasal airflow at selected points in time during the transition from nasal to stop consonants in bilabial and velar articulatory positions in sentences were estimated. The analysis was focused on the perceptual ratings of "velopharyngeal function" and "hypernasality.". A strong association was found between ratings of "velopharyngeal function" and "hypernasality" and the pattern of nasal airflow during the bilabial nasal-to-stop combination /mp/. Both the sensitivity and specificity were 1.00 for the bilabial temporal airflow measure in relation to ratings of "velopharyngeal function." The nasal airflow rate during /p/ in /mp/ had a sensitivity of 1.00 and specificity of 0.92 to 0.96 in relation to ratings of "hypernasality.". Assessment of the nasal airflow dynamics during the velopharyngeal closing phase in speech presents quantitative, objective data that appear to distinguish between perceptually normal and deviant velopharyngeal function with high sensitivity and specificity.

Topics: Articulation Disorders; Case-Control Studies; Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Observer Variation; Pulmonary Ventilation; Sensitivity and Specificity; Speech Disorders; Speech Production Measurement; Velopharyngeal Insufficiency; Voice Disorders

The soft tissue thickness before and after Le Fort I osteotomy was evaluated in 46 cleft patients. The sample consisted of 10 patients with isolated cleft palate (CP, mean age 25.5 years); 10 patients with bilateral cleft lip and palate (BCLP, mean age 21.7 years); and 26 patients with unilateral cleft lip and palate (UCLP, mean age 22.9 years). Patients with bimaxillary surgery, simultaneous rhinoplasty, or V-Y plasty of the upper lip were excluded. Soft tissue changes were analyzed by cephalograms taken shortly before surgery and at 6 months postoperatively. Horizontal advancement varied from 4.1 mm in the UCLP group to 5 mm in the BCLP group. The vertical lengthening varied from 3.7 mm in the CP group to 7.2 mm in the BCLP group. In all cleft types, thinning of the subnasal area, superior labial sulcus, and upper lip (anterior nasal spine-subnasale, point A-soft tissue point A, and prosthion-labrale superius) took place. Significant thinning of the upper lip occurred in the UCLP and BCLP patients. Surgical changes of the lower lip and mandibular area were small and insignificant. There were significant differences in soft tissue thicknesses between different types of clefts. The subnasal area and superior labial sulcus were significantly thicker in the CP group than in the BCLP or UCLP groups, both pre- and postoperatively. The upper lip was thickest in the BCLP group preoperatively but thickest in the CP group postoperatively. The upper lip was thinnest in the UCLP group both before and after the operation.

Topics: Adolescent; Adult; Cephalometry; Cleft Lip; Cleft Palate; Face; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Lip; Male; Mandible; Maxilla; Nasal Bone; Nose; Osteotomy, Le Fort; Statistics as Topic; Vertical Dimension

The aim of this study is to investigate effects of maxillary protraction on soft tissue profile in operated operated unilateral cleft lip and palate (UCLP) patients.. A total of 10 growing UCLP patients (male 7, female 3), age from 8.2 to 12 years old (Average: 10.4 years old), were selected to be treated with maxillary protraction using head gear-chin cap-long hook protraction appliance. The appliance was worn 12-14 hours per day, and the protraction force was 400-500 g each side. The protraction direction was forward and slightly downward. The treatment period was 4.7 months (Average: 5.8 months). Cephalometrics were taken before and after treatment. The changes of soft-tissue profile were studied using the computer-aid X-ray cephalometric analysis.. After protraction, the points of Prn, Sn and Ls moved forward significantly. The distance from points Ls to E plane changed significantly from 0.46 mm before treatment to 1.18 mm after treatment. The angle G-Prn-Pg' decreased significantly, and G-Sn-Pg' changed significantly from -0.30 before treatment to 6.260 after treatment. The anterior-posterior position of mandible and lower lip did not change significantly, the changes of angles Cm-Sn-Ls, A'ls/SiLi had no statistical significance. The results indicated that maxillary protraction could make maxilla and upper lip move forward, and the convexity of soft tissue profile improve significantly.. Maxillary protraction is an effective way to improve the facial deformity of operated UCLP patients. UCLP patients should have early interrupted treatment.

Topics: Cephalometry; Child; Cleft Lip; Cleft Palate; Extraoral Traction Appliances; Female; Humans; Lip; Male; Nose

A brother and a sister show very similar clinical features, including sparse hair in the first year of life, prominent nose, small mouth, micrognathia, high arched palate or cleft palate, crumpled upper helices, flexion limitation of the distal interphalangeal joint of the fingers, and mild developmental delay. Their clinical appearance suggests a premature aging phenotype, but is not really compatible with the hitherto known syndromes of that group. The mode of inheritance is likely autosomal recessive.

Topics: Abnormalities, Multiple; Aging, Premature; Cleft Palate; Ear; Female; Fingers; Hair; Humans; Infant; Infant, Newborn; Male; Micrognathism; Mouth Abnormalities; Nose; Phenotype; Syndrome; Toes

The purpose of this study was to audit the process and outcome in terms of nasal-tip symmetry of the first 20 patients with unilateral complete cleft lip and palate treated by the Pigott alar leapfrog primary nasal correction in the early 1970s and followed for 20 years. Symmetry was assessed using the Coghlan computer-based analysis of frontal and basal views to determine the stability of the correction. The Abyholm technique of alveolar bone grafting was performed in 12 of the 20 patients. Various other secondary procedures have been performed on the nose tip and septum to improve the airway or appearance. Photographs were taken within one year of ages 5, 10, 15 and 20 years, and the lower border of the nose, the alar domes and the nostrils were assessed. To assess the overall change from 5 years to 20 years, both views were available for 17 patients. No significant change was found in the lower border or nostril symmetry, but significant deterioration at the P< 0.01 level was found on the basal view. We assessed the 10, 15 and 20 year views of all 12 patients who had undergone alveolar bone grafting to determine early and late changes. No significant benefit was found from alveolar bone grafting or minor secondary procedures for appearance. Consequently, our criteria for undertaking minor adjustments to improve appearance have become more stringent. We consider that objective reporting of appearance should become essential in peer-reviewed journals.

Topics: Adolescent; Adult; Bone Transplantation; Child; Child, Preschool; Cleft Lip; Cleft Palate; Confidence Intervals; Esthetics; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Male; Nose; Photography; Statistics, Nonparametric; Treatment Outcome

The aim of the study was to visualize different soft tissues in the perioral, nasal, and paranasal region by means of magnetic resonance imaging (MRI) in patients with unilateral cleft lip and palate (UCLP).. In this descriptive study, images of different MRI systems were assessed and compared.. MRI was applied in five consecutive patients operated on for UCLP who underwent secondary lip and nasal correction, two patients who had not had UCLP operations, and five healthy volunteers as controls. The mimic muscles, vessels, and nasal cartilages were evaluated.. It was possible to visualize different parts of the paranasal and perioral mimic muscles and their interlacement in the upper lip. The nasal cartilages were also visible, and the changes after operation were demonstrated.. MRI shows differentiated visualization of soft tissues in the cleft region and their changes after surgery. It is a valuable tool in the preoperative planning and postoperative follow-up in patients with UCLP.

Topics: Adolescent; Adult; Case-Control Studies; Child; Cleft Lip; Cleft Palate; Face; Facial Expression; Facial Muscles; Humans; Infant; Lip; Magnetic Resonance Imaging; Nose

(1) To study the nasal airflow patterns during the velopharyngeal closing phase in speech produced by children with and without cleft palate. (2) To compare the nasal airflow patterns in bilabial, dental, and velar articulation in these children.. Prospective, cross-sectional study of a consecutive series of children with cleft palate referred for routine speech evaluation and controls.. Sahlgrenska University Hospital, Göteborg, Sweden.. Seventeen children with cleft lip and palate or cleft palate only and 22 controls aged 7 and 10 years.. Nasal airflow was transduced with a pneumotachograph attached to a nose mask and registered together with the acoustic speech signal. Sentences containing nasal-to-stop combinations in bilabial, dental, and velar articulatory positions were used.. The duration from peak to 5% nasal airflow, the maximum flow declination rate, and the nasal airflow at selected points in time during the transition from nasal-to-stop consonants.. In the cleft palate group, duration from peak to 5% nasal airflow was clearly longer than among the controls (p <.0001). The declination of airflow was slower (p <.006) and the rate of nasal airflow at the release of the stop consonant was higher (p <.004) in the cleft palate group. Differences between bilabial versus dental and velar articulation were found in the control group.. Studies of the temporal and dynamic characteristics of the nasal airflow variations during speech appear potentially useful for the assessment of velopharyngeal function.

Topics: Articulation Disorders; Case-Control Studies; Child; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Female; Humans; Male; Nose; Palate, Soft; Prospective Studies; Pulmonary Ventilation; Speech Production Measurement; Statistics, Nonparametric; Velopharyngeal Insufficiency; Voice Quality

The protruding premaxilla represents the most severe problem in the surgical closure of a bilateral cleft lip, alveolus and palate (BCLP). In principle there are two methods to overcome this obstacle: (1) preliminary lip adhesion and (2) presurgical repositioning with intraoral devices. According to the various degrees of premaxillary protrusion, sometimes adhesion alone is sufficient, if the surgical technique is unlikely to break down. In this paper a refined adhesion method is presented, withstanding traction to the wound margins and concomitantly enables lip and nose repairs in a single second operation. For patients with severe premaxillary protrusion, presurgical use of a Latham appliance achieves conditions for safe lip adhesion as above. Both treatment methods are outlined.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant; Lip; Maxilla; Nasal Septum; Nose; Orthodontic Appliances; Surgical Flaps; Suture Techniques

Lip repair and synchronous columella lengthening in bilateral clefts of the lip, alveolus and palate following lip adhesion according to the method outlined in Part 1 is described in this part of the paper. Together with lip and nose repair the gingivo-periosteoplasty can also be performed when the alveolar process is perfectly aligned and the greater and lesser segments abutt onto each other.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Dermatologic Surgical Procedures; Gingivoplasty; Humans; Lip; Maxilla; Nose; Periosteum; Surgical Flaps

The last part of this series outlines closure of the hard palate with various modifications depending on the remaining width of the cleft. Additionally the necessity and parameters of follow-up documentation are emphasized and detailed. For the two patients shown in Parts 1 and 2, the corresponding data are given. Accumulated facial growth curves of all the other patients treated the same way are also given. The main results are: (A) lip and nose can be reconstructed much more easily after repositioning of the premaxilla and (B) the reported anterior growth delay following use of the Latham appliance could not be confirmed during the ongoing follow-up.

Topics: Alveolar Process; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Lip; Male; Maxilla; Maxillofacial Development; Nose; Palate, Hard; Treatment Outcome

The purpose of this study was to assess the ability of shape parameters of nasal morphology to predict esthetics in individuals with complete unilateral cleft lip and palate (CUCLP).. This retrospective study involved 28 patients with repaired CUCLP. Nostril morphology was analyzed using nose casts and a video-imaging technique. Calculated shape parameters included area, perimeter, centroid, angle of the principal axis, major and minor moments of area, anisometry, bulkiness, lateral offset, and three-dimensional internostril angles. Esthetics was assessed using a panel of six orthodontists who rated nasal esthetics from frontal, lateral, basal, and three-quarters view slides and from nose casts. Correlations between esthetics and the shape parameters were completed using the entire group as well as using two statistically determined subsets: those with the best and those with the worst esthetics.. Nasal esthetics was related to only the perimeter and bulkiness parameter ratios. Symmetry of the perimeters between the right and left nostrils positively correlated with better esthetics using the entire sample group while symmetry of bulkiness between the right and left nostrils positively correlated with better esthetics using both the entire sample group and the best and worst subsets.. Only perimeter and bulkiness showed positive correlations with nasal esthetics. The group of parameters used to assess nostril morphology had neither significant correlation with-nor predictive power for-esthetics. Thus, an assessment of the entire nasal surface topography in three dimensions needs to be completed and assessed with respect to predictability of nasal esthetics.

Topics: Adolescent; Adult; Alveoloplasty; Bone Transplantation; Cephalometry; Child; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Image Processing, Computer-Assisted; Male; Models, Anatomic; Nose; Observer Variation; Orthodontic Appliances; Photography; Reproducibility of Results; Retrospective Studies; Statistics as Topic; Statistics, Nonparametric; Video Recording

The wide diversity of bilateral facial clefts makes it most difficult to assess surgical success, particularly in terms of long-term outcome. The aim of this work was to examine the rationale for the current protocol used for cleft surgery at the Grenoble University Hospital. In a first group of 28 children, a 3-step surgical protocol was applied. The first two steps were performed between 4 and 8 months with at least 3 months between each procedure. Skoog's unilateral cheilo-rhino-uranoplasty was used, associated with a periosteal tibial graft. The third step, performed between 10 and 12 months, was for staphylorraphy. Outcome was analyzed at 15 years and evidenced the deleterious effect of excessive and asymmetrical premaxillary scars, of the 2-step cheiloplasty and of columella lengthenings from the lip. The frequency of secondary revision of the superior labial vestibule and the medial labial tubercule (43%) was considered to be high; this procedure should be re-examined as should be osteotomy (32% revision). Palatine closure, acquired in 82% of the cases and premaxillary stability, achieved in 86%, would appear to favor use of the periosteal tibial graft. The osteogenic capacity of this graft tissue was less satisfactory after a second harvesting (from the same tibia three months later). These results have led us to modify our protocol, favoring early and total closure of the bony palate and continued use of the periosteal tibial graft. We now use the following operative protocol: premaxillary alignment using an active orthopedic plate at 2 months, lip adhesion associated with staphylorraphy and passive palatine contention plate at 3 months, definitive bilateral cheilo-uranoplasty associated with a single periosteal graft at 7 months. The preliminary results with this protocol in a group of 12 children have shown better quality scars, more harmonious maxillary arches, an excellent occlusion of the deciduous dentition, and preservation of the positive results obtained with the periosteal tibial graft.

Topics: Adolescent; Age Factors; Bone Transplantation; Child; Cicatrix; Cleft Lip; Cleft Palate; Clinical Protocols; Dental Arch; Dental Occlusion; Follow-Up Studies; Humans; Infant; Lip; Longitudinal Studies; Maxilla; Nose; Osteotomy; Palatal Obturators; Palate; Periosteum; Reoperation; Treatment Outcome

Many authors use a preliminary orthopedic procedure before cleft lip and palate surgical closure in order to prevent possible bone distortion following the rupture of the muscle belts resulting from the cleft. Actually, this is generally not only an orthopedic treatment but rather a surgical orthopedic step which includes lip adhesion before the surgical closure of the clefts. Following the procedures proposed by Georgiade and Latham, we have used since 1996 a treatment based on traction applied with an elastic chain on splints attached by transmaxillary pins for certain types of clefts, namely unilateral complete clefts with endognathy of the small fragment, unilateral complete clefts larger than 7 mm, bilateral wide complete clefts with premaxilla protrusion, and bilateral wide complete clefts with collapsus and premaxillary protrusion. Technical procedures vary with the type of cleft. Standard procedures with or without jacks are used for the other types of complete clefts. These orthopedic procedures with elastic traction are performed between the 3rd and 6th week, before lip adhesion of the upper part of the lip (combined with release of skin and subcutaneous tissues from the underlying alar cartilage). A palatine plate with or without a jack, fitted most of the time with a spring for nostril support, is then inserted until surgical closure.

Topics: Bone Nails; Cleft Lip; Cleft Palate; Dental Prosthesis Design; Dermatologic Surgical Procedures; Humans; Lip; Maxilla; Nose; Orthodontic Appliance Design; Orthodontic Appliances, Functional; Palatal Obturators; Splints

Topics: Age Factors; Child; Child, Preschool; Cleft Lip; Cleft Palate; Developing Countries; Humans; Infant; Infant, Newborn; Lip; Nose; Palate; Parents; Patient Care Planning; Postoperative Complications; Time Factors

This paper introduces a surgical technique for vestibuloplasty after secondary alveolar bone grafting of patients with cleft lip and palate (CLP). This paper also reports on the patients who underwent this modified vestibuloplasty.. The vestibuloplasty technique described in this paper consists of: (1) reduction of submucosal scar tissue of the upper lip, (2) V-Y plasty of the superficial mucosa, (3) placement of horizontal mattress sutures between nostril floor skin and freed marginal mucosa, (4) application of artificial skin to cover the exposed periosteal surface, and (5) use of a removable retention splint.. This surgical procedure appears to be very useful for patients with CLP. The technique enables the surgeon to obtain an adequate sulcus depth around the graft area. In addition, this technique releases the mucosal scar contraction and improves the shape and mobility of the upper lip.

Topics: Adolescent; Alveoloplasty; Bone Transplantation; Child; Cicatrix; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Lip; Male; Mouth Mucosa; Nose; Periosteum; Skin, Artificial; Splints; Suture Techniques; Vestibuloplasty; Wound Healing

To propose a new method, which allows for a complete description of primary and secondary cleft palates, incorporating elements that are related to the palate, lip, and nose that will also reflect the complexity of this problem.. To describe the type of cleft, two embryonic structures were considered: (1) the primary palate, formed by the prolabium, premaxilla, and columella and (2) the secondary palate, which begins at the incisive foramen and is formed by a horizontal portion of the maxilla, the horizontal portion of the palatine bones, and the soft palate. Anatomical characteristics to be considered were defined, and a new method is proposed to more fully describe any cleft.. A description of five cases was made using the method proposed in this work and compared with other published methods for the classification and description of clefts.. A mathematical expression was developed to characterize clefts of the primary palate, including the magnitude of palatal segment separation and the added complexity of bilateral clefts, yielding a numerical score that reflects overall complexity of the cleft. Clefts of the secondary palate are also considered in a separate score. Using this method, it is possible to incorporate elements that are not considered in other approaches and to describe all possible clefts that may exist.

Topics: Algorithms; Cleft Lip; Cleft Palate; Humans; Lip; Maxilla; Nose; Palate; Palate, Hard; Palate, Soft; Severity of Illness Index

The purpose of this study was to examine possible associations between severity of clefting in infants and maxillary growth in children with complete unilateral cleft lip and palate.. This was a retrospective study of measurements made on infant maxillary study casts and maxillary cephalometric variables obtained at 5 to 6 years of follow-up.. The study was performed at the Institute of Reconstructive Plastic Surgery of New York University Medical Center, New York, New York.. Twenty-four consecutive nonsyndromic unilateral complete cleft lip and palate patients treated during the years 1987 to 1994.. All the patients received uniform treatment (i.e., presurgical orthopedics followed by gingivoperiosteoplasty to close the alveolar cleft combined with repair of the lip and nose in a single stage at the age of 3 to 4 months). Closure of the palate was performed at the age of 12 to 14 months.. Infant maxillary study cast measurements correlated in a statistically significant manner with maxillary cephalometric measurements at age 5 to 6 years.. The results demonstrate the large variation in the severity of unilateral cleft lip and palate deformity at birth. Patients with large clefts and small arch circumference, arch length, or both demonstrated less favorable maxillary growth than those with small clefts and large arch circumference or arch length at birth.

Topics: Age Factors; Alveolar Process; Alveoloplasty; Cephalometry; Child, Preschool; Cleft Lip; Cleft Palate; Dental Arch; Follow-Up Studies; Gingivoplasty; Humans; Infant; Lip; Maxilla; Models, Dental; Nose; Palatal Obturators; Palate; Periosteum; Retrospective Studies; Statistics as Topic

This paper is a report on a procedure to perform open tip rhinoplasty at the time of lip repair in unilateral and bilateral cleft lip and palate deformity. A total of 69 patients who had this operation between 1994 and 1997 have been reviewed. Conventionally there is hesitation to do radical nasal correction for the cleft lip patient because of the fear of possible growth retardation. The present technique, while it achieves excellent postoperative results constantly, does not entail any more trauma to the cartilage complex than any of the conventional closed rhinoplasty techniques. Early results obtained by this method appear to be superior to those by closed rhinoplasty techniques.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Male; Nose; Rhinoplasty; Surgical Flaps; Treatment Outcome

This study investigated the effect of velopharyngeal insufficiency on aerodynamic measures of laryngeal function in children with cleft palate.. Data were analyzed using analysis of covariance. The independent variable was velopharyngeal closure, and the dependent variables were laryngeal resistance, laryngeal airflow, and transglottal pressure. Age and gender were covariates.. The data were collected at The Craniofacial Center, University of Illinois, a tertiary health care center located in Chicago.. Thirty-six children with cleft palate were recruited from among the patients at The Craniofacial Center. Ten children with velopharyngeal areas >5 mm2 during oral speech were placed in the incomplete closure group, while 26 children with areas <1 mm2 were placed in the complete closure group.. The three dependent variables (transglottal pressure, transglottal airflow, and laryngeal resistance) were measured.. Laryngeal resistance and transglottal pressure were significantly higher, and transglottal airflow was significantly lower in the group with complete closure.. In summary, cleft palate patients with complete velopharyngeal closure exhibited higher laryngeal resistances than those with incomplete closure.

Topics: Airway Resistance; Analysis of Variance; Child; Cleft Palate; Female; Humans; Larynx; Male; Nose; Pharynx; Pressure; Signal Processing, Computer-Assisted; Velopharyngeal Insufficiency

Because many patients with velocardiofacial syndrome (VCFS) are first examined by otolaryngologists for ear or speech problems before being diagnosed with VCFS, we describe a series of patients with this genetic disorder, which is associated with multiple anomalies, including velopharyngeal insufficiency, cardiac defects, characteristic facial features, and learning disabilities.. We retrospectively analyzed the medical charts and available nasoendoscopic observations for 35 patients who were diagnosed with VCFS and who had a microscopic deletion in chromosome 22q11 as shown by DNA probe and fluorescence in situ hybridization.. For most patients, the medical chart documented cardiac anomalies, velopharyngeal insufficiency with hypernasal speech, and characteristic facial features including nasal, auricular, craniofacial, and ocular abnormalities. Incidence of middle ear infection with associated conductive hearing loss was also high and necessitated early placement of pressure equalization tubes. Some patients were treated with adenoidectomy for chronic otitis media; consequently, velopharyngeal insufficiency and hypernasal speech worsened. Nasoendoscopic examination as documented in the medical chart showed occult cleft palate, a small adenoid pad, and pulsation in the muscular wall.. Otolaryngologists have an important role in diagnosis and treatment of persons with VCFS and therefore should familiarize themselves with the typical history and most frequent head and neck manifestations of this syndrome.

Topics: Adolescent; Adult; Child; Child, Preschool; Chromosome Deletion; Chromosomes, Human, Pair 22; Cleft Palate; Craniofacial Abnormalities; DNA Probes; Ear, External; Endoscopy; Eye Abnormalities; Female; Hearing Loss, Conductive; Heart Defects, Congenital; Humans; In Situ Hybridization, Fluorescence; Infant; Learning Disabilities; Male; Nose; Otitis Media; Otorhinolaryngologic Diseases; Retrospective Studies; Speech Disorders; Syndrome; Velopharyngeal Insufficiency

Major characteristics of the acrocallosal syndrome include severe mental retardation, agenesis or hypoplasia of the corpus callosum, and polydactyly of fingers and toes. In the past few years, anencephaly has also been noted, together with other midline defects. We report on a nonconsanguineous, Norwegian couple with a history of two pregnancies with a male and a female fetus, respectively, with anencephaly, median cleft lip and palate, omphalocele, and preaxial polydactyly, suggesting the diagnosis of the acrocallosal syndrome. Both fetuses also lacked eyes and nose, a finding not previously reported in the acrocallosal syndrome. Microphthalmia has been reported in the hydrolethalus syndrome, which may be caused by mutations in the same gene as the acrocallosal syndrome. The present report adds support to the hypothesis that the acrocallosal and hydrolethalus syndromes may be allelic conditions. The family history is consistent with autosomal recessive inheritance.

Topics: Abnormalities, Multiple; Agenesis of Corpus Callosum; Anencephaly; Anophthalmos; Cleft Lip; Cleft Palate; Corpus Callosum; Female; Fetus; Genes, Recessive; Hernia, Umbilical; Humans; Male; Nose; Nuclear Family; Polydactyly; Pregnancy; Syndrome; Ultrasonography, Prenatal

The purpose of this investigation was to determine whether temporal patterns of oral-nasal balance differentiate speakers with cleft palate who exhibit adequate and inadequate velopharyngeal function.. The Nasal Accelerometric Vibrational Index (NAVI) was used to measure the time course and amplitude of oral-nasal balance during the productions of syllables, words, and sentences. The measures obtained include mean amplitude, time integral (area under the curve), absolute duration, relative duration, rise time, and fall time.. The subjects for this study were 20 children with repaired cleft palates with or without cleft lip. Ten children (aged 5 through 18 years) were assigned to the velopharyngeal competence (VPC) group (normal oral-nasal resonance, no nasal emission of air). Ten children (aged 3 through 19) were assigned to the velopharyngeal insufficiency (VPI) group (hypernasal speech, velopharyngeal gap observed via nasal endoscopy).. Both mean amplitude and time integral of NAVI were greater in the VPI group than in the VPC group (p < .01). Absolute duration and relative duration of the NAVI signal were greater in the VPI group (p < .01). NAVI rise time was shorter in the VPI group (p < .01), and NAVI fall time was longer in the VPI group (p < .01). The amplitude measures contributed the most to discrimination of speaker group, but the durational measures become increasingly influential as a function of a speech task.. Although amplitude of nasalization may have the strongest perceptual salience in classification of velopharyngeal status, the temporal component may exert greater influence during more complex speech tasks.

Topics: Acceleration; Adolescent; Adult; Area Under Curve; Child; Child, Preschool; Cleft Lip; Cleft Palate; Endoscopy; Humans; Mouth; Nose; Palate, Soft; Pharynx; Phonetics; Speech; Speech Disorders; Speech Perception; Time Factors; Velopharyngeal Insufficiency; Vibration

The primary research aim of this study was to compare long-term differences in craniofacial morphology at adulthood between two groups of unilateral cleft lip and palate (UCLP) patients: one operated by primary periosteoplasty and the other by primary bone grafting.. The two groups were followed longitudinally at 5-year intervals; this study examined the 15- to 20-year age range.. University hospital/center located in Prague, Bohemia, Czech Republic.. 17 men with primary bone grafting, 29 men with primary periosteoplasty.. Primary bone grafting or periosteoplasty.. Serial cephalometric radiographs.. Conventional cephalometric and finite element measures.. The mandibular symphysis was larger in the bone-grafted group. The periosteoplasty group displayed a more horizontal growth of the mandible with less rotation than the bone-grafted group. There were no other significant differences.. We conclude that the original outcomes differences observed in childhood and adolescence were masked by skeletal and dental compensations in adulthood. These observations can be attributed to both natural growth and clinical intervention.

Topics: Adolescent; Adult; Bone Transplantation; Cephalometry; Cleft Lip; Cleft Palate; Finite Element Analysis; Follow-Up Studies; Frontal Bone; Humans; Longitudinal Studies; Male; Mandible; Maxilla; Maxillofacial Development; Nose; Periosteum; Rotation; Skull Base; Treatment Outcome

This study was conducted to evaluate the soft tissue profile changes after maxillary advancement with distraction osteogenesis (DO).. Sixteen subjects underwent maxillary advancement with rigid external distraction after a high Le Fort I osteotomy. There were 11 male and 5 female patients, ages 5.2 to 25.7 years. The subjects included 9 with unilateral cleft lip and palate (UCLP), 4 with bilateral CLP, 2 with facial clefts and bilateral CLP, and 1 with cleft palate. Pretreatment and posttreatment lateral cephalograms were compared to evaluate the changes in soft tissue profile. A line 7 degrees below the SN plane was used as the horizontal coordinate, and a perpendicular line through Sella was used as the vertical coordinate in an XY coordinate system.. The preoperative facial concavity (N'SnPg') was reduced by 15.59 degrees, and the nasal tip moved 3.75 mm forward and 2.05 mm upward. These changes were positively correlated with the change of ANS position. The soft-tissue-to-hard-tissue ratio was 0.53:1 for nasal tip and ANS. The ratio was negatively correlated with the age of the patient. The ratio of soft tissue A point to skeletal A point was 0.96:1 and for the incisal edge to vermilion border of the upper lip it was 0.8:1. The soft tissue B point and Pg did not change significantly with maxillary distraction. However, the nasolabial angle increased by 4.96 degrees, the upper lip curvature flattened by 0.65 mm, and the lower lip curvature was accentuated by 0.89 mm after distraction. The amount of upper incisal exposure increased from 1.1 to 5.01 mm in the rest position.. Maxillary DO improved the soft tissue profile by increasing nasal projection, normalizing the nasolabial angle, and making the upper lip more prominent. More upper anterior tooth show in the rest position was obtained, but the upper lip length did not change. The concave facial profile became convex, with improved facial balance and aesthetics.

Topics: Adolescent; Adult; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Esthetics, Dental; External Fixators; Face; Female; Follow-Up Studies; Humans; Lip; Male; Maxilla; Nose; Oral Surgical Procedures; Osteogenesis, Distraction; Osteotomy, Le Fort; Statistics, Nonparametric; Treatment Outcome

Cleft lip and palate is among the most common congenital anomalies. Its association with major blood disorders has rarely been reported. The purpose of this study was to report two patients who had major blood diseases associated with cleft lip and palate.. From June 1995 to December 1997, there were 2700 patients with cleft lip, cleft palate, or both who received treatment at Chang Gung Memorial Hospital. Two of them were found to have major hematological disorders. In both cases, the disorder was detected by preoperative blood cell counts and white cell differentiation. Case 1 was a 21-year-old woman patient with repaired right cleft lip. She was admitted for alveolar bone grafting and closure of oronasal fistula. Abnormal presentation of blast cells was found, and subsequent bone marrow study confirmed acute lymphocytic leukemia. Case 2 was a 26-year-old man with left secondary cleft lip nasal deformity scheduled to receive staged reconstructive operations. An elevated platelet count was found and subsequently confirmed to represent essential thrombocytosis. In both cases, reconstructive operations for the cleft-related deformities were performed.. Association of major hematological disorders and cleft lip, palate, or both is rare and is reported herein.

Topics: Adult; Alveolar Process; Blood Cell Count; Bone Transplantation; Cleft Lip; Cleft Palate; Contraindications; Diagnostic Tests, Routine; Female; Humans; Male; Nose; Oral Surgical Procedures; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Thrombocytosis

Individuals with unilateral cleft lip and palate (UCLP) manifest a plethora of phenotypic characteristics, including asymmetric development of the middle and lower facial skeleton. The purpose of this study was to retrospectively investigate the development of cranial base asymmetries in patients with UCLP noted on posteroanterior cephalometric radiographs.. Thirty individuals with UCLP and 64 controls participated in this study. Medial and lateral cranial base asymmetries were analyzed on frontal cephalometric radiographs relative to three developmental stages. Furthermore, the development of horizontal and vertical lower facial asymmetry in these patients with UCLP was assessed in relation to cranial base, nasomaxillary, and dentoalveolar structures.. Individuals with UCLP demonstrated cranial base asymmetries that did not significantly differ from individuals without cleft. In addition, lower facial asymmetry in patients with UCLP correlated with horizontal lower facial and dentoalveolar asymmetries but not with cranial base or nasomaxillary structures.. No significant vertical cranial base asymmetries were detected in patients with UCLP. Horizontal lower facial asymmetry appeared to develop in close relation to the vertical asymmetries of mandibular fossae and dentoalveolus.

Topics: Adolescent; Alveolar Process; Bone Diseases; Cephalometry; Child; Cleft Lip; Cleft Palate; Facial Asymmetry; Facial Bones; Female; Humans; Male; Mandible; Maxilla; Maxillofacial Development; Nose; Phenotype; Retrospective Studies; Skull Base; Tooth; Vertical Dimension

The purpose of this study was to develop a video-imaging mathematical method to assess nostril morphology.. This retrospective study involved two age-matched groups: 28 subjects with complete unilateral cleft lip and palate (CUCLP) and 19 noncleft controls. Nose casts were reproducibly oriented in a jig such that the casts could be rotated about the coronal axis. Video images of the nostrils were captured and then analyzed for area, perimeter, centroid, principal axis, moments about the major and minor axes (I11, I22), anisometry, bulkiness, lateral offset, internostril angle, and rotational angle.. All parameters identified nostril asymmetry in both groups. The results of the analyses using anisometry, I11, and I22 showed that, in both groups, one nostril was rounder and one was more elliptical. This asymmetry, however, differed between the two groups, and the difference was primarily based on the degree of ellipticity of the nostrils. Maximum dimension, perimeter, lateral offset, I11, and I22 were more asymmetric in the cleft group. In the control group, the right nostril was more elliptical and had a greater perimeter, and the left-side nostril had a greater bulkiness (enfolding).. The method developed was validated for assessment of nasal morphology in cleft and noncleft samples. Nostril morphology was asymmetric in both groups but more asymmetric in the cleft group than the control group. The dominant influence of the cleft resulted in more elliptical noncleft nostrils and greater nostril shape asymmetry in the cleft group. The validated video-imaging method can now be used to assess the efficacy of treatment on nasal morphology.

Topics: Adolescent; Adult; Algorithms; Analysis of Variance; Calibration; Case-Control Studies; Cephalometry; Child; Cleft Lip; Cleft Palate; Female; Humans; Image Processing, Computer-Assisted; Male; Models, Anatomic; Models, Biological; Nose; Nose Deformities, Acquired; Retrospective Studies; Statistics, Nonparametric; Videotape Recording

Cleft lip/palate (CLP) is a common human congenital defect in which the maxillary lateral incisors are often absent, malformed, and malpositioned. The present study was designed to examine the origin of the upper primary lateral incisor relative to the medial nasal process (MNP) and maxillary process (MP) fusion area and to the premaxillary/maxillary (incisive) suture in monkeys.. Scanning electron microscopy, histology, skeletal staining, and drying techniques were used to study facial development in embryo and fetal monkey specimens. A teratogenic dose of cyclophosphamide was administered to pregnant monkeys prior to fusion of the MNP and MP and fetuses were examined for CLP.. Formation of the anterior maxilla involved fusion of the MNP and MP at stages 14-18. At stages 18-20, the palatal portion of the MNP had formed the medial and lateral incisive mounds. By stage 22, the upper primary lateral incisor has formed within the MP, lateral to the MNP/MP fusion area and to the ossifying premaxilla. Ossification of the premaxilla begins in the MNP and subsequently spreads laterally across the MNP/MP fusion area into the MP. Accordingly, the lateral incisor undergoes a complex positional shift (mainly medial) relative to the incisive suture both prenatally and postnatally and is finally located medial to the suture. Examination of the cyclophosphamide-induced CLP fetuses showed that the lateral incisor is located lateral to the alveolar cleft and does not shift medial to the incisive suture.. Understanding the origin of the lateral incisor (the tooth closest to the cleft) and the shift after its formation provides clues to high incidence of malformations and ectopia of this incisor in cleft patients.

Topics: Alveolar Process; Animals; Cleft Lip; Cleft Palate; Coloring Agents; Cranial Sutures; Cyclophosphamide; Disease Models, Animal; Embryonic and Fetal Development; Face; Female; Humans; Incisor; Macaca fascicularis; Macaca mulatta; Maxilla; Microscopy, Electron, Scanning; Nose; Odontogenesis; Osteogenesis; Palate; Pregnancy; Teratogens; Tooth Migration

We describe the clinical findings and natural history in two unrelated deeply mentally retarded females, now 28 and 20 years old respectively. Both presented prenatal growth retardation and severe postnatal growth retardation. Their craniofacial appearance is distinct with nasal hypoplasia, triangular mouth and thin lips. Both have a cleft palate and a retinal coloboma at the right eye. Motor development is below the age of 1 year with a complex neurological syndrome with axial hypotonia and spastic quadriplegia.

Topics: Abnormalities, Multiple; Cleft Palate; Coloboma; Craniofacial Abnormalities; Facies; Female; Growth Disorders; Humans; Intellectual Disability; Nose; Retina; Syndrome

Oral and maxillofacial surgery approaches and techniques are important considerations in the comprehensive management of cleft nasal deformities. Establishing a proper bony base for the soft tissues can involve secondary procedures such as alveolar cleft grafting and orthognathic surgery. The cleft deformity itself, but particularly previous surgery, usually dictate modifications of orthognathic surgery techniques. Distraction osteogenesis potentially allows for earlier intervention as well as more extensive bony changes with decreased surgical risk.

Topics: Alveolar Process; Alveoloplasty; Bone Transplantation; Cleft Lip; Cleft Palate; Humans; Nose; Oral Surgical Procedures; Orthodontics, Corrective; Osteogenesis, Distraction; Osteotomy, Le Fort; Palatal Expansion Technique

The further improvement of well-established techniques in primary and secondary cleft surgery requires a detailed and interdisciplinary knowledge and observation of anatomical, functional and developmental problems. An investigation into the macroscopic and microscopic anatomy of the perinasal and perioral muscles and parts of the human nasal septum, as well as into the pathomorphology of ancient skulls with untreated clefts is presented. On this basis an interpretation of clinical findings in untreated newborns compared with surgically treated CLP-patients has been undertaken. The 3D-CT, superimposing photography and coloured experimental settings of nasal airflow complete the visualisation of the anatomical and functional findings.

Topics: Adult; Aging; Cleft Lip; Cleft Palate; Esthetics; Facial Expression; Facial Muscles; Functional Laterality; Humans; Infant, Newborn; Maxillofacial Development; Muscle Development; Nasal Septum; Nose; Skull; Tomography, X-Ray Computed

To describe subtle nasal deformities and microform cleft lips in parents whose children have complete cleft lip deformities.. Clinical analyses of three parents whose children had complete cleft lips. Subtle nasal deformities and microform cleft lips were identified.. An institutional general hospital: Manuel Gea González Cleft Lip and Palate Clinic in Mexico City, Mexico.. The study first examined the parents of all complete and incomplete cleft lip-palate patients who were seen from March 1994 to February 1997 by the authors (n = 1000). We identified three patients, each of whom had one parent who showed signs of subtle nasal deformity and microform cleft lip.. None for the parents. Interventions in the children with cleft lips and palates were known.. Qualitative photographic analyses were performed. Nostril symmetry, septal deviation, nasal floor position, and orbicularis oris malinsertions were carefully examined.. Three of the evaluated parents had one alar cartilage caudally displaced and a deviated septum. One parent's nasal floor was depressed. Two parents also had evidence of a minimal orbicularis oris muscle fissure located in the upper lip.. Genetic evaluations of children with complete and incomplete cleft lips might also include thorough evaluation of their parents. Although small in size, this study of three case histories identified nasal and lip deformities in the patients' parents.

Topics: Adult; Cleft Lip; Cleft Palate; Family Health; Female; Genetic Counseling; Genetic Variation; Humans; Infant, Newborn; Male; Nasal Cavity; Nasal Septum; Nose

We have observed clinically that some speakers wearing a speech appliance for correction of velopharyngeal incompetence can blow with variable intensity without nasal air escape. This clinical finding suggests that tightness of velopharyngeal closure may be regulated in accordance with oral air pressure during blowing. The purposes of this electromyographic study were (1) to examine whether levator vell palatini muscle activity can be changed in relation to oral air pressure during blowing when the speech appliance is removed, (2) to clarify whether or not the change is related to the severity of velopharyngeal incompetence, and (3) to examine whether placement of a speech appliance can alter levator muscle activity into the equivalent of that of normal speakers during blowing.. Eight patients with repaired cleft palate, who routinely wear a palatal lift prosthesis (PLP) or a hybrid speech appliance of a pharyngeal bulb and palatal lift (bulb-PLP), served as subjects. Subjects were classified into one of two groups according to their speech appliance (PLP group and bulb-PLP group). Electromyography of the levator veli palatini muscle was recorded with a speech appliance in place and then with the speech appliance removed as the subject blew through a tube at three different effort levels.. In the removed condition, the change in levator activity in relation to oral air pressure was variable across subjects in the bulb-PLP group, whereas levator activity changed in relation to oral air pressure change for all subjects in the PLP group. However, levator activity changed in relation to oral air pressure with either speech appliance in place for all subjects irrespective of their speech appliance types.. The severity of velopharyngeal incompetence might be related in part to change in levator activity in association with oral air pressure. The effect of a speech appliance to correct velopharyngeal incompetence might consist not only of mechanical obturation of the velopharynx but also of alteration of velopharyngeal function to become similar to normal speakers. Moreover, it is likely that the velopharyngeal system could be well regulated so as to exhibit a consistent outcome of velopharyngeal function.

Topics: Adolescent; Adult; Air Pressure; Child; Cleft Palate; Electromyography; Female; Humans; Male; Mouth; Nose; Palatal Muscles; Palatal Obturators; Palate, Soft; Reproducibility of Results; Speech; Speech Therapy; Velopharyngeal Insufficiency

The purpose of this study was to analyze the geometry of the primary cleft lip nasal deformity using three-dimensional computerized tomography in a group of 3-month-old infants with complete unilateral cleft lip and palate before surgical intervention. Coordinates and axes were reconfigured after the three-dimensional image was oriented into neutral position (Frankfurt horizontal, true anteroposterior, and vertical midline). Display and measurement of skin surface and osseous tissues were achieved by adjusting the computed tomographic thresholds. S-N, N-ANS, S-N-O, and S-N-ANS were measured from true lateral views. Biorbital (LO-LO), interorbital (MO-MO), intercanthal (en-en), and nasal (al-al) widths were measured from the anteroposterior view. The bony alveolar cleft width was measured from the inferior view. The study group was divided into two groups on the basis of skeletal alveolar cleft width: six patients with clefts narrower than 10 mm and six patients with clefts wider than 10 mm. Only the S-N-ANS angle differed between the two groups, i.e., it was greater in the group with the wider clefts (p < 0.05). Coordinates of six landmarks at the base of the nose [sellion (se), subnasale (sn), cleft-side and noncleft-side subalare (sbal-cl and sbal-ncl), and the most posterior point on the lateral piriform margins (PPA-CL and PPA-NCL)] were obtained for analysis of the nasal deformity. On average, the subnasale point was anterior to sellion and deviated to the noncleft side; the cleft-side sbal point was more medial, posterior, and inferior than the noncleft-side sbal point; and the PPA point on the cleft-side piriform margin was more lateral, posterior, and inferior than the PPA point on the noncleft side. These discrepancies were not universally observed. However, in all patients, four findings were observed without exception (p < 0.01): (1) subnasale (sn) was deviated to the noncleft side (mean distance from midline, 5.0 mm; range, 2 to 9.5 mm), (2) the cleft-side alar base (sbal-cl) was more posterior than the noncleft-side alar base (sbal-ncl) (mean difference, 3.6 mm; range, 1 to 5.5 mm), (3) the noncleft-side alar base (sbal-ncl) was further from the midline than the cleft-side alar base (sbal-cl) (mean difference in lateral distances of sbal-ncl and sbal-cl from the midline, 2.8 mm; range, 0.5 to 7 mm), and (4) the cleft-side piriform margin (PPA-CL) was more posterior than the noncleft side piriform margin (PPA-NCL) (mean difference, 2.1 mm; ran

Topics: Cephalometry; Cleft Lip; Cleft Palate; Humans; Image Processing, Computer-Assisted; Infant; Nose; Skull; Tomography, X-Ray Computed

Nasal deformity in unilateral cleft lip and palate patients increases with time, tongue malposition being one of the causes. Some authors have emphasized the role of nasal and adjacent facial musculature as active extrinsic agents. Another cause of alar deformity can be the lack of a proper foundation because of a maxillary hypoplasia in the region of the pyriform foramen. If alar collapse occurs, the septum bends convexly toward the cleft side. Tissues are soft and plastic during the neonatal period. Once the infant is about 3 months of age, it becomes difficult to correct the nasal deformity. Therefore, any resource used from the first day, and mainly during the first 15 days of life, will be useful to prevent the increasing deformity and to avoid the surgical correction. A controlled clinical trial was planned to compare the anthropometric measurements of the nasal region in two series of patients with unilateral complete cleft lip. In the first group, we included 44 patients who came to our clinic during the first 2 days of life and the second group consisted of 47 patients who were more than 15 days of age at the time of the first consultation. To provide control data for the evaluation of the results after 6 years of follow-up in both series of cleft patients, we also included a third group of 48 healthy 6-year-old children. A nasal component added to the occlusal prostheses was only used in the first group up to the time of surgery. The same surgeon performed a Millard II procedure with muscular reposition as described by Delaire in all the patients. Nasal measurements taken with a caliper, obtained directly from plaster models by using surface impressions of the babies, were confirmed by a laser three-dimensional measuring device. The statistical comparison between both series showed a significant increase of the columellar length in the first group. A 6-year follow-up to compare growth and cosmetic results of the nose revealed a better and permanent nasal nostril symmetry and no alar cartilage luxation in the patients who had had the nasal component. These results highlight the importance of the early treatment and allow us to suggest the nasal prostheses as a way to prevent the increasing nasal deformity, to help nasal remodeling, to obtain columellar elongation, and to avoid or decrease the need for primary surgery of the cleft nose.

Topics: Anthropometry; Child; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Nose; Splints

This study investigates the nasal airway in unilateral cleft palate patients by means of a noninvasive, objective diagnostic method that provides topographic information about the airway profile.. A consecutive sample of patients was measured.. Cleft palate rehabilitation center of the University of Mainz, Germany.. Forty-nine subjects were investigated: 34 full-grown patients with complete unilateral cleft lip and palate and 15 controls with subjective normal nasal patency.. A transnasal series of three acoustic measurements of nasal volume was performed per nostril; measurements were taken both before and after decongestion with 0.3 mg xylometazoline per nostril. Minimum cross-sectional area, nasal volume, and decongestion capacity were calculated for both the cleft side and the contralateral side and for both nasal sides in controls.. Pathologic obstructions (<0.4 cm2) were detected on the cleft side in 75% of patients but were detected in only 15% of patients on the contralateral side (p < .001). The valve area of the cleft side (0.32 +/- 0.2 cm2) yielded significantly (p < .001) lower cross-sectional values compared with the contralateral side (0.56 +/- 0.1 cm2). Total nasal volume was determined to be 35% smaller on the cleft side (p < .001). Significantly higher decongestion capacity was verified on the cleft side, thus indicating mucosal hypertrophy.. Despite a wide range of interindividual variability, we recognized a characteristic "descending W"" airway pattern in cleft palate patients. Acoustic rhinometry seems to be a powerful tool for acquiring topographic information about the individual airway profile. It has proven helpful in visualizing the location and amount of pathologic obstructions, rendering it especially useful for preoperative investigation and quality control in corrective cleft nose surgery.

Topics: Acoustics; Adolescent; Adult; Biophysics; Cleft Palate; Humans; Imidazoles; Nasal Cavity; Nasal Decongestants; Nasal Obstruction; Nose; Statistics, Nonparametric

Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. In this paper, we present a paradigm shift from the traditional methods of presurgical infant orthopedics. Some of the problems that the traditional approach failed to address include the deformity of the nasal cartilages in unilateral as well as bilateral clefts of the lip and palate and the deficiency of columella tissue in infants with bilateral clefts. The nasoalveolar molding (NAM) technique we describe uses acrylic nasal stents attached to the vestibular shield of an oral molding plate to mold the nasal alar cartilages into normal form and position during the neonatal period. This technique takes advantage of the malleability of immature cartilage and its ability to maintain a permanent correction of its form. In addition, we demonstrate the ability to nonsurgically construct the columella through the application of tissue expansion principles. This construction is performed by gradual elongation of the nasal stents and the application of tissue-expanding elastic forces that are applied to the prolabium. Use of the NAM technique has eliminated surgical columella reconstruction and the resultant scar tissue from the standard of care in this cleft palate center.

Topics: Acrylic Resins; Alveoloplasty; Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Nose; Palatal Obturators; Plastic Surgery Procedures; Stents

Topics: Abnormalities, Multiple; Brain Neoplasms; Child; Cleft Lip; Cleft Palate; Corpus Callosum; Humans; Hypertelorism; Lipoma; Male; Nose; Tomography, X-Ray Computed

The appearance of the nostril in cleft lip patients is very important in the subjective assessment of naso-labial forms and patient satisfaction. To improve the outcome of plastic surgery, a computer aided diagnostic system was developed. Facial forms were measured with a three-dimensional optical scanner (Ogis Range Finder RFX-IV) XYZ coordinates (256x240) and RGB (red, green, blue) image (512x480) data sets were then obtained with the apparatus. The nostril area was determined by discriminant analysis of the RGB data, and the landmarks of the nostril were extracted under geometric conditions. To assess the reliability of this technique with head inclination, five volunteers were measured in seven postures. Landmark stability was within approximately 1 mm when the Frankfort plane was 45-60 degrees. Subsequently, this system was applied to two cleft lip patients who had undergone a secondary nasal correction. For control data, 37 healthy adults (22 males and 15 females) were measured in the same manner. Nasal asymmetry in the unilateral case and wide and flat nostrils in the bilateral case were greatly improved after surgery. Conversely, the volume of the nasal tip decreased. This system was a great help in the diagnosis of nostril abnormalities.

Topics: Adolescent; Adult; Algorithms; Cleft Lip; Cleft Palate; Computer Systems; Discriminant Analysis; Esthetics; Face; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Lip; Male; Nose; Nose Deformities, Acquired; Patient Satisfaction; Posture; Reproducibility of Results; Software

To investigate acoustic assessment of complex structural anomalies in cleft lip and palate associated nasal deformities and its impact on the planning of corrective rhinosurgery.. Twenty-three consecutive patients with unilateral CL(P) during routine consultations, three of them prior to corrective surgery.. Acoustic measurements of the nasal airway crosssectional area were obtained for both nasal cavities. The size of isthmus area and isthmus location as well as the nasal volume and decongestion capacity in various regions of interest were determined.. Obstructions in the area of the nasal valve (< 0.4 cm2) were detected in 85% of the patients on the cleft side, but only 15% on the contralateral side. Severe mucosal hypertrophy was a common finding on the cleft side with a significantly higher capacity of decongestion, especially in the posterior region of the nasal cavity (P < 0.02). A second stenosis located behind the physiological isthmus was found in 16 patients.. Acoustic rhinometry is a noninvasive, objective method. It measures the degree and the exact location of airway obstructions. Apart from the equipment, the only prerequisite is a cooperative patient. The measurement has direct therapeutic consequences. If the exact cause and location of airway stenosis are known, it is easier to adapt the corrective surgical procedures to suit the individual patient. The decision in favour of additional therapeutic measures can be made on a more rational basis to prevent residual airway problems postoperatively. Preoperative acoustic rhinometry offers valuable information concerning the severity and location of nasal airway obstructions and thus proves to be a helpful tool in the planning of corrective operative measures.

Topics: Acoustics; Adolescent; Adult; Airway Resistance; Cleft Lip; Cleft Palate; Female; Humans; Male; Nasal Obstruction; Nose; Rhinoplasty

The objective of this study was to determine the influence of velopharyngeal (VP) inadequacy on respiratory speech compensations.. The pressure-flow technique was used to measure pressure, airflow, and timing variables associated with VP closure during the production of the initial plosive consonant /p/ in a series of the utterance "papa.". The study was conducted in the speech and breathing laboratory of the UNC Craniofacial Center.. Eighty-two subjects with cleft lip and/or palate were assessed. The subjects were divided into two groups, those with adequate VP closure (VP size <.010 cm2) and those with inadequate VP closure (VP size >0.10 cm2). The adequate group was comprised of 62 subjects, and 20 subjects were categorized as inadequate.. Peak intraoral pressure decreased in the inadequate group, but the difference was not significant. Nasal airflow increased (p < .01), but duration of the pressure pulse was the same for both groups. The area under the pressure curve decreased for the inadequate group (p = .04).. These data contrast with previously reported published data using /p/ in the utterance "hamper." This suggests that phonetic context influences the compensatory response to velopharyngeal inadequacy. Additionally, while the findings are somewhat similar to studies that involved noncleft subjects whose oral airway was suddenly vented during the production of /p/, there is enough difference to suggest that learning also affects the compensatory outcome.

Topics: Adolescent; Adult; Area Under Curve; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Learning; Male; Middle Aged; Mouth; Nose; Palate, Soft; Pharynx; Phonetics; Pressure; Pulmonary Ventilation; Time Factors; Velopharyngeal Insufficiency

This study was conducted to ascertain the frequency of surgeries typically required to adequately repair a cleft lip.. All operations performed on patients with clefts of the lip (alveolus and palate) from 1968 to 1990 in the Rostock Cleft Center were evaluated.. Procedures were classified as primary labioplasties versus secondary revisions. Patients were also classified according to cleft type, the anatomical segment revised, and the reason for lip revision. Two indices were calculated. The revision index related the number of revisions to the number of primary labioplasties. The index of indication related the number of patients with revisions to the number of primary labioplasties.. During the period of study, 712 primary labioplasties and 771 secondary revisions were performed. The overall revision index was 1.10. The index of indication varied from 0.28 for unilateral complete clefts of the lip to 0.67 for bilateral complete clefts of the lip. Revision of the lip was the most common secondary procedure, followed by nostril and columella revision, and revision of the oral vestibule.. The incidence of secondary surgery of the repaired cleft lip (index of indication) of about 35% is similar to previously reported data. However, the incidence varies with cleft type and is required more often with bilateral complete clefts of the lip.

Topics: Adolescent; Alveolar Process; Cleft Lip; Cleft Palate; Evaluation Studies as Topic; Germany; Humans; Incidence; Lip; Nose; Plastic Surgery Procedures; Reoperation; Retrospective Studies; Vestibuloplasty

This study evaluated the craniofacial form of a sample of Northern Irish children with unilateral cleft lip and palate (UCLP). The quality of the outcomes achieved was compared with the outcomes reported for the six centers involved in the European multicenter study (Mars et al., 1992; Mølsted et al, 1992).. Retrospective analysis.. All children born with complete skeletal UCLP in Northern Ireland during the years 1983 to 1987.. Cephalometric analysis was used to determine the craniofacial form and soft tissue profile. The quality of the dental arch relationships was independently assessed using the Goslon ranking system.. The sample comprised 25 children with complete skeletal UCLP who had cephalometric radiographs and study casts recorded at a mean age of 9.4 years (range, 8 to 11 years). Cephalometric analysis revealed no important skeletal differences between the Northern Irish UCLP children and the published results from the six Eurocleft centers. The soft tissue profile of the Northern Irish UCLP children was significantly more convex than the soft tissue profile recorded for center D in the Eurocleft study. The Goslon ranking system revealed that 18 (72%) of the Northern Irish UCLP children had good or satisfactory dental arch relationships.. No clinically important differences were detected between the mean cephalometric skeletal parameters of the Northern Irish UCLP children and those published for the six cleft centers involved in the Eurocleft study. On average, the Northern Irish UCLP children were found to differ significantly from Eurocleft's center D in their soft tissue facial contour and sagittal lip profile. The quality of the dental arch relationships of the Northern Irish sample was between the best and the less good Eurocleft centers.

Topics: Cephalometry; Child; Chin; Cleft Lip; Cleft Palate; Dental Arch; Europe; Evaluation Studies as Topic; Face; Facial Bones; Female; Humans; Incisor; Lip; Male; Mandible; Maxilla; Multicenter Studies as Topic; Northern Ireland; Nose; Radiography; Retrospective Studies; Sella Turcica; Skull; Treatment Outcome

To collect normative data using Horii's Oral Nasal Coupling Index (HONC) from 4- to 6-year-old children without cleft palate to be used in the evaluation of young children with cleft palate. In addition, to determine whether HONC values in children are similar to those of adults and thus show that the HONC ratio successfully normalizes nasal accelerometric signals across age, gender, and vocal intensity.. Measurement of accelerometric and acoustic signals from novel nasal and nonnasal utterances, which the children repeated after the experimenter. Measurements also included four sustained [m] productions, which were used to calibrate correction factors used to equate nasal and oral signals during a sustained [m] production.. Laboratory at a state university.. Ten girls and 10 boys, aged 4 to 6 years, with normal speech, language, and hearing.. Differences of 13 dB (HONC) were found to separate nasal from nonnasal sentences. No significant difference in HONC score was found across gender for nasal/nonnasal sentences and [m] productions. The correction factors generated during [m] calibration procedures did not differ between girls and boys.. Horii Oral Nasal Coupling Index differences between nasal and nonnasal utterances appear to be valid and reliable measures in both children and adults for detection of disorders of nasal resonance.

Topics: Acceleration; Adult; Age Factors; Calibration; Child; Child Language; Child, Preschool; Cleft Palate; Evaluation Studies as Topic; Female; Hearing; Humans; Male; Mouth; Nose; Phonetics; Reproducibility of Results; Sex Factors; Speech; Speech Acoustics; Velopharyngeal Insufficiency; Voice; Voice Quality

The aim of this paper is to delineate the importance of the correction of the nasal septum when attempting to improve the nasal shape and function in patients with cleft lip and palate (CLP) deformity. The particular problems of the nasal shape in CLP patients are assessed. Various approaches for adequate correction are reviewed and discussed. The method of extracorporeal septoplasty is presented in detail. This method was used between 1982 and 1997 in 141 out of 332 CLP patients who required septoplasties and appears particularly suited for this purpose since it offers the possibility of reconstructing an almost normal septum. This is necessary in order to achieve both a functionally and an aesthetically good result. Our experience over the past 16 years confirms the advantages of this approach.

Topics: Adult; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Male; Nasal Septum; Nose; Rhinoplasty; Treatment Outcome

Patients born with cleft lip and palate (CLP) present with a variety of nasal deformities. These are either congenital or iatrogenic. Our aim was to establish a correlation between aesthetic and functional nasal impairments in patients with CLP whose nasal reconstruction had been delayed. Fifty-four randomly selected patients with CLP deformities, all of whom had delayed nasal repairs were evaluated objectively, aesthetically in three planes, and functionally for symptoms of nasal obstruction, chronic maxillary sinusitis, and olfactory disturbances. Aesthetically the patients were analysed from 1:1 life-size full face, profile, and submental-vertex photographs, and full skull cephalograms. Nasal patency was assessed by rhinomanometry. The presence of chronic maxillary sinusitis and olfactory disturbances were deduced from the history. The degree of nasal dismorphism correlated with the severity of nasal functional impairments. Delayed nasal repairs in patients with CLP did not produce satisfactory aesthetic or functional results, probably because growth was retarded and midfacial development was disturbed at the time of delayed rhinoplasty and resulted in asymmetry. In CLP the nose should be repaired during the early primary cheilorhinoplasty, as this is essential for the restoration of a normally functioning and aesthetically pleasing nose.

Topics: Adolescent; Adult; Cephalometry; Chronic Disease; Cleft Lip; Cleft Palate; Esthetics; Evaluation Studies as Topic; Facial Asymmetry; Facial Bones; Female; Humans; Iatrogenic Disease; Male; Maxillary Sinusitis; Nasal Obstruction; Nose; Nose Deformities, Acquired; Nose Diseases; Olfaction Disorders; Photography; Postoperative Complications; Pulmonary Ventilation; Rhinoplasty; Time Factors; Treatment Outcome

In bilateral cleft lip repair numerous complicated problems still remain. In our opinion, it is better to begin treatment soon after birth. We start nonsurgical correction of a nasal deformity using a nose retainer and preoperative orthodontics using a palatal plate. Surgical repair of the lip is done within one month of birth, by which time the nose alveolus and projecting prolabium can be adequately changed into the desired form. Primary lip repair is performed in one stage which includes restoration of the muscle union, labial sulcus reconstruction and nasal correction. We use a two straight parallel suture line method for symmetric bilateral cleft lip repair. The distance between the two cupid's peaks is 4 mm. The central tubercle is reconstructed using bilateral cutaneo-mucosal flaps. The tissue volume of both sides is not the same in asymmetric cases so we have refined our method in order to achieve symmetry.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Infant; Infant, Newborn; Nose; Plastic Surgery Procedures; Surgical Flaps

This study was carried out as an attempt to evaluate the relationship between the results of nasal patency examinations and selected anthropometric measurements of nasal cavities in children with complete primary and secondary cleft palate. The examined group consisted of 130 children with cleft palate treated by means of surgery in early childhood owing to their clefts. Concerning the diagnostic methods the study group was divided into two subgroups. Group I consisted of 75 children in whom face photographs in frontal and axial projections towards the external nasal aperture were analysed. Group II consisted of 55 children in whom by means of P-A teleradiography projection the total area, the maximum height and width of nasal cavity were measured separately for the side with cleft and without cleft. The assessment of nasal patency tests using the objective method--active anterior rhinomanometry was carried out.

Topics: Adolescent; Anthropometry; Child; Child, Preschool; Cleft Palate; Female; Humans; Male; Manometry; Nose

Developing standardized outcomes and algorithms of treatment is a constantly evolving task. This article examines four variables in this process: cleft type, operative technique, surgical experience, and timing. Input from international cleft lip and palate programs regarding techniques and treatment modalities provide a dynamic tool for assessment and the development of guidelines in the treatment of the cleft lip and palate patient.

Topics: Adolescent; Age Factors; Algorithms; Alveoloplasty; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Malocclusion; Nose; Orthognathic Surgical Procedures; Palatal Obturators; Plastic Surgery Procedures; Surgical Flaps; Time Factors; Treatment Outcome; Velopharyngeal Insufficiency

The objective of this study was to report the effect of gingivoperiosteoplasty on growth of the midfacial skeleton 6 years following primary surgical repair. Patients with complete unilateral cleft lip and palate who underwent primary cleft lip and nose repair with and without gingivoperiosteoplasty (GPP) were retrospectively compared by means of a lateral cephalogram. Mean age at the time of evaluation was 5.7 years. All patients were treated at the Institute of Reconstructive Plastic Surgery, New York University Medical Center. All surgery and presurgical orthopedics was performed by the same surgeon and the same orthodontist. Twenty-five consecutively treated patients who presented with complete unilateral clefts of the primary and secondary palate were included in the study. Of these, 20 patients were available for 6-year follow-up cephalometric documentation and review. All patients received preoperative orthopedics with passive molding appliances, followed by repair of the lip, alveolus, and nose in a single stage at the age of 3 months. The repair was performed using the rotation/advancement technique. The difference between the two groups was whether or not gingivoperiosteoplasty was performed. The reason for not performing gingivoperiosteoplasty was incomplete approximation of the alveolar segments usually due to a late start in beginning therapy. Lateral cephalograms (68.5 months post primary surgery) were obtained and traced. Cranial base (S-N), maxilla (ANS-PNS), and mandible (Go-Pg) were digitized for shape coordinate analysis. No significant difference in the mean position of ANS-PNS was found between groups (with or without gingivoperiosteoplasty). There was, however, a significant difference in the variance of position for the points ANS-PNS between the groups (p < .002). We were unable to observe any difference (anteroposterior or supero-inferior) in the average position of the hard palate (ANS-PNS) between groups. We conclude that gingivoperiosteoplasty results in a more uniform position of the hard palate (ANS-PNS) relative to patients that did not receive gingivoperiosteoplasty. We were unable to demonstrate any clear impairment of maxillary growth in the patients treated with gingivoperiosteoplasty when compared to patients treated without gingivoperiosteoplasty.

Topics: Alveoloplasty; Cephalometry; Child, Preschool; Cleft Lip; Cleft Palate; Follow-Up Studies; Gingivoplasty; Humans; Mandible; Maxilla; Maxillofacial Development; Nose; Orthodontics, Corrective; Palatal Obturators; Palate; Periosteum; Retrospective Studies; Skull Base

The three-dimensional, facial soft-tissue changes of 24 patients with various cleft types following transpalatal Le Fort I osteotomy were measured using laser scanning techniques, radial measurements, and a color millimetric scale. There was a varying degree of midface retrusion in the different cleft groups, and a very similar pattern of retrusion over the nasal complex. Each group of patients showed a varying degree of relapse postsurgically, but there was a failure in all the cleft groups to correct the lack of nasal projection.

Topics: Adolescent; Adult; Cephalometry; Cleft Lip; Cleft Palate; Color; Face; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Lasers; Male; Maxilla; Nose; Osteotomy, Le Fort; Postoperative Complications; Recurrence; Sex Factors; Treatment Outcome

The stigmata of lip and palate clefting are well recognized, but recently it has been thought that these may be exacerbated by the surgical repair. Functional repair, however, with re-establishment of muscle continuity may result in less disruption to normal facial growth. This study examines mid-facial growth in 10 consecutive children aged 6.5 years with complete unilateral cleft lip and palate who had undergone functional repair. Outcomes were compared with non-cleft children and children who had undergone non-functional surgery.

Topics: Adult; Case-Control Studies; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Dental Arch; Facial Muscles; Female; Humans; Male; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Maxilla; Maxillofacial Development; Models, Dental; Nose; Palate, Soft; Radiography; Skull Base; Treatment Outcome

Midface retrusion in cleft lip and palate patients often results in personal, social, and psychological problems, along with the functional difficulty. Hence, soft tissue profile improvement in early childhood is of obvious importance. The purpose of this study was to investigate the soft tissue changes that occur during reverse headgear treatment in a homogeneous sample of Chinese boys born with unilateral complete cleft lip and palate. Boys with a similar congenital deformity and presenting similar skeletal morphology and maturity status were included for comparison. After 7.8 months of reverse headgear treatment, the soft tissue profile improved significantly as the concave tendency associated with maxillary deficiency decreased. The sagittal maxillomandibular lip relationship and the Holdaway angle increased significantly by 4.25 and 3.94 degrees, respectively.

Topics: Cephalometry; Child; Chin; China; Cleft Lip; Cleft Palate; Extraoral Traction Appliances; Face; Facial Bones; Follow-Up Studies; Forehead; Humans; Lip; Male; Mandible; Maxilla; Maxillofacial Development; Nose; Vertical Dimension

A new method based on anthropometric ratios and inclinations was evaluated to confirm or reject whether residual deformities in cleft patients' faces differ significantly from faces without previous clefts.. From a retrospective, a selective review of our clinical files, seven measurements were made on 156 photographs of the faces of 52 patients aged 19 to 25 years. There ratios and two inclination angles were recorded for each patient.. The primary hypothesis could be confirmed: the anthropometric ratios and angles used to express major residual deformities in cleft lip and nose patients differ significantly from normal values.. This new method allows for objective measurement and evaluation of both the stigmata and the outcome of their treatment.

Topics: Adult; Cephalometry; Cleft Lip; Cleft Palate; Evaluation Studies as Topic; Face; Female; Humans; Lip; Male; Maxilla; Nose; Photography; Reference Values; Retrospective Studies; Sex Factors; Treatment Outcome

This study was conducted to evaluate the relationship between size of residual clefts in the hard palate and speech.. Fifteen 7-year-old children born with complete cleft lip and palate were investigated.. All of the children were treated according to a surgical regimen involving early soft palate repair and delayed hard palate closure. Measures were taken of the area, length, and maximal width of the residual cleft in the hard palate about a year before its closure and correlated with a perceptual judgment of several speech variables.. Significant positive correlations were obtained between the size of the cleft and two variables: weak pressure consonants and hypernasality. Nasal escape was very common among the patients, and almost half the children had retracted palatal or velar articulation of dental stop consonants. Neither of these two variables correlated with the size of the residual cleft.. Perceived oral pressure and, perhaps, resonance seem to be related to size of the opening of the residual cleft, whereas audible nasal escape and articulatory compensations are not, at least not the latter once established.

Topics: Articulation Disorders; Cephalometry; Child; Cleft Lip; Cleft Palate; Evaluation Studies as Topic; Female; Humans; Male; Mouth; Nose; Palate; Palate, Soft; Phonetics; Pressure; Reproducibility of Results; Speech; Speech Disorders; Speech Intelligibility

Topics: Alveoloplasty; Cephalometry; Child; Cleft Lip; Cleft Palate; Gingivoplasty; Humans; Infant, Newborn; Maxilla; Nose; Palatal Obturators; Periosteum

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Orthodontics; Societies, Dental

The conotruncal anomaly face syndrome (CTAF) comprises congenital heart disease and dysmorphic face, and is frequently associated with cleft palate or hypernasality. There have been many discussions about the overlap with velocardiofacial syndrome (VCF). The aim of this study was to clarify the craniofacial characteristics of CTAF patients by clinical examination, and photogrammetric and cephalometric analyses, and to clarify the differences compared to published data on VCF.. The facial features of CTAF included hypertelorism, small palpebral fissures, upward slanting of palpebral fissures, bloated eye lids, low nasal bridge, small mouth, open mouth at rest, and malformed auricles. Cephalometric features included bialveolar protrusion, small gonial angle, backward rotation of the mandibular ramus, and labial inclination of the maxillary incisors. An acute cranial base angle was also noted. These results differed from those of VCF. There were, however, no obvious pathognomonic findings for the differential diagnosis between CTAF and VCF.. Considering these findings, use of CATCH 22, the inclusive classification of cardiac anomalies, cleft palate, and dysmorphic face may be of value for the clinical understanding in these patients.

Topics: Alveolar Process; Cephalometry; Child; Child, Preschool; Cleft Palate; Craniofacial Abnormalities; Diagnosis, Differential; Ear, External; Eyelid Diseases; Eyelids; Female; Heart Defects, Congenital; Humans; Hypertelorism; Incisor; Male; Malocclusion; Mandible; Maxilla; Mouth Abnormalities; Nose; Photogrammetry; Rotation; Skull Base; Speech Disorders; Syndrome

This retrospective study was undertaken to describe and compare frontal craniofacial dimensions in alveolar-bone-grafted and nongrafted complete unilateral cleft lip and palate (CUCLP) patients and in noncleft subjects with normal occlusions and good facial balance. Clinical data were obtained from the files of the Hospital for Sick Children, Toronto. Patients were eligible for inclusion if they had posteroanterior cephalograms (PA) taken at adulthood and no congenital anomalies other than CUCLP. A total of 86 adult Caucasian CULCP patients were studied, including 58 who had not received grafts, 28 who had received secondary alveolar bone grafts, and, for comparison, 60 noncleft Caucasian adults. The PA cephalometric radiographs were traced, digitized, and measured. Analysis of variance (ANOVA) was used to test for among-groups differences in the means of the ratios, proportions, and angular measures. Tukey-Kramer HSD procedure was used to conduct post-hoc pairwise comparisons following significant (p < or = 0.05) F-ratios from ANOVA. Sexual dimorphism was a common finding, with males demonstrating greater facial width. Despite primary surgical repairs, the anterior nasal spine in the nongrafted CUCLP patients was deviated to the noncleft side, and the alar base was depressed on the cleft side. The maxillary incisors close to the cleft site were irregularly inclined, and this irregularity was more severe in the nongrafted CUCLP patients. The long-term effects of secondary alveolar bone grafting on transverse craniofacial growth appears to be minimal and limited to the immediate area of the cleft.

Topics: Adolescent; Adult; Alveoloplasty; Analysis of Variance; Bone Transplantation; Cephalometry; Cleft Lip; Cleft Palate; Face; Female; Humans; Image Processing, Computer-Assisted; Incisor; Male; Malocclusion; Maxilla; Maxillofacial Development; Nasal Bone; Nose; Retrospective Studies; Sex Characteristics

The objective of this study was to investigate an instrumental assessment technique for acquiring reproducible, metric data on the nasal airway in cleft-palate associated nasal dysplasia. A consecutive sample of 23 unilateral, 17 bilateral CLP patients and 15 controls with subjective normal nasal patency from a cleft-palate rehabilitation centre were studied. A series of transnasal acoustic measurements (pressure wave: 55 dB for 2 ms) of nasal volume were performed before and after topical decongestion with 2 x 0.3 mg of xylometazoline. A standardized regimen of acoustic parameters of the nasal valve and the adjacent segment of the nasal cavity were calculated. The cleft side yielded a significantly (40%) lower nasal volume than the non-cleft side. Considerably lower values were recorded for the isthmus of the cleft side (0.31 cm2) compared with the non-cleft side (0.52 cm2). Decongestion capacity was higher in the posterior segment, indicating cleft-side massive mucosal hypertrophy. In bilateral CLP, the isthmus measured 0.46 cm2. By decongestion, individual side differences were reduced in unilateral CLP patients but enhanced in bilateral clefts. The prevailing pattern of the cleft-side airway profile can be described as a 'descending W'. Acoustic rhinometry is a non-invasive, instrumental assessment technique for acquiring reproducible metric data of nasal dysplasia in cleft-palate patients. By identification of the location and amount of nasal obstruction, it provides topographic information about the individual airway profile. It is suitable for the longitudinal investigation of nasal-airway development, as well as the preparation and follow-up of corrective rhinosurgery.

Topics: Acoustics; Adolescent; Adult; Child; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Hypertrophy; Imidazoles; Longitudinal Studies; Nasal Cavity; Nasal Decongestants; Nasal Mucosa; Nasal Obstruction; Nose; Nose Deformities, Acquired; Reproducibility of Results; Rhinoplasty; Sound

To evaluate the standard deviation of the nasalance scores in patients having normal and abnormal nasal resonance and to determine its potential value for clinical use. Additionally, the mean nasalance scores were examined across varying degrees of hypernasality.. Prospective study design.. Pediatric tertiary care hospital.. One hundred and forty-eight subjects, ranging in age from 4;0 to 37;0 years, having repaired cleft lip and/or palate and normal resonance, inconsistent, mild, or moderate/severe hypernasality.. Oral-nasal acoustic measurements were made using the Nasometer. The standard deviation and mean nasalance scores were calculated for subjects reading three standard passages (Zoo Passage. Rainbow Passage, Nasal Sentences).. The major finding in this study showed that the standard deviation score cannot distinguish speakers beyond a gross normal and abnormal resonance diagnostic category. The values obtained could not be used to distinguish among the varying degrees of hypernasality. A secondary finding was that a mean nasalance score in the high 20 s could be used to differentiate speakers with borderline velopharyngeal function from those who were non-nasal.. In general, the standard deviation value serves little overall clinical utility; however, it may be of benefit in some specific clinical situations. In support of previous research, the mean nasalance score continues to be the best measure of nasalance. It should serve as a supplement to but not a substitute for clinical judgments.

Topics: Acoustics; Adolescent; Adult; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Male; Mouth; Nose; Observer Variation; Palate, Soft; Pharynx; Prospective Studies; Reproducibility of Results; Speech; Speech Disorders; Speech Intelligibility; Velopharyngeal Insufficiency

The preceding study (Smahel, 1987) showed that after the abolishment of osteoplasty and introduction of primary reposition of nasal septum base in the 1970's the nasal deviation and asymmetry of nasal wing length in patients with unilateral cleft lip and palate had been reduced. The present study shows that this reduction continues after the introduction of total septum reposition. The deviation of septal base (columella) from the median plane and asymmetry in nostril position is reduced as well. The surgeon's experience however is the decisive factor determining the final shape of the nose.

Topics: Case-Control Studies; Cephalometry; Child; Cleft Lip; Cleft Palate; Clinical Competence; Follow-Up Studies; Humans; Nasal Septum; Nose; Nose Deformities, Acquired

Noses of 6 stillborn infants with unilateral lip and complete palate cleft were dissected and analysed. The surgical dissection revealed that the lower lateral cartilages are asymmetrical on both sides, indicating displacement of the lower lateral cartilages and the cartilageous septum which deviates to the normal side. Paired T Test shown that there is no significant difference between two sides in length and width. The conclusion is that the nasal deformities of the lip and palate cleft are congenital and one of the major causal factors is the displacement of lower lateral cartilages and cartilageous septum in the cleft side.

Topics: Abnormalities, Multiple; Anthropometry; Cartilage; Cleft Lip; Cleft Palate; Female; Fetal Death; Humans; Male; Nose; Pregnancy

Some types of surgery performed on the tip of the nose, such as secondary rhinoplasty on cleft lip and palate (CLP) patients, may have an uncertain end-result due to the difficulty in maintaining the surgically created status constant over time. This is precisely the reason behind the multiple proposals and surgical techniques presented by various authors through the years, in order to produce a long lasting, valid, surgical result. The problem has been approached by implementing varied and creative methods and still remains partially unsolved. Experience has shown that the application of a dynamic nasal splint has contributed efficiently to maintaining the surgical results by opposing healing contraction.

Topics: Adult; Child, Preschool; Cleft Lip; Cleft Palate; Equipment Design; Female; Humans; Methylmethacrylate; Methylmethacrylates; Nasal Bone; Nasal Septum; Nose; Rhinoplasty; Splints; Surface Properties; Wound Healing

Eleven patients (9 UCLP, 2 BCLP) were treated with segmental osteotomies with or without osteotomies at the Le Fort I level and simultaneous bone grafting of the alveolo-palatal clefts at adult age. These patients were clinically and radiographically evaluated after a mean follow-up period of 59 months (range 39-110 months). One patient showed complete dentoalveolar relapse, whereas the skeletal stability after miniplate fixation proved to be adequate in all cases. Only one patient presented with a persisting oro-nasal fistula. In six cases, the alar base asymmetry had improved to such an extent that further nasal corrections were not necessary. The procedure described is a reliable technique to graft the alveolo-palatal cleft and reposition the dentoalveolar segments simultaneously in those adult cleft palate patients who had no previous alveolar bone grafting.

Topics: Adolescent; Adult; Alveoloplasty; Bone Plates; Bone Transplantation; Cephalometry; Cleft Palate; Female; Fistula; Follow-Up Studies; Humans; Longitudinal Studies; Male; Maxilla; Mouth Diseases; Nose; Nose Diseases; Osteotomy; Postoperative Complications; Radiography; Recurrence; Reproducibility of Results

Nine cases of frontonasal dysplasia were seen during an 8-year period. Seven were managed in the authors' institution, and the two adult relatives were referred to adult units. The age and sex distribution, the types of defects, and the family pedigree of an affected family are described. Management criteria were formulated according to the severity and other associated abnormalities.

Topics: Abnormalities, Multiple; Adult; Child; Child, Preschool; Cleft Lip; Cleft Palate; Coloboma; Craniofacial Abnormalities; Diagnostic Imaging; Female; Frontal Bone; Humans; Hypertelorism; Infant; Male; Nose; Pedigree; Retrospective Studies

The influence of an open residual cleft in the hard palate on speech was studied in nine children with cleft lip and palate at about 7 years of age. The subjects were treated by early repair of the velum (before 12 months of age), whereas the repair of the cleft in the hard palate was postponed until about 8 years of age. Speech and velopharyngeal function were assessed systematically with the residual cleft open and temporarily covered with an oral bandage. Listeners' judgments, the Nasal Oral RAtio Meter (NORAM), videofluoroscopy, and cephalometrics were used for the analyses. Four patients were also examined with a pressure-flow technique. Nasality registered by NORAM, nasal escape, and weak pressure consonants judged by listeners were common but decreased appreciably when the residual cleft was covered. Retracted articulation was found in four patients (44%) and glottal compensations in one (11%), with no improvement after covering.

Topics: Age Factors; Articulation Disorders; Bandages; Cephalometry; Child; Cineradiography; Cleft Lip; Cleft Palate; Female; Fluoroscopy; Humans; Male; Nose; Palate; Palate, Soft; Pharynx; Pressure; Pulmonary Ventilation; Speech; Speech Disorders; Speech Perception; Video Recording

This is the case of a male newborn with holoprosencephaly, marked hypotelorism, and a rudimentary nasal structure, the proboscis. The head CT scan showed a single monoventricle and two ocular globes fused at the midline. Chromosome studies showed a normal karyotype. The importance of ultrasonography in the prenatal diagnosis of this malformation is presented.

Topics: Brain; Cleft Palate; Echoencephalography; Fatal Outcome; Female; Holoprosencephaly; Humans; Infant, Newborn; Karyotyping; Male; Nose; Pregnancy; Tomography, X-Ray Computed

A new technique for evaluating hypernasality using an acoustic approach is presented. In a preliminary study using this technique, nasal resonance was assessed in 17 normal subjects and 16 subjects judged to be hypernasal. Analyses of the one-third-octave power spectra revealed an increase in power level between the first and second formant, and a reduction in the power level in second and third formant regions among utterances judged to be hypernasal. Factor analysis of the perceptual ratings revealed that the consensus perception of hypernasality accounted for 71% of the total variance. An additional 8% was accounted for by individual differences. Multiple regression analysis revealed a high correlation between the consensus perception of hypernasality and the variance in two acoustic-power levels, these being the power level between the first and second formant and the power level of the second and third formant regions.

Topics: Adolescent; Adult; Child; Child, Preschool; Cleft Lip; Cleft Palate; Factor Analysis, Statistical; Female; Humans; Male; Nose; Phonetics; Regression Analysis; Sound Spectrography; Speech Acoustics; Speech Disorders; Speech Perception; Speech Therapy; Velopharyngeal Insufficiency

Three-dimensional laser surface scanning of the face was performed before and after Le Fort I maxillary advancement in 24 patients with replaced clefts of the lip and palate. The surgery resulted in advancement of the upper lip and para-alar tissues and an increase in the relative prominence of the nose within the face. These changes were produced at the expense of an increase in nasal width and a reduction in nasal tip protrusion. The changes in nasal morphology showed significant variation among patients.

Topics: Adult; Cephalometry; Cleft Lip; Cleft Palate; Face; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Lasers; Male; Maxilla; Nasal Septum; Nose; Osteotomy, Le Fort; Reproducibility of Results; Vertical Dimension

The early and late results of the Tajima cleft nose correction were objectively measured by computer on 24 unilateral complete cleft lip and palate patients (age range 5-29 years, median 14). Follow-up records were divided into early (within 3 months), intermediate (3 months to 1 year) and late (1 year+); the longest follow-up was 4.2 years. Comparison of the preoperative records with the early and intermediate follow-up photographs showed an improvement in symmetry (Wilcoxon signed rank, P < 0.01). In the late follow-up group the deformity recurred and the nasal shape could not be statistically separated from the preoperative appearance. A group of 25 normal control faces showed no changes, whilst 20 control cleft patients had some worsening of nasal symmetry over the same time scale. Analysis of the components of the corrected noses showed the best improvement (and later relapse) was in dome symmetry.

Topics: Abnormalities, Multiple; Adolescent; Adult; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Male; Nose; Photography; Reoperation; Rhinoplasty; Treatment Outcome

Topics: Abnormalities, Multiple; Cleft Lip; Cleft Palate; Female; Humans; Infant, Newborn; Nose

Forty-four lateral cephalograms from a sample of 15 white males with bilateral cleft lip and palate (BCLP) were evaluated to determine the growth pattern of the nose, identify timing of the nasal growth spurt, assess growth of the underlying bony elements relative to the nasal growth, and ascertain the relationship of the nose to the rest of the facial profile. The cephalograms (taken at ages 7.5 to 16.6 years) were divided into five groups according to age of subject. Fifteen variables related to soft tissue nose, nasal bone, maxilla, and facial convexity were assessed. Results of this investigation were as follows. First, the nose of subjects with BCLP grew more downward than forward. Second, the growth spurt occurred between the ages of 12 and 16 years. Third, forward growth of the nose was almost always found, whereas the maxilla becomes more retrusive. Fourth, the angle of soft tissue nasion (N')-pronasale (Prn)-soft tissue pogonion (Pog') had an average decrease of 3.56 degrees from age 8 to 16 years. Individual data showed that 12 of 15 patients had a decrease of this angle, whereas 3 had a small increase; 10 of 12 with a decrease demonstrated an increase of both sella-nasion (SN')-Prn and SN'-Pog'. The remaining 2 showed an increase of SN'-Prn and a decrease of SN'-Pog'. Thus, the profile of the nose (N'-Prn-Pog') became more convex over the observed period, which at least in part seemed to be due to the horizontal development of the nose itself.

Topics: Adolescent; Cephalometry; Child; Cleft Lip; Cleft Palate; Face; Humans; Male; Nose

Oral-nasal differential pressures are derived measures that incorporate both active (e.g., articulatory) and passive (e.g., nasal structure) components. This study was designed to examine integrated oral-nasal differential pressures in speakers with different levels of velopharyngeal closure. Integrated oral-nasal differential pressure data were obtained from 20 noncleft adults with normal speech and 166 speakers with repaired palatal clefts. Velopharyngeal competency for the cleft subjects, as determined by aerodynamic assessment, ranged from adequate to grossly incompetent. Results of the data analysis indicate that integrated pressures are not maintained at a consistent level across all groups. This lack of consistency across all degrees of velopharyngeal opening may reflect the flexibility, as well as structural limitations, of a speech pressure regulating system.

Topics: Adolescent; Adult; Analysis of Variance; Child; Child, Preschool; Cleft Palate; Female; Humans; Male; Middle Aged; Mouth; Nose; Palate, Soft; Pharynx; Phonetics; Pressure; Pulmonary Ventilation; Rheology; Speech; Velopharyngeal Insufficiency

The purpose of this study was to describe the clinical and radiographic observations on cantilever iliac bone grafts for reconstruction of cleft lip-associated nasal deformities.. Cantilever iliac bone grafts were performed on 14 patients with a severely deformed cleft lip-associated nose using the open rhinoplasty technique. An approximately 6-cm length of iliac bone was tightly inserted into a subperiosteal pocket over the nasal bones, and the nasal tip was elevated by the distal end of the graft. The clinical follow-up ranged from 7 months to 3 years.. All patients were judged to have satisfactory results. The grafted bone decreased slightly in size during the first 2 to 3 months, and irregularities in contour became rounded. During the same period, bony union with the underlying nasal bones was observed in all cases. After about 6 months, further changes did not occur in the grafts.. This type of bone graft can be used for additional structural support and to achieve the desired nasal projection and profile. Augmenting the nasal bridge creates the illusion of a narrower nose. The key to success of the operation seems to be the proper fixation of the grafted bone to the underlying nasal bones.

Topics: Adolescent; Adult; Bone Transplantation; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Rhinoplasty; Treatment Outcome

Evaluation of the fetal face is an essential part of the sonographic examination for high risk pregnancies. Even under optimal conditions, the complex curvature of the face makes it difficult to obtain adequate images with two-dimensional ultrasonography, and many cross-sectional images are required to obtain a complete impression. The purpose of this paper is to show preliminary work in assessing the utility of three-dimensional ultrasonographic visualization of the fetal face. Fetal facial features were evaluated with three-dimensional sonography by scanning with a volume transducer and compared to conventional two-dimensional ultrasonographic images in 27 fetuses (gestational ages 10 to 39 weeks). Surface rendered three-dimensional sonographic images of the fetal face were obtained in 24 of 27 fetuses. In four cases the upper lip was clearly imaged on three-dimensional ultrasonography when it could not be seen on two dimensional ultrasonography. Information requiring multiple planes with two-dimensional ultrasonography could be demonstrated on a single image from three-dimensional ultrasonography. Images of abnormal faces were seen with both two- and three-dimensional ultrasonography in two cases of cleft lip and one case of holoprosencephaly. Volume data acquisition required approximately 10 sec and reconstruction required approximately 5 sec with instantaneous review of planes through the volume data set. Surface rendering required 2 to 10 min depending on the angular viewing range. Three-dimensional ultrasonography has the potential to provide improved visualization of the fetal face compared with conventional two-dimensional sonographic imaging.

Topics: Anencephaly; Cleft Lip; Cleft Palate; Face; Female; Fetal Diseases; Gestational Age; Holoprosencephaly; Humans; Hypertelorism; Image Enhancement; Image Processing, Computer-Assisted; Lip; Nose; Pregnancy; Transducers; Ultrasonography, Prenatal

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant, Newborn; Male; Nose

Surgeons and orthodontists are still challenged to achieve 'better' noses for children with a unilateral cleft or lip, alveoulus and palate (UCLP). Various aspects are discussed: infant anatomy and later changes, developmental mechanics, cleft syndrome in animals with surgically produced facial clefts, untreated patients with congenital clefts, the radical primary correction of the UCLP nose, the unsolved problems in secondary rhinoplasty and suggestions for scientific communication.

Topics: Animals; Child; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Rhinoplasty

Topics: Abnormalities, Multiple; Cleft Lip; Cleft Palate; Humans; Infant; Male; Nose

Laryngeal airway resistance during vowel production was determined for 10 children without cleft palate and 14 children with cleft palate and adequate velopharyngeal function. The children with cleft palate were further grouped according to either complete or incomplete velopharyngeal closure. All children performed a syllable repetition task with nostrils occluded at self-determined effort and a targeted effort typical of adult speech. Results indicated that all children exhibited significantly greater laryngeal resistance at self-determined effort. No significant differences occurred among the groups of children at either effort level. Some children with incomplete velopharyngeal closure, however, tended to exhibit relatively increased laryngeal resistance at the targeted effort level when their nostrils were unoccluded. Implications for a regulation-control model of speech production and clinical assessment are discussed.

Topics: Airway Resistance; Case-Control Studies; Child; Cleft Palate; Female; Humans; Larynx; Male; Nose; Palate, Soft; Pharynx; Phonetics; Pressure; Pulmonary Ventilation; Speech Intelligibility; Surgical Flaps; Velopharyngeal Insufficiency

Cleft lip, with or without cleft palate, is one of the most common defects in craniofacial formation. The primary palatogenesis of mice is similar to that of humans and spontaneous cleft lip is associated with genotype in both mice and humans. To investigate the temporal and spatial expression of ras genes in cleft (A/WySn) and non-cleft strains of mice (BALB/cBy), a broad spectrum ras antibody was used. Positive staining was found in ectodermal, mesenchymal, and neuroepithelial cells of facial prominences before the primary palate formation stage (10 d 20 hr) in both strains. During the primary palate formation stage (11 d 20 hr), positive staining was found in the ectodermal and mesenchymal cells of the facial prominences of the non-cleft strain but not in those of the cleft strain. These results suggest ras genes may play a role in the primary palatogenesis of mice. Cleft lip could be associated with the deficiency of ras gene expression during primary palate formation of mice.

Topics: Animals; Cleft Lip; Cleft Palate; Ectoderm; Epithelium; Gene Expression Regulation, Developmental; Genes, ras; Gestational Age; Immunoenzyme Techniques; Maxilla; Mesoderm; Mice; Mice, Inbred A; Mice, Inbred BALB C; Mice, Inbred Strains; Nasal Mucosa; Neurons; Nose; Oncogene Protein p21(ras); Palate

We have developed a strategy for concurrent correction of multiple secondary clefting deformities based on the model proposed by Henderson and Jackson [1] which combines several cleft-related procedures. We have expanded this concept significantly to include as many as eleven procedures. The selected procedures are dictated individually by patients' needs. The constellation of corrective cleft-related surgeries has been given the name "cleft cluster" in the interest of simplicity. We are reporting on our experience with 85 consecutive patients using this approach. All patients in this series received bone grafting of the alveolar cleft as the primary procedure, plus multiple additional procedures as necessary. None of the patients reported received primary lip or palate surgery by the authors. The average number of procedures performed was 7.2. The average hospitalization was 4.1 days. The patients have been followed from 1 to 7 yrs. The fistula recurrence rate was 8%. Average patient age was 16.8 yrs with a range of 8 to 54 yrs. This approach eliminates multiple hospitalizations and outpatient procedures, allows flexibility to individualize patient care, provides consistent results, and is cost-effective.

Topics: Adolescent; Adult; Alveolar Process; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Cost-Benefit Analysis; Female; Fistula; Humans; Length of Stay; Lip; Male; Middle Aged; Mouth Diseases; Nose; Nose Diseases; Patient Care Planning; Recurrence; Reoperation; Surgery, Plastic; Surgical Flaps; Time Factors

This study was performed to compare soft tissue movements resulting from a series of Le Fort I osteotomies with those predicted for the same cases by means of a computerised software package (COG 3.4). The source material consisted of serial lateral cephalometric radiographs for 25 consecutive patients that had received similar Le Fort I osteotomies primarily to correct an antero-posterior skeletal discrepancy. Generally it was found that many of the digitised points on the facial profile were surprisingly well predicted. In addition, the chin and profile changes resulting from mandibular auto-rotation also were reasonably well predicted. However, in a number of cases prediction was less consistent and this was particularly true in the region of the nose and lips. In such instances, initial size, thickness and the existing morphology of the soft tissues appeared to be important factors. The tendency of the software occasionally to 'cross-over' the plots for the upper and lower lip profile made the judgement in this area of predicted profile change difficult in some cases.

Topics: Adolescent; Adult; Cephalometry; Chin; Cleft Lip; Cleft Palate; Face; Female; Forecasting; Humans; Lip; Male; Mandible; Maxilla; Middle Aged; Nose; Osteotomy; Radiographic Image Enhancement; Rotation; Software

The correction of nasal deformities in cleft patients presents a challenge in the secondary treatment of this malformation. The complexity of the nasal deformity in cleft patients partly depends on the congenital anomaly itself and partly on the surgical procedures which were previously carried out. The nasal deformities in unilateral CLP patients are typical. The nasal floor and the nostril sill are mainly constructed during primary lip repair. While the ala on the cleft side is repositioned, the septum deformity and the anterior spine dislocation are not touched. If large circular incisions are used at the time of primary operation to achieve symmetry, the situation usually deteriorates. One of the main characteristics of a classic cleft lip nose is the deviation of the external nose to the non-cleft side due to the typical septal deformity, where the anterior part of the septum and the caudal edge of the septum are subluxated to the non-cleft side (Fig. 1). Furthermore, there is a typical asymmetry of the nasal tip and the ala (Figs. 5 to 7). The columella is slanted and shortened on the cleft side. The ala cartilage on the cleft side is distorted and displaced. There are two important points in the concept of surgical rehabilitation: First, straightening the deviated nose, which often needs extracorporeal septum correction. This seems to be the prerequisite for correction of the external deviation. Second, rehabilitation includes the correction of the asymmetry of the tip and the nostril. A number of techniques have been suggested for this problem, which indicates that there is no ideal procedure. In our hands the triple-flap repair produced good and reliable results. There was no difference in the results, whether an open approach or an endonasal one was used.

Topics: Cleft Lip; Cleft Palate; Humans; Nasal Septum; Nose; Rhinoplasty; Surgical Flaps

Topics: Alveolar Process; Bone Transplantation; Cleft Palate; Facial Muscles; Fascia; Hearing Disorders; Humans; Lip; Maxilla; Maxillary Diseases; Mouth Mucosa; Nose; Nose Diseases; Oral Fistula; Speech Disorders; Surgical Flaps; Temporal Muscle; Tongue

This study compares the topography of the pharyngeal structures of 115 patients with isolated and combined cleft palates with the topography of the pharyngeal structures of 115 patients without cleft palates. The study revealed that the sagittal dimensions in the cleft palate patients are significantly reduced. The maximum closeness can be observed at the lower margin of the velum. In order to clarify growth dependent change of the sagittal pharynx dimensions the growth of the pharynx of 61 cleft palate patients was documented at 4 different points in time between age 7 and age 18. Over this period of growth only a slight increase in the sagittal plane of the pharyngeal area was observed. Especially conspicuous was the stagnation of the distance of the lower margin of the velum to the posterior pharyngeal wall. An increase in air passage resistance, which is the cause of incompetent breathing with all its consequences for growth and dentition development, is derived from these topographical relationships. The study concludes that the postoperative functional competence of the velum is a conditio sine qua non not only in relation to speech but also in relation healthy breathing.

Topics: Adolescent; Chi-Square Distribution; Child; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Female; Germany; Humans; Longitudinal Studies; Male; Maxilla; Nose; Pharynx; Radiography; Respiration

The anomaly of facial cleft no. 1 has been encountered recently. It is a rare finding and, accordingly, is being reported with the hope that more craniofacial clefts will be seen in the future and direct the attention of the medical community to the problems.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Diseases in Twins; Female; Humans; Incidence; Nose

Topics: Cleft Lip; Cleft Palate; Esthetics; Humans; Nasal Septum; Nose; Postoperative Complications; Reoperation; Rhinoplasty

The authors report their experience in the treatment of cleft palate patients, with or without cleft lip, carried out without lateral release incisions. The surgical approach was as follows: the cleft palate only was closed in one step at the age of 10 to 12 months, while the cleft of lip and palate was closed in two steps: at 6 months of age the soft palate together with lip and nose repair and at 18 to 24 months the hard palate with gingivo-alveoloplasty. Out of the 147 patients treated from 1984 until 1992, 124 (73 cleft palate, 51 cleft lip and palate) were treated without lateral release incisions, allowing first intention healing in 122 cases. The failures observed involved 2 cases: in the first (a bilateral case with a wide cleft) an almost total dehiscence of the suture at the level of the hard palate occurred, while in the second (a cleft palate case) a small oronasal fistula developed (healed spontaneously in 2 weeks). Our results confirm that by performing the described surgical technique without lateral release incisions, a 98% success rate for closure of a cleft palate could be obtained. Of course, in very large clefts the lateral release incision should be considered however.

Topics: Alveoloplasty; Child, Preschool; Cleft Lip; Cleft Palate; Fistula; Gingivoplasty; Humans; Infant; Lip; Maxillary Sinus; Methods; Mouth Diseases; Mouth Mucosa; Nose; Palate; Palate, Soft; Paranasal Sinus Diseases; Periosteum; Postoperative Complications; Surgical Wound Dehiscence; Wound Healing

A retrospective study of 25 patients with unilateral cleft lip and palate and 25 patients with hypoplastic maxillae without a cleft was carried out to evaluate the effects of maxillary osteotomies at the Le Fort I level on the lip and nose profile. The pre-surgical cephalometric tracing was superimposed twice on the post-surgical cephalogram, on the cranial structures and the anterior maxillary structures, for landmark movement measurement. Results showed statistically significant correlations between soft and hard tissue movement in the cleft group. On average, the ratios of horizontal nasal tip, nasal base and lip movement to underlying hard tissue movement were approximately one fourth, one half and two thirds respectively. The ratio of vertical lip to incisor movement was about one half. The correlations were less significant in the non-cleft group, only the upper lip movement showed statistically significant correlation with hard tissue movement, with a ratio of one half horizontally and one third vertically. It was concluded that in maxillary osteotomy, the cleft group showed a higher soft tissue to hard tissue movement ratio. The correlation between soft and hard tissue movements were more statistically significant in the cleft group than in the non-cleft group. However, though statistically significant, the level of correlation was not strong on an individual basis except in the horizontal lip response of the cleft group. Individual variation was wide and clinical judgement needs to be considered accordingly.

Topics: Adult; Cephalometry; Cleft Lip; Cleft Palate; Face; Female; Humans; Lip; Male; Mandible; Maxilla; Nasal Bone; Nose; Osteotomy; Retrospective Studies

In this study, sagittal facial growth of bilateral cleft lip and palate (BCLP) patients between 6 and 20 years of age is analyzed. The data of Nijmegen were derived from 131 lateral cephalograms taken in 21 BCLP patients who were treated in the Cleft Lip and Palate Center of the University Hospital of Nijmegen. Reported data of 90 BCLP patients treated at the Center of Oslo were used as a reference for comparison. Results of this investigation showed mandibular growth to be similar in both centers. In the premaxillary region some differences were found: The Nijmegen patients presented a more protrusive premaxilla than those at Oslo. The upper front teeth and hence, the premaxilla, were more retroclined in the Nijmegen sample. There were also statistically significant differences in the soft tissue profile. The mean z-score was positive for the nasolabial angle and negative for the angle N'-Sn-Pg'. At 18 years of age, these differences are still apparent. In comparison with Broadbent's values of normal individuals, the SNPg-angle was smaller and the mandibular angle greater in Nijmegen and Oslo. The profiles of the BCLP patients are more convex in Nijmegen and more concave in Oslo than in the noncleft group. Finally, the different treatment strategies of the Cleft Lip and Palate Centers of Nijmegen and Oslo are compared and discussed in terms of their long-term results.

Topics: Adolescent; Adult; Cephalometry; Child; Chin; Cleft Lip; Cleft Palate; Female; Humans; Incisor; Lip; Longitudinal Studies; Male; Maxilla; Maxillofacial Development; Netherlands; Norway; Nose; Vertical Dimension

Roentgencephalometry was used for the assessment of the development of clinically important facial characteristics in complete unilateral cleft lip and palate during the prepubertal and pubertal period. Thirty-one patients aged 8 and 11 years and 30 patients aged 11 and 14 years were examined repeatedly. All of them were operated upon and orthodontically treated with the same methods. An unfavorable development of facial convexity, sagittal jaw relations, configuration of the soft profile, and of the prominence of the upper lip occurred during both periods. An improvement of overjet that was attained during the prepubertal period showed a renewed impairment during the period of puberty. The impairment was not caused by the higher facial growth rate, but was attributable to the exhaustion of the compensation and adaptation mechanisms of the dentoalveolar component of the upper jaw produced by the preceding orthodontic therapy. The development of sagittal jaw relations and of facial rotation was not related to the initial patterns of these characteristics, but the possibility of an improvement of the inclination of upper incisors and of overjet was influenced by their initial pattern. During the prepubertal period the development of overjet was not related to the development of sagittal jaw relations or of mandibular growth rotation, as was the case during puberty.

Topics: Adolescent; Cephalometry; Child; Chin; Cleft Lip; Cleft Palate; Female; Humans; Incisor; Lip; Male; Malocclusion; Mandible; Maxilla; Maxillofacial Development; Nose; Orthodontic Appliances, Removable; Orthodontics, Corrective; Palatal Expansion Technique; Puberty; Rotation

A sample of 40 teenage individuals with repaired complete bilateral cleft lip and palate, 20 of whom had received presurgical infant orthopedics, was obtained to test the effects of presurgical infant orthopedics on facial esthetics. All subjects had surgery by the same surgeon. The age and sex distribution was approximately equal between the two groups. A panel of five judges evaluated the lip and nose esthetics from full face and profile slides and a mean panel score for each subject was derived for six individual features and three total scores. No difference in the esthetic scores between the two groups could be detected. No differences were found in the number of revisionary surgical procedures required to the lip or nose. The findings indicate that conservative presurgical orthopedics for infants with complete bilateral cleft lip and palate has no lasting effect on the esthetics of the lip and nose, and does not alter the need for subsequent revisionary surgery.

Topics: Adolescent; Cleft Lip; Cleft Palate; Esthetics; Face; Female; Humans; Infant; Lip; Male; Nose; Orthodontic Appliances; Orthodontics, Corrective; Palatal Obturators; Preoperative Care; Reoperation; Retrospective Studies

A single nostril associated with alobar holoprosencephaly is a rare congenital lesion. This paper reports two female term neonates with holoprosencephaly. The first neonate asphyxiated at birth had a single nostril, hypotelorism, posterior cleft palate, inferonasal coloboma of the iris and disc and persistent tunica vasculosa lentis. The other neonate had cleft lip and palate and recurrent convulsions. Both neonates had gross motor and developmental delay. Cranial sonography and CT scan showed features consistent with alobar holoprosencephaly. Karyotyping for the first neonate and her family members was normal. Both of them were treated conservatively and supervised.

Topics: Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Holoprosencephaly; Humans; Infant, Newborn; Nose; Orbit

Authors have reported an interest in the latero-nasal incision for surgical treatment of nasal deformities of patients with median and paramedian orbito-facial clefts. Validity of this "L" approach is correlated to its respect for the integrity of aesthetic facial units and to its position in a natural fold (naso-labial fold). A series of patients with median and paramedian orbito-facial clefts were operated upon using this approach and good results were obtained which support its theoretical value.

Topics: Abnormalities, Multiple; Child, Preschool; Cleft Lip; Cleft Palate; Face; Female; Humans; Infant; Male; Nose; Orbit; Surgery, Plastic; Surgical Flaps

Roentgencephalometric study was used for the assessment of 16 adult males with unilateral cleft lip and palate and an osseous bridge and of 10 males with a soft tissue bridge. They were compared with 32 individuals with a complete cleft and with a control group of 50 normal males. All patients were operated upon and subsequently treated with the same methods. In contrast to the soft bridge, an osseous bridge prevents the reduction of upper face height, and an increased width of the nasal cavity. Both an osseous and a soft tissue bridge exert a favorable effect on the shortening and retrusion of the maxilla and thus also on the maxillo-mandibular relations and on facial configuration. The thickness of the upper lip is related to the presence of a soft bridge, while deviations of the lower jaw and the posterior position of the maxilla are not related to the presence of either type of bridge. Alveolar retroinclination was insignificantly smaller in the presence of both types of bridges. These differences disclosed that clefts with soft bridges cannot be pooled with complete clefts (or with clefts with osseous bridges), when there is not definite evidence of the same proportion of both forms of clefts in the series used for comparison.

Topics: Adult; Cephalometry; Cleft Lip; Cleft Palate; Face; Humans; Lip; Male; Mandible; Maxilla; Nasal Cavity; Nose; Orbit; Vertical Dimension

During the last 15 years, cleft lip and palate (CLP) patients with maxillary deficiency in the care of the Bergen CLP team have undergone an interceptive orthopedic treatment phase during the deciduous and mixed dentition period. The present study includes 68 patients who received maxillary transverse expansion by use of a modified quad-helix appliance and 98 cases given maxillary protraction by a facial mask. All cases were treated until an acceptable normal occlusion was attained. Lateral cephalograms were taken immediately before and after the active treatment periods. Sagittal changes of the soft-tissue profile during transverse expansion and protraction were analyzed separately for unilateral complete cleft lip and palate (UCLP) patients and bilateral complete cleft lip and palate (BCLP) patients. The soft-tissue profiles of the groups were compared to growth changes of noncleft age-matched children (NORM group). During the short period of maxillary transverse expansion (mean period, 3.5 months) no significant change of the soft-tissue profile was found, except in the protrusion of the lower lip in the BCLP group. During the period of maxillary protraction (mean periods, 12 months in the UCLP group and 15 months in the BCLP group) the soft-tissue profile improved significantly by reducing the characteristic tendency towards a concave profile in CLP patients with maxillary deficiency. Significant increases of the sagittal maxillomandibular lip relation (angle SS-N-SM: mean increase, 2.5 degrees) and the Holdaway-angle (H-angle: mean increase, 3.0 degrees) were found to be similar in the UCLP and BCLP groups. However, the use of different reference lines for evaluation of treatment effects upon the soft-tissue profile resulted in conflicting findings suggesting that anteriorly situated reference lines are more suitable for the evaluation of CLP patients. Thus, the esthetic line (E.line) indicated a favorable position of the lips after treatment; the subspinale-pogonion line (ss.pg) revealed an improved soft-tissue profile; the soft-tissue-facial line (N.PG) showed a retruded nose and upper lip; whereas basal references such as the nasionsella line (NSL) and the occlusal-line perpendicular (OLP) mainly showed major differences between the CLP groups and the NORM groups.

Topics: Cephalometry; Child; Child, Preschool; Chin; Cleft Lip; Cleft Palate; Esthetics, Dental; Extraoral Traction Appliances; Female; Humans; Lip; Male; Maxilla; Maxillofacial Development; Nose; Orthodontic Appliances; Orthodontics, Interceptive; Outcome and Process Assessment, Health Care; Palatal Expansion Technique; Reference Values; Retrognathia; Self Concept; Vertical Dimension

DiGeorge syndrome (DGS) comprises thymic hypoplasia, hypocalcaemia, outflow tract defects of the heart, and dysmorphic facies. It results in almost all cases from a deletion within chromosome 22q11. We report the clinical findings in 44 cases. We propose that DiGeorge syndrome should be seen as the severe end of the clinical spectrum embraced by the acronym CATCH 22 syndrome; Cardiac defects, Abnormal facies, Thymic hypoplasia, Cleft palate, and Hypocalcaemia resulting from 22q11 deletions.

Topics: Abnormalities, Multiple; Child; Child, Preschool; Chromosomes, Human, Pair 22; Cleft Palate; DiGeorge Syndrome; Ear, External; Face; Female; Genetic Variation; Heart Defects, Congenital; Humans; Hypocalcemia; Infant; Male; Nose; Phenotype; Terminology as Topic; Thymus Gland

The size, site, and influence on speech of oronasal fistulas were studied in 12 patients with unilateral and 32 with bilateral cleft lip and palate. There were more and larger fistulas in the bilateral group. The series was divided into: those with fistulas that affected speech (group A, n = 18) and those with fistulas that did not affect their speech (group B, n = 26). Group A had significantly larger fistulas than group B, but there were no differences in the sites of the fistulas, either between the bilateral and unilateral groups or between groups A and B. Most fistulas were located in the region of the incisive foramen or in the hard palate. Judgements by listeners and analyses by the NORAM instrument were made of the speech of 12 of the patients in group A before and after temporary covering of the fistulas. Significant differences in hypernasality, according to both listener's judgments and instrumental analyses were found. This finding is further evidence that an oronasal fistula can influence and contribute to velopharyngeal dysfunction.

Topics: Adolescent; Adult; Child; Cleft Palate; Fistula; Humans; Nose; Palate; Speech

Although the effects of cleft lip and palate on nasal airway size and breathing have been reported for adults, little information is available on children. The present study assessed the effect of age on nasal cross-sectional size and, in particular, whether type of cleft influenced the outcome. The results indicate that, while the cleft nose continues to grow with age, it remains about 30% smaller than the noncleft nose. The airway is smallest in patients with unilateral cleft lip and palate and is largest in those with bilateral clefts. The prevalence of oral breathing is considerably higher in the cleft population in comparison to noncleft.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cleft Lip; Cleft Palate; Humans; Nose; Respiration

A method of open-tip rhinoplasty using nostril and columella rim incisions at the time of unilateral cleft lip repair is described. This preliminary report details experience gained using this technique in the Malaysian centre of Alor Setar following its introduction in September, 1991.

Topics: Adolescent; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Nose; Rhinoplasty; Suture Techniques

The management of the cleft lip and palate patient usually requires multiple primary and secondary surgical procedures to correct the deformity. This paper presents surgical methods in the secondary management of the cleft nose and presents three case reports to help illustrate these methods.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Fistula; Humans; Male; Maxilla; Mouth Diseases; Nasal Septum; Nose; Nose Diseases; Osteotomy; Rhinoplasty; Time Factors

Two populations were studied and compared to determine the effects of cleft lip and palate surgery on the nose and face. In the first, three anthropometric measurements, two nasal and one facial, were taken before primary lip repair from infants with complete unilateral cleft lip and palate (UCLP) and with bilateral cleft lip and palate (BCLP). In the second, ten measurements were taken from the nose and face of patients surgically treated for UCLP and BCLP. The high frequency of noses disproportionately wide in relation to their height in both cleft types before primary lip repair greatly decreased after surgery. Among the residual deformities after surgery for UCLP, nostril floor width asymmetry was the most frequent, followed by columella length asymmetry, flat nasal bridge, wide soft nose, flat nasal tip, and small nasal tip protrusion. In the BCLP patients, nostril floor width asymmetry was also the most common stigma, followed by flat nasal tip, wide soft nose, columella length asymmetry, flat nasal bridge and bilaterally angled alae, and small nasal tip protrusion. A subnormally flat upper face inclination was observed in UCLP and BCLP patients. Quantitative determination of these nasal stigmata in cleft lip and palate patients who have undergone primary lip repair provides valuable information for surgical correction of the cleft soft-tissue deformities.

Topics: Adolescent; Adult; Anthropometry; Cephalometry; Child; Cleft Lip; Cleft Palate; Face; Female; Humans; Infant; Male; Nasal Septum; Nose; Reference Values

A retrospective study of morbidity due to primary radical nasal correction was undertaken on 33 consecutive cases of complete unilateral cleft lip and palate within one year of their 10th birthday. Primary surgery was performed by one surgeon (RWP) using the Alar Leapfrog technique. Morbidity was assessed by the number of manoeuvres required for revisional surgery up to the age of 10 and was derived from the case notes. A total of 12 patients required no revision. The number of revisional manoeuvres was 39 in 27 anaesthetic sessions. Cleft lip noses treated by a technique of primary radical nasal correction (Alar Leapfrog) required a significant number of secondary manoeuvres to produce an acceptable result. This must be balanced against reduced teasing due to improved symmetry over this period.

Topics: Child; Cleft Lip; Cleft Palate; Esthetics; Humans; Male; Morbidity; Nose; Postoperative Complications; Reoperation; Retrospective Studies; Rhinoplasty; Surgery, Plastic; Time Factors

A computer-based system of assessing asymmetry was used to compare standardised photographs of primarily corrected cleft noses, uncorrected cleft noses and control (normal) noses. A significant difference was found between control and cleft groups for both upper nasal perimeter (p < 0.001) and nostril outline (p = 0.001), and between uncorrected and corrected noses for upper nasal perimeter (p = 0.03) but not for nostril outline (p = 0.99). Comparing the results achieved by panel assessment (Cussons et al., 1992) with this of the same patients revealed some discordance related to the influence of extraneous factors on panel decisions. Panel assessment is needed in the evaluation of overall appearance, whilst the computer method is able to assess the results of different techniques, and from different centres, on specific features where symmetry is a major objective of surgical technique.

Topics: Attitude of Health Personnel; Child; Cleft Lip; Cleft Palate; Diagnosis, Computer-Assisted; Facial Asymmetry; Humans; Nose; Observer Variation; Treatment Outcome

There is a need to be able to assess the overall result in a significant series of cases of a method of management of the cleft lip and nose deformity in order to avoid "best case" reporting often used to introduce new techniques. The present study was performed by a panel placing standardised base view photographs in rank order. The photographs were of 10-year-old subjects of whom 15 were normal controls, 22 were from the Rikshospitalet, Oslo, all of whom had no primary nasal correction and 25 from Frenchay Hospital, Bristol, who all had radical primary nasal correction. Ranking was performed for upper nasal perimeter symmetry, nostril outline symmetry and for overall aesthetic appearance. Analysis of the results showed a significant difference between the three groups, with the corrected noses showing better symmetry. Inter and intraobserver correlations were very close. The limitations of a ranking and marking method of panel assessment are discussed, and a computerised method is presented in subsequent papers.

Topics: Child; Cleft Lip; Cleft Palate; Esthetics; Facial Asymmetry; Humans; Nose; Photography; Rhinoplasty; Surgery, Plastic; Time Factors

A patient with median cleft lip is reported, but the patient showed no evidence of holoprosencephaly, which was ruled out by MRI. When the neonate's head circumference is within two standard deviations of the mean and normotelorism occurs with median cleft lip, it can be assumed that the brain is not holoprosencephalic. The importance of this cannot be overemphasized because median cleft lip is commonly associated with holoprosencephaly and severe microcephaly. The mother developed overt diabetes mellitus after the patient was born. However, infants of diabetic mothers are known to be at increased risk of giving birth to infants with holoprosencephaly. Since a prediabetic woman may sometimes give birth to large and/or malformed infants before developing overt diabetes mellitus, it is intriguing to speculate that the prediabetic state might have resulted in a forme fruste of holoprosencephaly, affecting, in this case, only the face and not the brain.

Topics: Anodontia; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Holoprosencephaly; Humans; Infant, Newborn; Intellectual Disability; Male; Nose; Prediabetic State; Pregnancy; Pregnancy in Diabetics

This paper is a preliminary report on a strategy to perform open tip rhinoplasty at the time of lip repair in bilateral cleft lip and palate deformity. This method was devised to suit unique socio-economic circumstances in the Malaysian centre of Alor Setar. Of 8 cases having surgery in 1991, 7 returned for follow-up with results being documented photographically. It is concluded that this aggressive approach is justified in severe bilateral cleft lip and palate deformity because of the cost effectiveness of limiting the number of interventions. Furthermore, it provides optimally orientated nasal tip anatomy and reduces the social stigma of cleft lip nose appearance from the earliest possible time in the child's development.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Infant; Lip; Malaysia; Male; Medically Underserved Area; Nose; Palate; Rhinoplasty; Suture Techniques

Sixty patients with unilateral cleft lip and palate were compared for lip and nose appearance. All patients were photographed from an anteroposterior and a basal view at 7-10 years of age. The photographic registration method was tested for validity and accuracy. Although the four groups of 15 patients each were treated according to different protocols, many similarities were found with shorter lip heights at the cleft side and inclination of the rima oris. Asymmetry of nose and retropositioning at the cleft side naris were generally seen. Significantly straighter noses were demonstrated in the group treated with a two-stage lip nose operation combined with nose plugs, and the two groups where vomer flaps were used showed the greatest deviation of the nose.

Topics: Child; Cleft Lip; Cleft Palate; Clinical Protocols; Esthetics; Female; Humans; Lip; Male; Nose; Photography

The results of a follow-up study of 17 patients who underwent a quadrangular osteotomy, are presented. The indication for a quadrangular osteotomy includes a hypoplastic maxilla with retruded infra-orbital rims and infra-orbital area, but with normal nose projection. Almost all patients were satisfied with the result. Relapse in a horizontal direction appeared to be approximately 12%; however, considerable relapse was seen in the vertical direction (61.7%-158%). A major problem during operation appeared to be the high rate of fractures of the infra-orbital wing. Sensory loss in the area of the infra-orbital nerve occurred in 79% of the operated sides. Four patients needed surgical correction of conditions that should be considered complications resulting from the osteotomy, including a case of partial ischaemic necrosis of the premaxilla in a BCLP patient.

Topics: Adolescent; Adult; Attitude to Health; Cephalometry; Cleft Lip; Cleft Palate; Esthetics; Follow-Up Studies; Humans; Malocclusion, Angle Class III; Mandible; Mastication; Maxilla; Nose; Orbit; Orthodontics, Corrective; Osteotomy; Patient Satisfaction; Pulmonary Ventilation; Recurrence; Zygoma

The external nose is a structure that provides prominence to the face. The internal nose is a paired nasal cavity that extends from the face to the pharynx. Turbinates are major structures within the lateral walls of the nose. They perform the major functions of the nose that include respiration, humidification, temperature regulation, and filtration of the inspired air. Conditions that obstruct the nose interfere with its optimal function. These range from acute or chronic infection to enlarged tonsils and adenoid tissue to nasal septal deviation. Surgeons caring for patients with clefts must have familiarity with nasal anatomy and function and conditions that alter them. Correction of these conditions may require medical and/or surgical treatment.

Topics: Adenoids; Bacterial Infections; Child; Cleft Palate; Humans; Hypertrophy; Infant; Nasal Cavity; Nasal Obstruction; Nasal Septum; Nasopharynx; Nose; Palatine Tonsil; Paranasal Sinuses; Pulmonary Ventilation; Respiration; Respiratory Tract Infections; Rhinitis; Smell; Turbinates

Management of common problems of nasal airway obstruction in cleft and noncleft patients by the subnasal approach through the maxillary Le Fort I osteotomy are discussed. The effects of maxillary surgical repositioning on the esthetics of the nose and upper lip are presented, as well as the sequencing and timing of orthognathic surgery and nasal reconstruction in the cleft patient. Case presentations illustrate the results of this treatment approach.

Topics: Adenoidectomy; Adolescent; Cleft Lip; Cleft Palate; Humans; Jaw Abnormalities; Male; Malocclusion; Maxilla; Maxillary Sinus; Nasal Obstruction; Nasal Septum; Nose; Orthognathic Surgical Procedures; Osteotomy; Time Factors; Turbinates

A sample of 97 untreated cleft lip and palate adult patients, with and without Simonart's band, was analyzed. The dimensions and form of the maxillary dental arches were analyzed. Comparison of this sample with a "normal" group indicated maxillary dental arch size and shape are distorted by the presence of a cleft which is characterized by a constriction that becomes more severe in the medial and anterior regions. The presence of Simonart's band affects the cleft arch form, redirecting the anterior extremity of the major segment towards the minor segment.

Topics: Adolescent; Adult; Bicuspid; Cephalometry; Cleft Lip; Cleft Palate; Cuspid; Dental Arch; Female; Humans; Lip; Male; Maxilla; Middle Aged; Models, Dental; Molar; Nose; Sex Factors; Signal Processing, Computer-Assisted

From extraoral photographs taken from the front and in profile of 61 16-year old children with unilateral cleft lip, alveolus, and palate (UCLAP) who had been treated by three different treatment regimes, the nasolabial appearances were assessed by a panel. The photographs were masked, leaving only the mid face including the nose and lips. The following features were assessed using a five point scale: nasal form, symmetry of the nose, vermilion of the upper lip, shape of the vermilion border, total symmetry of upper lip, and nasal profile including the upper lip. The number and type of secondary operations required were recorded. Intraobserver reliability was good but interobserver agreement was poor, some observers systematically scoring more severely than others. A panel of six was therefore set up to establish an acceptable mean assessment. The treatment regime that included secondary bone grafting, and the one that included primary bone grafting and presurgical orthopaedic-T-traction, scored better on all features assessed compared with the group that underwent primary bone grafting but no T-traction. The latter group required fewer secondary revisionary procedures, however, which could explain these results.

Topics: Adolescent; Alveolar Process; Cleft Lip; Cleft Palate; Esthetics; Follow-Up Studies; Humans; Lip; Maxillofacial Development; Methods; Nose; Observer Variation; Reoperation

The craniofacial morphology and the soft tissue profile were evaluated in this part of the intercenter study of the European Cleft Lip and Palate Research Group. The sample was comprised of cephalometric x-rays of the full cohort of 151 cases from the six European cleft palate centers. The facial morphology in complete unilateral cleft lip and palate patients was evaluated by means of roentgen cephalometry. Approximately 25 consecutive cases from each of six European cleft palate centers were compared. Only one center showed notable and consistent differences from the others. A contributing factor for these differences may be an inconsistent treatment regimen with many surgeons involved. Analysis of the soft tissue profile between the centers showed more pronounced differences than analysis of the skeletal profile. The treatment outcome in centers with more complex or expensive programs was no better than those centers using simpler management approaches.

Topics: Analysis of Variance; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Europe; Face; Humans; Infant; Lip; Male; Nose; Outcome Assessment, Health Care; Radiographic Image Enhancement; Retrospective Studies; Treatment Outcome

One hundred and fifteen frontal and profile photographs of the nasolabial area of subjects with complete unilateral clefts of the lip and palate from six European centers were assessed. Four components of the nasolabial area were rated separately by a panel of judges using a five-point scale of attractiveness. The Tukey multiple comparison test showed significant differences between the centers. The relative position of the six centers in this study followed a similar pattern to their respective positions in the cephalometric and dental cast studies.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Esthetics, Dental; Europe; Female; Humans; Infant; Lip; Male; Maxillofacial Development; Nose; Outcome Assessment, Health Care; Photography; Reproducibility of Results; Retrospective Studies; Treatment Outcome

Velopharyngeal insufficiency was assessed using multiview videofluoroscopy on eight patients with hypernasality, 10 patients with hypernasality and audible nasal emission, and 10 patients with nasal turbulence (rustle). Patients demonstrating hypernasality, with or without audible nasal emission, were found to have a significantly larger velopharyngeal gap than those with nasal rustle. This finding suggests that the degree of the velopharyngeal insufficiency can be predicted to some extent based on perceptual assessment. If the presence of a nasal rustle suggests a small velopharyngeal gap, despite the severe distortion of speech, then speech therapy should be considered prior to surgery in those cases.

Topics: Adolescent; Adult; Child; Child, Preschool; Cineradiography; Cleft Lip; Cleft Palate; Fluoroscopy; Humans; Movement; Nose; Palate, Soft; Pharynx; Speech Disorders; Velopharyngeal Insufficiency

Peroral examination of the soft palate is of greater value than generally recognized. The nasendoscopic examination provides essential information on the velopharyngeal valve physiology and pathology. However, nasendoscopy cannot be performed in individuals who are uncooperative such as young children, patients with personality disturbances or those mentally retarded, or in the presence of severe deformity of the nose. In these patients the peroral examination is of particular practical clinical application. Forty cases of occult and overt submucous cleft palate were included in the present study. We describe the contribution of systematic assessment of the soft palate intraorally, based on a correlation with nasendoscopic examination of the velopharyngeal valve in speech. An accurate peroral examination can provide additional information on abnormality of the velar musculature as well as the existence of Passavant's ridge. This information is particularly important in children who are too young for nasendoscopix examination, but because of their poor speech intelligibility, early diagnosis and treatment are imperative.

Topics: Adolescent; Adult; Child; Child, Preschool; Cineradiography; Cleft Palate; Diagnosis, Differential; Endoscopy; Female; Fluoroscopy; Humans; Male; Nose; Oropharynx; Palate; Palate, Soft; Pharynx; Phonation; Phonetics; Physical Examination; Uvula

The relationship between nasal airway size and articulatory performance was studied in a group of cleft palate patients. Articulation analysis revealed that children with bilateral cleft lip and palate were nearly twice as likely to manifest compensatory articulations as children with unilateral cleft lip and palate or with cleft palate only. When subjects were grouped according to speech performance, aerodynamic assessment indicated that children with compensatory articulations had significantly larger nasal cross-sectional areas than children without compensatory articulations. The findings suggest that children with comparatively large nasal airways may be at increased risk for developing abnormal speech patterns. If these findings are confirmed by further research, such children may be candidates for relatively early palate repair.

Topics: Articulation Disorders; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Nose; Palate, Soft; Pharynx; Phonetics; Pressure; Prevalence; Pulmonary Ventilation; Speech; Speech Intelligibility

Johnston and Hunter (1989) reported that in monozygotic twins discordant for cleft lip +/- palate, the noncleft twins demonstrated what appeared to be a bimodal distribution of nasal cavity width. Two thirds showed reduced airway size and one third showed normal or slightly greater airway size. They suggested that the two-thirds group may represent reduced size of the medial nasal prominences and the other may represent underdevelopment of the maxillary prominence. We were particularly interested in the findings because the difference in distribution may represent differences in pathogenesis and therefore have etiologic significance. With this in mind we assessed nasal cross-sectional areas in 37 subjects with cleft lip or cleft lip +/- palate using the pressure-flow technique during breathing. A group of 72 noncleft individuals served as controls. As expected, the data revealed that subjects with clefts had a significantly reduced nasal airway (p = .0001). More important, the distribution of nasal airway size in the cleft group was similar to that reported by Johnston and Hunter (1989). This comparability suggests that it may be possible to assign most cleft lip +/- palate patients to a particular group. Since heredity may differ among the two groups (Chung et al., 1986), we may have a simple technique to assess the risk of occurrence for cleft lip +/- palate.

Topics: Adolescent; Adult; Aged; Cleft Lip; Cleft Palate; Disease Susceptibility; Female; Humans; Male; Middle Aged; Nasal Cavity; Nose; Pressure; Pulmonary Ventilation; Retrospective Studies

The relationship between nasalance scores and perceptual judgments of hypernasality and hyponasality was examined for 74 subjects (51 with cleft palate and 23 noncleft controls). Twenty-nine of the 51 subjects with cleft palate had received pharyngeal flap surgery. Predictive analyses were performed to assess the sensitivity, specificity, and efficiency of the Nasometer as a screening instrument. The overall relationship between perceptual judgments of hypernasality and nasalance scores was good for the nonflap subjects when a nasalance cutoff score of 26 was used. A sensitivity coefficient of 0.87 and a specificity coefficient of 0.93 were obtained. Ninety-one percent of the nasometry-based classifications accurately reflected listener judgments of hypernasality. The correspondence between nasalance scores and clinical judgments of hyponasality was also good for the nonflap subjects when a nasalance cutoff score of 50 was used. Ninety-one percent of these classifications were consistent with the listener judgments. Efficiency of nasometry was poorer for the flap subjects.

Topics: Adolescent; Adult; Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Manometry; Middle Aged; Nose; Observer Variation; Phonetics; Pressure; Pulmonary Ventilation; Sensitivity and Specificity; Speech Disorders; Speech Perception; Surgical Flaps

Proboscis lateralis of type IV has not yet been reported from the Indian subcontinent. The authors gives a report on a case of this type and describes the technique of reconstruction not described before. A case of a right-sided proboscis lateralis associated with ipsilateral hemi-nasal aplasia and contralateral nostril and alar defect, a contralateral cleft lip and alveolus, hypertelorism and mild hydrocephalus is presented and documented on a boy coming from the Indian subcontinent.

Topics: Abnormalities, Multiple; Cleft Palate; Humans; Hydrocephalus; Infant; Male; Nose; Surgery, Plastic

Comparison of the outcome of treatment of patients with clefts of the lip and palate can yield valuable pointers for discriminating between beneficial and harmful procedures. The development of a standardized rating scheme to assess the facial appearance of these patients is described. The rating scheme can be used in conjunction with conventional cephalometric analysis and dental arch evaluation. A method is described in which the nasolabial area is masked, thus reducing the influence of the surrounding facial features since it is shown that judges are influenced by general facial attractiveness. An ordinal scale has been evaluated in which four features of the nose and lip are assessed separately and in total by a panel of judges. The nasolabial profile, the nasal symmetry, the nasal form, and vermilion border were assessed using a 5-point scale. Acceptable pooled levels of reliability and reproducibility were obtained. This standardized rating system may be used to differentiate treatment outcome in patients from different treatment centers.

Topics: Adolescent; Analysis of Variance; Bias; Child; Cleft Lip; Cleft Palate; Esthetics; Face; Humans; Lip; Nose; Observer Variation; Orthodontics; Photography; Reproducibility of Results; Treatment Outcome

Midfacial hypoplasia in patients with complete clefts of the lip and palate is considered to be the result of congenital dysmorphogenesis combined with surgical effects. The present study describes congenital correlates of midfacial hypoplasia by examining the relationships between premaxillary size and a number of adjacent oronasal capsular components in a sample of second trimester normal and complete cleft fetal specimens. Midfacial relationships from previously published data from 3-D computer reconstructions of histologic material were assessed by multiple regression and path analyses. Stepwise multiple regression analysis revealed that the combination of age (body size) and nasal septal length were the best predictor variables of premaxillary length and accounted for 90 percent and 93 percent (p less than .01) of the variance in normal and cleft fetal specimens, respectively. Tongue length was seen to slightly increase the R2 values in the cleft, but not the normal sample. Path analysis results revealed that with body size held constant, nasal capsule volume explained only 3 percent of premaxillary variance, while septal length accounted for approximately 45 percent of the variance (p less than .05). Results show that the relationships of the midfacial components in the cleft fetal sample closely followed normal second-trimester midfacial growth patterns and suggest that the septal-traction model may be a more parsimonious and primary explanatory mechanism of early midfacial growth than the functional matrix model in both normal and complete cleft fetal specimens.

Topics: Body Constitution; Cartilage; Cephalometry; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Fetus; Gestational Age; Humans; Image Processing, Computer-Assisted; Maxilla; Multivariate Analysis; Nasal Septum; Nose; Regression Analysis; Tongue

The videofluoroscopic and nasopharyngoscopic observations of velopharyngeal movements during speech were compared in 80 subjects with hypernasal speech. An endviewing flexible fiberoptic endoscope was used for nasopharyngoscopic examination. This failed to demonstrate movements of the lateral pharyngeal walls that were videofluoroscopically documented in one third of the patients. In the cases of disagreement, the angle of view was impaired because of the presence of adenoid tissue. The misinterpretation at nasopharyngoscopy was explained by an unfavorable observation position of the flexible scope and failure to pass it further into the pharynx. Conclusions are satisfactory that videofluoroscopy is an indispensable procedure for assessing velopharyngeal function.

Topics: Adolescent; Adult; Child; Child, Preschool; Cineradiography; Cleft Lip; Cleft Palate; Endoscopy; Fluoroscopy; Humans; Middle Aged; Movement; Nasopharynx; Nose; Palate, Soft; Pharynx; Phonetics; Speech; Speech Disorders; Video Recording

The reliability and validity of human judgments in rating the severity of cleft-related facial impairment were examined in this series of studies. The goal of the research was to develop scales for rating the severity of facial cleft impairment using psychophysical methods for measuring human judgment. The principle findings were: (1) Four photographic categorized scales with high inter-group reliability and satisfactory content and construct validity were developed; (2) Raters used objective stimulus characteristics of the face to scale impairment; (3) Ratings of facial attractiveness decreased as the severity of impairment increases; (4) Full face ratings of the severity of impairment correlated highly with ratings of the same photographs cropped below the eyes. The implications of these findings for clinical and research application are discussed.

Topics: Adolescent; Adult; Age Factors; Cleft Lip; Cleft Palate; Education; Esthetics; Face; Female; Humans; Judgment; Lip; Male; Maxilla; Nose; Observer Variation; Photography; Psychometrics; Reproducibility of Results; Severity of Illness Index; Students; Students, Medical

The following is our experience with the correction of 103 uni- and bilateral cleft noses at the Department of Oral and Maxillofacial Surgery at the University of Münster from 1982 to 1989. The typical features of this kind of nose deformity, certain surgical aspects, the aesthetic and functional postoperative results as well as perioperative rhinomanometric findings are reported. To achieve optimal results in these cleft cases, which should be carried out by an experienced maxillofacial surgeon, we recommend: 1. A one-step nose repair, which will be not only aesthetic but also give improved function. 2. Avoiding interference with any primary repair of a cleft palate. 3. Simultaneous secondary cleft lip and palate correction in order to minimize hospital admissions.

Topics: Adolescent; Cleft Lip; Cleft Palate; Humans; Nose; Patient Satisfaction; Rhinoplasty; Treatment Outcome

A case is reported of median cleft face syndrome with bifid tongue and odontoid peg and failure of formation of the anterior arch of the atlas. These are features which have not been reported previously. The preoperative CT demonstrated its potential to enhance our understanding of complex and rare craniofacial deformities.

Topics: Abnormalities, Multiple; Cervical Atlas; Cleft Palate; Face; Female; Humans; Hypertelorism; Infant, Newborn; Lip; Mandible; Nose; Syndrome; Tongue

Although the validity of the pressure-flow technique has been verified in a number of laboratories, some questions still remain. The purpose of this study was to determine whether the procedures involved in estimating orifice size affect the pressure and airflow variables being measured. Twenty subjects with demonstrated velopharyngeal inadequacy on pressure-flow testing (VPO greater than or equal to 0.10 cm2) were assessed under two contrasting conditions. Subjects were asked to produce (p) in the word "hamper" with a) one nostril occluded by a cork as in pressure-flow testing and b) both nostrils patent. The results indicate that the increased nasal resistance resulting from occlusion of one nostril does not appreciably affect pressure and airflow associated with plosive consonant production in patients with velopharyngeal inadequacy.

Topics: Adolescent; Adult; Aged; Airway Resistance; Child; Child, Preschool; Cleft Palate; Humans; Middle Aged; Mouth; Nose; Palate, Soft; Pharynx; Phonetics; Pressure; Pulmonary Ventilation; Speech; Time Factors; Transducers, Pressure; Velopharyngeal Insufficiency

Topics: Airway Resistance; Cleft Lip; Cleft Palate; Humans; Nose; Pressure; Pulmonary Ventilation

The nasopharyngeal area in 149 patients with cleft lip and palate and 157 normal individuals was evaluated by cephalometric radiography. The patients were male and female Caucasians, ranging in age from 12 to 16 years. Linear cephalometric parameters: (Ptm'-Sl; Ptm'-IPPF; IPPF-I, I-Ptm'), ANS angle and nasopharyngeal area were utilized. From comparative analysis of nasopharyngeal area in the cleft and the control groups, the following conclusions were made: 1) The nasopharyngeal area was smaller in the cleft group. 2) There was no correlation between ANS angle and nasopharyngeal area in either group.

Topics: Adolescent; Cephalometry; Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Maxilla; Maxillofacial Development; Nasal Cavity; Nasopharynx; Nose; Palate; Pharynx; Sella Turcica

This study determined the effect of a speech aid prosthesis on resting breathing. Nasal cross-sectional area was measured during inspiration and expiration in eight cleft palate patients. The measurements were made for the unobturated defect during both phases of respiration and then repeated while the defect was obturated by a speech aid prosthesis. The results of the study revealed that the presence of a speech aid prosthesis significantly decreased the cross-sectional region of the nasal airway. In 50% of the subjects, the cross-sectional region was less than 0.40 cm2 with concomitant impairment in nasal respiration when the speech aid prosthesis was present in the oral cavity. The data suggest that the design of these prostheses should account for breathing requirements as well as for speech.

Topics: Analysis of Variance; Cleft Palate; Humans; Nasopharynx; Nose; Palatal Obturators; Pressure; Pulmonary Ventilation; Respiration; Speech Therapy

In the present study, the size and rate of growth of the tongue was assessed in human fetuses. For comparative purposes, 29 human fetal specimens (20 "normal" and 9 with cleft lip and palate were celloidin embedded, sectioned, stained with hematoxylin and eosin, and serially photomicrographed. The specimens ranged from 8 to 21 weeks postmenstrual age. The application of a well documented three-dimensional reconstruction technique provided quantification of several aspects of the tongue. Tongue length and volume were larger in the cleft specimens than for the normal specimens, while both length and volume were growing at a faster rate. Growth curves were produced by plotting length and volume against postmenstrual age and a significant difference was noted between the slopes (growth rate) of the growth curves for tongue length and volume for the two groups. Tongue length increase was approximately 2.27 times greater and tongue volume increase was approximately 1.64 times more for the cleft specimens than for the normal specimens from 8 to 21 weeks. In support of these findings, tongue volume was relatively larger expressed as a contribution of total oronasal capsule volume in the cleft specimens. For an initial age category (8 to 12 weeks), tongue volume in the cleft specimens was larger, growing at a faster rate than normal tongue volume and a significant difference was noted between the slopes of the growth curves. No significant difference was observed between the tongue length indices in the initial or the 8 to 21 week age category.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cephalometry; Cleft Lip; Cleft Palate; Embryo, Mammalian; Fetus; Gestational Age; Humans; Image Processing, Computer-Assisted; Mouth; Nasal Septum; Nose; Palate; Regression Analysis; Tongue

Kabuki make-up syndrome (Niikawa-Kuroki syndrome), recognized in Japan in 1981, is characterized by mental and growth retardation with specific craniofacial malformation such as lower palpebral eversion and depressed nasal tip. In this paper we describe a case associated with cleft lip and palate. Attention should be paid by maxillofacial surgeons to this syndrome, since 41% of the cases have been associated with cleft lip and palate (Niikawa et al., 1988; Tonoki and Niikawa, 1988).

Topics: Cleft Lip; Cleft Palate; Eyebrows; Eyelids; Female; Humans; Infant; Infant, Newborn; Intellectual Disability; Nose; Syndrome

With better understanding of microcirculation of the flaps and with the introduction of the concept of myocutaneous flaps, nasolabial flap has regained its past popularity. Although it has been used increasingly for oral defects, its use for reconstruction of palatal defects has not been reported. Large anterior fistulae of palate are commonly produced when a wide cleft of palate is being repaired in an adult patient, especially by a beginner in plastic surgery, and are difficult to treat surgically. We have used superiorly based nasolabial myocutaneous island flap in one such case and report it here.

Topics: Adult; Cleft Palate; Fistula; Humans; Lip; Male; Nose; Palate; Postoperative Complications; Surgical Flaps

A nasal anemometer is a useful tool for speech therapists in their assessment of treatment effectiveness. This work is the second part of a research scheme which describes how the system is compatible with the use of an IBM PC-AT microcomputer using a suitable analogue-to-digital convertor. This enables the system to perform signal processing and to display, draw, and calculate a numerical 'figure of merit' using Kendall's tau nonparametric correlation.

Topics: Cleft Palate; Diagnosis, Computer-Assisted; Humans; Microcomputers; Nose; Pulmonary Ventilation; Rheology; Signal Processing, Computer-Assisted

Pressure-flow data were obtained on 20 noncleft adults with normal speech and 26 adults with repaired cleft palate. All subjects had adequate velopharyngeal function as determined by preliminary aerodynamic assessment. Subjects were considered to have adequate closure if they had velopharyngeal areas no greater than 0.049 cm2 during production of /p/ in the word "hamper." Although the subjects in both groups demonstrated velopharyngeal adequacy, the subjects with cleft palate produced speech with significantly less nasal airflow. In addition, their intra-oral pressure curve was shifted forward in time. These differences suggest that speakers with cleft palate and adequate velopharyngeal function make certain compensatory adjustments that may be necessary because of differences in velopharyngeal movement capabilities. The potential significance of this for treatment planning is discussed.

Topics: Adolescent; Adult; Air Pressure; Cleft Palate; Female; Humans; Male; Middle Aged; Mouth; Nose; Palate, Soft; Pharynx; Phonetics; Pressure; Pulmonary Ventilation; Speech; Time Factors

Findings of 55 ultrasound examinations have been evaluated in 35 fetuses with various facial malformations detected by ultrasound and confirmed at birth. Ultrasonographic presentations and diagnostic criteria are given for major facial, palate and lip clefts, abnormal nasal shape, hypo and hypertelorism, microphthalmia, exophthalmia, micro and macrogenia, macroglossia. Ultrasonography proves to be a highly revealing diagnostic study with the provision of a good structural visualization and physicians' skill.

Topics: Cleft Palate; Eye Abnormalities; Female; Humans; Hypertelorism; Nose; Pregnancy; Ultrasonography, Prenatal

Phoneme-specific nasal emission was identified in 36 children ranging in age from 3 years, 3 months to 16 years, 5 months; 19 children had no physical anomalies of the orofacial mechanism, whereas 17 had findings ranging from minor to severe. Five patterns of phoneme-specific nasal emission were exhibited by 2 or more children. An additional eight patterns were exhibited by 1 child each. Sibilants were clearly the most frequently affected phonemes. There was no significant correlation between the number of phonemes affected by nasal emission and the number of phonologic processes exhibited by the children in either subject group. The two subject groups were more alike than different in the speech behaviors observed, underscoring a fundamental homogeneity among speakers who exhibit phoneme-specific nasal emission.

Topics: Adolescent; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Phonetics; Pulmonary Ventilation; Speech Disorders; Velopharyngeal Insufficiency

Clefts of the lip and palate generally result in reduced size of the nasal airway. Procedures such as the placement of a pharyngeal flap tend to further compromise nasal breathing. The purpose of this study was to determine how size of the nasal airway affects the mode of breathing in adults with cleft lip and/or palate. A heterogeneous population of 50 adult subjects with cleft lip and/or palate was studied. Nineteen of the subjects had pharyngeal flaps. Respiratory inductive plethysmography was used in combination with an integrating pneumotachograph to measure percent nasal breathing. Pressure-flow studies were used to estimate nasal airway size. The data revealed that a majority of subjects had an airway size of less than 0.4 cm2, which constitutes impairment. Mean cross-sectional area for all subjects was 0.38 cm2 +/- 0.20 SD. Seventy percent of the subjects studied were oral breathers to some extent. A Spearman rank correlation coefficient of 0.725 (p less than 0.0001) indicated that oral-nasal breathing mode was related to airway size. Airway size in the subgroup with pharyngeal flaps was even smaller (0.31 cm2), while percent nasal breathing was lower. Mouthbreathing was observed in all subjects whose airway size was less than 0.38 cm2.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Humans; Mouth Breathing; Nose; Plethysmography; Pressure; Pulmonary Ventilation; Respiration; Rheology; Surgical Flaps; Tidal Volume; Transducers

Topics: Cleft Palate; Foot Deformities, Congenital; Hand Deformities, Congenital; Humans; Nose; Syndrome

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Infant, Newborn; Male; Nose

Tissue expansion can be a valuable tool in the reconstruction of soft-tissue defects in craniofacial clefts. To our knowledge, there have been no reports in the literature of the use of tissue expanders to help solve this problem. We report the case of a child with an atypical Tessier no. 3 craniofacial cleft who had a forehead tissue expander placed, inflated, and thus used to provide sufficient local facial skin for repair of the soft-tissue defect.

Topics: Cleft Lip; Cleft Palate; Facial Bones; Humans; Infant; Male; Nose; Tissue Expansion; Tissue Expansion Devices

Topics: Adolescent; Adult; Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Surgery, Plastic

Topics: Adult; Cleft Palate; Female; Humans; Intubation, Intratracheal; Nose; Reoperation

The classification by Tessier of rare craniofacial clefts brought, for the surgeon, order to a previously confusing array of anatomic and developmental descriptions. An ordered two-dimensional categorization of severe clefting malformations evolved from his clinical, radiologic, and surgical observations. The purpose of this paper is to report a complete series of facial clefts studied with computed tomography (CT) and three-dimensional reconstruction. The CT analysis supports some, but contradicts other, hypotheses and speculations presented by Tessier. The CT data reveal the scale of the reconstructive challenge and allow the assessment of our therapeutic interventions.

Topics: Adolescent; Adult; Child; Child, Preschool; Cleft Lip; Cleft Palate; Eye Abnormalities; Facial Bones; Female; Humans; Infant; Male; Mandibulofacial Dysostosis; Maxilla; Nose; Orbit; Tomography, X-Ray Computed; Zygoma

A lateral proboscis usually occurs in the region of the inner canthus. We present a case of holoprosencephaly accompanied by an oblique facial cleft and an anterior encephalocele in which a proboscis lateralis occurred in a very lateral location.

Topics: Abnormalities, Multiple; Brain; Cerebellar Diseases; Child, Preschool; Cleft Lip; Cleft Palate; Encephalocele; Eye Abnormalities; Facial Bones; Female; Humans; Hypertelorism; Nose

The present paper describes the craniofacial form of subjects with maxillonasal dysplasia and reports its occurrence in two siblings who also have cleft palate and mandibular retrognathia. Maxillonasal dysplasia and a cleft deformity may be illustrative of a field effect of a teratogen on developing midface components or even suggestive of a possible inherited etiology.

Topics: Cephalometry; Child; Child, Preschool; Cleft Palate; Female; Humans; Infant; Maxilla; Nose; Pierre Robin Syndrome; Retrognathia

Cleft lip/nose/palates are almost always accompanied by typical deformity of the inner and outer nose. The septum, which is usually considerably misshapen also influences the degree of deformity of the external nares. With extreme septum deformation it has proved expedient to remove the septum in its entirety and to replant it after suitable straightening. This technique is described.

Topics: Cleft Lip; Cleft Palate; Female; Humans; Male; Nasal Septum; Nose; Replantation; Rhinoplasty

The authors analyse the role of the ectomesenchyme in facial organogenesis, and the biology of fetal and infant cephalic development, supply valid arguments for the application of new principles in cheiloplasty for labial or labiomaxillary clefts. Instead of dermatoplasty alone, the procedure involves anatomically selective muscle reconstruction of the nasolabial confines, a structure that is predominantly muscular. Cheilomesethmoidoplasty of the transverse and nasolabial muscles of the orbicularis of the upper lip is therefore a totally valid procedure. This procedure has applied by the authors in 36 cases.

Topics: Cleft Lip; Cleft Palate; Facial Muscles; Female; Humans; Infant; Infant, Newborn; Male; Nasal Bone; Nose

Topics: Cleft Palate; Humans; Nose; Respiration; Speech

Topics: Adolescent; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Nasal Septum; Nose; Rhinoplasty

The secondary nasal skin envelope asymmetries were studied after unilateral cleft lip repair using the original (obsolete) rotation-advancement (Millard I) and the triangular flap techniques (Bardach's modification). Secondary correction of the nasal deformity was not performed in either group. Our findings indicated that in both groups, vertical asymmetries of the nasal skin envelope were similar. The alar dome on the cleft side was depressed, the columella was shorter on the cleft side, and there was hooding at the nostril apex. The principal difference between the two lip repairs was observed in the horizontal dimension of the nasal skin envelope. The position of the alar base was more normal following the Millard I repair, while the triangular flap repair left the alar base laterally displaced. When considered together with flattening of the cleft alar dome, a horizontal skin-envelope deficiency from middome to lateral alar crease was produced in the Millard I group. More lateral positioning of the alar base after the triangular flap technique minimized this horizontal skin deficiency. The triangular flap technique produced a secondary nasal deformity that looked worse but was easier to correct. The clinical implications of these findings are discussed.

Topics: Adolescent; Child; Cleft Lip; Cleft Palate; Humans; Methods; Nose; Surgical Flaps

There is much controversy in the literature concerning how to handle the nasal deformity in patients with cleft lip. This is a challenging problem that needs an exact analysis, careful planning and an atraumatic operative technique. We present our experience of 239 patients with cleft noses, treated from 1980 to 1988, and suggest a new technique for the correction of the asymmetrical alae. Symmetrical nostrils are achieved by two local flaps, either by the external or the intranasal approach.

Topics: Adult; Cartilage; Cleft Lip; Cleft Palate; Humans; Male; Nasal Septum; Nose; Rhinoplasty

Patterns of velopharyngeal (VP) valving and the location of velopharyngeal gaps were investigated in 246 consecutive nasopharyngoscopy studies. The predominant pattern of closure was coronal (68 percent), followed by the circular (23 percent), circular with a Passavant's ridge (5 percent), and sagittal (4 percent) patterns. Gaps were found in 181 patients; in 121 they were considered typical (centrally located), in 28 they were in one of the lateral aspects of the valve, and in 32 they were attributed to the shape of the adenoid tissue or to abnormalities in the anatomy or function of the posterior border of the soft palate. Atypical findings occurred primarily in patients with a coronal pattern of valving. These findings raise further questions about treatment for patients with atypical valving problems.

Topics: Child; Cleft Palate; Endoscopy; Face; Humans; Motion Pictures; Nose; Palate, Soft; Pharynx; Skull; Speech Disorders; Velopharyngeal Insufficiency

The prevalence of mouthbreathing among individuals with cleft lip and palate is significantly higher than in the normal population. This has been attributed to nasal deformities that tend to reduce nasal airway size. The purpose of the present study was to determine how a heterogeneous adult group with cleft lip and palate differs in terms of nasal airway cross-sectional area from an adult group without cleft during the inspiratory and expiratory phases of breathing. The pressure-flow technique was used to estimate nasal airway size in 15 adults without cleft (15 years or older) and 37 adults with cleft lip, cleft palate, or both. Mean areas and standard deviations for subjects without cleft were 0.63 cm2 +/- 0.17 during inspiration and 0.56 cm2 +/- 0.14 during expiration. This difference is statistically significant (p less than 0.01). Mean areas and standard deviations for all subjects with cleft were 0.37 cm2 +/- 0.18 during inspiration and 0.40 cm2 +/- 0.20 during expiration. This difference is not statistically significant (p greater than 0.15). Twenty-two of the subjects with cleft had nasal areas considered to be impaired (below 0.40 cm2) as compared with only three of the subjects without cleft. A two factor analysis of variance (ANOVA) demonstrated that area changes during respiration are different for subjects with and without cleft (p less than 0.005), and that cleft nasal areas are smaller than noncleft areas for both phases of breathing (p less than 0.001). Inspiratory-expiratory differences between subjects with and without cleft are probably the result of developmental defects, reparative surgery or both.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Cleft Lip; Cleft Palate; Humans; Nose; Pressure; Pulmonary Ventilation; Respiration; Transducers

By redefining the surgical anatomy of the nose, we were able to develop a new technique for the repair of the bilateral cleft lip nose. The lower one-third of the nose was divided into an outer layer, composed of skin, and an inner composed of fascia, muscle, cartilage and the skin of the vestible. From this viewpoint, the bilateral cleft lip nose deformity was reinterpreted as a combination of dislocation and deformity of the inner layer, and rotational displacement of the inner layer with respect to the outer layer. Using the double alar wing flap incision, we were afforded good visualization and anatomic reconstruction without tension by rotating the inner and outer layers in opposite directions. The length of the columella, the alar facial angle, the width of the nose and the size of alae have been satisfactory in 6 patients.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Infant; Infant, Newborn; Nose; Surgical Flaps; Suture Techniques; Wound Healing

Topics: Adolescent; Cleft Lip; Cleft Palate; Dental Abutments; Denture Design; Dentures; Humans; Male; Nose; Prostheses and Implants; Prosthesis Design

In 20 adult cleft patients, the influence of a Le-Fort-I-osteotomy and ventral-caudal advancement of the maxilla on nasal breathing was studied. An increase of nasal air flow in the majority of patients is due to an increase in the volume of nasal skeleton and/or in the nasolabial angle and alar nasal base. Rhinomanometric measurements and X-ray examination confirm the results.

Topics: Adult; Cleft Palate; Humans; Maxilla; Nose; Osteotomy; Pulmonary Ventilation; Radiography; Respiration

We have suggested that compensatory behaviors associated with cleft palate may be strategies developed for the purpose of satisfying the requirements of a speech regulating system. The purpose of the present study was to test this hypothesis in subjects demonstrating various degrees of velopharyngeal inadequancy. The pressure-flow technique was used to assess aerodynamic responses to a loss of velar resistance in 74 subjects compared to a control group of 137 subjects with adequate velopharyngeal closure. The results of this study demonstrate that as degree of inadequacy increased, airflow rate also increased. Although intraoral pressure fell as inadequacy increased, many subjects were able to maintain pressures above 3.0 cm H2O by increasing airflow rate. Nasal pressure increased in proportion to the decrease in intraoral pressure while combined nasal plus oral pressure remained constant across groups. These findings suggest that a loss of resistance at the velar port is compensated by an increase in resistance at the nasal port. Airflow rate appears to be adjusted to total upper airway resistance. These findings support our contention that the speech system is constrained to meet aerodynamic requirements.

Topics: Adolescent; Adult; Aged; Air Pressure; Atmospheric Pressure; Child; Child, Preschool; Cleft Palate; Female; Humans; Male; Middle Aged; Mouth; Nose; Speech; Velopharyngeal Insufficiency

Three rare cases of congenital anomalies (mid-line nasal proboscis, subintegumental mid-line cleft lip and congenital palatoglossal synechia) are presented with their management. The embryological considerations of these cases are discussed.

Topics: Cleft Lip; Cleft Palate; Face; Female; Humans; Infant; Male; Nose; Palate; Tongue

The cleft lip deformity has been present throughout mankind, and has entered into the folklore of Nations. There has been a multitude of described repairs. Still they do not provide the hoped for final results. Some of the changes have been based on "thought out" ideas, others on futile guesses. The last few years have seen changes in the surgical direction due to a clearer understanding of the basic embryology. These changes have been made possible by advances in equipment and technology. Changes in animal research, both intra- and extra-uterine, have made possible experiments which may answer some of the suppositions put forward covering both development and healing. The classification of cleft lip places all the deformities in one group, but there may in fact be several groups with different actual causes and failures leading to the same clinical picture. The understanding of the failure or failures that occur in development should lead to a logical approach to the repair of the cleft deformity.

Topics: Cleft Lip; Cleft Palate; Female; Gestational Age; Humans; Infant, Newborn; Lip; Nose; Palate; Pregnancy; Research

We report a family with oligosymptomatic EEC syndrome. Whereas the mother had most symptoms of this syndrome, one son presented a minimal ectrodactyly and a highly arched palate and one daughter showed only a unilateral stiff thumb. The variability of this syndrome is discussed. The penetrance of this dominantly inherited disorder is judged to be reduced to about 78%.

Topics: Adult; Child; Cleft Palate; Ectodermal Dysplasia; Female; Fingers; Humans; Infant; Male; Nose; Syndrome; Thumb

This study was designed to test the hypothesis that simultaneous lip and palate repair results in more severe craniofacial growth aberrations than lip repair or palate repair performed separately. Seventy-six purebred beagles were divided into five groups. Two of these groups were controls (unoperated and unrepaired animals); the three remaining groups were experimental (in one group only the lip was repaired, in another only the palate was repaired, and in the last the lip and palate were repaired simultaneously). Cephalometric measurements were analyzed using univariate and multivariate statistical techniques. In multivariate analysis, stepwise multiple regression and discrimination were applied to precisely assess the effects of the various surgical procedures. The results of this study indicate that simultaneous lip and palate repair results in more severe craniofacial growth aberrations than lip repair or palate repair performed separately.

Topics: Animals; Cephalometry; Cleft Lip; Cleft Palate; Dogs; Malocclusion; Mandible; Maxilla; Maxillofacial Development; Nose

Clefts of the lip and palate often produce significant nasal deformities and reduced nasal airway size. The purpose of this study was to assess how type of cleft affects nasal cross-sectional area and mode of breathing. The pressure-flow technique was used to estimate nasal airway size and modified inductive plethysmography was used to determine percent of nasal breathing in 60 children with cleft lip and palate aged 6 to 15 years. Ninety-five normal children served as controls. The data demonstrate that nasal size decreased among cleft types as follows: children with bilateral cleft lip and palate had largest airway, followed by unilateral cleft lip, cleft of the hard and soft palate, cleft of the soft palate, and unilateral cleft lip and palate. The data also indicated that most subjects with cleft were mouth breathers. Results of otolaryngologic examinations suggest that septal deformities affecting nasal valve function are responsible for much of the impairment, especially in the group with unilateral cleft lip and palate. The differences among groups appear to relate to developmental differences associated with the original defect and the surgical procedures used in primary repair.

Topics: Adolescent; Air Pressure; Child; Cleft Lip; Cleft Palate; Humans; Mouth Breathing; Nose; Respiration

This article proposes a set of minimal standards for reporting the results of surgery on patients with cleft lip with or without cleft palate and cleft palate only. These standards do not represent what is technically possible, only what is considered minimally acceptable for presentation in a public forum. They have a clinical focus and should be attainable by any well-constituted cleft palate team. As the title indicates, this document is a proposal. It is hoped that the readership will respond to the recommendations presented so that some set of standards can be adopted in the near future. Once adopted, these standards should be reviewed and updated periodically.

Topics: Cleft Lip; Cleft Palate; Clinical Protocols; Hearing; Humans; Lip; Maxillofacial Development; Nose; Palate; Speech

Topics: Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Nasal Septum; Nose; Surgery, Plastic

Topics: Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Male; Nose; Nose Deformities, Acquired; Reoperation; Surgery, Plastic

Topics: Cleft Lip; Cleft Palate; Dentures; Humans; Maxillofacial Prosthesis; Nose; Orthognathic Surgical Procedures; Speech

Topics: Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Magnetic Resonance Spectroscopy; Muscles; Nose

As part of an ongoing study of cleft palate fetal morphology, normal and dysmorphic development of the human fetal nasal capsule was studied in a cross-sectional sample of 29 human fetuses (20 "normal" and 9 cleft), ranging in age from 8 to 21 postmenstrual weeks. The specimens were celloidin embedded, sectioned at 20 microns, and every tenth section stained with hematoxylin and eosin. A computer reconstruction technique was applied to produce three-dimensional representations of the nasal capsule, nasal septal cartilage, and nasal airway. Qualitatively, the cleft palate nasal capsule exhibited gross abnormalities including cartilaginous nasal septum deformities, abnormal septal volume and hypertrophy, reduced nasal airway and capsule volumes, and abnormal spatial relationships between the nasal capsule components. These results suggest that the reduced nasal airways, noted clinically in cleft perinates, may be a function of an interaction of nasal capsule deficiency and nasal septum hypertrophy. However, when lengths and volumes were plotted against fetal postmenstrual age, producing fetal "growth" curves, no significant differences (p greater than 0.05) were noted for growth rates (slopes) or nasal capsule size between the normal and cleft palate fetal samples. Curvilinear regression analysis revealed that both normal and cleft palate nasal capsule and septum lengths changed in a sigmoidal fashion, with the steepest increases from 13 to 17 weeks. In contrast, nasal capsule, airway, and septum volumes changed curvilinearly, showing slow relative growth rates from 8 to 17 weeks, which increased sharply from 18 to 21 weeks. Results suggest that from 8 to 21 weeks prenatally, normal and cleft palate specimens exhibited a similar pattern of fetal nasal capsule development that was characterized by an initial anteroposterior elongation followed by circumferential (i.e., volumetric) growth.

Topics: Cleft Palate; Embryonic and Fetal Development; Fetus; Gestational Age; Humans; Image Processing, Computer-Assisted; Nasal Bone; Nasal Septum; Nose; Palate

The present study aimed to determine the nasal respiratory resistance (NRR) in subjects with cleft deformity of the lip and palate. The cleft sample was subdivided into cleft lip (N = 15) (mean age 13.4 years, median age 14 years), cleft palate (N = 19) (mean age 12.7 years, median age 12 years), and unilateral cleft lip and palate subjects (N = 27) (mean age 16.4 years, median age 16 years). A control group consisted of 38 patients (mean age 14.4 years, median age 12 years) attending for orthodontic diagnosis. Respiratory resistance was determined by a Mercury rhinomanometer, which was calibrated dynamically before each session. Subjects were given 0.1% xylometazoline hydrochloride half an hour before each session. Resistance was determined unilaterally by the anterior method as well as bilaterally by the posterior method. The results showed that the bilateral nasal resistance did not differ significantly between the cleft samples and the controls. Unilateral measurements of nasal resistance showed higher values for the cleft side than for the noncleft side, both in the cleft lip (CL) and the unilateral cleft lip and palate (UCLP) samples (p less than 0.001). In the cleft palate sample as well as in the controls, unilateral nasal resistance did not differ between the two sides.

Topics: Adolescent; Adult; Airway Resistance; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Male; Manometry; Nose; Respiration

Two groups of parents (27 parents of children with cleft palate and 25 parents of normal children) listened to 14 pairs of tape-recorded words produced by two children with cleft palate. In each pair, one word was produced with compensatory articulation and the other with audible nasal escape of air. The parents indicated their preference by selecting from each pair the word that sounded better. Parents considered single words produced with compensatory articulation to be better than single words produced with nasal escape of air. Results are interpreted in terms of existing hypotheses and information concerning the acquisition of speech by children with cleft palate.

Topics: Adult; Air; Articulation Disorders; Child; Cleft Palate; Female; Humans; Male; Middle Aged; Nose; Parent-Child Relations; Sex Factors; Speech

Topics: Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Humans; Male; Nose

In the surgical management of cleft lip and palate, the reconstruction of the paranasal and perioral mimic musculature is of particular value. These muscles are decisive for the shaping of the bones in the middle of the face. Early application of this technique can prevent secondary skeletal changes, or can at least reduce them to such an extent that they can be treated orthodontically.

Topics: Cleft Lip; Cleft Palate; Facial Muscles; Humans; Methods; Nose; Surgical Flaps

An unusual congenital anomaly of a bilateral complete cleft of the primary palate, a complete cleft of the left secondary palate with abnormal nostrils without external openings and right choanal atresia is presented. The child also has a lachrymal fistula below the right lower eyelid and a coloboma of the same eyelid medially. Neither lachrymal system drained into the nose.

Topics: Abnormalities, Multiple; Choanal Atresia; Cleft Palate; Female; Humans; Infant, Newborn; Lacrimal Apparatus; Nose

An interpretation of the role of the nasal septum on maxillonasal growth in patients with congenital labiomaxillary clefts is presented. Salient features of the anatomic pathology and resultant dysfunction of the premaxillary-maxillary suture and the position and orientation of the nasolabial muscles relative to the nasal septum are discussed for unilateral and bilateral deformities. The nasal septum plays an important direct role in growth of the premaxilla and an indirect role in growth of the maxilla.

Topics: Cleft Lip; Cleft Palate; Facial Asymmetry; Facial Muscles; Humans; Infant; Maxillofacial Development; Nasal Septum; Nose

The residual anomalies of the soft and hard tissues of the nose were studied in a group of adult bilateral cleft palate patients. Standard morphanalytic techniques were used to produce objective and accurate pictorial representations of the mean nasal deformities in three dimensions. The spatial positions of these mean outlines were tested statistically against normal means. Mean bilateral cleft nasal outlines were shown to have symmetric lateral and superior displacement of both alae with nasal blunting and retrusion and rounding of the nasal dorsum. The analytic techniques used indicated that the reduction in the depth of the external nose was confined to its posterior part. The presence of a palatal cleft in conjunction with the bilateral labial cleft only slightly increased the degree of deformity. In the case of asymmetrically incomplete bilateral clefts the nasal deformity in adulthood retained certain asymmetric features.

Topics: Adolescent; Adult; Anthropometry; Cleft Lip; Cleft Palate; Female; Humans; Male; Nasal Septum; Nose; Radiography

A review of the surgical management of adult patients with cleft lip and palate is presented together with the anatomical relationship to surgical procedures. There is still a much higher tendency to relapse after maxillary osteotomy in cleft patients compared to non-cleft patients. However relapse can be reduced by prolonged cranio-maxillary fixation or by direct skeleton fixation with bone plates. Techniques which mobilise the badly scarred palate and avoid dragging it forward with the osteotomy also reduces relapse.

Topics: Adult; Alveolar Process; Cleft Lip; Cleft Palate; Female; Humans; Male; Malocclusion; Maxilla; Maxillofacial Development; Nose; Osteotomy

Topics: Abnormalities, Multiple; Cleft Lip; Cleft Palate; Female; Heart Defects, Congenital; Humans; Infant; Intubation, Intratracheal; Nose; Silicones

We describe two sibs born to a consanguineous couple. Among other clinical findings both have mental retardation, short stature, facial and skeletal abnormalities characterized by hypertelorism, broad notched nasal tip, cleft lip/palate, campto-brachy-poly-syndactyly, fibular hypoplasia, and marked anomalies of foot structures. Facial signs of the reported patients resemble those present in the fronto-nasal "dysplasia" syndrome; however, the whole clinical picture in the present patients suggests a true MCA/MR syndrome, most likely inherited as an autosomal recessive trait. Clinical and genetic aspects of the present family are discussed.

Topics: Abnormalities, Multiple; Child; Cleft Lip; Cleft Palate; Consanguinity; Dermatoglyphics; Facial Bones; Female; Foot Deformities, Congenital; Genes, Recessive; Humans; Intellectual Disability; Male; Nose; Osteochondrodysplasias; Skull; Syndactyly

This project examined modeled velopharyngeal orifice area estimation under conditions simulating voiceless stop consonant production in the presence of nasal airway obstruction. The results indicated that accurate estimates of velopharyngeal orifice area can be obtained using Warren's hydrokinetic equation during aerodynamic events like those known to exist during speech in the presence of increased nasal airway resistance. These findings provide support for clinical and research use of Warren's pressure-flow approach to investigate velopharyngeal function during speech production.

Topics: Airway Obstruction; Airway Resistance; Cleft Lip; Cleft Palate; Forecasting; Humans; Models, Biological; Nose; Palate, Soft; Pharynx; Phonetics; Pressure

Three articles on the influence of timing of palatal closure on jaw development, ENT condition and speech are subjected to an overall evaluation. A number of questions are formulated, which are still to be answered before a well-founded decision on the timing of palatal surgery can be taken. The evidence presently available made the author conclude that the whole palate should be closed before the age of 18 months, at least if the development of speech has priority over development of the maxilla.

Topics: Age Factors; Child; Child, Preschool; Cleft Palate; Hearing Disorders; Humans; Infant; Maxilla; Nose; Nose Deformities, Acquired; Orthodontics, Corrective; Otitis; Palate, Soft; Speech; Speech Disorders; Time Factors

Topics: Air Pressure; Cleft Palate; Electromyography; Humans; Nasal Cavity; Nose; Palatal Muscles; Palate, Soft; Pharynx; Phonation; Pulmonary Ventilation; Voice

The purpose of this study was to demonstrate a new application of the pressure-flow technique and to determine whether the temporal characteristics of aerodynamic data associated with single-word utterances could reliably differentiate speakers with adequate palatopharyngeal closure from those with inadequacy. The groups included 10 normals, 20 patients with cleft palate who had adequate closure (0.0-0.09 cm2), 20 patients who had borderline closure (0.10-0.19 cm2), and 20 patients who had inadequate closure (greater than 0.19 cm2). The test sound was the nasal-plosive blend /mp/ in the word hamper. The data were processed by a PDP 11/34 computer. The results demonstrate the utility of the pressure-flow technique for studying timing parameters associated with speech and reveal that patients with adequacy of closure can be differentiated from those with inadequacy using timing criteria. Additionally, the data suggest that the perception of nasal resonance in the group with borderline closure appears to be influenced by the timing of closure.

Topics: Cleft Palate; Computers; Humans; Nose; Palate, Soft; Pharynx; Pressure; Pulmonary Ventilation; Speech; Speech Articulation Tests; Speech Production Measurement; Time Factors; Velopharyngeal Insufficiency

The most obvious deformity in a unilateral cleft of the lip is asymmetry of the lip and nose. Operation must repair the cleft, lengthen the lip, restore muscle continuity, and create an adequate labial sulcus. Simultaneous correction of the nasal deformity should be carried out to the greatest extent possible at the same time. The rotation-advancement repair has advantages over other repairs in scar placement, correction of the nasal deformity, and conservation of lip and nose tissue. If revision of the lip or nose is required, it can be accomplished more easily following the rotation-advancement repair than other techniques.

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Infant; Lip; Male; Nose; Rhinoplasty; Surgical Flaps; Suture Techniques

Residual deformities of the lip and nose in individuals with repaired unilateral and bilateral clefts may very in severity depending on the state of the original defect, the care taken in the initial surgical procedure, the pattern of the patient's facial growth, and the effectiveness of interceptive orthodontic techniques. Because each patient has a unique combination of deformities, their surgical reconstruction usually requires the modification and combination of several surgical techniques. In this article, a summary of various reconstructive techniques is presented, beginning with an evaluation of secondary cleft defects.

Topics: Alveoloplasty; Cicatrix; Cleft Lip; Cleft Palate; Dentures; Humans; Lip; Malocclusion; Nose; Postoperative Complications; Rhinoplasty; Surgery, Plastic; Suture Techniques

This study was carried out to evaluate the NORAM (Nasal-Oral-RAtio-Meter), developed at the Department of Speech Communication and Music Acoustics, RIT. The speech samples used were the recorded speech of normal and nasally deviant speakers. NORAM measures the total speech time and the duration of the nasalized portions, it also calculates the ratio between these two values. The signals are picked up by two contact microphones, one placed on the alar cartilage of the nose and the other on the outside of the lamina of the thyroid cartilage. They are compared and the segment is rated as nasal, if the signal from the nose pick-up is close in intensity to the larynx signal. It was found that the threshold should be set 9 dB below the larynx signal. The reliability of the measurements depends to a large degree on the accurate calibration of the instrument. In sentences lacking nasal consonants, produced by normal speakers, some nasal segments were registered at word boundaries and at the end of phrases. In the patient material these segments tended to be broader and additional segments were also found.

Topics: Cleft Palate; Humans; Nose; Speech; Speech Acoustics; Speech-Language Pathology

Two persons within the same family were discovered to be trisomic for the segment 7qter. However, several features differed from those described in other patients with this syndrome, for example, normal birth weight and neck size, cleft palate, and beaked nose. In addition to the phenotypic variation, there were three independently segregating autosomal translocations in the pedigree: t(1;7)(q43;q32), t(1;6) (p22.3;q14.1), and t(3;10)(q26.1;p11.21). This is a finding that, to our knowledge, has not been previously reported.

Topics: Adult; Birth Weight; Chromosome Banding; Chromosomes, Human, 1-3; Chromosomes, Human, 6-12 and X; Cleft Palate; Female; Humans; Infant, Newborn; Intellectual Disability; Karyotyping; Male; Nose; Pedigree; Phenotype; Syndrome; Translocation, Genetic; Trisomy

A short historical review of proboscis lateralis is given and some of the important contributions highlighted. Forster was the first to mention this abnormality. I collected 34 cases from the literature (including one of my own) and have divided them clinically into four groups. The proboscis is most commonly associated with deformities of the ipsilateral half nose, the eye, and its adnexa. The various lines of management of this problem are discussed. I recommend dilating the canal of the proboscis as a useful step when it is used for reconstructing the absent heminose. A case of a left proboscis lateralis associated with an ipsilateral heminasal aplasia, a bilateral cleft of the lip and palate, a congenital cleft ala, and microphthalmia with a coloboma of the lower eyelid is documented.

Topics: Abnormalities, Multiple; Adult; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Nose; Nose Diseases

Topics: Abnormalities, Multiple; Cleft Palate; Female; Humans; Infant, Newborn; Meningocele; Nose

An extremely rare case of congenital accessory ectopic eyelid associated with an oblique facial cleft is reported. The clinical features, histological findings and morphogenesis are briefly described.

Topics: Abnormalities, Multiple; Child, Preschool; Cleft Lip; Cleft Palate; Eyelids; Humans; Male; Nose; Surgery, Plastic

The purpose of this paper is to present a 5-year experience using a comprehensive surgical approach to reconstruct what we have chosen to call the "end-stage cleft lip and palate deformity." The deformity consists of varying degrees of midface retrusion, malocclusion, nasal deformity, and lip deformity. Most of the patients afflicted had unacceptable upper lip anatomy characterized by tightness and lack of cupid's bow and bulk. All had severe palatal scarring with resulting arch collapse and severe malocclusion. Most had had multiple surgical attempts to improve nasal aesthetics using standard rhinoplasty techniques with little or no improvement. The procedure involves splitting the upper lip with incisions extending into the upper buccal sulcus and rim of the nose allowing wide skeletalization of the maxilla and osteocartilagenous nasal skeleton. LeFort I or II maxillary advancement, nasal reconstruction, and upper lip modification (with Abbé flap if indicated) are done. The jaws are placed in intermaxillary fixation for 6 to 8 weeks. This comprehensive approach has been used in 16 patients, aged 15 to 29 years, with follow-up of up to 5 years. Excellent functional and aesthetic improvement has occurred in all patients, and complications have been minimal.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Face; Female; Humans; Male; Malocclusion; Maxilla; Nose; Surgery, Plastic

Nine midline sinuses of the upper lip in eight patients have been described previously. They have been located from the skin under the columella to the frenulum, and have always been directed towards the frenulum. Three new cases are presented: a sinus reaching from the skin of the philtrum to the frenulum in a child with Pierre Robin syndrome, another one in the frenulum of a patient with two separate midline sinuses of the nose, and a third in the frenulum of a child with a partial median cleft lip. The midline sinus is probably caused by disturbed development of the nasofrontal process. The combination of upper lip sinus and Pierre Robin's syndrome is hardly coincidental and supports the concept that the latter is not caused solely by a foetal malposition.

Topics: Adult; Cleft Lip; Cleft Palate; Epithelium; Female; Humans; Infant, Newborn; Lip; Male; Micrognathism; Nose; Pierre Robin Syndrome

A model was designed for evaluating protocol and management strategies in the multidisciplinary approach to cleft lip and palate treatment. The treatment history and present status of 45 patients 14 to 22 years of age were evaluated by a plastic surgeon, orthodontist, and speech pathologist. Results indicated that only about half of these patients had completed treatment by one of the specialties by the time they were 14 years or older. Even more surprisingly, only 7 patients (16%) had completed treatment by all three specialties by this age. Factors that may contribute to this low percentage of completed treatments are discussed.

Topics: Adolescent; Adult; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Infant; Male; Nose; Orthodontics; Patient Care Team; Speech-Language Pathology; Surgery, Plastic

A considerable number of procedures have been described for secondary improvements of the lip. They involve the scars, the Cupid's bow, the philtrum, the alar base, the vestibulum and the columella. In fact, these procedures may give a good aesthetic result in a static position, but the truly successful results occur with normal movements. A normal motion of the lip is impossible without a proper dissection and reorientation of the muscles. Satisfactory lip motion cannot be realized with a defective alveolus or piriform aperture that retracts the alar base. Consequently, a good lip or nasal base cannot be achieved without bony restoration of the alveolus and piriform aperture. A transversely short lip never has normal mobility, and it must be widened by an Abbé flap. A tight, retruded lip on a retruded maxilla cannot be improved by a prosthetic vestibular plate because a greater tension will restrict movements. The lip must be advanced with the maxilla, then widened if necessary by an Abbé flap. A thick prolapsed lip never has normal movement; it must be raised by an infranasal excision. A cleft lip has nothing to gain from being displayed under a short nose, or, still worse, under a upturned nose. The nose must be kept long enough to cast a shadow on the lip. For the same reason, a bone graft is often necessary in bilateral clefts because the nose is short and retruded.

Topics: Adolescent; Adult; Bone Transplantation; Child; Chin; Cicatrix; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Male; Maxilla; Nose; Reoperation; Surgery, Plastic; Surgical Flaps

Research has shown that cleft lip and palate individuals have higher nasal airway resistance than normal subjects (Warren, Duany, and Fischer, 1969). The present work examined the predictive nature of modeled velopharyngeal orifice area calculations obtained using the hydrokinetic equation (Warren and DuBois, 1964) under conditions simulating increased degrees of nasal obstruction. The results of this project suggested that Warren's hydrokinetic method can be used to obtain accurate estimates of velopharyngeal orifice area under conditions of increased nasal airway resistance when airflow rates are nonvariant.

Topics: Air Pressure; Airway Resistance; Cleft Lip; Cleft Palate; Humans; Mathematics; Models, Biological; Nose; Palate, Soft; Pharynx

Topics: Abnormalities, Multiple; Cleft Palate; Ear, External; Hearing Loss, Sensorineural; Humans; Infant; Male; Mouth Abnormalities; Nose; Seizures; Syndrome

Aeromechanical data are presented for six patients with oronasal fistulas and one with a maxillary cleft. Patients were studied with the defects open and again with them closed with either acrylic dental appliances, dental wax, or denture adhesive. Only the largest openings appeared to allow sufficient loss of intraoral air pressure to weaken obstruent consonants. All but the smallest of the defects were associated with nasal air flow during syllable strings. Thus the data are compatible with a hypothesis that in the presence of small air leaks patients maintain sufficient intraoral air pressure for accurate consonant production. Presumably this is achieved by increase in respiratory effort. The relationship between fistula size and speech or speech related variables appears to be similar to that between area of the velopharyngeal opening and speech. However, the fistula is more constant in area across utterances than is the pathological velopharyngeal mechanism.

Topics: Adolescent; Adult; Air Pressure; Atmospheric Pressure; Child; Cleft Lip; Cleft Palate; Female; Fistula; Humans; Male; Mouth; Mouth Diseases; Nose; Nose Diseases; Pulmonary Ventilation; Speech

A comparative study was made of the otological and rhinological conditions at adult age of two groups of patients with unilateral total cheilognathopalatoschisis. In group A (51 patients), the palate was closed around the 3rd year of life, in group B (54 patients), around 6th year. All patients were operated on with an identical technique, by the same surgeon. There was no difference between the two groups in regard to permanent loss of auditory acuity; however, nasal patency appeared to be better in patients in group A than in those of group B.

Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Cleft Lip; Cleft Palate; Ear Diseases; Ear, Middle; Follow-Up Studies; Hearing; Hearing Disorders; Humans; Nose; Nose Diseases

This paper discusses the significance of the surgical anatomy of the adult cleft deformity in reconstruction. The essential asymmetry of the unilateral cleft is explained and methods suggested for reconstruction in three categories of cases; those with simple alveolar defects; those with additional retroposition of the maxillae; and those with vertical maxillary deficiency. The indications for two-stage osteotomies are presented. Finally a new surgical approach for osteotomy of the premaxilla in bilateral clefts is described and illustrated.

Topics: Adult; Cleft Lip; Cleft Palate; Humans; Nose; Osteotomy; Surgery, Plastic

Topics: Cleft Lip; Cleft Palate; Facial Muscles; Humans; Infant; Lip; Methods; Nose; Surgical Flaps

Topics: Cleft Lip; Cleft Palate; Humans; Lip; Methods; Nose; Periosteum

The superficial facial topography of children born with complete unilateral or bilateral cleft lip and palate was studied with anthropometry and subjective assessments of standardized photographs. All the children had been bone grafted early with Nordin's "four-flap" technique. The unilateral deformities group comprised two sub-groups: one of 39 children (mean age 17.6 years) primarily operated without preoperative orthopedics, and another of 46 children (mean age 10.8 years) primarily operated after preoperative "T-traction" The bilateral group, 19 children (mean age 15.1 years) was primarily operated after preoperative premaxillary retropositioning pressure, if necessary, combined with outward rotation of the lateral maxillary segments. The groups were compared with each other and then in the anthropometric study with nonclefts. With 14 expert observers the subjective assessment method was found to be useful when comparing groups of children. When comparing the two unilateral groups, the "T-traction" group showed a straighter and more normal nose and less difference in sagittal and vertical directions between the levels of the alar bases. Overall facial features scored closer to normals than did those of the non-traction group. On comparing the unilateral groups with nonclefts our findings for several variables corresponded to what was found by others earlier. The width of the mouth was narrower in unilateral clefts than in nonclefts. Unlike that reported by others, our unilateral cleft sample had shorter medial vertical upper lip length and shorter and broader noses than nonclefts.

Topics: Adolescent; Anthropometry; Child; Cleft Lip; Cleft Palate; Female; Humans; Lip; Male; Maxilla; Mouth; Nose; Orthopedics; Photography

Four cases of frontonasal dysplasia are reported in two boys and two girls. Clinical diagnosis was made at 16 months in one case and sooner in 3 cases (1 month-3 1/2 months) in presence of following features: severe hypertelorism (4/4), paramedian lip and palate cleft (3/4), nose root broadering (4/4), bifid or cleft nose tip (3/4), window's peak (3/4) mediofrontal swelling (4/4), cranium bifidum occultum (2/4). Many abnormalities were associated: conduction deafness (1/4), goldenhar syndrome (1/4), GH deficiency (1/4), etc... In three cases when cerebral investigation was possible, it was pointed out: corpus callosum agenesis (3/3), hydrocephalus (3/3), Dandy-Walker cyst (2/3). Caryotype is normal in whole cases which are sporadic. Two children are dead. The two alive remaining have severe mental impairment.

Topics: Abnormalities, Multiple; Child; Child, Preschool; Cleft Palate; Female; Forehead; Humans; Jaw Abnormalities; Lip; Male; Nose; Syndrome

Cytogenetic study of a day-old infant showed a terminal del(7q): 46,XX,del(7)(pter leads to q32:). This infant had cebocephaly with holoprosencephaly. These clinical findings are atypical for the 7q - syndrome, in which patients usually have growth and mental retardation with few facial abnormalities.

Topics: Abnormalities, Multiple; Chromosome Deletion; Chromosomes, Human, 6-12 and X; Cleft Palate; Face; Female; Humans; Infant, Newborn; Maxilla; Microphthalmos; Nose

A newborn female with intrauterine growth retardation, bilateral cleft lip and palate, absent external nares and eyelids, low set ears, short contracted limbs, webbed digits, intestinal malrotation, and unilateral renal agenesis is reported. These multiple malformations are considered part of the Neu-Laxova syndrome.

Topics: Abnormalities, Multiple; Cleft Lip; Cleft Palate; Eyelids; Female; Fetal Growth Retardation; Humans; Intestines; Kidney; Limb Deformities, Congenital; Nose; Pregnancy; Syndrome

The morphogenesis of median facial clefts induced in mice by treatment with diazo-oxo-norleucine (DON) was studied. Following maternal treatment with 0.4 mg/kg DON on the 11th gestational day, 23.1% of fetuses recovered at the 18th day exhibited median facial clefts, which were characterized by a separation in the midline of normal midfacial components, i.e., the premaxilla, nasal bones, and nasal capsule. Malformed embryos could first be identified grossly 24 hr after DON administration by the presence of an abnormally wide separation between the two narrowed medial nasal processes. Evidence of cellular degeneration was observed in the mesenchyme of the nasal processes of DON-treated embryos 8 and 12 hr after treatment, but little or no pyknotic debris remained at 24 hr post-injection. Loss of cells due to cell death was reflected in decreased cell density observed in all areas of facial mesenchyme examined 24 hr after DON administration. It is suggested that DON-induced median facial clefts may be caused by a reduction in tissue volume, particularly in the midline, or by an interference with normal facial growth resulting in increased facial width and consequent failure of merging of the medial nasal processes.

Topics: Abnormalities, Drug-Induced; Animals; Azo Compounds; Cell Division; Cleft Lip; Cleft Palate; Diazooxonorleucine; Face; Female; Mice; Mice, Inbred ICR; Nose; Pregnancy

Children with bilateral complete cleft lip and palate were treated by a two stage repair of the lip and nasal floor, including a small prolabial flap to lengthen the columella according to the technique of Skoog. Seventeen of these children, now at least 2 years of age were reviewed. In no case was normal length of the columella obtained, six children had obvious scars, in five the flap bulged at the base of the columella, and in four there was a displacement of the flap toward the lip. Three cases have already required a secondary forked flap. We concluded that the results of this procedure are inconsistent and od not justify the additional scarring.

Topics: Child; Cicatrix; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Lip; Methods; Nose

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Maxillofacial Development; Nose

Topics: Adolescent; Child; Child, Preschool; Cleft Lip; Cleft Palate; Face; Female; Humans; Infant; Lacrimal Apparatus; Male; Mandibulofacial Dysostosis; Nose; Nose Deformities, Acquired; Surgery, Plastic

A craniofacial malformation is caused by a developmental arrest that results in focal fetal dysplasia. The severity, location, and number of these dysplasias make a wide spectrum of abnormalities possible. In this spectrum nasal dysplasia and, more particularly, the malformations characterized by a cleft in the lateral part of the nose play a prominent role, but in past years they have received only scant attention. In Tessier's classification this nasoschizis is the Number 1 cleft. We present here our observation in 2 patients with nasoschizis and the procedure used to correct it. Both patients were operated on at the Rambam Medical Center in Haifa, Israel.

Topics: Cleft Lip; Cleft Palate; Facial Bones; Female; Humans; Infant; Nose; Surgery, Plastic

Topics: Cartilage; Cleft Lip; Cleft Palate; Humans; Nose; Surgery, Plastic; Surgical Flaps

This paper describes the use of stainless steel wire mesh as the basic material in fabricating a sheath to be inserted as a surgical implant. This sheath can be moulded into various shapes and sizes by hand at the time of operation. It has been used for reconstruction in various areas. It is inexpensive and its range of application appears to be considerable. It has been used to date in 16 patients and two cases have now been followed up for over one year.

Topics: Adult; Chin; Cleft Palate; Female; Finger Injuries; Humans; Humerus; Metacarpus; Nose; Prostheses and Implants; Stainless Steel; Surgery, Plastic; Surgical Mesh; Thumb

Topics: Brain Diseases; Cleft Palate; Craniofacial Dysostosis; Female; Foot Deformities, Congenital; Humans; Hypertelorism; Infant; Infant, Newborn; Joint Dislocations; Nose

This study was designed to investigate some acoustic (formant) effects of systematic changes in oral-nasal coupling area during whispered vowel productions. One adult female cleft palate subject was fitted with a specially-designed prosthetic speech appliance. The appliance was drilled to provide seven controlled diameters of oral nasal coupling, ranging from no coupling to a maximum of 14 mm. At each coupling condition, the subject's whispered productions of each of two test vowels (/i/,/u/) were magnetically recorded. From narrowband (3 Hz) acoustic spectra of the recorded vowels, measurements of formant frequency, intensity, and bandwidth were obtained for the formants visualized below 4 K HZ. The most reliable acoustic indicators of increased coupling were changes in the measurements for formant two of /i/ and for formant three of /u/ and, for both test vowels, the appearance of "extra formants." In general, however, the findings appeared consistent with the view implicit in acoustic transmission line theory that the spectrographically-delineated formant effects of oral-nasal coupling may be inherently inconsistent and difficult to predict.

Topics: Acoustics; Adult; Cleft Palate; Female; Humans; Mouth; Nose; Phonetics

Topics: Child, Preschool; Cleft Palate; Follow-Up Studies; Humans; Infant; Infant, Newborn; Lip; Methods; Nose; Palate

The anatomy of harelip is described, as well as attempts to correct it--bilaterally and unilaterally--in a manner producing normal nasal tips.

Topics: Adolescent; Adult; Child; Child, Preschool; Cleft Lip; Cleft Palate; Facial Bones; Female; Humans; Infant; Infant, Newborn; Male; Nose

A patient with hypotelorism, nasomaxillary hypoplasia and cleft lip and palate is presented. The absence of an associated intracranial abnormality, mental retardation or seizures places this patient in a separate category from those described by deMyer. Her intelligence is above normal but at four years of age, she is having psychological problems and difficulties interacting with her peers.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Eye Abnormalities; Follow-Up Studies; Humans; Infant; Infant, Newborn; Intelligence; Male; Maxilla; Nose; Skull

Topics: Birth Injuries; Cleft Lip; Cleft Palate; Esophageal Atresia; Heart Defects, Congenital; Hematoma, Subdural; Hernias, Diaphragmatic, Congenital; Humans; Hydrocephalus; Infant, Newborn; Infant, Newborn, Diseases; Larynx; Lung Diseases; Neoplasms; Neural Tube Defects; Nose; Parenteral Nutrition; Postoperative Care; Preoperative Care

The existence of a cartilaginous facial structure, the mesethmoid, has been demonstrated in the newborn human infant. This structure is the peri- and post-natal tissue developed from the embryonic cartilaginous nasal capsules. Unrecognized during facial development, the cartilaginous mesethmoid, partly because of its multidirectional growth, is responsible for frontonasomaxillary osteomembranous centrofacial morphogenesis. Practical aspects are discussed, and studies to determine the post-natal structures derived from the mesethmoid are in progress.

Topics: Cartilage; Cartilage Diseases; Cleft Palate; Ethmoid Bone; Facial Muscles; Humans; Infant, Newborn; Maxillofacial Development; Morphogenesis; Nose

Topics: Cleft Lip; Cleft Palate; Craniofacial Dysostosis; Humans; Hypertelorism; Maxilla; Nose

Surgery of the clefts of lips and jaws, particularly the prevention or correction of their sequels, is based on a sound knowledge of the anatomy and physiology of the mimic muscles. Their function is essential for the morphogenesis of the underlying skeletal structures. To restore the physiological functional pattern of all of these muscles is the aim of any surgical procedure in these cases. If the sequels of the cleft are of a certain importance at the time when orthodontic treatment usually takes place, it is indispensable to restore a well-balanced muscle function. Surgery might be done before or immediately after orthodontic treatment, but anyway it has to be done at this age, when the child is still going through a period of intensive growth. The last corrective measures only, aimed at merely aesthetic improvements (surgery upon nasal cartilage and revision of scars), are deferred until growth has ceased.

Topics: Adolescent; Age Factors; Child; Cleft Lip; Cleft Palate; Facial Muscles; Female; Humans; Infant; Lip; Male; Nose; Orthodontics, Corrective

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Facial Muscles; Humans; Lip; Malocclusion; Nose

A new method was developed to evaluate more objectively the morphology of the soft tissue lip and nose after treatment of the unilateral cleft lip and palate deformity. Plaster casts of the mid-face of the patients were analysed by use of angular, linear and surface measurements. Thirty cases were studied 4--10 years after the primary surgery of the lip, performed in two stages ad modum Johanson. The results indicated a satisfactory though slightly short lip in the former cleft area. The alar base of the nose was at the same horizontal level on the cleft as the noncleft side. The cleft nostril, however, was significantly greater in surface area and the length of its long axis as well as its angulation, differed between the two sides.

Topics: Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Humans; Infant; Lip; Male; Methods; Nose

Topics: Airway Obstruction; Cleft Palate; Cysts; Humans; Nose; Oral Hygiene; Pharynx

This paper deals with the unique aspects and surgical indication of "dish face" deformity, including "flat face" deformity, due to cleft lip and palate. The importance of deformities of the nose and lip caused by cleft lip and palate and the role of their reconstruction in the treatment of "dish face" deformity are described in detail. For the protruding chin and pseudoprognathism, vertical osteotomy of the ramus of the mandible is recommended over advancement osteotomy of the hypoplastic maxilla.

Topics: Cleft Lip; Cleft Palate; Esthetics; Humans; Jaw Abnormalities; Lip; Maxilla; Nose; Osteotomy; Surgery, Plastic

Topics: Abdominal Muscles; Anus, Imperforate; Cleft Lip; Cleft Palate; Congenital Abnormalities; Disorders of Sex Development; Genetic Counseling; Heart Defects, Congenital; Hernia, Umbilical; Hernias, Diaphragmatic, Congenital; Humans; Infant Care; Infant, Newborn; Intestinal Atresia; Neural Tube Defects; Nose; Tracheoesophageal Fistula; Transportation of Patients

An anatomical reconstruction of the protruded premaxillary segment of an infant with bilateral cleft of the primary palate was made from serial histological sections and described in comparison with reconstruction columella, alar cartilages, nasal septum, and premaxillae of a neonatal control specimen. Most of the bilateral cleft abnormality was seen in the premaxillary bones which were advanced on the nasal septum and whose alveolar process protuded anteriorly into the columellar area. The medial crura of the alar cartilages and the nasal septum in the cleft specimen showed an essentially normal structure. Underdevelopment of the columbella was considered as primarily failure in the development of columellar skin caused by the invasive obstruction by the premaxillary bones.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Humans; Incisor; Infant, Newborn; Maxilla; Nasal Septum; Nose; Prognathism

This paper describes a new, simple technique for instantaneously rating velopharyngeal competency during speech. The instrument, designed on the basis of data obtained from aerodynamic studies, provides an index of palatopharyngeal closure. Results from model studies and 75 cleft palate subjects demonstrate how the instrument is used to differentiate between problems related to velopharyngeal closure and those resulting from other variables which often influence the performance of speakers with cleft palate.

Topics: Adolescent; Adult; Airway Resistance; Child; Cleft Palate; Computers; Humans; Manometry; Middle Aged; Models, Biological; Mouth; Nose; Palate; Pharynx; Pressure; Rheology; Speech

This report has been prepared for the purpose of updating the previous State-of-the-Art reports on the status of research on the anatomy and physiology of cleft lip and palate (Dickson, et al,. 1974, 1975; Maude-Dickson, 1977). It covers the literature from August, 1976 to August, 1978, on middle ear musculature, the auditory tube, the velopharyngeal mechanism, the lip, mandible, tongue, nose, and larynx. It also includes a review of the literature from August, 1972, through August, 1978, on the growth and development of the craniofacial skeleton. Significant advances have been made in our understanding of the velopharyngeal mechanism and auditory tube. Further investigation is needed on the innervation and blood supply to the velopharyngeal mechanism and on the effects of age, race, and sex on the development of the craniofacial skeleton in both normal and cleft-palate individuals. There is a continued need for interdisciplinary research.

Topics: Cleft Lip; Cleft Palate; Ear, Middle; Eustachian Tube; Face; Humans; Larynx; Lip; Mandible; Maxillofacial Development; Muscles; Nose; Palatal Muscles; Palate; Pharynx; Skull; Tongue; Velopharyngeal Insufficiency

Eight surface measurements of the nose and quality of nostril type and ala shape helped in the classification of 184 nostril asymmetries found in 1312 health North American Caucasians six to 18 years of age. Twenty-one of 1312 persons (1.6%) revealed severe degrees of nostril asymmetry characterized by uneven level of the alar base, asymmetries in the width of the nostril floor and length of the columella, and deviations in the columella and nasal bridge. This variation was most similar to the nasal disfigurement found in noncleft members of cleft families (Fukuhara and Saito, 1963; Tolarová et al., 1971). In order to accept this variation as a microform of the cleft anomaly, further anthropometrical study of the nose of noncleft members of cleft families will be required;

Topics: Adolescent; Cephalometry; Child; Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Humans; Male; North America; Nose; White People

Topics: Abnormalities, Multiple; Chromosome Deletion; Cleft Lip; Cleft Palate; Heart Septal Defects, Ventricular; Humans; Hypertelorism; Infant; Infant, Newborn; Male; Nose; Sex Chromosomes; Transposition of Great Vessels; Y Chromosome

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Infant, Newborn; Lip; Methods; Nose; Rhinoplasty

Topics: Animals; Cell Movement; Cleft Palate; Face; Hemorrhage; Humans; Neural Crest; Nose; Palate; Skull; Vitamin A

Topics: Adolescent; Adult; Air Movements; Child; Cleft Palate; Humans; Mouth; Nose; Palatal Obturators; Speech; Velopharyngeal Insufficiency

A case of facial duplication with its surgical correction in childhood and the consequences on facial growth is reported. It is a unique case in the duration of observation. The following structures were fully duplicated: the nose, the premaxilla, the cribriform plate, the crista galli. In addition there was an enormous facial cleft including lip, alveolus and palate. Additionally there were two rudimentary eye sockets, eyes, and two supplementary eyebrows. The monstrous hypertelorism with the facial duplication was corrected at the age of ten. The surgical procedure is described and the postoperative complications are discussed. Gross lack of growth of the middle third of the facial skeleton was observed. This was probably the consequence of the initial corrective surgery. Overgrowth of the mandible created a gorilla-like appearance by the end of the growth period. This was corrected in one operation by advancement of the middle third in three sections and repositioning of the mandible as a whole together with the mandibular anterior alveolar segment. Finally all parts of the lower half of the nose had to be enlarged, both soft tissues as well as the cartilaginous framework. A pharyngoplasty in addition to the correction of the intermaxillary abnormalities did much to improve the speech quality of the patient. A large secondary cranial defect was successfully reconstructed with the use of 14 halved ribs. In spite of the removal of four ribs from one side and three ribs from the other, there were no postoperative respiratory problems. Spontaneous rib regeneration was found where ribs had been removed one year earlier.

Topics: Adolescent; Alveolar Process; Child; Cleft Palate; Face; Hematoma; Humans; Infant; Male; Mandible; Maxilla; Maxillofacial Development; Nose; Orbit; Osteotomy; Patient Care Planning; Postoperative Complications; Prognathism; Radiography; Retrognathia; Sepsis; Skull; Speech; Vision, Ocular

Computer morphometrics was used to analyze 21 adult patients who underwent total maxillary advancement; ten had bone grafting behind the tuberosity and 11 did not. Each group was subclassified as those with idiopathic maxillary deficiency and those with cleft lip and cleft palate; all patients were treated by the same basic operative technique. The results of the study indicate that those patients who had bone grafts had optimum stability. However, individuals with maxillary deficiency who undergo minimal advancements (less than 0.5 mm) can have overcorrections at surgery and, therefore, do not require bone grafts for good stability.

Topics: Adolescent; Adult; Bone Transplantation; Cephalometry; Cleft Lip; Cleft Palate; Computers; Dental Occlusion; Esthetics, Dental; Face; Follow-Up Studies; Humans; Malocclusion, Angle Class III; Maxilla; Nose; Osteotomy; Retrospective Studies; Time Factors; Transplantation, Autologous

This papaer describes some of the advantages of the external rhinoplastic approach in managing the nasal tip, in particular, in revision surgery and cleft palate nose. It also reviews many of the methods of tip management which are essentially similar in the external and closed procedures e.g. altering projection, rotation and shortening of the tip, and management of asymmetries.

Topics: Abnormalities, Multiple; Cartilage; Cleft Lip; Cleft Palate; Humans; Nasal Septum; Nose; Rhinoplasty; Surgery, Plastic

Rhinophony, which is a change of vocal sound, can appear as a major symptom in many peripheral or central disorders of childhood, adolescence and adulthood. Its investigation, aetiology and management from various points of view are discussed. These are considered broadly as rhinophony aperta (palatal paralysis, functional rhinophony aperta, congenitally short palate); as rhinophony clausa (organic in origin, functional nasal speech); and mixed types of rhinophony. Typical phoniatric problems related to cleft lip and palate are also presented.

Topics: Auscultation; Central Nervous System Diseases; Cleft Lip; Cleft Palate; Diagnosis, Differential; Humans; Jaw Abnormalities; Nose; Palate; Paralysis; Peripheral Nervous System Diseases; Speech Disorders; Voice

Based on 25 cases with unilateral clefts of lip, alveolus and palate with retromaxillism (CLAP) and 25 cases with pure retromaxillism (RM) the effect on the nose of advancing the maxilla by a Le Fort I osteotomy is analyzed. It can be shown that on average the base of the nose which is at the same time the base of the upper lip, follows the base of the maxilla in the ratio of 4 : 7 while the nasal tip is advanced in a ratio of 2 : 7. This means that to achieve a specified advancement of the nasal base, the maxilla has to be brought forward about twice this amount. A planned advancement of the tip of the nose can, on average, only be obtained by an advancement of the maxilla by three times this amount. The tangent to the columella is tilted considerably forewards and upwards. The movement is a little more marked in CLAP than in RM. The amount of maxillary advancement influences the ratios very little. It seems that they are slightly better after significant advancement. Leaving the nasal spine intact and tilting the maxilla forwards and upwards have a favourable influence on the advancement of the nasal tip. There is no satisfactory explanation of why the extremes in all groups for all measurements are placed so very far apart. As was found in the evaluation of lip movements (Freihofer 1976) this leads to the conclusion that in spite of careful planning the result in the individual case can differ considerably from that expected.

Topics: Adult; Alveolar Process; Cleft Lip; Cleft Palate; Evaluation Studies as Topic; Humans; Maxilla; Methods; Nose; Osteotomy; Retrognathia

Topics: Animals; Cleft Lip; Cleft Palate; Facial Muscles; Fascia; Humans; Lip; Masticatory Muscles; Maxillofacial Development; Mouth; Muscle Development; Nasal Septum; Nose; Rats

Topics: Cleft Lip; Cleft Palate; Humans; Nose; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

An 8-month-old infant boy with median facial cleft syndrome had eyelid coloboma, symblepharon, and a cytic mass in the left upper eyelid. The mass proved to be an ectatic cornea containing a large cystic lens. Maldevelopment of the entire anterior segment of the eye was also present, although the posterior globe was well formed. We postulate that an area of localized abnormal mesodermal differentiation and fusion at the 17- to 20-mm stage of development served as a common mechanism for all the defects noted.

Topics: Abnormalities, Multiple; Cleft Lip; Cleft Palate; Coloboma; Cornea; Craniofacial Dysostosis; Eye; Eye Abnormalities; Eyelids; Face; Hair; Humans; Hypertelorism; Infant; Male; Nose; Nose Deformities, Acquired; Orbit; Skull; Syndrome; Tissue Adhesions

Topics: Cleft Lip; Cleft Palate; Humans; Infant; Methods; Nose; Surgery, Plastic

We suggest the bilateral placement of nasopharyngeal tubes of appropriate size as a simple aid in constructing lateral ports of the correct size when doing a superiorly-based, lined, pharyngeal flap for velopharyngeal incompetence. If one leaves the tubes in for 24 to 48 hours postoperatively, they are of great help in maintaining a clear airway during that period.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cleft Palate; Humans; Intubation; Middle Aged; Nose; Pharynx; Respiration; Surgery, Plastic

A new experimental method for assessment of velopharyngeal adequacy/inadequacy, using nasal manometric pressure readings for three types of speech conditions under controlled incremental bleed conditions, is described. Cleft palate speakers (N = 30) tended to have higher nasal pressure readings than non-flect palate speakers (N = 56), with or without bleed conditions. Reduction in nasal pressure under controlled incremental bleed for non-cleft palate speakers and cleft palate adequate (CPA) speakers is compatible with an aerodynamic quadratic equation. Unlike cleft palate inadequate (CPI) speakers, non-cleft palate speakers and CPA speakers exhibit similar ability to achieve 0 cm nasal monometric pressure under a bleed bore diameter of 4 mm for a circular bleed orifice. Results for cleft palate marginal (CPM) speakers are less conclusive. Reliability of nasal manometric bleed testing was limitedly tested but not conclusively established in the present report. Further study of reliability and validity is necessary.

Topics: Adolescent; Child; Cleft Palate; Evaluation Studies as Topic; Female; Humans; Male; Manometry; Methods; Mouth Diseases; Nose; Palate; Pharyngeal Diseases; Pharynx; Pressure; Speech; Speech Disorders

Topics: Adolescent; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Face; Factor Analysis, Statistical; Female; Humans; Male; Maxillofacial Development; Nasopharynx; Nose; Skull

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Infant; Nose; Surgery, Plastic

Topics: Cephalometry; Child; Child, Preschool; Chin; Cleft Lip; Cleft Palate; Face; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Lip; Male; Maxillofacial Development; Nose

Nasal emission confined solely to the sibilants or sibilants and affricates may be encountered as an articulatory phenomenon in speakers who do not demonstrate velopharyngeal incompetency. This phenomenon may occur both in patients who previously had an incompetent mechanism and in patients in whom such incompetency has never been documented. In the latter case, the patient may be referred to a cleft palate clinic on suspicion of a submucous cleft or other form of palatopharyngeal incompetency. Typically the nasal emission is combined with incorrect tongue placement. The persistent oral-nasal misarticulation may be viewed simplistically as a residual of earlier velopharyngeal incompetency, documented or undocumented. The speaker's own acoustic target for these consonants is grossly deviant, perhaps owing to such factors as malocclusion and earlier compensatory articulation gestures. Many such cases prove impervious to extensive articulation therapy, yet physical management may constitute "over-correction" with undesirable sequelae. Inventive approaches to articulation therapy may be required in these cases, since correction of the combined oral-nasal distortion requires the speaker to make many simultaneous changes in articulator placement without benefit of visual cues.

Topics: Adolescent; Cephalometry; Child; Child, Preschool; Cineradiography; Cleft Palate; Female; Humans; Infant; Male; Mouth Diseases; Nose; Palate; Pharyngeal Diseases; Phonetics; Pulmonary Ventilation; Speech Disorders; Speech Therapy; Tongue

Topics: Cleft Palate; Endoscopy; Fiber Optic Technology; Humans; Nose; Palate; Pharynx; Radiography; Speech; Ultrasonography

Topics: Cephalometry; Child, Preschool; Cleft Palate; Female; Humans; Male; Nose; Preoperative Care

Topics: Cleft Palate; Electronics, Medical; Evaluation Studies as Topic; Humans; Methods; Nose; Phonetics; Speech Disorders

Topics: Cleft Palate; Foreign Bodies; Humans; Infant; Nose; Paper; Preoperative Care; Wood

Topics: Adolescent; Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Phonetics; Speech Disorders; Speech Therapy

Topics: Acoustics; Cleft Palate; Hemiplegia; Humans; Nose; Palatal Neoplasms; Palate; Phonetics; Speech; Tape Recording

Topics: Age Factors; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Face; Female; Humans; Infant; Lip; Male; Mandible; Maxilla; Maxillofacial Development; Nose

Topics: Cleft Palate; Fistula; Humans; Methods; Nose; Orthodontics, Corrective; Suture Techniques; Tongue

Topics: Animals; Cleft Palate; Disease Models, Animal; Female; Haplorhini; Macaca; Male; Malocclusion; Maxillofacial Development; Nasal Septum; Nose; Nose Deformities, Acquired

Topics: Achondroplasia; Bone and Bones; Cartilage Diseases; Cleft Palate; Diagnosis, Differential; Dwarfism; Eye Abnormalities; Female; Humans; Infant, Newborn; Karyotyping; Limb Deformities, Congenital; Nose; Ossification, Heterotopic; Radiography

Topics: Cleft Lip; Cleft Palate; Ectoderm; Humans; Nose

Topics: Abnormalities, Multiple; Ankle Joint; Bone and Bones; Carpal Bones; Child; Cleft Palate; Dwarfism; Elbow Joint; Epiphyses; Facial Expression; Femur Head; Finger Joint; Hip Joint; Humans; Knee Joint; Male; Nose; Shoulder Joint; Wrist Joint

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Female; Humans; Maxilla; Maxillofacial Development; Maxillofacial Prosthesis; Nose; Nose Deformities, Acquired; Surgery, Plastic

Topics: Adolescent; Adult; Cleft Palate; Female; Humans; Male; Manometry; Middle Aged; Nose; Sound; Speech Disorders; Voice

Topics: Cleft Lip; Cleft Palate; Electrophysiology; Humans; Nose; Palate; Pharynx; Respiration; Speech; Speech Therapy

Topics: Chromosome Aberrations; Chromosome Disorders; Chromosomes, Human, 16-18; Cleft Lip; Cleft Palate; Dermatoglyphics; Female; Humans; Immunoelectrophoresis; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Infant, Newborn; Male; Microcephaly; Nose; Pneumoencephalography; Pregnancy

Topics: Brain; Cleft Palate; Encephalocele; Ethmoid Bone; Female; Humans; Infant, Newborn; Male; Meningocele; Nose; Orbit; Skull

Topics: Abnormalities, Multiple; Adolescent; Child; Child Development; Cleft Lip; Cleft Palate; Female; Humans; Intelligence; Male; Nose; Personality Development; Social Adjustment

Topics: Acoustics; Adolescent; Adult; Child; Child, Preschool; Cleft Palate; Cultural Deprivation; Electronics, Medical; Female; Humans; Methods; Monitoring, Physiologic; Mouth; Myasthenia Gravis; Nose; Phonetics; Prostheses and Implants; Reinforcement, Psychology; Speech Disorders; Speech Therapy; Voice

Topics: Cartilage; Cleft Lip; Cleft Palate; Humans; Male; Methods; Nose; Nose Deformities, Acquired; Rhinoplasty; Suture Techniques; Transplantation, Autologous

Topics: Abnormalities, Severe Teratoid; Adult; Cerebral Cortex; Cleft Palate; Eye Abnormalities; Face; Facial Bones; Female; Head; Humans; Infant, Newborn; Limbic System; Male; Microphthalmos; Nose; Pedigree; Pregnancy; Telencephalon

Topics: Abnormalities, Multiple; Cleft Palate; Congenital Abnormalities; Deafness; Esophageal Stenosis; Female; Glaucoma; Hernia, Umbilical; Hernias, Diaphragmatic, Congenital; Hip Dislocation, Congenital; Humans; Hydronephrosis; Hymen; Infant, Newborn; Intestinal Atresia; Jaw Abnormalities; Lip; Nose; Tongue

Topics: Cephalometry; Cleft Palate; Humans; Infant; Male; Malocclusion; Nose; Orthodontic Appliances; Patient Care Planning; Periosteum; Splints; Time Factors; Tooth, Deciduous

Topics: Anesthesia, Dental; Child, Preschool; Cleft Palate; Dental Equipment; Female; Foreign Bodies; Humans; Iatrogenic Disease; Nose; Rubber

Topics: Adolescent; Adult; Aerobiosis; Anaerobiosis; Bacteria; Child; Cleft Palate; Humans; Mouth; Nose; Otitis Media; Pharynx; Respiratory Tract Infections; Speech

Topics: Adolescent; Adult; Child; Child, Preschool; Cleft Palate; Humans; Manometry; Middle Aged; Nose; Pharynx; Phonetics; Speech; Voice

Topics: Adolescent; Adult; Anthropometry; Cheek; Chin; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Infant; Lip; Male; Maxillofacial Development; Nose; Sex Factors

Topics: Abnormalities, Multiple; Adolescent; Child, Preschool; Cleft Lip; Cleft Palate; Craniofacial Dysostosis; Craniosynostoses; Dermoid Cyst; Encephalocele; Eye Neoplasms; Eyelids; Face; Female; Humans; Infant; Infant, Newborn; Intellectual Disability; Limb Deformities, Congenital; Micrognathism; Microphthalmos; Nose; Strabismus

Topics: Child; Cleft Palate; Humans; Nose; Speech; Voice

Topics: Age Factors; Animals; Bone Development; Cartilage; Cleft Palate; Facial Bones; Humans; Incisor; Maxillofacial Development; Nasal Septum; Nose; Nose Deformities, Acquired; Rabbits; Radiography; Thymidine; Tooth; Tritium

Topics: Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Scrotum; Skull; Spinal Dysraphism; Sternum

Topics: Air; Cleft Palate; Humans; Manometry; Mouth; Nose; Pressure; Respiration; Speech

Topics: Adolescent; Adult; Cleft Palate; Female; Humans; Male; Middle Aged; Nose; Speech

Topics: Adolescent; Adult; Air; Cephalometry; Child; Child, Preschool; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Mouth; Nose; Palate; Pressure; Respiration; Speech

Topics: Acoustics; Child; Cleft Palate; Humans; Mouth; Nose; Psychophysics; Speech

Topics: Acoustics; Cleft Palate; Humans; Mouth; Nose; Palate; Pressure