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PubMed2001

Audit of a multidisciplinary approach to the care of children with unilateral and bilateral cleft lip and palate.

Cleft lip and palate affects the child in many ways, particularly appearance, dental arch relationships, growth of the face, and speech development. The key to successful care is management in a multidisciplinary team adhering to a well-designed protocol, and careful audit of results. We present the intermediate outcome audit of 15 patients with complete bilateral and unilateral cleft lip and palate whose condition was managed in a multidisciplinary team according to a strict protocol. We give the results observations of operations of a single surgeon's functional primary surgery over a 6-year period in terms of dental arch relationships, cephalometric analyses, aesthetic assessments, and speech analysis. The results show good early facial growth, with dental arch relationships appropriate for the age and group; we found only minor speech discrepancies, with no patients requiring pharyngoplasty. The results show the importance of multidisciplinary management, the value of keeping to sound surgical protocols, and functional techniques in cleft lip and palate surgery. Our study includes the neglected group of children who have bilateral cleft lip and palate, and it conforms to the style of pan-European projects.

Cephalometry↗
PubMed2000

Major hematological diseases associated with cleft lip and palate.

OBJECTIVE: 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. PATIENTS AND RESULTS: 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. CONCLUSIONS: Association of major hematological disorders and cleft lip, palate, or both is rare and is reported herein.

Adult↗
PubMed2000

Multidisciplinary care of the child born with cleft lip and palate.

Cleft lip and cleft palate affect about one in every 700 children born in the United States. Parents of newborns with orofacial clefts, often unaware of the cleft until birth, need emotional support and professional guidance in caring for their baby. As the child grows, it is important to properly time surgical procedures, speech therapy, hearing evaluations, and dental interventions and to assess the child's psychological status. Multidisciplinary cleft palate teams provide a significant resource to families of children with facial clefts. This article describes the role of team members, provides an overview of the cleft condition, and lists resources for families and healthcare professionals.

Cleft Lip↗
PubMed2006

[Developmental disturbances of medial part of face of patients with bilateral cleft lip and palate with special consideration of a nose].

UNLABELLED: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSIONS: It was stated that the patients with bilateral cleft lip, alveolus and palate tended to have flat and wide nose.

Abnormalities, Multiple↗
PubMed2000

A clinical profile to assess the potential risk factors for cleft lip and palate.

Cleft lip and palate is one of the most common malformations in man. Although the subject of a great deal of investigation, etiologic factors contributing to these congenital deformities remain largely unknown. Various factors like race, sex, parental age at the time of conception etc. have been listed as the exogenous factors. This article strives to project any significant relationship of these factors to cleft lip and cleft palate.

Adolescent↗
PubMed2006

Description of a new syndrome: auricular abnormalities and cleft lip in two sibs, in association with cleft palate and unusual opthalmological findings.

We describe the association of auricular abnormalities and cleft lip with or without cleft palate in two siblings. One sibling has postauricular pits, profound myopia, nystagmus and retinal pigment abnormalities. The second sibling was a fetus of 23 weeks gestation with severe cleft lip, cleft palate and external ear abnormalities. As this constellation of features has not been described together before, we believe this is a new syndrome.

Cleft Lip↗
PubMed1997

[When a child is born with a cleft lip and palate].

The child born with cleft lip and palate. Cleft lip, cleft palate and cleft lip and palate are among the most common facial abnormalities. The birth of a child with any of these and the prospect of a schedule of treatments that will continue into late adolescence puts enormous stress on the entire family. Between 1989 and 1994, 160 babies with such malformations were born in Quebec. In a study of eight families from this population, the author examines ways in which they communicate, share tasks, react to difficulties, show interest and solve problems. By means of interviews and three questionnaires, the author determined that the first three months following the birth are the most crucial. During this time, the nurse can help the family through a redefinition of roles brought on by the prospect of numerous medical and surgical procedures. The nurse can also provide the family with emotional and educational support; help them understand and come to terms with the child's malformation, so that the child is fed properly; and help lessen the family's feelings of helplessness. The nurse must ensure that these parents are adequately informed and provide them with additional information about cleft lip, cleft palate and cleft lip and palate. She must be aware of appropriate resources and, whenever possible, refer the families to an organization or a centre specializing in this type of malformation.

Adaptation, Psychological↗
PubMed1982

Mitotic index in mouse embryos with 6-aminonicotinamide-induced and inherited cleft lip.

Three types of cleft lip were studied histologically before and during lip formation in mouse embryos. C57BL/6 embryos observed near term following treatment with 6-aminonicotinamide (6AN) at gestation D9/12 (vp day = day 0) had 18% median cleft lip. Treated embryos observed at D10 and D11 showed retarded somite and nasal placode development. Sections at lip closure time showed marked reduction of medial and some reduction of lateral nasal processes, and the mitotic index was significantly reduced in the nasal area on D10 and D11 but less consistently in the neural area. 6AN-treatment on D10/8, caused 22% lateral cleft lip. Treated embryos showed initial retardation of somite and nasal placode development that became normal by D11/14. Sections showed reduction of the medial and lateral nasal processes, and less organized denser nasal ectoderm. The mitotic index was significantly reduced in the nasal and neural areas on D10 and D11. In crosses having the major gene mutation dancer (Dc) 20% of embryos had lateral cleft lip and potential cleft lip mutant embryos showed reduced lateral and medial nasal processes. Mitotic index was not reduced in the nasal area but it was in the neural area. The CL/Fr strain, with a predisposing face shape in which 26% of the embryos have cleft lip of multifactorial origin, had a mitotic index similar to that of C57BL/6 (0% cleft lip) at lip closure time, D11/14, and prominent medial nasal processes. It is postulated that 6AN-induced median cleft lip is due to reduced cell proliferation in and size of the medial nasal processes; 6AN-induced lateral cleft lip to reduced cell proliferation and reduced medial and lateral nasal processes and dancer lateral cleft lip to reduction of the medial nasals.

6-Aminonicotinamide↗
PubMed1992

Radiological survey of the cervical spine in cleft lip and palate.

Cleft lip and palate is known to be associated with a number of other skeletal anomalies. The purpose of this study was to investigate the prevalence of possible malformations of the cervical spine and their relationship to velopharyngeal incompetence. The lateral cephalometric radiographs of 30 patients aged between 14 and 27 years of age with cleft lip and palate were compared with these of a control group, who had been involved in cycle accidents. The radiographs were assessed for morphological anomalies of the first and second cervical vertebrate and, in addition, longitudinal and angular measurements performed. Speech was assessed by electromagnetic articulography. A greater number of cervical spine anomalies were found in patients with cleft lip and palate and these were also associated with significantly (P < 0.05) greater osseous-nasopharyngeal depth.

Adolescent↗
PubMed1993

[Vestibuloplasty in patients with cleft lip and palate].

After cleft lip repair the upper lip is sometimes attached at the premaxilla. The scar bands and contractures may occur deleterious effects on: the growth, the facial expression, the speech, problems during orthodontic treatment and in prosthetic dental care, regression of the attached gingiva, resorption of the transplanted bone and the aspect of the upper lip. In nine edentulous patients with cleft lip palate, in six patients with cleft lip palate and with a mutilated dentition and in ten younger patients with cleft lip palate the buccal sulcus was successfully restored. The importance of a free upper lip and adequate sulcus has been under-emphasized in treatment of the patient with cleft lip palate.

Adult↗
PubMed1983

Procedures for repair of the cleft lip nose.

The cleft lip nose is a combination of various deformities, which should be considered in relation to the shape of the whole face. This paper deals with (1) the characteristics of the cleft lip nose; (2) time of the operation; (3) primary operative procedure; (4) secondary operative procedure; and (5) aesthetic operation for the cleft lip nose.

Cleft Lip↗
PubMed2005

Chlorhexidine in cleft lip and palate patients with multibracket appliances. Results of a prospective study on the effectiveness of two different chlorhexidine preparations in cleft lip and palate patients with multibracket appliances.

AIM: The aim of this study is to reduce the caries risk in cleft lip and palate (CLP) patients with multibracket appliances via a compliance-independent method. PATIENTS, MATERIALS AND METHODS: Sixty-eight CLP patients with multibracket appliances were submitted to professional tooth cleaning at 4-week intervals. After randomization, patients in group A wore a splint filled with chlorhexidine (CHX) gel (Chlorhexamed) for 15 minutes (3 x 5 min) every 12 weeks. Patients in group B were treated with CHX varnish (EC40) every 12 weeks. Fluoride varnish (Fluoridin) was applied to all teeth 4 and 8 weeks after the respective CHX treatments. Regular salivary bacteria counts (CRT) were carried out to determine therapeutic effectiveness. Initial DMFS values were compared to the final ones. RESULTS: Initial findings of the salivary test and DMFS index confirmed the high caries risk. The DMFS value increased dramatically in both groups despite this systematic prophylaxis program. The bactericidal effect of both CHX preparations turned out to be markedly weaker than that described in the literature. CONCLUSIONS: Though the CHX and fluoride application had a limited effect (at least in this test population), one should keep in mind that it is precisely this population that requires very intensive prophylaxis, and that no antibacterial adjuvant is more effective than CHX. However, the application interval should be individually adapted to the bacteria count.

Adolescent↗
PubMed1998

Unilateral cleft lip with or without cleft palate and handedness: is there an association?

OBJECTIVE: The purpose of this study was to investigate the possibility of a relationship between the side of occurrence of unilateral clefting of the lip and/or palate and handedness, also taking into account the type of the initial cleft condition, a factor that has not been adequately assessed in previous studies. DESIGN: This was a retrospective study. SETTING: Division of Orthodontics, The Hospital for Sick Children, Toronto, Canada, and Cleft Lip and Palate Program, Children's Hospital, Winnipeg, Canada. PARTICIPANTS: Subjects were 289 patients (176 males and 113 females) 9 years of age or older presenting with a history of unilateral clefts of the lip with or without the palate. Of these patients, 217 were recruited from the patient pool of the Orthodontic Clinic at the Hospital for Sick Children in Toronto. The remaining 72 were selected from the registry of the Cleft Lip and Palate Program of the Children's Hospital in Winnipeg. Any syndromic cases were excluded from the sample. MAIN OUTCOME MEASURES: Assessment of handedness was performed by asking the patients to fill out a multi-item questionnaire in which patients were asked to identify which hand they would use for different tasks. The side and type of the initial cleft condition were identified by reviewing each patient's hospital chart and by cross-referencing with clinical examination. Statistical evaluation of the results was performed by using the chi-square test. RESULTS: There was a significantly larger number of left-sided clefts (198) in the sample than right-sided clefts (91), (p < .001). The proportion of left-sided clefts among left-handers (84.6%) was higher than that among right-handers (66.8%). However, the relationship between side of cleft and handedness was not statistically significant (p = .185). Clefts of the primary palate only seemed to occur on the left side 3.5 times more often than on the right, whereas the corresponding ratio of left:right manifestation for clefts of the primary and secondary palate was 1.8:1. The difference was statistically significant (p < .05). CONCLUSION: The findings of this study confirm the affinity of unilateral clefts for the left side but suggest that there are differences between clefts of the primary palate only and clefts of the primary and secondary palate. Also, non-right-handed patients show a greater predilection for having a cleft on the left side than do right-handed patients.

Chi-Square Distribution↗
PubMed1996

Sagittal skeletal and dental changes of reverse headgear treatment in Chinese boys with complete unilateral cleft lip and palate.

Cleft lip and palate patients often develop maxillary retrusion after cleft repair. Maxillary protraction treatment during early childhood helps to achieve more favorable occlusion with positive overjet and overbite and allows a more normal growth pattern to occur. The purpose of this study was to investigate the skeletal and dental changes during reverse headgear treatment in a homogeneous group, i.e., Chinese boys born with unilateral complete cleft lip and palate. The results showed that after 7.8 months of reverse headgear wear, normalization of the sagittal maxillomandibular relationship (ANB angle) was achieved. Significant skeletal changes included anterior position of the maxilla and posterior position of the mandible. Dental changes within the respective skeletal units were not significant except for the mandibular molar.

Cephalometry↗