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At least 1,153 records · Page 64Linked to original sources
PubMed1997

Mandibular and maxillary asymmetry in individuals with unilateral cleft lip and palate.

OBJECTIVE: This study was conducted to evaluate the degree of maxillary and mandibular asymmetry in the verticle and transverse planes seen in posteroanterior cephalometric radiographs relative to chronologic age in postoperative complete UCLP patients compared to controls. METHOD: Mandibular and nasomaxillary asymmetry was retrospectively studied in complete unilateral cleft lip and palate (UCLP) and noncleft individuals (controls) by means of posteroanterior cephalometric analysis. All the UCLP patients available (total 40) and randomly selected noncleft controls (total 142) were included in the study. The UCLP patients had undergone lip and palate reconstruction in Strong Memorial Hospital, University of Rochester, Rochester, New York, and orthodontic treatment in the Department of Orthodontics, Eastman Dental Center, Rochester, New York. The controls were selected based on the age that treatment was initiated and were treated in the department for various malocclusions; none had undergone maxillary expansion or surgical treatment. The asymmetry assessed on mixed longitudinal records of the patients with UCLP was analyzed relative to three chronologic age groups and compared to the controls. In addition, mandibular asymmetry was correlated to maxillary asymmetry in UCLP individuals to investigate possible growth patterns between the two jaws. RESULTS: Mandibular asymmetry in UCLP individuals was found to increase with growth and time and peaked at post-pubertal growth-spurt stages. The cleft subjects were more asymmetric than controls in all stages of growth. Mandibular asymmetry followed the affected maxilla closely, indicating a parallel growth pattern of the jaws. CONCLUSION: The unilateral cleft lip and palate patients manifested asymmetry of the mandible. This asymmetry develops in a parallel pattern with the affected maxilla, suggesting that early evaluation and treatment of the anomalies in the nasomaxillary skeleton as well as in the mandible is necessary when treating unilateral cleft lip and palate individuals.

Adolescent↗
PubMed1998

Short-term cost-effectiveness analysis of presurgical orthopedic treatment in children with complete unilateral cleft lip and palate.

OBJECTIVE: The aim of this article was to investigate cost-effectiveness in cleft palate treatment using cost-effectiveness of presurgical orthopedic treatment (PSOT) as an example. DESIGN: A three-center randomized clinical trial compared PSOT with non-PSOT for children with unilateral cleft lip and palate (UCLP, n=52). PATIENTS: The inclusion criteria for the trial were: complete UCLP, no other malformations, born at term, both parents Caucasian, trial entrance preferably within 2 weeks after birth, and informed consent by the parents. INTERVENTIONS: PSOT was performed by means of a passive plate according to Hotz and Gnoinski. MAIN OUTCOME MEASURE: The short-term cost-effectiveness of PSOT was based on the time taken for the surgical lip closure procedure. Medical and nonmedical costs until surgical lip closure at 18 weeks of age were analyzed. RESULTS: The durations of the surgical lip closure procedures did not differ significantly (57.2 minutes for PSOT and 56.4 minutes for non-PSOT). The mean medical cost for PSOT treatment was US$852. The non-PSOT treatment group had a significantly different mean medical cost (US$304). Mean travel costs and indirect nonmedical costs were US$128 and US$231 for PSOT and US$79 and US$130 for non-PSOT, respectively. CONCLUSIONS: The combination of a clinical trial and an economic evaluation makes it possible to relate effects to costs involved in treatment alternatives. Longer-term costs and effects will be incorporated into an extended cost-effectiveness analysis to determine the cost-effectiveness of PSOT.

Analysis of Variance↗
PubMed1998

Oral and dental health status of children with cleft lip and/or palate.

OBJECTIVE: To ascertain the oral and dental health status of children with cleft lip and/or palate. DESIGN: Oral and dental examinations were carried out on 114 selected children with cleft lip and/or palate, using standard criteria and indices. SETTING: These children were examined at two cleft palate clinics in the United Kingdom. PATIENTS: All children examined were between the ages of 3 and 18 years. RESULTS: Sixty one (53.5%) of the subjects exhibited no evidence of previous caries experience, but as many as 20% exhibited active decay. The mean caries experience in the deciduous dentition (dmfs) was 2.3, and that in the permanent dentition (DMFS) was 0.9. Caries experience of the Caucasian children of the sample was lower (mean dmfs 1.9) than that of the Asian children (mean dmfs 5.5). The mean simplified debris index of the sample was 0.9, and the mean gingival bleeding index was 0.4. Children with cleft lip and palate had generally poorer oral and gingival health than those with isolated clefts of the lip or palate. CONCLUSION: Twenty percent of the sample had active decay. These children had poor oral health in the surgically repaired anterior segment.

Adolescent↗
PubMed1999

Effect of primary repositioning of the nasal septum on facial growth in unilateral cleft lip and palate.

OBJECTIVE: The objective of this study is to evaluate whether manipulation of the nasal septum, its release, and changing of its abnormal position in infancy has an impact on maxillary growth and facial development in patients with unilateral cleft lip and palate. DESIGN: Roentgencephalometric investigation. SETTING: Cleft Centre at the Clinic of Plastic Surgery, Prague. PATIENTS: Two consecutive groups of male patients (n = 32 and 30) with complete unilateral cleft lip and palate without associated malformations at 15 years of age. INTERVENTIONS: The patients were operated on by the same team of surgeons and by the same method (lip: Tennison and primary periosteoplasty; palate: pushback with pharyngeal flap surgery), with the exception of complete primary repositioning of the nasal septum performed only in one group. MAIN OUTCOME MEASURES: Roentgencephalometric data of both series of patients were compared with a t-test. All measurements were performed by one investigator. RESULTS: Patients with primary repositioning of the nasal septum had a more favorable nasal prominence and better vertical growth of the upper and whole face in posterior height. Better growth in anterior height was only suggested; maxillary retrusion was equal in both groups. CONCLUSIONS: Primary repositioning of the nasal septum has a favorable effect on nasal development, and it neither deteriorates nor markedly improves maxillary growth in patients with unilateral cleft lip and palate.

Adolescent↗
PubMed1999

Comparison of periodontal disease in patients with clefts of palate and patients with unilateral clefts of lip, palate, and alveolus.

OBJECTIVE: Long-term health of the stomatognathic system as well as esthetic aspects are the therapeutic goals in patients with orofacial clefts. The aim of this study was to analyze the periodontal condition of patients with cleft palate (CP) and cleft lip, palate, and alveolus (CLP) and to determine the differing degrees and localization of periodontal disease. DESIGN: In 30 patients with unilateral cleft lip, palate, and alveolus and 30 patients with cleft palate (CP), periodontal lesions were identified and classified according to the Community Periodontal Index of Treatment Needs (CPITN) and pathological mobility of teeth was noted. The state of oral hygiene was recorded by the Approximal Plaque Index. RESULTS: In general, poor oral hygiene was found in all patients. Patients with CLP were classified as CPITN code 0 in 0%, codes 1 and 2 in 7%, code 3 in 43%, and code 4 in 50% of cases. Patients with cleft palate showed code 0 in 0%, codes 1 and 2 in 30%, code 3 in 45%, and code 4 in 25% of cases. In this study, periodontal disease was found in patients with cleft palate to a similar extent to that in the general population, whereas patients with cleft lip, palate, and alveolus had a predisposition to deep periodontal destruction of teeth adjacent to the cleft. The registration of pathological mobility of teeth and resulting loss of attachment corresponded to the periodontal disease classification according to the CPITN. CONCLUSION: A critical periodontal situation was found in patients with unilateral cleft lip, palate, and alveolus. In contrast, patients with cleft palate exhibited a similar periodontal situation to that found in the general population, with additional damage that may be attributed to orthodontic treatment.

Adolescent↗
PubMed1999

Symmetry and morbidity assessment of unilateral complete cleft lip nose corrected with or without primary nasal correction.

OBJECTIVE: Unilateral complete cleft lip patients treated with or without a primary nasal correction at the time of cleft lip repair were compared to evaluate the relevance of early surgical correction of the nose by using two assessments: nasal symmetry and morbidity. DESIGN, SETTING, PATIENTS: The no nasal correction group (NNC, n = 19) was operated by surgeon A using the Millard technique. The primary nasal correction group (PNC, n = 9) was operated by surgeon B combining the modified Millard technique with a columellar lift and alar mobilization. Symmetry was assessed on two sets of standardized photographs at 9 years of age using a computer-assisted analysis. Both cleft groups were compared with normal controls (NC, n = 20). The computer method included area and angular measurements. Morbidity was assessed by the number of procedures on the vermilion, the lip, and/ or nose for revisional surgery up to the age of 9 (NNC, n = 26; PNC, n = 12). RESULTS: No significant differences in symmetry were found between the NNC and PNC groups regarding the area and angular measurements. With regard to the area measurements, both cleft groups produced a significant asymmetry when compared to the NC group. Concerning the angular measurements, however, the NNC group differed significantly from the NC group, whereas such a difference could not be noted between the PNC group and NC group. With respect to morbidity, no revisional procedures were performed in the PNC group. The number of revisional procedures in the NNC group was 16 in 10 patients. CONCLUSION: Results are presented that favor, up to the age of 9 years, a primary nasal correction at the time of cleft lip repair.

Child↗
PubMed1999

Changes produced by presurgical orthopedic treatment before cheiloplasty in cleft lip and palate patients.

OBJECTIVE: The purpose of this study was to test the hypothesis that, with the use of preoperative treatment, the dimensions of the upper part of the oral cavity of an infant with unilateral cleft lip and palate (UCLP) become more similar to those of a noncleft infant. DESIGN: This was a retrospective study of upper dental casts taken at birth and prior to lip repair at 6 months of age. A treated group, an untreated group, and a group of noncleft contemporaries were compared cross-sectionally and longitudinally. Models were analyzed by the trigonometric method. SETTING: The study was performed at a maxillofacial center servicing a population of two million. PARTICIPANTS: The treated group consisted of 24 babies born after 1990 with UCLP that started presurgical treatment within 20 days of life. The untreated group consisted of 25 randomly selected UCLP casts taken at birth and 25 casts taken just before lip surgery. The noncleft group consisted of 25 full-term infants whose mothers participated in the longitudinal growth study. All participants belonged to the same ethnic group. INTERVENTIONS: Presurgical treatment consisted of the babies constantly wearing a thin, passive acrylic plate mimicking the normal palate and a slim adhesive tape fixed to the lip segments to bring them slightly together. RESULTS: The upper oral cavity in a newborn with UCLP was significantly larger than in a noncleft infant, the only exception being in the sagittal dimension. After presurgical treatment, the upper oral cavity was remodeled and slightly enlarged; there was a lesser difference from the noncleft at 6 months than at birth. The cleft in the alveolus reduced significantly, and the position of the incisive point improved. The group without presurgical treatment had no remodeling, and the growth dynamics were similar to the noncleft so that the dimensional differences from the normal remained the same as at birth. CONCLUSION: The morphological characteristics of the upper part of the mouth change if the functional conditions in the oral cavity are changed. Infants with presurgical orthopedics become more similar to noncleft contemporaries than those without presurgical orthopedics.

Cleft Lip↗
PubMed2000

Repairing the cleft lip nasal deformity.

OBJECTIVE: The repair of the cleft lip nose and nasal deformity remains a challenging endeavor for reconstructive surgeons. Psychosocially, this complex, multifaceted deformity significantly stigmatizes the patient. Numerous techniques have been advocated by multiple authors for the treatment and reconstruction of these deformities, usually requiring serial staged reconstructions. METHOD: Described is our technique for early primary repair of the cleft lip nasal deformity. The use of multiple suspension sutures to repair the nasal defect facilitates the repair of even very wide cleft lips. CONCLUSIONS: These maneuvers provide an aesthetic and functional repair of the nasal defect in conjunction with the lip repair. Long-term results have minimized the need for surgical revision.

Cleft Lip↗
PubMed2000

Congenital heart disease in a patient with microform cleft lip.

OBJECTIVE: Microform cleft lip (MCL), also known as congenital healed cleft lip, is a rare anomaly that is thought to be a spontaneously healed variant of the more common clefting of lip and palate. Although conventional clefting is known to be associated with congenital heart disease (CHD), MCL has not been similarly associated. We present one patient with MCL and CHD in the form of coarctation of the aorta, an association not previously described. CONCLUSION: As is done in patients with cleft lip, cleft palate, or both, patients with MCL should be carefully examined for evidence of CHD and referred to a pediatric cardiologist if deemed advisable.

Aortic Coarctation↗
PubMed2003

Breast-feeding and sugar intake in babies with cleft lip and palate.

OBJECTIVE: To investigate the pattern of breast-feeding and sugar intake among babies with cleft lip and palate. PARTICIPANTS: Caretakers of 200 babies with cleft lip and palate enrolled at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil. RESULTS: A low prevalence of breast-feeding was found. The most reported reason was the sucking inability of the baby. Complete cleft lip and palate was the primary cause affecting sucking. The first contact with sugar occurred mainly through the baby bottle with milk during the first month of life. For nutritional supplement, the children were given sugar and fruit juices in the bottle. CONCLUSIONS: It was observed that dietary habits in babies with cleft lip and palate are more risky. This highlights the role played by early education and constant oral hygiene follow-up for prevention in these patients.

Animals↗
PubMed2003

Tourette's syndrome with rapid deterioration by self-mutilation of the upper lip.

A case of Tourette's syndrome is presented in a thirteen-year-old boy with obsessive-compulsive symptoms including self-mutilation of the upper lip. His upper lip injury was caused by complication of picking with fingernail, and self-biting with the lower anterior teeth. It became rapidly worse and the median part of the upper lip collapsed. But the placement of an acrylic splint was able to prevent further damage of the upper lip.

Adolescent↗
PubMed1987

A study of the association of fraenal attachment, lip coverage, and vestibular depth with plaque and gingivitis.

The effects of fraenal attachment, upper lip coverage, and mandibular vestibular depth on plaque and bleeding indices in the maxillary and mandibular anterior segments were studied in a group of 1015 school children aged 11.5 to 12.5 years. The position of the mandibular labial fraenum was relatively unimportant to plaque and mandibular gingivitis, but anterior fraenal attachment in the maxilla appeared to affect the retention of plaque and the degree of gingivitis. Maxillary and mandibular plaque and bleeding scores increased with decreasing upper lip coverage at rest. In the mandibular anterior segment, plaque and bleeding indices decreased with increasing vestibular depth. Further analysis demonstrated that fraenal attachment and vestibular depth and fraenal attachment and lip coverage were significantly associated. However, two-way analysis of variance indicated that the influence of fraenal attachment, vestibular depth, and lip coverage on plaque and gingivitis was independent. The influences of these soft tissue variables on plaque accumulation and gingivitis were of small clinical significance and not in themselves a justification for mucogingival surgery.

Child↗
PubMedDate not supplied

[Regional metastases of squamous cell carcinoma of the lower lip].

INTRODUCTION: Lower lip squamous cell carcinoma is the most common oral carcinoma. In relation to other oral carcinomas, it has a better clinical course. If regional metastases appear, lower lip carcinoma has a very poor prognosis. METHODS: This study included patients treated for lower lip squamous cell carcinoma in the period 1984-2001. We examined neck metastases and time of their appearance after operation of the primary neoplasm. RESULTS: Our retrospective study included 305 patients with lower lip carcinoma in a twelve-year period. Out of this number, 293 had no positive neck lymph nodes, and only 12 patients had (4%). More than 75% of metastases appeared in the first year after surgery of the primary neoplasm. Contra-lateral metastases were most common. CONCLUSION: Taking into consideration the percentage of metastases, particularly during the first year after surgery, we suggest identification of sentinel lymph nodes and depending on PH finding one should decide about the type of neck operation. Frequent check-ups are necessary, especially during the first year.

Carcinoma, Squamous Cell↗
PubMed1998

Early and one stage repair of bilateral cleft lip and nose.

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.

Child, Preschool↗
PubMed2001

Maxillary double lip: report of two cases.

Two cases of double lip malformation, an uncommon oral anomaly, are presented, and the factors involved in the development, pathogenesis, diagnosis, and treatment of these uncommon lesions are reviewed. Double lip is usually associated with Ascher's syndrome, which is a rare disease with three more or less consistently associated abnormalities: double upper lip, blepharochalasis and enlargement of the thyroid. Two cases of double lip are reported; one of which was related with Ascher's syndrome, while the other had a traumatic origin.

Adolescent↗
PubMed1976

The influence of primary periosteoplasty on maxillary growth and deciduous occlusion in cases of complete unilateral cleft lip and palate. A longitudinal study from infancy to the age of 5.

The influence of infant periosteoplasty upon the growth of the maxilla, its form and size, and the prevalence of malocclusion in the deciduous dentition was investigated. The material consisted of 66 patients with total unilateral clefts of the primary and secondary palate. Thirty-six had periosteoplasty performed in conjunction with cleft-lip and/or palate repair. Thirty patients were operated upon without periosteoplasty and served as controls. Repair of the lip had a notable effect upon the width of the alveolar cleft and palatal cleft, both in the periosteoplasty cases and in the controls, with no certain difference between the groups. Following lip repair, the anterior width of the alveolar arch was slightly reduced. After palatal repair a further reduction was noted in the deciduous dentition, both in the cases treated with periosteoplasty and in the controls, while the posterior width of the palate across the tuberosities increased during growth. In the deciduous dentition, no differences were found in intercanine and intermolar dimensions between the periosteoplasty cases and the controls. Thus, the new bone formed in the cleft area after periosteoplasty does not seem to withstand the contracting forces introduced by palate surgery. An increased length of the buccal alveolar arch on the cleft side, compared with that on the non-cleft side, was found at both the lip repair and the palate repair in the periosteoplasty cases, as well as in the controls. In the deciduous dentition, this difference was negligible. In the deciduous dentition an anterior position of the lateral maxillary segment proved more common in the periosteoplasty cases than in the controls. On the non-cleft side, there was an increased frequency of mesial occlusion and a corresponding decrease of neutral and distal occlusion in the periosteoplasty cases. No increased frequency of anterior crossbite was found even after repeated periosteoplasty, nor was the maxillary dental-arch length unfavourably influenced. Descriptive analysis of occlusion revealed an increase of buccal crossbite in the periosteoplasty cases of a select group of the widest clefts, treated by repeated periosteoplasty. These cases also had the highest total occlusal score according to the numerical classification, while the total occlusal score after one periosteoplasty in patients with less wider clefts was smaller than in the controls. In all patients who had undergone periosteoplasty new bone formed within the alveolar cleft. A good amount of new bone developed in about half the number of cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Bone Development↗
PubMed1988

"The open sky rhinoplasty" for correction of secondary cleft lip nose deformity, Technique and recent results.

The typical nose deformity after cleft-lip repair still represents great challenge for the plastic surgeon in this field. Many methods have been designed in attempts to correct the deformity, either during primary closure of the lip or as a secondary procedure when growth of the nose is complete. In this paper the author's own technique of secondary rhinoseptoplasty in cleft-lip patients is presented. The different cartilaginous and osseous structures are approached through a transcolumellar incision and the skin of the nose completely reflected upwards. This so-called "open sky view" gives a total perspective on the entire pathology of the cleft-lip nose deformity and makes it possible to correct it accordingly. Emphasis is put on some important surgical manoeuvers. Recent results are presented and the pros and cons of this procedure discussed.

Adult↗
PubMed1990

The one-stage repair of bilateral cleft lip.

Twenty children with broad, complete clefts of lip, alveolus, and palate were studied. For functional restoration of the lip in complete bilateral clefts we advocate a one-stage modification of the Millard procedure even if the clefts are broad. Orthodontic treatment is done first to achieve maximal maxillary growth. Reconstruction of the lip is done at the age of 5 to 6 months. Our method of lip restoration is described with special attention to the muscle reconstruction. The lengthening of the columella, which is done at the age of 4 years, is still a problem.

Cleft Lip↗