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Dental CT and orthodontic implants: imaging technique and assessment of available bone volume in the hard palate.

PURPOSE: Palatal implants (PI) have been introduced for orthodontic treatment of dental and skeletal dysgnathia. Due to the restricted amount of bone in this region, precise preoperative anatomic information is necessary. The aim of this study was to determine whether dental CT could serve as a tool to locate the optimal size and position for orthodontic implant placement. MATERIALS AND METHODS: In 32 patients, where palatal implant placement was planned, axial CT scans of the maxillary bone were acquired. Using a standard dental software package (Easy Vision dental software package 2.1, Philips; Best, The Netherlands), paracoronal views were reconstructed and measurements of palatal bone height in 3 mm increments, dorsally from the incisive canal, were performed in the median and both paramedian regions. RESULTS: The overall mean bone height was 5.01 mm (S.D. 2.60), ranging from 0 to 16.9 mm. The maximum palatal bone height was 6.17 mm (S.D. 2.81) at 6 mm dorsally from the incisive canal. Due to the lack of adequate bone (less than 4 mm), implant placement was not performed in 3 cases (7%). In the remaining 39 cases (93.0%), primary implant stability was achieved and complications, such as perforation of the palate, could be avoided. CONCLUSION: The results demonstrate that dental CT promises to be a valuable tool in evaluating the potential and optimal size and site for orthodontic implant placement.

Adolescent↗

Speech summer camp for treating articulation disorders in cleft palate patients.

INTRODUCTION: Compensatory articulation disorder (CAD) severely affects speech intelligibility of cleft palate children. CAD must be treated with speech therapy. Children can manage articulation better when they use language in event contexts such as every day routines. OBJECTIVE: The purpose of this paper is to study and compare two modalities of speech intervention in cleft palate children with associated CAD. The first modality is a conventional approach providing speech therapy in 1-h sessions, twice a week. The second modality is a speech summer camp in which children received therapy 4h per day, 5 days a week for a period of 3 weeks. We were aimed to determine if a speech summer camp could significantly enhance articulation in CP children with CAD. MATERIALS AND METHODS: Forty-five children with repaired cleft palates who exhibited CAD were studied. A matched control group of 45 children with repaired cleft palate who also exhibited CAD were identified. The patients included in the first group attended a speech summer camp for 3 weeks. The matched control subjects included in the second group received speech therapy aimed to correct CAD twice per-week in 1-h sessions. RESULTS: At the onset of either the summer camp or the speech therapy period, the severity of CAD was evenly distributed with non-significant differences across both groups of patients (p > 0.05). After the summer camp (3 weeks) or 12 months of speech therapy sessions at a frequency of twice per-week, both groups of patients showed a significant decrease in the severity of their CAD (p < 0.05). However, when the distribution of the severity of CAD was compared at the end of the summer camp or the speech therapy period, non-significant differences were found between both groups of patients (p > 0.05). CONCLUSIONS: A speech summer camp is a valid and efficient method for providing speech therapy in cleft palate children with compensatory articulation disorder.

Articulation Disorders↗

A bilateral musculomucosal buccal flap method for cleft palate surgery.

PURPOSE: This article introduces a new technique for the repair of cleft palate with a bilateral musculomucosal buccal flap. PATIENTS AND METHODS: From 1990 to 2001, 26 patients with cleft palate of different types were treated for the repair of cleft palate with the bilateral musculomucosal buccal flaps. Their age ranged from 3 to 12 years (mean age, 6.4 years). They were followed up from 2 to 8 years. The velopharyngeal closure was examined by nasopharyngoscopy. RESULTS: The postoperative results of all the patients who could be followed up were clearly satisfactory without any postoperative complications such as dehiscence or perforation or maxillary deformity. The velopharyngeal closure was satisfactory. CONCLUSION: Repair of cleft palate with bilateral musculomucosal buccal flaps is a very useful method for repairing cleft palate and possibly reduces postoperative complications of dehiscence, perforation, and growth retardation.

Child↗

Palatal approach for maxillary alveolar distraction.

PURPOSE: The purpose of this report was to describe a surgical technique for performing alveolar distraction in the upper jaw via a palatal approach. PATIENTS AND METHODS: To illustrate this technique we report 2 clinical cases in which palatal-approach alveolar distraction was used to rectify insufficient alveolar rim height. The first case involves a 50-year-old man with atrophy of the alveolar rim in the posterior upper jaw. From the palatal side, a transport segment pedicled to the vestibular mucosa was cut, and 2 Lead System distractors (Leibinger, Kalamazoo, MI) were placed. The second case involves a 23-year-old woman with a bone defect in the alveolar rim in the premaxillary sector of the upper jaw. Again, from the palatal side, a transport segment pedicled to the vestibular mucosa was cut, and a single Lead System distractor was placed. RESULTS: In both cases the height of the alveolar rim was successfully increased by 8 mm, allowing placement of three 12-mm implants in case 1, and two 12-mm implants in case 2. CONCLUSIONS: We recommend a palatal approach and intraosseous distractors for alveolar distraction in the upper jaw.

Adult↗

Radiofrequency soft palate procedure in snoring: influence of energy delivered.

OBJECTIVE: We conducted a retrospective study to evaluate the influence of amount of energy delivered during radiofrequency procedure for soft palate reduction in snoring, to improve the cure rate. METHODS: Consecutive patients with chronic disruptive snoring presenting to our department were successively treated in an outpatient procedure. A visual analog scale was used to assess the severity of snoring by the bed partner and the pain by the patient, before treatment and after each treatment session. The soft palate was divided into 3 treatment sites: middle, lateral right, and lateral left. Any mucosal injury of the soft palate was classified as a complication. RESULTS: Forty-3 patients were classified into 2 groups according to energy assignment. The total amount of energy delivered was 1250 J in group 1 (n = 15) and 1500 J in group 2 (n = 28). Energy was predominantly distributed in the middle of the soft palate in group 1 (550 J) and group 2 (800 J). After each treatment session, the 1500-J delivery of radiofrequency energy (total per session) led to a better snoring grading reduction in comparison with the 1250-J delivery with a significant difference after 2 treatment sessions (P < 0.05). The mean pain score and the incidence rate of complications per treatment were not statistically different in comparing both groups. CONCLUSION: Better snoring scores can be expected by increasing radiofrequency energy applied to the soft palate. Further randomized long-term investigations are required to confirm that the cure rate can be improved when increasing energy with a suitable distribution and good clinical tolerance.

Adult↗

Histologic effects of injection snoreplasty and radiofrequency in the rat soft palate.

OBJECTIVE: This study was undertaken to compare the effects of radiofrequency and injection snoreplasty on the histological structure of the soft palate in an animal model. STUDY DESIGN AND SETTING: This is a blinded, controlled histologic evaluation of rat soft palates that underwent separate palatal interventions. Fifty rats were divided into 5 groups of 10 rats (Group 1 = injection snoreplasty [IS], Group 2 = IS + steroid, Group 3 = saline injection, Group 4 = radiofrequency ablation [RFA], and Group 5 = no intervention). The animals were sacrificed after 24 hours, 1 week, 3 weeks, and 5 weeks. Then the soft palates were subjected to histological analysis. RESULTS: Histological analysis demonstrated normal remucosalization in all specimens, with fibrosis increased in Group 1. Interstitial edema was minimal in Group 2. Keratinization was most apparent in Group 4. CONCLUSION: Radiofrequency and injection snoreplasty stiffen the rat soft palate compared with controls.

Animals↗

Reduction of procarbazine-induced cleft palates by prenatal folic acid supplementation in rats.

We investigated the effects of prenatal folic acid supplementation on procarbazine (PCZ)-induced intra-uterine growth retardation (IUGR), cleft palates, and microgenia. Three groups of gravid rats were treated with 200 mg/kg body weight (BW) PCZ on day 13.5 of gestation (GD13.5). Two groups of them were additionally supplemented with 1 and 2.5 mg/kg folic acid, respectively, from GD13.5 through GD16.5. On GD19.5, all fetuses were delivered by caesarian sections and sexed subsequently. Numbers of live and dead fetuses as well as resorptions were counted. Data on fetal BW, crown-rump length, tail length, placental weight, and diameter were collected. Fetal heads were histologically scrutinized for the occurrence of cleft palates and microgenia. Folic acid at 2.5 mg/kg diminished PCZ-induced IUGR. In male fetuses, both folic acid doses significantly reduced the incidence of cleft palates and microgenia, while in females, only the high folic acid dose was capable of lowering the occurrence frequency of cleft palates. We conclude that folic acid supplementation at the used doses confers a substantial protection against PCZ-induced IUGR and incidence of cleft palates and microgenia. However, these effects are gender-related and dose-dependent.

Animals↗

Nasal airflow and olfactory function after the repair of cleft palate (with and without cleft lip).

OBJECTIVE: The objective of this study was to examine nasal airflow and olfactory functions in patients with repaired cleft palate compared with matching normal controls. STUDY DESIGN: The all-cleft group consisted of 25 patients with hard palate cleft comprising 15 patients with unilateral cleft palate and lip (UCLP); 2 with CP but no cleft lip (UCLP subgroup) and 8 patients with bilateral cleft lip and palate (BCLP subgroup). All had had surgical correction of the palate in infancy. The control group consisted of 20 nonaffected orthodontic patients. The median age of both groups was 14 years. The tests included the following: (1) nasal airflow measured by anterior rhinomanometry, (2) smell threshold for isoamyl-acetate determined using a 3-way forced choice method, (3) a self-administered questionnaire regarding the subjective perception of smell sense function, and (4) orthonasal and retronasal smell identification (correct/incorrect) and hedonics using visual analog scale (VAS). RESULTS: The respective test results follow. (1) When compared with the control group, the total airflow in the UCLP subgroup was significantly lower especially on the affected side; while in the BCLP subgroup it was lower than in the control group bilaterally. No significant difference was found between the cleft side of UCLP and BCLP subgroups. (2) The smell threshold of the UCLP subgroup was significantly higher than that of the control group and BCLP subgroup. No significant differences were found between right and left nostrils within the BCLP patients and between them and the control group. (3) No difference was found between the groups regarding the subjective perception of smell. (4) No significant differences were found between the UCLP and BCLP subgroups and between the all-cleft group and the control group, except for one item, regarding orthonasal and retronasal smell identification and hedonics. CONCLUSION: Although nasal airflow is significantly lower and the smell threshold higher on the cleft side, the day-to-day function of the sense of smell of cleft patients is similar to that of normal controls.

Adolescent↗

Effects of ovariectomy and/or dietary calcium deficiency on bone dynamics in the rat hard palate, mandible and proximal tibia.

The effects of ovariectomy and/or dietary calcium deficiency on bone dynamics were examined by comparing the histomorphometric changes in these bones. Five groups of rats were studied, (1) unoperated basal controls; (2) sham-operated, fed on a normal-calcium diet; (3) ovariectomized, fed on a normal-calcium diet; (4) sham-operated, fed on a calcium-deficient diet; (5) ovariectomized, fed on a calcium-deficient diet. The basal controls were killed at 6 weeks of age, and the remaining groups were killed at 18 weeks of age. The hard palate, mandible and proximal tibia were processed undemineralized for quantitative bone histomorphometry. Bone volume, eroded surface, osteoid surface and bone-formation ratio were calculated. A significant age-related increase in bone volume and a significant decrease in bone formation were observed in the hard palate and mandible, whereas no significant age-related increase in bone volume could be found in the tibia. In the hard palate, ovariectomy neither inhibited age-related increases in bone volume nor affected bone dynamics, while both the combined ovariectomy and dietary calcium deficiency and dietary calcium deficiency alone led to bone loss and increased bone turnover. In contrast, in the mandible and proximal tibia, ovariectomy alone as well as dietary calcium deficiency led to bone loss and increased bone turnover. Ovariectomy, therefore, produced no significant changes in the hard palate, but affected bone dynamics in the mandible and tibia. However, dietary calcium deficiency induced bone loss and increased bone turnover in the hard palate, mandible and proximal tibia, independently of ovariectomy.

Analysis of Variance↗

Congenital heart disease and associated malformations in children with cleft lip and palate in Pakistan.

Children with cleft lip and palate often have other associated malformations. The reported incidence and types of associated malformations vary between different studies. There is a great paucity of literature on the subject from the region in general and none from Pakistan at all. The purpose of this study was to assess the frequency of associated malformations, particularly congenital heart disease, in children with cleft lip and palate presenting to the Aga Khan University (AKU) and Murshid Hospital (MH). From 1st October 1999 to 31st March 2002, all children with cleft lip and palate who presented to AKU and MH were prospectively enrolled in the study group. Socio-demographic characteristics and a number of other variables were documented. All children underwent a thorough clinical examination and an echocardiogram as part of the study protocol. 123 children formed the study group. Thirty-five (29%) of these children were found to have associated malformations. The most common of these was congenital heart disease, which accounted for 51% of all associated malformations. Thirty percent of cleft palate children had associated anomalies while 27% of cleft lip, with or without cleft palate, children had associated anomalies. There was a significant association between children born of a consanguineous marriage and the risk of associated malformations (p-value: 0.001). Consanguinity was present in 74% of children with associated anomalies as compared to 40% of children with no associated anomaly. Dysmorphic features and the presence of associated anomalies were also significantly associated (p-value: 0.009). Dysmorphic features were present in 46% of children with anomalies as compared to 21% of children with no associated anomaly. Fifty percent of children with associated anomalies had a low birth weight compared to 34% of children with no anomalies, but the difference was not statistically significant. The presence of consanguinity in a child with dysmorphic features should raise the suspicion of an associated anomaly. The likelihood of this being a cardiac defect is high and should be ruled out with a thorough clinical examination, supplemented with an echocardiogram in certain cases.

Abnormalities, Multiple↗

Palatal lymphoepitheliomas and a review of head and neck lymphoepitheliomas.

AIM: Lymphoepithelioma is principally a tumour of the nasopharynx with only sporadic cases arising elsewhere in the head and neck. We describe the clinical and imaging features of a group of rare lymphoepitheliomas related to the palate. PATIENTS AND METHODS: Four patients with lymphoepithelioma of the palate are described. In each case we retrospectively reviewed the clinical records, laboratory results, and imaging which consisted of computed tomography (CT) and ultrasound in all four cases and magnetic resonance imaging (MRI) in two patients. RESULTS: All four patients were ethnic Chinese (non-smokers, non-drinkers). All cases were Epstein-Barr virus (EBV) related. Tumour was related to the palate in two cases and extended into the nasal cavity in one patient. The fourth patient had a tumour in the floor of the nasal cavity with invasion of the palate on biopsy but not imaging. Cervical lymphadenopathy was seen in two cases, and the nasopharynx was normal in all the four patients. CONCLUSION: Lymphoepitheliomas occur in the region of the palate, where they are also EBV related in southern Chinese. Compared with the keratinizing squamous cell carcinomas, patients with lymphoepitheliomas have a better prognosis and these tumours are not tobacco or alcohol related. They should not be misdiagnosed as metastatic nasopharyngeal carcinoma (NPC), particularly since the nasopharynx is invariably normal on imaging and adequate nasopharyngeal biopsy is negative for malignancy.

Aged↗

Medial edge epithelium transforms to mesenchyme after embryonic palatal shelves fuse.

The disappearance of palatal medial edge epithelium (MEE) after fusion of secondary palatal shelves is often cited as a classical example of embryonic remodeling by programmed cell death. We reinvestigated this phenomenon in 16-day rat embryos, using light and electron microscopy. We confirm reports that the periderm of the two-layered MEE begins to slough after shelves assume horizontal positions. In vitro, peridermal cells are not able to slough and are trapped during the adhesion process. In vivo, however, surface cells shed before the shelves in the anterior palate adhere, allowing junctions to form between opposing basal epithelial cells. Midline seams so formed consist of two layers of basal cells, all of which appear healthy. Even though its cells are dividing, growth of the seam fails to keep pace with palatal growth and it thins to one layer of cells, and then breaks up into small islands. The basal lamina disappears and elongating MEE cells extend filopodia into adjacent connective tissue. Electron micrographs reveal transitional steps in loss of epithelial characteristics and gain of fibroblast-like features by transforming MEE cells. One such feature, observed with the aid of immunofluorescence, is the turn of the mesenchymal cytoskeletal protein, vimentin. No cell death or macrophages are observed after adhesion and thinning over most of the palate. These data indicate that MEE is an ectoderm that retains the ability to transform into mesenchymal cells. Epithelial-mesenchymal transformation may be expressed in other embryonic remodelings (R.L. Trelstad, A. Hayashi, K. Hayashi, and P.K. Donahue, 1982, Dev. Biol. 92, 27), resulting in heretofore unsuspected conservation of embryonic cell populations.

Animals↗

Otoacoustic emissions in screening cleft lip and/or palate children for hearing loss--a feasibility study.

Patients with cleft lip and/or palate abnormalities are likely to suffer permanent conductive (PCHL) or sensorineural hearing loss (SNHL) due in part to the association with syndromes known to include PCHL or SNHL. The presence of otitis media, a nearly universal complication in these patients, makes identifying the hearing impaired in this population a challenge, since the detection of permanent hearing loss is made more difficult. This problem might be overcome by using click-evoked otoacoustic emissions (CEOAE's) shortly after birth. Twenty-one out of 28 newborns presented to the regional cleft palate team were eligible for CEOAE screening shortly after birth. Among these 21 infants, five had anomalies other than cleft lip and/or palate associated with an increased risk for hearing impairment. At the first CEOAE screening (ILO88 Emission Analyser, mean age 3 weeks, range 1-11 weeks) clear CEOAE's were present in all of the 18 ears of nine infants with isolated lip and/or jaw clefts. In 24 ears of 12 infants with palatal clefts, CEOAE's were present in only six ears (three infants), not demonstrable due to noisy registration in another six ears and absent in 12 ears despite a quiet registration. During follow-up of those who failed the first screening (18 ears, nine infants), normal hearing was found in 14 ears (seven infants) and sensorineural hearing loss was documented in four ears (two infants). CEOAE screening in infants with isolated lip and/or jaw clefts seems feasible and effective. In infants with palatal clefts an auditory brain stem screening might be more appropriate.

Acoustic Stimulation↗

[Treatment of cleft lip and palate in the children's Hospital Reine Fabiola in Bruxelles].

The priority in the treatment of facial clefts is to avoid the iatrogenic sequellae by restoring a normal anatomy of the face. The difficulty of this treatment is that the majority of the sequellae are only observed 15 years after the primary treatment. After having treated our children during more than 20 years by a primary closure of the lip at 6 months and closure of the palate by push back according to Veau Wardill at 18 months, we adopted the technique of René Malek since 1981 with early closure of the palate at 3 months then, without undermining of the palatal mucosa, closure of the bony palate with a vomer flap at the age of 6 months. Since 1988, in unilateral complete cleft, we perform a complete closure of the lip and palate at 3 months according to the same surgical principles. The study of the dental casts according to the Golson Yardstick at the age of 10 and the cephalometric study by lateral Xrays at the age of 15 show an excellent facial growth in the majority of the cases with only 6% needing a osteotomy at the end of growth. Moreover the phonation of these children was very good in the majority of the cases, 15% only needing a secondary surgery. The only remaining sequellae are in the auditory field with an abnormal frequency of sero mucous otitis. These could not be improved until now despite the early use of tympanic drains.

Belgium↗

Changes in soft palate taste buds of rats due to aging and zinc deficiency--scanning electron microscopic observation.

The effects of aging and zinc deficiencies on taste were studied. The soft palate of zinc-deficient old rats, prepared by feeding with a zinc-deficient diet, were studied by a light microscope and a scanning electron microscope, and comparative examination was made on the morphological changes in soft palate papillae and taste buds of young normal rats and control old rats. In the case of young normal rats, papillae similar to lingual fungiform papillae were observed on the soft palate; one taste bud per one papilla was observed. The papillae were concentrated in the central area of the soft palate continuing from the hard palate. In the case of old rats, decrease in the number of papillae, flattening of papillae, exfoliation and atrophy of mucosal epithelium and leveling of microplicae were observed. In the case of zinc-deficient old rats, the above-mentioned tendencies were more significant. While dense substance and microvilli were observed in taste pores of taste buds of young normal rats, these were found to decrease or disappear in the zinc-deficient old rats.

Aging↗

Retinoic acid-induced asymmetric craniofacial growth and cleft palate in the TO mouse fetus.

The etiology and pathogenetic mechanisms of cleft palate (CP) are rather uncertain. Both genetic and environmental factors are known to cause failure of horizontalization and/or failure of fusion of the palatal shelves resulting in CP. Retinoic acid (RA)-induced CP in the mouse is reported to exhibit two peaks of incidence separated by a less sensitive window. The morphologic bases of the differential sensitivity are not known. The objectives of this study were to determine whether the TO mouse had similar peaks of sensitivity to RA-induced CP, and if it did, to evaluate the morphologic and histologic bases of CP induced at an early [Gestation Day (GD) 8] and at a late (GD 12) stage of embryonic development. Single doses of all-trans-RA were administered to groups of mice on one of GD 8 to 15. On GD 18, fetuses were evaluated for the presence of CP, and the developmental stage of the palatal shelves was determined. All doses of RA were found to induce a high incidence of CP in the GD 8 to 13 treatment groups. GD 14 and 15 were not susceptible. There were no stage-dependent peaks or less sensitive windows, indicating that RA-induced CP in this strain is a continuum from GD 8 through 13. Morphologically clefting in the GD 8-RA treatment group was characterized by extreme hypoplasia (65% to 100%, depending on the dose) or agenesis (35% in the 200 mg/kg group) of the palatal shelves and associated with astomia, microstomia, aglossia, microglossia, and micrognathia with fusion of mandible, maxilla, and zygoma. Treatment on subsequent days of gestation resulted in CP with the shelves reaching progressively higher levels of maturity in terms of developmental staging. There was no case of CP with horizontalized shelves apposing but failing to fuse with each other. The facial skeleton of GD 12-RA group was hypoplastic but not malformed. Reduction in all dimensions of the cranium and mandible was highly significant (P < 0.001) in the GD 8-RA group, whereas there was a clear imbalance between the vertical growth and that in other directions in the GD 12-RA group. The CR length, head and body weights, and the protein content of heads of GD 8-RA-treated embryos were significantly reduced. Histologic studies showed that both the intrinsic and extrinsic muscles of the tongue and face, growth of the Meckel's cartilage, and ossification of the mandible were severely affected in the GD 8 treatment group, whereas these tissues were only moderately affected in the embryos of the GD 12-RA group. However, the quality of cytodifferentiation of the muscles was not affected in either group. These data provide evidence for the susceptibility continuum of CP in this strain. They also indicate that agenesis and hypoplasia of the palatal shelves and primordia of craniofacial skeleton and musculature contribute to CP, the relative involvement of the components depending on the stage of drug administration. In the absence of pronounced cell death, it appears that RA possibly produces its deleterious effects on the precursors of craniofacial primordia, such as the neural crest, by misexpression of developmentally important genes.

Animals↗

Sex-related differences in procarbazine-induced cleft palate and microgenia and the anti-teratogenic effect of prenatal folic acid supplementation in rats.

Sex-related differences in the frequency of cleft palates and microgenia in rat fetuses prenatally treated with procarbazine (200 mg/kg on day 14 of gestation (GD14), group 1), and the anti-teratogenic effect of prenatal folic acid supplementation (4 mg/kg on GD14 through GD17, group 2) were studied in LEW.1A rats. In group 1, complete clefts were observed in 69% of the male and in 36% of the female fetuses while incomplete clefts (present only in the hard palate) were exhibited by 31% of the males and 43% of the females. Microgenia occurred in all males but only in 64% of the female fetuses. In group 2, the prenatal folic acid supplementation significantly reduced the occurrence frequency of complete clefts to 9% in males and to 0% in females. In contrast, incomplete clefts increased to 82% in males and 91% in females. Microgenias were reduced to 73% and 57% in male and female fetuses, respectively. Since incomplete clefts present in the hard palate are assumed to be residues of spontaneous intra-uterine repair processes of exogenously induced complete palatal clefts, we conclude that prenatal supplementation with folic acid at a dose of 4 mg/kg promotes the intra-uterine repair of cleft palates and offers a partial protection against procarbazine teratogenicity. Furthermore, it is deduced that gender-specific differences exist in the susceptibility to procarbazine and in the anti-teratogenic effect of folic acid on procarbazine-induced microgenia.

Animals↗

Anthropometric profile evaluation of the midface in patients with cleft lip and palate.

This study was done to determine those profile anthropometric measurements that are abnormal in the midface profile in patients with cleft lip and palate. The sample population consisted of 30 randomly selected skeletally mature white patients with cleft lip and palate who had been treated by the same team who were accredited by the American Cleft Palate-Craniofacial Association. Twenty patients had unilateral and 10 had bilateral complete clefts. None of these patients had previously undergone orthognathic surgery or definitive rhinoplasty surgery. Fifteen facial anthropometric features were measured on each person's face. The result from this study showed that in patients with cleft lip and palate right versus left side differences did not exist and only four statistically significant differences existed between the unilateral and bilateral cases. However, in all patients, four of these esthetic facial features were consistently and significantly abnormal: obtuse nasofrontal angle: obtuse nasomental angle; a posteriorly positioned infraorbitale relative to globe; and an obtuse general facial angle. Several other features were abnormal in a high percentage of persons in this study. These were lack of supratip break, flat to concave paranasal contour, increased subnasale-alargroove:subnasale-pronasale ratio, decreased nasal protrusion:nasal length ratio, decreased nasolabial angle ratio, decreased maxillary length ratio, increased nasal bridge projection:nasal protrusion ratio, and deficient cheek contour. This data indicates that the major deformity in persons with adult cleft lip and palate exist in the nose and secondarily in other components of the midface.

Adolescent↗