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Prior to lip operations upon children with cleft lip and palate, the authors make use of denture-like acrylate plates and external elastic rubber bands. Occurring anomalies are treated already in the deciduous dentition. In this way, the very marked jaw deformity in cleft children may be reduced to a minimum.
Real-time ultrasonography in pregnancy can accurately detect gestational age, position of the fetus, position of the placenta, sex of the fetus, and many congenital anomalies before birth. To date, however, there has been no report of detection of a cleft lip-palate deformity by ultrasound. Two cases, in approximately 200 scans, have been found in patients with no previous family history of cleft lip-palate. The first case was a bilateral cleft lip-palate visualized at 28 weeks gestation. The second was a unilateral cleft lip-palate detected at 33 weeks gestation. Diagnosis of cleft lip-palate is dependent on appreciation of facial topography in multiple planes, adequate experience in the technique, and observation of the degree of excursion of the undulating tongue. Detection of the facial clefting in utero by ultrasound has resulted in our formulation of a routine for informing the parents of the deformity and referring them for consultation with a plastic surgeon. This is recommended before birth, so that the parents are well acquainted with what the deformity will look like and the sequential steps necessary for its correction. We encourage plastic surgeons, obstetricians, pediatricians, and ultrasonographers to be aware of the ability to diagnose cleft lip-palate before birth.
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Since about 10 years a coordinated timing of procedures has been used in Zürich for the management of CLP cases. It equally considers the requirements of growth and functional development. Early orthopedic treatment can, however, only be efficient if concomitant primary surgery is adequately timed and performed. The importance of two-stage palatal closure (soft palate 18 months, hard palate after 5 years of age) is emphasized. In contrast to results of former treatment methods, present cleft patients show good arch form and intermaxillary relationship in deciduous and early mixed dentition. The need for orthodontic treatment is considerably reduced. As far as speech development is concerned, the procedure proves to be beneficial as well.
OBJECTIVE: To investigate the prevalence of the presence of a soft tissue bridge (Simonart's band) in patients with complete cleft lip and alveolus and complete cleft lip and palate. DESIGN: Cross-sectional. SAMPLE: We assessed 407 consecutive unoperated patients first attending the Hospital for Rehabilitation of Craniofacial Anomalies of University of São Paulo, in Bauru, São Paulo, Brazil, in the year 2000. The patients were classified as presenting complete cleft of the primary palate or of the primary and secondary palate, unilateral or bilateral, as follows: unilateral cleft lip, bilateral cleft lip, unilateral cleft lip and palate, and bilateral cleft lip and palate. METHOD: Clinical examination. The band was considered as present whenever there was a soft tissue bridge between the separated alveolar ridges, regardless of volume and position. Results were analyzed by descriptive statistics and were expressed as percentages, according to the type of cleft. CONCLUSION: 31.2% of patients presented with Simonart's band. The band was observed more frequently in patients with unilateral clefts than in patients with bilateral clefts, and in patients with complete cleft lip and alveolus than in patients with complete cleft lip and palate.
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Several studies have demonstrated an association between facial shape in parents and the presence of oral clefts in their offspring. However, these observations have been of little practical value because it has been assumed that facial shape was just one predisposing component among many in a multifactorial model of inheritance. Cephalometric analysis of a large family with 5 generations of affected individuals suggests that facial shape can be used to identify presumed carriers of a major gene associated with an increased risk for oral clefts. Discriminant function analysis indicates that such at risk individuals can be recognized effectively through a combination of increased midfacial and nasal cavity widths, reduced facial height, and a flat facial profile. The ability to identify minimally affected gene carriers within families would provide critical information needed in the search for molecular markers that segregate with the genetic risk for clefting.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.