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PubMed1995

Incomplete midline cleft of lower lip.

Midline cleft of the lower lip is defined as a midline vertical cleft of the soft tissue of the lower lip. It may present with a midline cleft of the mandible. It may also be accompanied by other congenital anomalies such as a cleft tongue, ankyloglossia, a heart lesion, and absence of the hyoid bone. The etiologic cause is thought to be a failure of mesodermal penetration into the midline structures of the first branchial arch. This case report is on a female child who presented with an incomplete midline cleft of the soft tissue of the lower lip. It was surgically corrected with a vertical wedge excision and primary closure.

Branchial Region↗

PubMed1995

Cranial base in newborns with complete cleft lip and palate: radiographic study.

In a 1993 study, Mølsted and colleagues found an increased width of the spheno-occipital synchondrosis in newborns with complete clefts of the lip, alveolus, and palate compared with newborns with incomplete clefts. As the spheno-occipital synchondrosis represents remnants of the early chondrocranium that later ossifies and incorporates in the cranial base, it is possible that an inborn alteration, such as a deviant growth of cartilage, or a delayed maturation in the early development of the cartilaginous cranial base, can affect not only the length and the width of the cranial base, but also the petrous portion of the temporal bone and the nasal septum, as these structures also have a cartilaginous origin. The purpose of the present study was to measure the cranial base width, including the width of the maxilla, and to measure the bilateral angulation of the petrous portion of the temporal bone and the sphenoid bone in 3-month-old children with complete clefts and in 3-month-old children with an incomplete cleft of the lip, and to compare the two groups. Fifty-two children with complete clefts (CLP) without associated malformations comprised the test group. Forty-eight children with a minor, incomplete cleft lip (CL) constituted the control group. The results of the comparison showed marked differences between the CLP and CL groups. In the CLP children, the cranial base width and the bilateral angulation of the sphenoid bone increased. An increased angulation was also seen between left and right sides of the pars petrosa. Furthermore, increased maxillary width was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Cartilage↗

PubMed1995

Skeletal asymmetries of the nasomaxillary complex in noncleft and postsurgical unilateral cleft lip and palate individuals.

Asymmetries in the nasomaxillary skeleton are very common in individuals with unilateral cleft lip and palate. The purpose of this study was to retrospectively evaluate postsurgical asymmetries of the nasomaxillary skeleton in unilateral cleft lip and palate patients. Included in this study were 36 complete cleft lip and palate subjects, along with 36 noncleft (control) subjects. Skeletal asymmetry, deviations of the anterior nasal spine, and the premaxillary area were compared by chronologic age and skeletal maturation in cleft subjects and controls. Comparison between cleft and control cases was assessed. Results indicated that skeletal asymmetry in unilateral clefts and controls peaks during the pubertal growth spurt. The anterior nasal spine and nasal septum always tend to deviate toward the noncleft side of the nasal cavity, although individual variation exists. Cleft subjects were found to be more asymmetric than noncleft subjects to a statistically significant degree.

Adolescent↗

PubMed1996

Comparison of facial form in primary alveolar bone-grafted and nongrafted unilateral cleft lip and palate patients: intercenter retrospective study.

The purpose of this study was to describe and compare posttreatment craniofacial morphology in samples of complete unilateral cleft lip and palate (CUCLP) patients treated at two leading clinics: The Children's Memorial Hospital Cleft Palate Clinic, Chicago, Illinois, and the Lancaster Cleft Palate Clinic, Lancaster, Pennsylvania. These centers have well-defined treatment protocols that allow the long-term effects on craniofacial form of the following treatment regimes to be contrasted: (1) Chicago--primary alveolar bone grafting, with definitive lip repair at age 4 to 6 months and hard and soft palate repair at 6 to 12 months; and (2) Lancaster--definitive triangular-flap lip repair at 3 months of age, followed by staged surgeries of the hard and soft palates, both completed by 18 months of age, but without primary alveolar bone grafting. Although the Lancaster center now performs secondary alveolar bone grafting, the majority of the patients studied here were treated before this procedure became part of their protocol. Patients were eligible for inclusion if they had no other congenital anomalies and no previous orthodontic treatment. A sample of 43 (24 male, 19 female) CUCLP patients was obtained from the Chicago Center, each of which was then matched to a nongrafted Lancaster CUCLP patient. The matching criteria were age, sex, and sella-nasion distance (to control, at least in part, for size differences). Lateral cephalometric radiographs of these 86 CUCLP patients were traced, digitized, and analyzed. Additionally, all linear data were adjusted to a standard magnification of 8% because the cephalograms from each center featured different enlargements. The Chicago and Lancaster samples had mean posttreatment ages of 10.32 years (SD = 1.96) and 10.40 years (SD = 2.18), respectively. The grafted Chicago group had faces that were on average less maxillary protrusive compared with the nongrafted Lancaster sample; it appeared, however, that the mandible compensated for the maxillary position by downward and backward rotation. As a result, a similar maxillomandibular relationship was noted in both groups, although, in the Chicago group, the lower anterior facial height increased.

Alveolar Process↗

PubMed1996

Craniofacial morphology in twins with cleft lip and palate.

The craniofacial morphology of 11 pairs of monozygotic (MZ) and 28 pairs of dizygotic (DZ) Finnish twins, discordant or concordant for cleft of the lip (CL), unilateral cleft lip and palate (UCLP), or cleft palate only (CP) were investigated by means of lateral cephalometric radiographs. The results were compared to those of age-, sex-, and cleft-type matched single-birth cleft subjects, and also with normative data from the Nordic population. The co-twins with no cleft lip or palate (NONC) showed only slightly more obtuse gonial and steeper mandibular angles compared to normative data. Twins with CL, UCLP or CP had a more retrusive mandible, a wider cranial base and mandibular angle, and a wider angle between the maxilla and mandible than did the single-birth cleft subjects. Comparison of the noncleft twin group with the CL, UCLP, and CP twin groups for the CL twins showed no significant differences. For the UCLP twins, a more retrusive and down- and backward rotation of both jaws, a wider gonial angle, and a wider cranial base angle was seen. The CP twins had their maxillae slightly retrusive, the down- and backward rotation of both jaws was apparent, and the gonial angle was more obtuse. A comparison between the noncleft MZ and noncleft CDZ twins showed no significant differences. The MZ CP twins had a more retrusive mandible and more down- and backward rotation of both jaws than did DZ CP twins. It thus can be suggested that twinning itself does not seem to have an effect on maxillofacial morphology, but the features of the mandibular structure, the cranial base angulation, and the inclination of the jaws are at least partly genetically induced.

Adolescent↗

PubMed1996

Prevalence of natal/neonatal teeth in cleft lip and palate infants.

In the daily routine of the Hospital for Research and Rehabilitation of Cleft Lip and Palate, a high frequency of natal/neonatal teeth was observed. Therefore, this retrospective study was conducted to determine the prevalence of this anomaly in 692 patients with complete unilateral and 327 bilateral cleft lip and palate, who were less than 3 months old, without prior surgery, and registered at the Hospital from 1989 to 1994. A higher prevalence of such teeth was found in the complete bilateral cleft group (10.6%), than in the complete unilateral cleft group (2.02%). Both, however, were higher than that reported for noncleft groups. There were also different characteristics in the appearance of these teeth in cleft patients from those previously related in the literature for normal patients. The conclusion was that these differences constitute another particularity of the cleft lip and palate patient.

Brazil↗

PubMed1996

Septoplasty for obstructive sleep apnea in infants after cleft lip repair.

A neonate with a unilateral cleft lip and palate usually presents with a deviated nasal septum due to the asymmetric bony base associated with cleft palate. Prior to repair, the facial cleft offers a wide open breathing passage despite the septal deviation. Cleft lips are traditionally repaired in neonates at about 3 months of age. These patients usually do not present with significant symptoms of nasal obstruction following repair, except in unusual cases. Severe septal deviation may cause obstructive sleep apnea. Repair of septal deformities in children is controversial due to the potential alteration of facial growth. We present two patients with documented obstructive sleep apnea that began after cleft lip repair. Conservative surgical correction of the septal deviation resulted in relief of the sleep apnea.

Cleft Lip↗

PubMed1996

Facial growth in patients with unilateral clefts of the lip and palate: a two-center study.

Two groups of 10-year-old patients with complete unilateral clefts of the lip and palate were examined in this study. Two centers; Bristol, U.K. and Oslo, Norway, who had different treatment regimens were used. The groups comprised 40 patients from Oslo and 32 from Bristol. The groups were matched, in proportion to the size of the groups, for age, sex, and presence of Simonart's bands. In Oslo, a Millard lip repaired was performed at 3 months of age with a von Langenbeck palatal repair at 18 months, no presurgical orthopedics was employed and there was no primary nasal correction. The Bristol center also repaired the lip at 3 months with a Millard type repair but also performed a radical nasal correction at the same time. The palate was repaired at 6 months with a Veau repair, and presurgical orthopedics using a pinned arch orthopedic plate was carried out. In addition, the volume of primary repairs per surgeon was much higher in Oslo, and a much stricter treatment protocol was used compared with Bristol. Lateral cephalograms obtained within 1 year of the child's tenth birthday were digitized, and the craniofacial morphology of the two groups was compared. Significant differences in maxillary growth and soft tissue profile were noted with a much more retruded mid-face and flatter nasiolabial angle in the Bristol group. The main factors for the better results in Oslo are suggested to be the absence of presurgical orthopedics, no radical nasal correction, the high volume of operations performed per surgeon, and the stricter protocol.

Age Factors↗

PubMed1997

A peculiar malformation of the upper lip: report of six cases.

Six cases of a peculiar type of upper lip malformation have been observed by the author during the last 40 years. The malformations in this case series were remarkably similar, suggesting a single teratologic entity not been reported before. The six patients included 1-, 11-, 4-, and 6-month-old males, a 20 year-old male, and an 11-year-old female. Each was characterized by a crooked folded philtrum, a flat thin vermilion region of the upper lip, and high-positioned ala(e), that was unilateral or bilateral. The upper median incisors were separated occasionally by the thick lip frenulum without marked distortion of the nasomaxillary framework. The author speculates that these cases exhibited some disturbed penetration of the lateral nasal eminence (process) to the median part of the nasolabial region in their early embryologic development.

Adult↗

PubMed1997

Congenital midline sinus of the upper lip: case report and review of literature.

A case report of a congenital midline sinus of the upper lip in a 5-year-old girl is presented. The patient complained of intermittent swelling around the frenulum of the upper lip. The sinus was located on the midline of the philtrum just below the base of the columella. Excision of the sinus tract via an intraoral approach gave a satisfactory result. Microscopic examination of the resected sinus revealed it to be lined by stratified squamous epithelium with sebaceous glands and hair follicles. Fifteen other cases have been reported in the English literature and are reviewed. There are two postulates that can account for the formation of the upper lip sinus based on two major theories of the development of the face: the fusion theory and the merging theory. However, the etiology of this rare congenital sinus remains obscure.

Child, Preschool↗

PubMed1997

Incisor crossbite and repaired unilateral cleft lip and palate: changes in jaw movement and temporalis muscle activity before and after edgewise treatment--case report.

OBJECTIVE: To examine the changes in jaw movement and temporalis muscle activity of a patient with unilateral cleft lip and palate before and after edgewise treatment. DESIGN: Clinical case study. SETTING: University dental hospital, department of orthodontics. PATIENT: A 12-year 3-month-old male with incisor crossbite, molar malocclusion, and repaired unilateral cleft lip and palate who had completed first-phase orthodontic treatment. MAIN OUTCOME MEASURES: This patient was treated with an edgewise appliance. Jaw movement and temporalis muscle activity during the chewing of a hard gummy jelly were recorded at 2 kHz from the sixth to the twentieth stroke before edgewise treatment and after a retention period of 2 years. RESULTS: Optimum intercuspation of teeth was achieved. The reversed crossing jaw-movement pattern before treatment changed to a normal grinding after treatment. The posterior temporalis muscle on the chewing side exhibited an earlier burst than the contralateral one during chewing at the post-treatment stage, as is observed in cases with good occlusion. CONCLUSION: Improvement in the occlusion using an edgewise appliance is necessary for acquiring a good masticatory function in patients with incisor crossbite, molar malocclusion, and cleft lip and palate.

Child↗

PubMed1998

Incidence of cleft lip and palate and risks of additional malformations.

OBJECTIVE AND METHODS: Children with cleft lip and/or palate (n = 251) born between 1991 and 1995 in the county of Stockholm, Sweden, were studied with reference to incidence and rate ratios (RRs) of different types of clefts, gender, birth weight, mother's age, and length of pregnancy. Children who had clefts and additional malformations were compared with children who had clefts but no additional malformations. RESULTS: The incidence of clefts was 2.0/1000 live births, and it was higher among males than among females. The RR, an index of relative risk, was 1.58. The main groups, children with isolated cleft lip, children with cleft lip and palate, and children with isolated cleft palate, showed similar incidence values (0.6-0.7/1000 live births). Children with bilateral clefts had an incidence of 0.3/1000 live births. Additional malformations were found in approximately every sixth newborn with a cleft when children with Robin sequence were excluded. There was a tendency for newborns with bilateral clefts to have additional malformations (RR = 1.36; confidence interval = 0.74-2.49). Children with clefts and additional malformations had lower birth weight and were born earlier than children with clefts only. CONCLUSION: Preterm cleft children with low birth weight should be screened for the presence of other birth defects.

Adult↗

PubMed1998

Birth weight, body length, and cranial circumference in newborns with cleft lip or palate.

OBJECTIVE: This paper reports on birth weight, body length, body mass index, and cranial circumference at birth of infants with cleft lip and/or palate born between 1973 and 1992. METHODS: Data were obtained from two nationwide Swedish health registries. Infants with syndromes, twins, and infants with immigrant parentage were excluded from the study. Comparisons were made with all singleton births with the same exclusion criteria (n = 2,031,140). RESULTS: The body dimensions of infants with isolated cleft lip (n = 865) were found not to differ from those of control subjects, but infants with isolated cleft palate (n = 811) or cleft lip and palate (n = 1139) were found to be lighter and shorter than control subjects. Also, infants with the Pierre Robin sequence (n = 121) had a tendency to be lighter and shorter than control subjects, but these differences did not reach statistical significance despite the large study population.

Birth Weight↗

PubMed1998

Otologic and audiologic status of Russian children with cleft lip and palate.

OBJECTIVE: In this study, researchers evaluated the otologic and audiologic status of 112 children with repaired cleft lip and palate who had received primary palatal repair by means of Frolova palatoplasty, a surgical technique developed by Dr. Larisa Y. Frolova, founder and director of the National Pediatric Center for Congenital Maxillofacial Pathology, Moscow, Russia. DESIGN: Results of hearing thresholds and tympanograms for these Russian children were compared with data previously reported from a group of 48 children and adults with repaired cleft lip and palate at the University of Florida Craniofacial Center, Gainesville, Florida. RESULTS: There were no substantial differences in hearing thresholds between the two groups, which was surprising in view of the vast differences between middle ear management techniques used in Russia and the United States. CONCLUSIONS: Considering these findings and the growing body of literature favoring a more conservative approach to the management of middle ear effusion in infants with cleft lip and palate, a reexamination of otologic strategies in the United States seems advisable.

Acoustic Impedance Tests↗

PubMed1999

Aesthetic and functional outcome of surgical and orthodontic correction of bilateral clefts of lip, palate, and alveolus.

OBJECTIVE: To assess the aesthetic and functional long-term results of surgical and orthodontic treatment of patients with bilateral cleft lip, palate, and alveolus. DESIGN: Long-term follow-up study. SETTING: Teaching hospital in Austria. PATIENTS: Twenty adult patients who had been operated on as children for bilateral cleft lip, palate, and alveolus. INTERVENTIONS: Lateral cephalometric and model analysis. The sum of all mesiodistal tooth diameters in the maxilla and mandible were compared with standard Bolton tracings. MAIN OUTCOME MEASURES: Aesthetic and functional results. RESULTS (MODEL ANALYSIS): The upper arch was too wide in 12 patients and the mandibular arch was too wide in 4 patients. In 11 patients, the lateral teeth were crowded, and all had a persistent transverse space deficit and a reduction in sagittal measurements. Fifteen patients had alveolar midline displacement of the maxilla as well as of the mandible. RESULTS (LATERAL CEPHALOMETRIC MEASUREMENTS): The lateral cephalograms showed a mean sella-nasion-A point angle of 77 degrees and a maxillary baseline-nasion-sella line angle of 9 degrees, indicating a tendency toward maxillary retrognathia. An anterior facial height index of 42% (compared with the standard 58%) indicated a slight reduction in midface height with consequent increase in the height of the lower face. CONCLUSION: There is specific growth impairment of the midface in adults who were treated as children for bilateral clefts of lip, palate, and alveolus. An optimal result can be achieved only by additional orthognathic surgery (Le Fort II osteotomy).

Adult↗

PubMed2000

Mental development in infants with cleft lip and/or palate.

OBJECTIVE: Investigated mental development in infants and toddlers with cleft lip and/or palate (CLP). DESIGN: This was a retrospective analysis of developmental scores on qualified children between 4 and 36 months of age. Cross-sectional analysis included children in four age groups (6, 12, 18, and 24 months); longitudinal analysis included children at mean age 9.1 (range = 4 to 15) months at Time 1 and 24 months (range = 16 to 36) at Time 2. PARTICIPANTS: Cross-sectional analysis included 180 children (59% male participants) in four diagnostic groups (cleft lip only [CL], cleft lip and palate [CLP], cleft palate only [CP], and Pierre Robin). The longitudinal sample included 85 children (64% male children) in the same diagnostic groups. MAIN OUTCOME MEASURES: Mental Scale (MDI) of the Bayley Scales of Infant Development. RESULTS: Mean MDIs were in the average range but decreased significantly between youngest and oldest groups in both cross-sectional (F(3,179) = 4.9, p<.01) and longitudinal samples (F(1,84) = 6.87, p<.01). There was a significant difference among cleft types (F(3,179) = 3.5, p<.025). Infants with CL obtained the highest scores, and infants with Pierre Robin Sequence obtained the lowest. Perceptual-motor development in the first year of life was predictive of developmental status at age 2. CONCLUSIONS: The number of children with CLP who may be at risk for developmental problems during the second year of life is greater than would be expected. Children at greatest risk may demonstrate early delays in acquisition of perceptual-motor skills during the first year of life.

Analysis of Variance↗

PubMed2000

Prevalence of intranasal ectopic teeth in children with complete unilateral and bilateral cleft lip and palate.

OBJECTIVE: The objective of this study was to determine the prevalence of ectopic eruption of intranasal teeth. DESIGN: This was a retrospective study, where records of children with repaired cleft lip and palate were analyzed. SETTING: The study was conducted at a large craniofacial center, the Hospital for Rehabilitation of Craniofacial Anomalies, USP, Bauru, São Paulo, Brazil. SUBJECTS: The sample consisted of 815 records from patients with bilateral cleft lip and palate (BCLP) and 1,495 records from patients with unilateral cleft lip and palate (UCLP). The age of the subjects was 5 to 10 years old and the groups included both males and females. RESULTS: The results showed that 0.61% of the children with BCLP and 0.40% of those with UCLP had an intranasal tooth. The prevalence of an intranasal tooth for the whole group was 0.48%, and it appeared to be more common in females.

Brazil↗

PubMed2000

Unilateral cleft lip repair--state of the art.

OBJECTIVE: A number of surgical techniques are utilized to correct the unilateral cleft lip, including variations of the rotation-advancement technique. This attests to the variability of the original deformity and the esthetic and functional results from any one technique, especially those based on traditional geometric rearrangement of the skin and associated tissues. RESULTS: Most recent advances in cleft lip repair have occurred in two main areas. The morphological result has been improved by functional muscular reconstruction of the lip with or without orthopedic molding. Early correction of the nasal deformity has also been readvocated based on newer principles with excellent results demonstrated. CONCLUSION: Further work continues in these areas and improved outcomes will continue to be seen along with a clearer understanding of surgical affects on growth and development.

Cleft Lip↗