Christopher L Kalmar, Laura S Humphries, Carrie E Zimmerman, Giap H Vu, Jordan W Swanson, Scott P Bartlett, Jesse A Taylor
BACKGROUND: Patients undergoing orthognathic skeletal correction present with a variety of comorbidities that may affect surgical outcomes. The purpose of this study is to understand how patient risk factors and operative technique contribute to complication rates after orthognathic surgery in the era of patient-specific implants. METHODS: Retrospective cohort analysis was conducted of pediatric patients undergoing LeFort I osteotomy, bilateral sagittal split osteotomy, and/or genioplasty from 2014-2018...
August 19, 2020: Plastic and Reconstructive Surgery
Jean Michel Faure, Eve Mousty, Michèle Bigorre, Constance Wells, Pierre Boulot, Guillaume Captier, Florent Fuchs
OBJECTIVES: The aim of this study was to define the prenatal ultrasound semiology of cleft palate without cleft lip using 3D visualization of the fetal palate. METHODS: A prospective longitudinal study was performed in our University Hospital Center from 2011 to 2018. The fetal secondary palate was studied in 3D, starting with 2D axial transverse ultrasound view. We defined a cleft palate as a disruption of the horizontal plate of the palatine bone of the secondary palate...
July 16, 2020: Prenatal Diagnosis
Donglin Cai, Jie Zheng, Wenying Kuang, Zhelun Li, Shiyu Yuan, Hui Xiong, Wenjun Yuan
BACKGROUND: Presurgical nasoalveolar molding (NAM) is the most common preoperative treatment for cleft lip and palate. However, NAM may have some limitations such as requiring high technical sensitivity and frequent visits. To simplify the device, some scholars have changed the traditional NAM into a split-NAM consisting of a alveolar molding plate and a nasal hook. This study compared the shaping effect of split NAM and traditional NAM on nasolabial soft tissue using three-dimensional (3D) measurement...
June 18, 2020: Journal of Craniofacial Surgery
Arezoo Jahanbin, Abdollah Jamalinasab, Barat Ali Ramazanzadeh, Seyed Hosein Hoseini Zarch, Hooman Shafaee, Reza Shojaeian
OBJECTIVE: The main aim of this study was to evaluate the effect of immediate versus delayed addition of the nasal stent to the nasoalveolar molding plate on the nose shape and alveolar cleft area in unilateral cleft lip and palate infants. METHOD: Twenty nonsyndromic newborn infants with unilateral cleft lip and palate were scanned 3 dimensionally using Proface software. In the experimental group, the nasal stent was added on the day the molding plate arrived, and in the control group when the alveolar gap reached 5 mm...
September 2020: Journal of Craniofacial Surgery
Josip Tomic, Philipp Metzler, Andre Alcon, Norbert Jakse, Wolfgang Zemann, Monika Schanbacher, Tomislav A Zrnc
OBJECTIVE: To determine weight gain during treatment with the modified palatal plate (MPP) in infants with isolated and syndromic Pierre Robin Sequence (PRS) suffering from micrognathia, upper airway obstruction (UAO), and failure to thrive (FTT), the authors conducted a retrospective study of infants treated with the MPP. METHODS: The main outcome measure was infant weight (g) for up to three months after birth. Demographic and outcome data (associated syndromes, comorbidities, presence of cleft lip or palate, intubation attempts, tracheotomy and cleft repair) were collected...
March 31, 2020: Journal of Cranio-maxillo-facial Surgery
Prasad Nalabothu, Benito K Benitez, Michel Dalstra, Carlalberta Verna, Andreas A Mueller
The aim of this cohort study was to quantify the morphological changes in the palatal cleft and true cleft areas with passive plate therapy using a new analysis method based on three-dimensional standardized reproducible landmarks. Forty-five casts of 15 consecutive patients with complete unilateral cleft lip and palate were laser scanned and investigated retrospectively. The landmarks and the coordinate system were defined, and the interrater and intrarater measurement errors were within 1.0 mm. The morphological changes of the cleft palate area after a period of 8 months of passive plate therapy without prior lip surgery are presented graphically...
March 31, 2020: Journal of Clinical Medicine
Lomeli Carpio Shull, Rwik Sen, Johannes Menzel, Susumu Goyama, Mineo Kurokawa, Kristin Bruk Artinger
The formation of the craniofacial skeleton is a highly dynamic process that requires proper orchestration of various cellular processes in cranial neural crest cell (cNCC) development, including cell migration, proliferation, differentiation, polarity and cell death. Alterations that occur during cNCC development result in congenital birth defects and craniofacial abnormalities such as cleft lip with or without cleft palate. While the gene regulatory networks facilitating neural crest development have been extensively studied, the epigenetic mechanisms by which these pathways are activated or repressed in a temporal and spatially regulated manner remain largely unknown...
February 7, 2020: Developmental Biology
Domenico Dalessandri, Ingrid Tonni, Laura Laffranchi, Marco Migliorati, Gaetano Isola, Stefano Bonetti, Luca Visconti, Corrado Paganelli
The aim of this study was to evaluate the accuracy, invasiveness and impact on clinical results of a digital oral impression protocol in the pre-surgical orthopedic treatment (PSOT) of newborn cleft lip and palate (CLP) patients undergoing primary alveolar surgical repair. Six patients were divided, according to impression technique used, into a digital (intraoral scanner (IOS)) and a non-digital (tray and putty (T&P)) group. Parents considered IOS impressions to be less invasive, compared to T&P impressions...
December 9, 2019: Dentistry Journal
Gajanan Shanbhag, Swapnil Pandey, Nirali Mehta, Yogesh Kini, Ashwini Kini
Presurgical nasoalveolar molding (PNAM) is a key step in the early management of cleft babies. It involves making an impression of the alveolar segments and the lip elements, after which an appliance is fabricated and activated to achieve optimal alveolar and nasal positions for a superior surgical result. These appliances are fabricated and activated in babies as young as 10 days, and the molding is ideally carried on till the baby is ready for the primary lip repair. This article outlines in detail a digital method of fabricating the PNAM appliance using a combination of intraoral scans, computer-assisted digital software, and computer-assisted machining, facilitated by milling machines...
November 7, 2019: Cleft Palate-craniofacial Journal
Kasper Stokbro, Torben Thygesen, Lillian Marcussen
PURPOSE: Inferior maxillary repositioning has continued to be among the most unstable orthognathic procedures. The overall purpose of the present study was to measure skeletal stability after inferior maxillary repositioning. MATERIALS AND METHODS: We implemented a retrospective cohort study. The study cohort was derived from all orthognathic patients who had undergone treatment from January 2011 to December 2013 in Odense University Hospital. The inclusion criteria were orthognathic surgery with inferior maxillary repositioning in patients without maxillary segmentation or cleft lip/palate...
August 28, 2019: Journal of Oral and Maxillofacial Surgery
Christian F Poets, Bernd Koos, Siegmar Reinert, Cornelia Wiechers
Various treatments, many of them considerably invasive, are currently applied to infants with Robin sequence (RS) and accompanying upper airway obstruction (UAO). We present a narrative review of our data on the Tübingen palatal plate (TPP) which show the following: a) in a randomized trial, the TPP was superior to a sham procedure in alleviating UAO; b) children treated with the TPP in infancy showed an intellectual development within the reference range; c) prone positioning is no alternative, as it is ineffective and associated with an increased risk of sudden death; d) the TPP reduces the mixed-obstructive apnea index to near-normal values, both in isolated and most (83%) syndromic RS, e) of 443 infants (129 syndromic) treated with the TPP in our center, 23 (5%) ultimately received a tracheostomy (all with syndromic RS), f) recent data suggest that the TPP may induce mandibular catch-up growth, g) the TPP may also help to reduce respiratory complications following cleft closure in RS, and h) TPP treatment is applied by various centers around the world, although it is unclear if its effectiveness is invariably controlled by endoscopy and sleep studies, although both are necessary...
August 20, 2019: Journal of Cranio-maxillo-facial Surgery
Jie Zheng, Hong He, Wenying Kuang, Wenjun Yuan
An 8-day-old male infant with unilateral cleft lip, alveolus, and palate had a wide alveolar defect, soft tissue deformity, and a markedly sunken nasal wing at the cleft side. The patient was treated with a series of 3D-printed molding plates and synchronously with a nasal hook. The cleft edges moved closer by 9 mm at the alveolar ridge and the nasal wing was lifted considerably. Split-type 3D printing of presurgical nasoalveolar molding helped to reduce the cleft gap, improve the arch form, approximate lip segments, and distinctly improve the morphology of the nose by correcting the flattened nasal wings...
September 2019: American Journal of Orthodontics and Dentofacial Orthopedics
J Schiebl, F X Bauer, F Grill, D J Loeffelbein
OBJECTIVE: Nasoalveolar molding (NAM) is an accepted presurgical treatment modality for newborns with cleft lip and palate (CLP). However, the therapy is time-consuming and requires high expertise. To facilitate the treatment, we reveal an algorithm for the automated generation of patient individual NAM devices for neonates with bilateral cleft lip and palate (BCLP) and present results of software validation. METHODS: The algorithm was implemented utilizing Python 2...
August 12, 2019: IEEE Transactions on Bio-medical Engineering
Aaron M Foglio, Jonathan Y Lee, Sanjay Naran, Lindsay A Schuster, Alexander Davit, Jesse A Goldstein, Joseph E Losee
Patients presenting with a unique unilateral cleft phenotype may be at risk of nasal airway obstruction which can be exacerbated by presurgical infant orthopedic (PSIO) appliance therapy and lip taping. Four patients presented to the UPMC Children's Hospital of Pittsburgh Cleft-Craniofacial Center with a cleft phenotype characterized by: An anteriorly projected greater alveolar segment and medial collapse of the lesser segment posteriorly, leading to cleft alar base displacement posteromedial to the anteriorly projected greater segment...
July 30, 2019: Cleft Palate-craniofacial Journal
William Tobolowsky, Pranjal Gupta, Joseph Lopez, Regina Cho, Gerhard S Mundinger, Robin Yang, Anthony P Tufaro
INTRODUCTION: Maxillary hypoplasia after cleft lip and palate (CLP) repair can result in significant functional and aesthetic impairments. Le Fort I osteotomy & advancement and Le Fort I distraction osteogenesis are standard treatment options for individuals with CLP-associated midface retrusion. However, both of these modalities continue to be associated with a high relapse rate. This study describes surgical outcomes of a 2-stage technique utilizing distraction osteogenesis combined with bone grafting and rigid fixation, which may optimize skeletal stability by reducing relapse...
June 20, 2019: Journal of Craniofacial Surgery
John Abramyan
Since its initial discovery in a Drosophila mutagenesis screen, the Hedgehog pathway has been revealed to be instrumental in the proper development of the vertebrate face. Vertebrates possess three hedgehog paralogs: Sonic hedgehog (Shh), Indian hedgehog (Ihh), and Desert hedgehog (Dhh). Of the three, Shh has the broadest range of functions both in the face and elsewhere in the embryo, while Ihh and Dhh play more limited roles. The Hedgehog pathway is instrumental from the period of prechordal plate formation early in the embryo, until the fusion of the lip and secondary palate, which complete the major patterning events of the face...
April 24, 2019: Journal of Developmental Biology
Tom W M Walker, Nazanin Ahmadi-Lari, Annie Pellatt, Alistair R M Cobb
Midline clefts of the lower lip, tongue, and mandible are a rare type of facial cleft classified as "Tessier 30." We present the case of a female patient with an isolated Tessier 30 facial cleft affecting the tongue, lower lip, and mandibular symphysis with ankyloglossia. This was reconstructed with a template-guided resorbable "U"-shaped plate at 10 months of age. The procedure was carried out in one stage, which avoided the need for a repeat general anesthetic for the patient. We had a successful outcome with normal dental eruption and we believe such an approach could be considered as a relevant treatment modality for future cases...
April 10, 2019: Cleft Palate-craniofacial Journal
Rahime Burcu Nur Yilmaz, Derya Germeç Çakan, Didem Nalbantgil
OBJECTIVE: The aim of the present study is to compare the aesthetic assessments of infants with different types of cleft before (T1), during (T2), and after (T3) orthopedic therapy (OT) by orthodontists, dentists, and laypersons. METHODS: Photographs of 3 patients (incomplete lip [C1], complete unilateral [C2], and complete bilateral cleft [C3]) at T1 (C1, C2, C3 chronologic age: 5, 2, 2 days), T2 (C1, C2, C3 chronologic age: 32, 28, 35 days; using forehead anchoraged nasal stent or conventional nasoalveolar therapy plates), and T3 (C1, C2, C3 chronologic age: 80, 91, 105 days) were collected from the archive...
November 2018: Journal of Craniofacial Surgery
Yijin Ren, Ralph Steegman, Arjan Dieters, Johan Jansma, Harry Stamatakis
OBJECTIVE: This prospective controlled study evaluated the effect of bone-anchored maxillary protraction therapy in cleft children with Class III malocclusion using CBCT-derived 3D surface models. MATERIALS AND SUBJECTS: Eighteen cleft patients between 10 and 12 years old were included. Intermaxillary elastics were worn after the placement of four zygoma bone plates for 18 months. Uniquely, three age-matched untreated groups including both cleft subjects and non-cleft subjects with Class III malocclusion served as controls...
May 2019: Clinical Oral Investigations
Karl-Friedrich Krey, Anja Ratzmann, Philine Henriette Metelmann, Marcel Hartmann, Sebastian Ruge, Bernd Kordaß
OBJECTIVE: In most cases, according to our treatment concept, a presurgical orthodontic treatment (POT) is performed on patients with cleft lip and palate (CLP). The aim of this case report is to demonstrate a completely digital workflow for the production of a palate plate. MATERIALS AND METHODS: For the assessment of the maxillary arch, a digital impression of the jaw was made on two patients with an intraoral scanner (Cerec Omnicam Ortho). After reconstruction of a virtual model from the scan data, appropriate areas of the jaw could be blocked out and a plate constructed...
2018: International Journal of Computerized Dentistry
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