A Multicentre Comparison of Treatment Regimens for Unilateral Cleft Lip and Palate Using a Multiple Regression Model (original) (raw)
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The Journal of craniofacial surgery, 2018
The aim of this study was to investigate the effect of orthodontic treatment on the maxillofacial growth of patients with unilateral cleft lip and palate. The Great Ormond Street, London and Oslo (GOSLON) yardstick was used for a longitudinal evaluation of 24 patients with cleft lip and palate treated at the Cleft Center of the Lauro Wanderley University Hospital, Paraiba State, northeastern Brazil. Dental casts were evaluated by 3 orthodontists and classified according to the GOSLON yardstick. The evaluation was performed at 2 different stages: T1 (before orthodontic treatment) and T2 (follow-up evaluation) after a 6-year mean follow-up interval. The Kappa test was used to evaluate intra- and interexaminer agreement, and paired t-test was used to compare the differences between T1 and T2, with a 99% confidence interval. The average intraexaminer Kappa was 0.979, ranging from 0.971 to 0.990. The interexaminer Kappa value was 0.926 at T1, ranging from 0.885 to 0.964, and 0.896 at T2,...
Plastic and Aesthetic Research , 2020
Aim: The purpose of this study was to ascertain the effect of surgical procedures and their timing on maxillofacial growth in unilateral cleft lip and palate (UCLP) patients through a systematic literature review. Results: Eleven articles were included. An important finding was the wide range of treatment protocols. Eight studies performed a multistage procedure, whereas three studies applied a simultaneous repair of cleft lip, palate, and alveolus in a single surgical session. The findings in these articles were based on cephalometric measures. Comparative tables were constructed regarding method of study and time and technique of closure. Conclusion: The results of the articles were conflicting, and it was clear that more research on this subject is necessary. Overall, most studies agreed on the important factor of palatoplasty in maxillofacial growth. The most common finding was a retrusive maxillary growth in comparison to a noncleft control group. This was illustrated by a negative effect on A-point-nasion-B-point. A lot of discussion remains on the effect of lip closure. However,
Journal of Cranio-Maxillofacial Surgery, 2019
The aim of this study was to review the effects of early and late hard palate repair on maxillary growth. PubMed, Scopus, Web of Science, LILACS, Cochrane Library CENTRAL databases, OpenGrey, Google Scholar, and Clinical Trials were searched using a PICO strategy, with terms related to unilateral cleft lip and palate (UCLP) and timing of repair. Methodological quality evaluation was carried out using the Fowkes and Fulton guidelines, and quality (or certainty) of evidence and strength of recommendations were evaluated using GRADE (grading of recommendations, assessment, development and evaluation). Five retrospective and nonrandomized studies were included in the study. Folkes and Fulton assessment showed a high risk of bias in all articles and very low levels of certainty (GRADE). The results showed conflicting findings for comparisons of the effects of timing of repair of hard palate in UCLP. Two studies presented better maxillary growth in a group operated on later (18 months after birth), two presented no differences between the results, and another presented better results in the group operated on earlier than 18 months of age. At this point, it cannot be proven or refuted that postponing hard palate surgery brings benefits for maxillary growth. Studies included in this review did not show similar conclusions. Randomized clinical trials present some ethical issues that make them difficult to perform.
Stomatologija / issued by public institution "Odontologijos studija" ... [et al.], 2014
OBJECTIVES. Cleft lip palate is congenital growth disease with unknown etiology, probably linked to both genetically and external causes. The aim of this work consists in presenting the effects of these diseases on cranio facial growth and the surgical protocols described in literature. MATERIALS AND METHODS. The literature review articles conducted by Medline ranged from 1998 to 2011 have been selected. The key words of the research were "cleft lip palate", "cleft lip palate facial growth", "cleft lip palate surgery". The inclusion criteria were articles that analyzed surgical protocols and the growth of unilateral lip and palate clefts, the timing repair of lip, palate and alveolus. We excluded case reports, studies without control group in the sample and the other types of publication as thesis or conference presentation. 60 articles had the selection criteria of the research. RESULTS. The cleft lip and palate is one of the most common birth defects ...
Journal of Craniofacial Surgery, 2018
The aim of this paper was to assess growth, speech, and aesthetic results at the completion of growth in patients with unilateral cleft lip and palate treated with the 2 stages Milan surgical protocol. Craniofacial growth was evaluated with cephalometric analysis and a theoretical need for orthognathic surgery. Nasolabial appearance was qualitatively assessed using the Asher McDade Aesthetic Index. Speech was assessed using the Gos.Sp.Ass '98 modified for Italian language scoring system. Burden of care was recorded in terms of number of secondary surgical procedures. All of the patients were treated and evaluated at
Journal of Cranio-Maxillofacial Surgery, 2015
Objective: To study the growth and speech outcomes in children who were operated on for unilateral cleft lip and palate (UCLP) by a single surgeon using two different treatment protocols. Material and methods: A total of 200 consecutive patients with nonsyndromic UCLP were randomly allocated to two different treatment protocols. Of the 200 patients, 179 completed the protocol. However, only 85 patients presented for follow-up during the mixed dentition period (7e10 years of age). The following treatment protocol was followed. Protocol 1 consisted of the vomer flap (VF), whereby patients underwent primary lip nose repair and vomer flap for hard palate single-layer closure, followed by soft palate repair 6 months later; Protocol 2 consisted of the two-flap technique (TF), whereby the cleft palate (CP) was repaired by two-flap technique after primary lip and nose repair. GOSLON Yardstick scores for dental arch relation, and speech outcomes based on universal reporting parameters, were noted. Results: A total of 40 patients in the VF group and 45 in the TF group completed the treatment protocols. The GOSLON scores showed marginally better outcomes in the VF group compared to the TF group. Statistically significant differences were found only in two speech parameters, with better outcomes in the TF group. Conclusions: Our results showed marginally better growth outcome in the VF group compared to the TF group. However, the speech outcomes were better in the TF group.
Journal of Dental Health, Oral Disorders & Therapy
Objectives: To summarize the combination of different Orthodontic treatment protocols and different Surgery techniques required in the management of patients born with cleft lip and/or palate. Materials and methods: We searched the relevant articles from PubMed, on the web of science, EMBASE, Google scholar and manually search by using the following search terms: "Orthodontic management and cleft lip or palate", "Post orthodontic management and cleft lip or palate" "surgery techniques and cleft lip or palate" all relevant articles in English language published from 2007 to 2017 were reviewed. Abstracts and title were evaluated and full-text analysis was performed, we excluded abstracts without full articles, articles published not in English language, Case reports, and all types of review. Results: A total of 8 articles were included in the qualitative synthesis, they were of retrospective and cohort study design. Four articles1−4 assessed the surgical timing of cleft repair and favored early (mixed dentition) over late (permanent dentition) Secondary Alveolar bone grafting (SABG). The studies on postoperative orthodontic treatment5−8 and concluded that maxillary expansion and surgical advancement are generally needed for most cleft palate patients. Conclusion: Orthodontic treatment plays an integral role in the rehabilitation phase toward the preparations of alveolar bone grafting and orthognathic surgery.