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Cleft Lip

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41. Beware the Alar Base Optical Illusion in Assessment of Unilateral Cleft Lip Nasal Deformity. (Abstract)

Beware the Alar Base Optical Illusion in Assessment of Unilateral Cleft Lip Nasal Deformity. After repair of unilateral cleft lip, lateral drift of the alar base is expected and may require revision. Although the alar base appears wider than on the noncleft side, by measurement it could be symmetric or narrow. Is this an optical illusion?This is a retrospective photographic evaluation of children who underwent repair of unilateral complete cleft lip and palate. On submental standardized (...) photographs, raters judged whether the alar base position was wider, equal to, or narrower than on the noncleft side. The true alar base position was measured by photogrammetry and the frequency of alar base misjudgment was assessed. On control photographs, the cleft side alar base was wider than the noncleft side. On test photographs, the cleft side alar base was narrower than the noncleft side. Possible association between misjudgment and nasal features was also evaluated. Data were analyzed using

2019 Plastic and reconstructive surgery

42. Symmetric Philtral Column Repair for Unilateral Cleft Lip. (Abstract)

Symmetric Philtral Column Repair for Unilateral Cleft Lip. When treating a patient with a unilateral cleft lip, the goal is to try and achieve a result that is the least perceivable at conversational distance. The result should be a balanced and symmetric lip with scars that are hidden or are placed in natural anatomical lines. Several methods have been described to repair the lip. The most popular repairs at present are the rotation-advancement or its modifications and the various versions (...) of the straight-line repair.In the author's unit, a method has evolved entitled the symmetric philtral column repair. In this method, the author attempts to achieve a philtral column that mirrors the philtral column on the normal side, producing a balanced appearing lip. This method has been used for the past 14 years in over 500 patients.The results have been satisfying, with a lip revision rate of 6 percent.The symmetric philtral column repair of a unilateral cleft lip is an effective and safe repair

2019 Plastic and reconstructive surgery

43. The Smile Index: Part 2. A Simple, Prognostic Severity Scale for Unilateral Cleft Lip. (Abstract)

The Smile Index: Part 2. A Simple, Prognostic Severity Scale for Unilateral Cleft Lip. There is no universally accepted classification system for unilateral cleft lip that objectively quantifies the spectrum of disease, making it difficult to evaluate postoperative outcomes in the context of preoperative severity.Anthropometric measurements and photographs were prospectively collected from unilateral cleft lip patients in Morocco, Bolivia, Vietnam, and Madagascar. Columellar angle, cleft width (...) , nostril widths, vertical lip heights, and horizontal vermillion lengths were measured preoperatively and postoperatively. "Unacceptable" postoperative outcomes were defined as those with a cleft-side/non-cleft-side vertical lip height discrepancy greater than 3 mm, based on previous sociologic and cleft outcome studies.Of the 147 patients studied, 22 had unacceptable outcomes. Univariate logistic and multivariate logistic stepwise models showed that among preoperative characteristics, cleft width

2019 Plastic and reconstructive surgery

44. Orthodontic burden of care for patients with a cleft lip and/or palate. (Abstract)

Orthodontic burden of care for patients with a cleft lip and/or palate. Patients with a cleft lip and/or palate may require multiple episodes of orthodontic treatment, e.g. before alveolar bone grafting, upper arch alignment, orthodontic camouflage and in combination with orthognathic surgery. There is little published regarding the overall orthodontic burden of care for these patients.To assess the orthodontic burden of care for patients with a cleft lip and/or palate.Data were collected (...) retrospectively from all consecutive cleft patients who had completed orthodontic treatment between January 2014 and December 2015 at Great Ormond Street Hospital, London, United Kingdom.Forty-two patients were included in the study: Twenty-three patients with a cleft lip and palate; nine with an isolated cleft palate; eight with cleft lip and alveolus; and two with cleft lip. The mean age of orthodontic treatment commencement was 13.4 years (range = 8.9-18.2 years) with a mean duration of 3.4 years (range

2019 Journal of Orthodontics

45. The Influence of Four Different Treatment Protocols on Maxillofacial Growth in Patients with Unilateral Complete Cleft Lip, Palate, and Alveolus. (Abstract)

The Influence of Four Different Treatment Protocols on Maxillofacial Growth in Patients with Unilateral Complete Cleft Lip, Palate, and Alveolus. The purpose of this study was to evaluate the effect of four different treatment protocols on maxillofacial growth in patients aged 7 to 8 years with unilateral complete cleft lip, palate, and alveolus.Sixty-one patients with nonsyndromic unilateral complete cleft lip, palate, and alveolus were entered into this study and grouped as follows: group 1 (...) patients had a repaired lip and an unrepaired palate; group 2 patients underwent one-stage palatoplasty; group 3 patients underwent two-stage palatoplasty; and group 4 patients underwent lip adhesion and two-stage palatoplasty. The control group was composed of 16 patients with unilateral incomplete cleft lip. The Kolmogorov-Smirnov test was used to test the nature of data distribution. The Bonferroni test and the Kruskal-Wallis H test were used for multiple comparisons.Group 5 showed a more protruding

2019 Plastic and reconstructive surgery

46. Three-Dimensional Outcome Assessments of Cleft Lip and Palate Patients Undergoing Maxillary Advancement. (Abstract)

Three-Dimensional Outcome Assessments of Cleft Lip and Palate Patients Undergoing Maxillary Advancement. The aim of this retrospective case series study was to compare three-dimensional postsurgical outcomes of patients with cleft lip and palate following maxillary advancement.Fifty consecutive cleft lip and palate patients who underwent whole-pieced Le Fort I advancements were assigned to the major (advancement ≥ 5 mm) or minor (advancement < 5 mm) groups. Three-dimensional surgical simulation (...) revealed that the outcome discrepancy measurements were affected by different combinations of independent variables. The reliability test showed high consistency of the authors' method for three-dimensional measurements.The actual surgical outcomes of cleft lip and palate patients differed from the virtual simulations. The outcome discrepancies are impacted by multiple factors. The outcome discrepancies of all rotational surgical corrections (roll, yaw, and pitch) were positively correlated

2019 Plastic and reconstructive surgery

47. Accurate diagnosis of fetal cleft lip/palate by typical signs of magnetic resonance imaging. (Abstract)

Accurate diagnosis of fetal cleft lip/palate by typical signs of magnetic resonance imaging. This study aims to evaluate the accuracy of magnetic resonance imaging (MRI) in diagnosing orofacial clefts and proposes specific signs for determining the type of cleft.Pregnant women in whom fetal facial malformations are suspected by ultrasonography (US) underwent 1.5T Magnetic Resonance Imaging (MRI). The accuracy of the prenatal US and MRI diagnosis was compared with the postnatal findings.A total (...) 71 fetuses were included in the final analysis, which comprised of 35 cases of isolated cleft lip, six cases of cleft lip and alveolus, 21 cases of cleft lip and palate, four cases of isolated cleft palate, and five normal fetuses. MRI was more sensitive than US (MRI 100%, US 77.5%; Fisher exact test: MRI vs. US 0.000). The accuracy of MRI for all types was 100%. Specific signs (Inverted T, L/anti-L, U, and 'Notch' signs) were proposed, indicating the normal hard, unilateral cleft, bilateral

2019 Prenatal diagnosis

48. Intensive speech therapy in Ugandan patients with cleft (lip and) palate: a pilot-study assessing long-term effectiveness. (Abstract)

Intensive speech therapy in Ugandan patients with cleft (lip and) palate: a pilot-study assessing long-term effectiveness. In resource-limited countries, traditional models for speech therapy delivery are not adequate to reach all patients in need. In those countries, intensive speech therapy might be a solution. Preliminary results of previous research demonstrated that intensive speech therapy can be effective in the short term for patients living in countries with limited access to speech (...) therapy. Questions might arise whether or not intensive treatment results in long-term benefits for these patients. Hence, the present study investigated long-term effectiveness of intensive speech therapy provided to Ugandan patients born with a cleft palate with or without cleft lip (CP ± L) in terms of different speech characteristics.Five Ugandan patients with CP ± L, who received intensive speech therapy in the past, were contacted to participate in this follow-up study. All patients agreed

2019 International Journal of Pediatric Otorhinolaryngology

49. The effect of a small triangular skin flap on vermillion height after cleft lip repair: a photogrammetry study. (Abstract)

The effect of a small triangular skin flap on vermillion height after cleft lip repair: a photogrammetry study. During primary cleft lip repair, a small triangular flap of about 2mm is sometimes required to achieve better symmetry of Cupid's bow. The aim of this study was to evaluate the symmetry of Cupid's bow, with and without the use of a small triangular skin flap (STSF). Forty-five children who underwent the repair of unilateral cleft lip between January 1999 and December 2000 were (...) the patients in the two groups. Thus, there is no difference in vermillion height ratio with or without a STSF in cleft lip repair. The use of a small triangular skin flap needs to be assessed carefully, as it will create an unsightly scar over the philtrum area.Copyright © 2019 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

2019 International Journal of Oral and Maxillofacial Surgery

50. Anatomical patterns of cleft lip and palate deformities among neonates in Mekelle, Tigray, Ethiopia; implication of environmental impact. Full Text available with Trip Pro

Anatomical patterns of cleft lip and palate deformities among neonates in Mekelle, Tigray, Ethiopia; implication of environmental impact. Cleft lip and palate deformities are considered one of the most common birth defects of the head and neck that pose significant medical, psychosocial and financial burdens on the affected individuals and families, especially in low income communities. The etiology and pathogenesis of cleft lip and palate is complex and is known to involve genetic (...) and/or environmental factors.To assess the patterns of anatomical cleft lip and palate deformities among neonates in Mekelle and Ayder Comprehensive Specialized hospitals, Tigray, Northern Ethiopia.A hospital-based retrospective study was conducted from May 2017 to June 2017 at Mekelle and Ayder Comprehensive Specialized hospitals, both in Mekelle city. Data was collected from all medical charts of neonates registered from 2011 to 2016 and analyzed using SPSS version 21.0 and OpenEpi software. Results were

2019 BMC Pediatrics

51. Correction of labial tubercle defect in repaired bilateral cleft lips using bilateral vermilion musculomucosal sliding flaps: Case series. Full Text available with Trip Pro

Correction of labial tubercle defect in repaired bilateral cleft lips using bilateral vermilion musculomucosal sliding flaps: Case series. Insignifificant, asymmetrical or lack of labial tubercle often occurs after cleft lip surgery due to improper treatment of vermilion tissue. Especially in the cases of bilateral cleft lip, because of short front lip and insuffificient vermilion tissue, the median vermilion depression often occurs after surgery, forming a "whistling" deformity. The object (...) of this study is to verify the outcomes of patients with median labial tubercle detects after treatment with bilateral vermilion musculomucosal sliding flflaps (VMSF).Six patients with median labial tubercle defect after bilateral cleft lip repair from March 2015 to May 2017 were enrolled in our department and subjected to bilateral lip deformity correction under general anesthesia.Secondary deformity of bilateral cleft lip forming a "whistling" deformity were diagnosed in all the patients.Bilateral VMSF

2019 Medicine

52. Comparison of the Fisher Anatomical Subunit and Modified Millard Rotation-Advancement Cleft Lip Repairs. (Abstract)

Comparison of the Fisher Anatomical Subunit and Modified Millard Rotation-Advancement Cleft Lip Repairs. When analyzing cleft lip repair techniques, the modified rotation-advancement repair is most widely used; however, the anatomical subunit approach is gaining popularity. The purpose of this study was to compare the outcomes of these two surgical techniques performed by the same surgeon.Anthropometric measurements were performed on postoperative photographs of cleft lip repairs performed (...) by a single surgeon. As described by Rossell-Perry, four parameters were measured: lip height, lip width, vermilion height, and alar base width. An aesthetic ratio of cleft to noncleft sides for each measurement was used as a quantitative measure of outcome. Qualitative analysis of cleft lip repair was evaluated using the Steffensen criteria.TWELVE: modified rotation-advancement repairs and 10 anatomical subunit repairs were analyzed. A one-sample t test was used to assess the difference of each aesthetic

2019 Plastic and reconstructive surgery

53. Association of Pediatric Patient Demographic Factors and Scar Anatomic Features With Scar Outcomes After Surgical Repair of Cleft Lip. (Abstract)

Association of Pediatric Patient Demographic Factors and Scar Anatomic Features With Scar Outcomes After Surgical Repair of Cleft Lip. Scar outcomes following cleft lip repair are an important component of pediatric patient and family satisfaction and indicate the need for future surgical interventions.To assess the association of pediatric patient demographic factors and scar anatomic features with scar outcomes following cleft lip surgical repair.A case-control study was conducted involving (...) 58 pediatric patients who underwent surgical repair of a cleft lip from October 31, 2008, to August 4, 2016, at a tertiary care pediatric specialty hospital. Data on patient demographic factors, cleft type, and the surgical technique used were collected and analyzed from June 11, 2009, to November 21, 2017. Scar outcomes were subjectively rated by 3 physicians at 6-month and 12-month postoperative intervals.Overall scar outcomes at 6-month and 12-month postoperative intervals were based on rating

2019 JAMA facial plastic surgery

54. Unilateral cleft lip nasal deformity: 3D analysis of the primary deformity and longitudinal changes following primary correction of the nasal foundation. (Abstract)

Unilateral cleft lip nasal deformity: 3D analysis of the primary deformity and longitudinal changes following primary correction of the nasal foundation. Objective assessment of the unilateral cleft lip nasal deformity and the longitudinal changes with treatment is critical to optimizing cleft care. We used 3D images to evaluate nasal base morphology.Consecutive patients undergoing cleft lip repair and foundation-based rhinoplasty were included (N=102). 3D images pre-op, post-op, and at 5 years (...) displacement of non-cleft subalare, narrowing of non-cleft nostril, and intercanthal widening. Surgery corrected nasal base displacements along all axes resulting in landmark positions similar to controls. The symmetry of nasal base correction persisted at 5-year follow-up with no recurrent cleft alar base retrusion, regardless of initial cleft type.Unilateral cleft lip nasal deformity may be 'driven' by displacement of anterior nasal spine and caudal septum. The cleft alar base is normal in position

2019 Plastic and reconstructive surgery

55. Tooth-borne distraction osteogenesis versus conventional Le Fort I in maxillary advancement of cleft lip and palate patients. (Abstract)

Tooth-borne distraction osteogenesis versus conventional Le Fort I in maxillary advancement of cleft lip and palate patients. Distraction osteogenesis (DO) is rapidly becoming a mainstream surgical technique for correction of maxillary deficiency. The aim of this study was to compare the effectiveness of a newly designed tooth-borne osteogenic distraction device with conventional Le Fort 1 osteotomy in maxillary advancement of cleft lip and palate patients.The DO group consisted of 10 subjects (...) osteogenic distraction device can effectively advance the maxilla forward in patients with cleft lip.

2019 Minerva stomatologica Controlled trial quality: uncertain

56. Cone beam computed tomography evaluation of ponticulus posticus in patients with cleft lip and palate: a retrospective radio-anatomic study. Full Text available with Trip Pro

Cone beam computed tomography evaluation of ponticulus posticus in patients with cleft lip and palate: a retrospective radio-anatomic study. Ponticulus posticus (PP) is an abnormal bony bridge on the atlas. It plays a significant role in patients undergoing C1 lateral mass screw procedure. Patients with cleft lip and palate (CLP) have higher risk than patients in general population for the appearance of cervical vertebral anomalies. The purpose of the this study was twofold: to determine (...) the prevalence and characteristics of PP in patients with CLP, and to compare the findings with patients in general population using cone beam computed tomography.Cone beam computed tomography images from 54 individuals who had undergone surgical repair of cleft lip and/or palate were analysed as the study group. For comparison purposes a control group was randomly selected from 108 patients and matched with the CLP subjects.Although 12 of the 54 (22.3%) patients with surgically repaired cleft lip

2019 Folia morphologica Controlled trial quality: uncertain

57. The impact of cleft lip and/or palate on parental quality of life: A pilot study. Full Text available with Trip Pro

The impact of cleft lip and/or palate on parental quality of life: A pilot study. Cleft lip and/or palate (CL/CP/CLP) is one of the most common congenital anomalies. Children may suffer from a variety of health problems including difficulties with feeding and speech, middle ear problems, hearing loss and associated psychosocial concerns. The extent of impact of this disorder on the parents, however, has not yet been thoroughly evaluated. This pilot study was performed to evaluate the impact (...) of having a child with CL/CP/CLP on the parents' quality of life (QoL) and family functioning and to compare between cleft subgroups.Forty-five parents with children aged 6 months to 6 years with CL/CP/CLP, followed by the multidisciplinary orofacial cleft team of Ghent University Hospital, completed following standardized questionnaires: Impact on Family Scale (IOFS), Family Impact Scale (FIS) and Care-Related Quality of Life Instrument (CarerQoL). Subgroups were compared with diverse unpaired

2019 International Journal of Pediatric Otorhinolaryngology

58. Acoustic analysis of voice in children with cleft lip and palate following vocal rehabilitation. Preliminary report. (Abstract)

Acoustic analysis of voice in children with cleft lip and palate following vocal rehabilitation. Preliminary report. Cleft lip and palate (CLP) is the most common craniofacial anomaly. CLP affects resonance, voice and speech. Besides the most frequently reported resonance and speech disorders, several reports have addressed acoustic abnormalities in the voice of patients with CLP. However, there are just a few reports focusing on vocal treatment in this population.To study whether a Speech (...) and Language Pathology (SLP) intervention including vocal rehabilitation for children with CLP and velopharyngeal insufficiency (VPI) provides significant improvement of abnormal acoustic parameters of voice.Fifteen children with cleft lip and palate (CLP) and velopharyngeal insufficiency (VPI) were studied. Age ranged 4-5 years. A matched control group of children without craniofacial anomalies and adequate speech, resonance and voice was assembled. All children underwent acoustic analysis of voice

2019 International Journal of Pediatric Otorhinolaryngology

59. Lipofilling in patients with a cleft lip (and palate) - a pilot study assessing functional outcomes and patients' satisfaction with appearance. Full Text available with Trip Pro

Lipofilling in patients with a cleft lip (and palate) - a pilot study assessing functional outcomes and patients' satisfaction with appearance. Lipofilling of the upper lip as secondary treatment in patients with a cleft lip (and palate) (CL ± P) has been proposed to improve projection and volume especially in profile view. The purpose of the present study was to document differences in functional (i.e. logopaedic) and self-reported aesthetic outcomes by comparing pre- and postoperative results (...) after lipofilling of the upper lip in patients with CL ± P.Eight Dutch-speaking youngsters and young adults (three women, five men) with CL ± P were included. The median age was 19 years (range: 14-24 years). Logopaedic outcomes (i.e. assessment of orofacial myofunctional behavior, articulation and lip strength) and self-reported aesthetic outcome (i.e. patients' satisfaction using the Cleft Evaluation Profile) were determined.Neither for lip strength and orofacial myofunctional behavior nor

2019 International Journal of Pediatric Otorhinolaryngology

60. Impact of nasalis muscle repair in unilateral cleft lip patients. (Abstract)

Impact of nasalis muscle repair in unilateral cleft lip patients. Although the role of nasalis muscle in the establishment of nasal deformity is well recognized; its abnormal anatomy and role in the correction of alar deformity in cleft lip patients have not been adequately studied. This work aimed to study the effect of nasalis muscle repair on the postoperative nasal symmetry.A controlled prospective randomized study was conducted on 45 cases of unilateral complete pre-alveolar cleft (...) . Patients were divided into two groups; Group 1 (repair of the Orbicularis muscle only), Group 2 was further divided into 2 subgroups: Subgroup A (repair of the orbicularis oris muscle and dissection and repair the origin of the nasalis muscle). Subgroup B (repair of the orbicularis oris muscle and dissection of both origin and abnormal insertion of the nasalis and repair of the origin). Evaluation was conducted both subjectively and objectively through cleft lip evaluation profile and nostril angles

2019 Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery Controlled trial quality: uncertain

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