The Cleft Palate-Craniofacial Journal (CLEFT PALATE-CRAN J )

Publisher: American Cleft Palate-Craniofacial Association


The Cleft Palate-Craniofacial Journal is an international, interdisciplinary journal reporting on clinical and research activities in cleft lip/palate and other craniofacial anomalies, together with research in related laboratory sciences. It is the journal of The American Cleft Palate-Craniofacial Association.

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    Cleft Palate-Craniofacial Journal, The website
  • Other titles
    The Cleft palate-craniofacial journal, Cleft palate craniofacial journal
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    Journal / Magazine / Newspaper, Internet Resource

Publications in this journal

  • The Cleft Palate-Craniofacial Journal 11/2014;
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    ABSTRACT: Background: A cleft in the lip and/or the palate (CL/P) is considered to be a lifelong condition, yet relatively little is known about the long-term outcomes for patients. Existing literature is largely outdated and conflicted, with an almost exclusive focus on medical aspects and deficits. Objective: To explore the psychological adjustment and possible support needs of a large number of adults born with CL/P from their own perspective. Design: Fifty-two individual telephone interviews eliciting qualitative data. Results: Qualitative analysis identified five themes. Participants reported a range of challenges in relation to ‘discharge’ from the service, additional surgery as an adult, social and romantic relationships, higher education, vocational achievement and access to psychological support. The findings imply that most adults with a cleft adjust well to these challenges and report many positive outcomes. For a minority of patients, issues attributed to the cleft may continue to cause distress in adulthood. Conclusions: Adults with CL/P may require psychological support, information about the heritability of cleft, signposting and referrals from non-specialists, support regarding further treatment and opportunities to take part in research and activities. New issues arising in adulthood, such as entering the workplace, forming long-term relationships and starting a family, may warrant both further investigation and additional support. Further work is needed to identify the factors which contribute to psychological distress and resilience, as well as the timing of particular points of risk and opportunity for personal growth.
    The Cleft Palate-Craniofacial Journal 11/2014;
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    ABSTRACT: Monobloc Le Fort III distraction osteogenesis allows superior skeletal advancement in treating severe syndromic craniosynostosis. We report a rare orbital complication in a 3-year-old boy with Crouzon syndrome who developed right-eye exodeviation with limited abduction during the intradistraction period following this surgery. Images from a computed tomography scan confirmed direct impingement of the distracted right lateral orbital wall to the lateral rectus muscle. The impingement was surgically relieved via lateral orbital wall osteotomy. Ten months postdistraction, a review showed normal eye movement. A lateral orbital osteotomy cut for a monobloc Le Fort III distraction should be designed near the rim to prevent this complication.
    The Cleft Palate-Craniofacial Journal 07/2014;
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    ABSTRACT: Background: One of the key challenges facing young adults with CL/P is decision-making around starting a family, due to the increased likelihood of their own child being diagnosed with CL/P. Should this occur, a second key challenge is how to deal with their child's diagnosis and subsequent treatment. Objective: To explore the views, experiences and possible support needs of this unique group of parents in order to inform the services provided by non-specialist Health Professionals, cleft teams and genetic counsellors. Design: Individual telephone interviews eliciting qualitative data. Results: Qualitative Thematic Analysis identified five themes. Accessing accurate information and appropriate support around heritability presented a significant challenge. Parents described feelings of responsibility and distress at their child's diagnosis, as well as a number of factors which had helped or hindered their adjustment. Parents also described ways in which their own experiences had impacted on their parenting style, and how becoming a parent had changed the way they felt about their own cleft. Conclusions: Young adults' understanding of what it means to grow up with CL/P may impact on their decision to start a family and their experiences of having children. Possible methods of supporting prospective parents through this potentially difficult stage will be discussed. Keywords: cleft, adult, parent, genetics, psychological adjustment, qualitative
    The Cleft Palate-Craniofacial Journal 01/2014;
  • The Cleft Palate-Craniofacial Journal 01/2014;
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    ABSTRACT: Abstract We report a female infant with presentation of epignathus teratoma involving duplication of both the mandible and tongue. Epignathus with duplication of the mandible has rarely been reported in the literature thus far. The location and extent of the tumor, as well as the involvement of adjacent structures, resulted in trismus and upper airway obstruction at birth. Thus, staged operations including debulking and correction of anatomical anomaly were performed on this patient after life-saving tracheostomy. As a result, we not only prevented morbidity associated with the anomaly but also refined the patient's appearance and improved her quality of life.
    The Cleft Palate-Craniofacial Journal 10/2012;
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    ABSTRACT: To determine the influence of ventilation tubes (VTs) on the formation of cholesteatoma and hearing in operated cleft palate patients with chronic ear problems. Retrospective 72-month follow-up of 116 operated cleft palate patients. Demographic data, clinical examination, and hearing were evaluated. The patients were divided according to age and type of cleft and subdivided in a subgroup with (VT+) or without ventilation tube (VT-). The effect of ventilation tubes (VT) on the incidence of cholesteatoma formation and degree of hearing loss in operated cleft palate patients with chronic ear problems. The overall incidence of cholesteatoma was 15.5% (VT+, 14.0%; VT-, 16.7%; not significant). Bilateral hearing loss of >20 dB remained in 14.0% of the VT+ patients and in 22.7% of the VT- patients (p < .05). Submucous cleft palate (SM CP) adults (n = 15) developed high rates of cholesteatoma and hearing loss of >20 dB (both 26.7%). Tube insertion had no influence on the development of cholesteatoma. Adults with submucous cleft palate especially require periodic otologic evaluation because they have Eustachian tube-related otologic disease and hearing loss at a higher rate than expected.
    The Cleft Palate-Craniofacial Journal 11/2009; 46(6):598-602.
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    ABSTRACT: Objective: To radiographically evaluate the prevalence of tooth abnormalities of number and position in the permanent dentition of individuals with complete bilateral cleft lip and palate. Design: Cross-sectional retrospective. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil. Patients: 205 individuals with complete bilateral cleft lip and palate. Interventions: Analysis of patient records and panoramic radiographs. Main outcome measures: Evaluation of hypodontia and supernumerary teeth and analysis of the position of the permanent maxillary lateral incisor in relation to the alveolar cleft. Results: Hypodontia was observed in 144 patients (70.24%) and the highest prevalence was observed for the maxillary lateral incisor. When both lateral incisors were present (43%), they were primarily located on the distal side of the cleft (25%). Supernumerary teeth were observed in 11.7% of individuals. Conclusion: Patients with cleft lip and palate presented high prevalence of hypodontia and supernumerary teeth. The prevailing characteristics of their location may suggest the presence of a similar genetic component for the occurrence of hypodontia and cleft. Key words: cleft lip, cleft palate, hypodontia, supernumerary.
    The Cleft Palate-Craniofacial Journal 10/2009;
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    ABSTRACT: A 41-year-old man with cleft palate presented with a wide dehiscence and missing teeth. Six implants had been placed for fabrication of an overdenture, which was unsatisfactory. A bar was waxed and cast for connection to the implants; semi-precision attachments were placed laterally for retention. A fixed partial denture was fabricated, and milled crowns were fabricated at the molar region to provide a guiding plane for insertion of a removable palatal obturator. Good swallowing and speech outcomes were achieved. This technique provided functional and esthetic comfort, enhanced oral hygiene, and improved the psychological aspect of the patient. Key words: Cleft palate; Palatal obturators; Dental Prosthesis, Implant-supported.
    The Cleft Palate-Craniofacial Journal 09/2009;
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    ABSTRACT: The purpose of this research was to develop a novel quantitative method of describing calvarial shape by using ellipsoid geometry. The pilot application of Ellipsoid Analysis was to compare calvarial form among individuals with untreated unilateral coronal synostosis, metopic synostosis, and sagittal synostosis and normal subjects. The frontal, parietal, and occipital bones of 10 preoperative patients for each of the four study groups were bilaterally segmented into six regions using three-dimensional skull reconstructions generated by ANALYZE imaging software from high-resolution computed tomography scans. Points along each segment were extracted and manipulated using a MATLAB-based program. The points were fit to the least-squares nearest ellipsoid. Relationships between the six resultant right and left frontal, parietal, and occipital ellipsoidal centroids (FR, FL, PR, PL, OR, and OL, respectively) were tested for association with a synostotic group. Results from the pilot study showed meaningful differences between length ratio, angular, and centroid distance relationships among synostotic groups. The most substantial difference was exhibited in the centroid distance PL-PR between patients with sagittal synostosis and metopic synostosis. The measures most commonly significant were centroid distances FL-PR and FL-PL and the angle OR-FR-PR. Derived centroid relationships were reproducible. Ellipsoid Analysis may offer a more refined approach to quantitative analysis of cranial shape. Symmetric and asymmetric forms can be compared directly. Relevant shape information between traditional landmarks is characterized. These techniques may have wider applicability in quantifying craniofacial morphology with increase in both specificity and general applicability over current methods.
    The Cleft Palate-Craniofacial Journal 09/2009; 46(5):487-93.
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    ABSTRACT: To investigate whether the craniofacial vertical and sagittal jaw relationship in patients with cleft lip and palate (CLP) differed from that of age-matched noncleft controls, before and after the pubertal growth spurt. Retrospective observational study. The study group comprised 126 patients with CLP, subdivided according to gender and cleft type, and the control group comprised 53 age-matched skeletal class I patients. Angular and linear measurements were taken from prepubertal and postpubertal lateral cephalograms of all patients. In patients with cleft lip and palate, the maxillary retrognathism became more remarkable with increasing age; whereas, the retrognathic position of the mandible became less pronounced as compared with controls. Reduced posterior midfacial height, a common prepubertal finding in patients with cleft lip and palate, was significant in postpubertal girls and young women with unilateral cleft lip and palate (p = .002). The total anterior facial height in male patients with bilateral cleft lip and palate was larger than in control patients (p = .002) after the pubertal growth spurt due to an increased anterior midfacial height. In male patients with unilateral cleft lip and palate, this finding was due to an increased anterior lower facial height (p < .001). Patients with cleft lip and palate treated according to a standardized treatment concept had adequate craniofacial jaw relationships after puberty. Despite a measured skeletal class I in both male and female patients with cleft lip and palate regardless of cleft type, there was a slight tendency toward a skeletal class III. Findings were similar for all groups of cleft lip and palate patients irrespective of the type of orthodontic treatment performed.
    The Cleft Palate-Craniofacial Journal 09/2009; 46(5):512-20.
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    ABSTRACT: To investigate the microbial etiology of suppurative chronic otitis media (SCOM) in patients with complete cleft lip and palate and isolated cleft palate and to determine the sensitivity of isolated microorganisms to antibiotics by drug diffusion from impregnated discs in agar and the minimum inhibitory concentration of each drug to these microorganisms by drug dilution in agar. Effusion samples of SCOM obtained from 40 patients with cleft lip and palate registered at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, at Bauru, Brazil, were bacteriologically analyzed by cultures. The isolated bacteria were submitted to an in vitro susceptibility test to clinically used drugs. Positive cultures were obtained in 100% of studied cases. Among the 57 strains observed, the most frequent were Pseudomonas aeruginosa (35%), Staphylococcus aureus (15.5%), Enterococcus faecalis (14%), and Proteus mirabilis (12%). The frequency of Gram-negative bacilli (enterobacteriaceae and nonfermentative bacilli) was 67%. Pseudomonas aeruginosa presented the highest sensitivity to ciprofloxacin, and enterobacteriaceae exhibited the highest sensitivity to gentamicin. The strains of S. aureus and E. faecalis presented the highest sensitivity to imipenem and sulfamethoxazole/trimethoprim, respectively. Patients with cleft lip and palate presenting with SCOM exhibited 100% positive cultures, with the highest frequency of Pseudomonas and enterobacteriaceae. With regard to the action of antibiotics, imipenem was effective against the four species of isolated microorganisms, followed by ciprofloxacin, which was effective against 75% of isolated species.
    The Cleft Palate-Craniofacial Journal 09/2009; 46(5):461-7.
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    ABSTRACT: To determine the percentage of patients with complete unilateral cleft lip and palate and complete bilateral cleft lip and palate treated at SickKids since birth who would benefit from orthognathic surgery. Retrospective cohort study. The review comprised records of 258 patients with complete unilateral cleft lip and palate and 149 patients with complete bilateral cleft lip and palate born from 1960 to 1989. Of these, 211 and 129 patients, respectively, had been treated at SickKids since birth. Patients with syndromes or associated anomalies were excluded. Patients who had undergone orthognathic surgery were recorded. For the remaining patients, arbitrarily set cephalometric criteria were used in order to identify the "objective" need for surgery. Lateral cephalometric radiographs taken beyond the age of 15 years were digitized using Dentofacial Planner cephalometric software. Of the 211 patients with complete unilateral cleft lip and palate, 102 (48.3%) were deemed to benefit from orthognathic surgery. For the complete bilateral cleft lip and palate sample, the percentage was 65.1% (84 of 129). Definitive information on presurgical orthopedics was available for a small subsample (101 patients) of the complete unilateral cleft lip and palate cohort. The need for orthognathic surgery for this group was slightly higher (59.4%, or 60 of 101). These results suggest that a considerable percentage of patients with a history of complete cleft lip and palate at our institution require orthognathic surgery. Factors that need to be considered in the interpretation of these results include the quest for improvement in the profile aesthetics; the fact that the Canadian health care system covers the costs of surgery, making it more accessible to the patients; and the inclusion in the above figures of patients who had orthognathic surgery solely for reasons of closure of previously ungrafted alveolar clefts and associated fistulae.
    The Cleft Palate-Craniofacial Journal 09/2009; 46(5):498-502.
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    ABSTRACT: To evaluate the parental craniofacial morphology in Chinese patients with sporadic nonsyndromic cleft lip with or without palate. A total of 98 parental pairs of nonsyndromic unilateral incomplete cleft lip children, 207 parental pairs of nonsyndromic complete cleft lip and palate children, and 206 normal persons from Sichuan University were involved in this study. A conventional cephalometric analysis was used to measure angles, linear distances, and their ratios. Two-sample Student's t tests and a multivariate discriminant analysis were applied to the data. Data indicate that the unaffected parents of nonsyndromic cleft lip children had on average significantly more acute cranial base angle (Angle N-S-Ba) and larger nasal width (NC-NC') (p < .01). The healthy parents of nonsyndromic cleft lip and palate children consistently displayed a more acute cranial base angle (Angle N-S-Ba), shorter palatal length (A- PNS) and maxillary length (PNS-ANS), a more obtuse gonial angle (Angle Me-Go-Ar), and a larger y-axis length (S-Gn) and nasal width (NC-NC') (p < .01). All these results indicate that the healthy parents of patients with nonsyndromic cleft lip with or without palate show distinct characteristics in craniofacial morphology. These parental craniofacial features are more obvious in patients with cleft lip with palate than those with cleft lip only. In general, the characteristics seem to be more distinct in the fathers than in the mothers of cleft patients.
    The Cleft Palate-Craniofacial Journal 09/2009; 46(5):468-76.