Early Dimensional Changes in Maxillary Cleft Size and Arch Dimensions of Children with Cleft Lip and Palate and Cleft Palate.
ABSTRACT Abstract Objective: To study changes in cleft size and maxillary arch dimensions from infancy to 5 years and evaluate these changes in relation to performed surgical procedures. Design: Retrospective longitudinal study. Setting: The Cleft Palate Centre, University Hospital Uppsala, Sweden. Patients: Dental study models of 79 consecutive children, 28 with unilateral cleft lip and palate (UCLP), 39 with cleft palate (CP) and 12 with Pierre Robin Sequence (PRS) were analyzed. Interventions: Lip repair at 3-4 months, soft palate repair at 6-10 months and hard palate repair at 25-26 months of age. Main Outcome Measures: Cleft size was measured before each surgical intervention up to 2 years and arch dimensions were measured before each surgical intervention and at 5 years. Results: Cleft widths decreased from infancy up to 2 years in all groups. The antero-posterior cleft length in CP was unchanged between 6 months and 2 years. Arch widths at C-C1and T-T1 and also the change over time in C-C1 and T-T1 differed significantly between the groups. Conclusions: Cleft widths decreased after lip closure and/or soft palate closure. The UCLP children had wider maxillary arch dimensions than the CP and PRS children during the first years of life, but after hard palate closure the transverse growth was reduced in the UCLP children. At 5 years the UCLP children had smaller maxillary widths than the CP and PRS children especially at the level of the cuspids. Key words: cleft lip and palate, cleft palate, cleft size, maxillary arch dimensions and two-stage palatal repair.
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ABSTRACT: In order to visualize and quantify the direction and extent of morphological upper-jaw changes in infants with unilateral cleft lip and palate (UCLP) during early orthodontic treatment, a three-dimensional method of cast analysis for routine application was developed. In the present investigation, this method was used to identify reaction patterns associated with specific cleft forms. The study included a cast series reflecting the upper-jaw situations of 46 infants with complete (n=27) or incomplete (n=19) UCLP during week 1 and months 3, 6, and 12 of life. Three-dimensional datasets were acquired and visualized with scanning software (DigiModel®; OrthoProof, The Netherlands). Following interactive identification of landmarks on the digitized surface relief, a defined set of representative linear parameters were three-dimensionally measured. At the same time, the three-dimensional surfaces of one patient series were superimposed based on a defined reference plane. Morphometric differences were statistically analyzed. Thanks to the user-friendly software, all landmarks could be identified quickly and reproducibly, thus, allowing for simultaneous three-dimensional measurement of all defined parameters. The measured values revealed that significant morphometric differences were present in all three planes of space between the two patient groups. Patients with complete UCLP underwent significantly larger reductions in cleft width (p<0.001), and sagittal growth in the complete UCLP group exceeded sagittal growth in the incomplete UCLP group by almost 50% within the first year of life. Based on patients with incomplete versus complete UCLP, different reaction patterns were identified that depended not on apparent severities of malformation but on cleft forms.Fortschritte der Kieferorthopädie 06/2013; DOI:10.1007/s00056-013-0153-0 · 0.82 Impact Factor
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ABSTRACT: To celebrate the 50th year of the Cleft Palate-Craniofacial Journal we look back to where we started in 1964 and where we are now, and we speculate about directions for the future in a "Then and Now" editorial series. This editorial examines changing trends and perspectives in anatomical, basic science, and genetic studies published in this 50-year interval. In volume 1 there were 45 total papers, seven (16%) of which were peer-reviewed basic science and genetic articles published: four in anatomy, three in craniofacial biology, and none in genetics. In contrast, in volume 50, of 113 articles there were 47 (42%) peer-reviewed basic science and genetic articles published: 30 in anatomy, five in craniofacial biology, and 12 in genetics. Topical analysis of published manuscripts then and now reveal that similar topics in anatomy and craniofacial biology are still being researched today (e.g., phenotypic variability, optimal timing of surgery, presurgical orthopedics, bone grafting); whereas, most of the more recent papers use advanced technology to address old questions. In contrast, genetic publications have clearly increased in frequency during the last 50 years, which parallels advances in the field during this time. However, all of us have noticed that the more "cutting-edge" papers in these areas are not being submitted for publication to the journal, but instead to discipline-specific journals. Concerted efforts are therefore indicated to attract and publish these cutting-edge papers in order to keep the Cleft Palate-Craniofacial Journal in the forefront of orofacial cleft and craniofacial anomaly research and to provide a valuable service to American Cleft Palate-Craniofacial Association members.The Cleft Palate-Craniofacial Journal 03/2014; 51(3). DOI:10.1597/14-022 · 1.11 Impact Factor