bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dentoalveolar Growth Inhibition Induced by Bone Denudation on Palates: A Study of Two Isolated Cleft Palates with Asymmetric Scar Tissue Distribution
Authors: Ishikawa Hiroyuki , Iwasaki Hiroshi , Tsukada Haruka , Chu Soowon , Nakamura Shinji , Yamamoto Katsuyuki 
Published: October 2018

Objective: This report presents two cases of isolated cleft palate with asymmetric distribution of postsurgical scar tissue determined by laser Doppler flowmetry. To determine the effect of mucoperiosteal denudation of the bone on maxillary alveolar growth, the analysis of dentoalveolar structures compared the affected side to the unaffected side of each case. Method: Two Japanese girls with isolated cleft palates were examined. Both subjects had undergone pushback operations (a modified version of the procedure of Wardill) for palatal repair at 18 months of age. Palatal blood flow was examined by laser Doppler flowmetry when the girls were 12 years old to determine the extent of postsurgical scar tissue over the denuded bone. To analyze the maxillary dentoalveolar structures three dimensionally, the whole surface of the upper dental cast was measured and recorded by an optical measuring device when the girls were 7 years old. Results and Conclusions: Analysis via flowmetry showed that the palatal scar tissue area was limited to the anterior tooth region on the right (unaffected) side but extended posteriorly to the premolar region on the left (affected) side in both subjects. The two girls had similar dentoalveolar structures, with the dental and alveolar arches deflected lingually at the deciduous molar area on the affected side. There were no differences in the buccolingual inclination of deciduous molars or in the vertical growth of the alveolar processes between the affected and unaffected sides. In both girls, bone denudation in the premolar region appeared to result in less than 3 mm of displacement of the teeth palatally, with no change in lingual inclination. Any effects of scar tissue on the vertical development of the alveolus were not substantiated.
Dentoalveolar Relations in Children Born with a Unilateral Cleft Lip and Palate (UCLP) in Western Australia
Authors: Johnson Nicola , Williams Alison C. , Singer Steven , Southall Peter , Atack Nikki , Sandy Jonathan R. 
Published: October 2018

Objective Our objective was to evaluate complete unilateral cleft lip and palate repair outcome in the Cleft Unit in Perth, Western Australia, by assessment of dentoalveolar relationships. Design This is a retrospective study. Setting Our subjects were individuals under the care of the cleft team in Perth, Western Australia. Participants All patients with unilateral cleft lip and palate and available 6-year casts who had been born since January 1, 1985, were identified from the cleft unit's database. The nature of the cleft was verified by examination of birth study models and photographs. A total of 54 such patients were identified. Main outcome Measures Main outcome measures were identified through dental arch relationship grading of study models using the 5 Year Old Study Model Index. Results Interexaminer and intraexaminer agreement kappa statistics revealed good to very good agreement using this index. The results indicate that the surgical outcome was graded as excellent, good, or fair for 77% of patients and poor or very poor for 23% of patients. Conclusions The results of the Western Australia study compare favorably to the overall U.K. outcome (the Clinical Standards Advisory Group study) but unfavorably to the results of some European centers, such as Oslo.
The Adult Unoperated Cleft Patient: Absence of Maxillary Teeth outside the Cleft Area
Authors: Lekkas C. , Latief B.S. , Ter Rahe S.P.N. , Kuijpers-Jagtman A.M. 
Published: October 2018

Objective The purpose of this study was to investigate the possible absence of teeth in the postcanine region of the upper jaw of the unoperated adult cleft patient. Method The study was performed on 266 dental casts of fully unoperated adult cleft patients. The patients were divided into four groups according to the type of the cleft: unilateral cleft lip and alveolus, unilateral cleft lip and palate, bilateral cleft lip and alveolus, and bilateral cleft lip and palate. Results No absence of permanent teeth in the canine and postcanine area of the upper jaw could be found. Conclusion The results are in contradiction with the established hypothesis that absence of teeth outside the cleft area of the maxilla is due to an unknown congenital factor. On the contrary, the findings support the hypothesis that surgery for the closure of the hard palate in early childhood is the most important etiological factor for the absence of teeth outside the cleft area in the early operated cleft patient. The superficial position of the tooth germs (at the time of the palatal surgery), especially those of the premolars, supports this hypothesis.
Radiographic Determination of the Position of the Maxillary Lateral Incisor in the Cleft Alveolus and Parameters for Assessing its Habilitation Prospects
Authors: Shashua Dafna , Omnell M. Lena 
Published: October 2018

Objective Develop patient selection criteria and guidelines for the diagnostic work-up for early secondary alveolar bone graft designed to accommodate a lateral incisor in the cleft. Design A literature review with clinical examples. Interventions For the majority of cleft lip and palate (CLP) patients, the timing of the secondary alveolar bone graft procedure is devised to accommodate the eruption of the maxillary canine. However, when the lateral incisor is present in the cleft area, a decision may be made to perform early grafting in order to salvage an additional tooth. Appropriate case selection for this intervention is the key for successful dental habilitation in the cleft area. Results and Conclusions Attempts to maintain the lateral incisor are recommended only if the tooth contributes to the comprehensive orthodontic and restorative patient care and when the presence of a lateral incisor with adequate size, shape, and proper position may be demonstrated. For optimal decision making, the position, form, and periodontal ligament support of the lateral incisor should be assessed. Evaluation of these parameters is based chiefly on radiographic imaging. Occlusal projections and traditional tomography may augment the information available from periapical and panoramic radiographs. However, each of these has benefits and drawbacks that require consideration.
Combined Bone Grafting and Delayed Closure of the Hard Palate in Patients with Unilateral Cleft Lip and Palate: Facilitation of Lateral Incisor Eruption and Evaluation of Indicators for Timing of the Procedure
Authors: Lilja Jan , Kalaaji Amin , Friede Hans , Elander Anna 
Published: October 2018

Objective To compare outcomes of bone grafting performed before eruption of the lateral incisor to outcomes of grafting performed before eruption of the canine and to evaluate the long-term results of bone grafting combined with delayed closure of the hard palate during mixed dentition. Design Seventy consecutive patients (52 men and 18 women) with complete unilateral cleft lip and palate were studied. All patients underwent bone grafting with simultaneous closure of the cleft in the hard palate at the stage of mixed dentition. The velum had been repaired in infancy. Mean age for the bone grafting procedure was 8.4 years. Bone grafting was performed to facilitate eruption of the lateral incisor in 43 (61%) of the patients and to facilitate eruption of the canine in the remaining 27 (39%) patients. Intraoral radiographs were used to evaluate the morphologic characteristics of the cleft and the stage of eruption of the permanent lateral incisor and canine before bone grafting. Mean follow-up time was 4.0 years (range, 1–10.1 years). Results The mean time for the surgery, which included bone grafting and repair of the residual cleft in the hard palate, was 109 minutes, and the mean amount of bleeding was 121 ml. The rate of dehiscence in the flap covering the alveolar bone graft was 14%, and the rate of total failure of bone grafting was 3%. An oronasal fistula developed in the hard palate of 13% of patients, but the fistula was of sufficient size to serve as an indication for reoperation in only 6%. The postoperative alveolar bony height in the cleft area was more than 75% of the normal height in 94% of patients. Closure of the cleft space in the dental arch was performed or planned to be achieved orthodontically in 91% of patients. When bone grafting was performed to facilitate eruption of the lateral incisor, the cleft space was closed orthodontically in 100% of patients. The optimal indicator for timing of the bone grafting procedure from an orthodontic point of view was when the permanent lateral incisor or the canine close to the cleft was covered by a thin shell of bone (i.e., 7–9 years of age).
Closure of Palatal Fistula with a Local Mucoperiosteal Flap Lined with Buccal Mucosal Graft
Authors: Honnebier M.B.O.M. , Johnson D.S. , Parsa A.A. , Dorian A. , Parsa F.D. 
Published: October 2018

Objective Oro-nasal fistula is a common complication of palatoplasty. Current methods for fistula repair utilize mucoperiosteal flaps or pedicled flaps. These procedures are often cumbersome and leave a raw nasal surface, which may increase the incidence of postoperative risks and problems. In addition, the recurrence rate of the fistula is as high as 34%. We propose a simple two-layer method of fistula repair to avoid recurrences. Design A standard mucoperiosteal flap is raised on the oral side. A buccal mucosal graft is harvested from the cheeks and sutured to the nasal side of the flap that is then inset into the fistula. Setting Patients were either referred to the senior author's private practice (four patients) or were patients who had previously been operated on by the senior author himself (three patients). Subjects Study subjects consisted of seven patients, four males and three females, ages 14 months to 8 years. All patients had previously undergone cleft palate repair, complicated by subsequent oro-nasal fistula formation. Interventions All patients underwent oro-nasal fistula repair under general anesthesia with a local mucoperiosteal flap lined with buccal mucosal grafts placed on the nasal side of the flap. Results In all cases, the fistula was completely closed at first attempt without complications. Patients were followed for a minimum of 2 years, without evidence of recurrence. Conclusions Our proposed surgical procedure for fistula closure using a standard mucoperiosteal flap lined with a buccal mucosal graft is a suitable alternative for the repair of postpalatoplasty oro-nasal fistulas. Further study and long-term follow-up is needed to establish this method as a new standard form of repair.
The Anchor of the Nasal Ala in Cleft Lip-Nose Patients: A Morphological Description and a New Surgical Approach
Authors: Morselli Paolo G. 
Published: October 2018

Objective The purpose of this article is to describe a morphological condition that is readily seen in both primary and secondary deformed noses of cleft patients and to present a new surgical technique to correct this specific deformity that afflicts the alar dome. This anomaly resembles a taut cord-like tissue that runs vertically from the pyriform aperture and is anchored onto the alar cartilage, thus impeding the cartilage's normal growth process. This new surgical technique releases the anchor and corrects the deformity of the nasal rim by using a triangular flap V-Y advancement technique. Results From 1994 to 1997, 88 cleft lip-nose cases were operated on by the author using the triangular flap V-Y advancement technique for releasing the anchor. Forty-two cases were primary repairs and 46 were secondary repairs. Conclusions By studying the normal and pathological anatomy of the nose and its proportions, the surgeon can obtain ideas for new surgical corrective techniques that can be used to restore anatomical balance and harmony between the nose and the face. Only in the last 15 to 20 years has the plastic surgeon begun to be interested in primary rhinoplasty in cleft lip-nose patients. Within this time, many different techniques have been proposed. All primary and secondary cases that have undergone this specific technique for release of the anchor have shown good results for restoring the height of the alar dome's affected side to that of the noninvolved side, thus establishing a more anatomically balanced nose.
Skull Base Factors in Relation to Hearing Impairment in Cleft Palate Children
Authors: Carrie S. , Sprigg A. , Parker A.J. 
Published: October 2018

Objective This investigation was performed to determine if an easily measurable, reproducible, bony parameter could be identified that might predict hearing loss in cleft palate children. Subjects In this prospective study performed at the Sheffield Children's Hospital (U.K.), 34 children with successfully repaired cleft palate who responded to a postal request for volunteers were assessed clinically, audiologically, and by lateral soft tissue neck radiography. Six children were excluded because of previous otologic surgery or poor quality radiographs. Twenty-six children who had the same series of investigations were randomly selected from routine otolaryngological outpatient clinics and acted as controls. Methods The sphenopalatine angle (SPA), which relates the facial and cranial components of the skull, was measured on each child's radiograph. Results The median SPA in the cleft palate group was significantly greater than in the control group (p = 0.01). In those cleft palate children with a hearing loss the sphenopalatine angle was smaller than in their normal hearing counterparts (p = 0.01). No significant difference was found in the SPA between the hearing loss and normal hearing controls. There was no significant difference in age ranges between the hearing and hearing loss subgroups in each of the two primary groups. Conclusions In this study, those cleft palate children with a smaller SPA have a greater incidence of hearing loss.
Comparison between Palatal Configurations in UCLP Infants with and without a Hotz Plate until Four Years of Age
Authors: Mishima Katsuaki , Mori Yoshihide , Sugahara Toshio , Minami Katsuhiro , Sakuda Masayoshi 
Published: October 2018

Objective To evaluate the efficacy of presurgical orthopedic treatment three dimensionally, we previously developed a novel measuring system and described the efficacy of the treatment until 18 months of age. The aim of this study was to compare palatal configuration in complete unilateral cleft lip and palate (UCLP) infants fitted with a Hotz plate to those without it until four years of age using the same measuring system. Patients Twenty complete UCLP infants were divided into two groups. A Hotz plate was used with 12 patients who first visited our clinic from January 1990 to March 1992 and was not used with an additional eight patients who first visited from April 1992 to July 1993. Main outcome Measures Palatal casts taken from birth until four years of age were measured three dimensionally and were compared between the two groups. Results and Conclusions The width of the palate was larger in the group with a Hotz plate than in the group without it at four years of age. No difference was observed between the anteroposterior distance of the palate in the two groups at four years of age. Similarly, the alveolar arch form did not differ between the two groups. The degree of curvature of the palatal surface was smaller in the group with a Hotz plate than in the group without it. These data were similar to data obtained at 18 months of age.
An Epidemiologic Study of Oral Clefts in Iran: Analysis of 1669 Cases
Authors: Rajabian Mohammad Hossain , Sherkat Mehdi 
Published: October 2018

Objective The objective of this study was to assess the epidemiology and some genetic aspects of oral clefting in Iran. Design The study was a 15-year cross-sectional (prevalence) study from August 1976 to September 1991. Setting The setting for the study was two plastic surgery departments, both mostly referral centers, and a maternity hospital in Iran. Participants The participants were 1669 consecutive surgical cases with oral clefts (79% between 1 day and 18 months of age), registered in two centers. In a parallel study, 19,369 livebirths born in a maternity hospital within the same period were surveyed to ascertain prevalence of clefting at birth. Normal children of this population were used as the control group. Samples were analyzed by prevalence of clefting at birth, type of oral cleft, side of clefting, sex ratio, associated malformations, clefts in relatives, and parental consanguinity. Results The prevalence of clefts was 1.03 per 1000 births. Cleft lip (without cleft palate) had a higher (34.9%) and cleft palate alone had a significantly lower prevalence (17.4%) than expected. Cleft lip (without cleft palate) was more common in females (53.6%) than in males (46.4%). The rate of associated malformations in cleft patients (7.73%) was higher than in controls (0.093%). Association between clefting and consanguinity was significant (45.8% in cases versus 43.1% in controls). Occurrence of noncleft congenital malformations among first-degree relatives of our cases (2.77%) was nearly two times that of controls (1.55%). Conclusion Our study reveals that the population incidence of oral clefts in Iran is much closer to Europian than Arab-African or South East Asian countries. However, significant variations in other epidemiologic and some genetic features were observed.
Are Infants with Orofacial Clefts at Risk for Insecure Mother-Child Attachments?
Authors: Maris Catherine L. , Endriga Marya C. , Speltz Matthew L. , Jones Karen , Deklyen Michelle 
Published: October 2018

Objective Several risk factors in the early lives of children with clefts are believed to interfere with their development of secure attachments to parents; however, this possibility has rarely been studied empirically. This study compared 12- and 24-month attachment classifications of infants with cleft palate (CP), infants with cleft lip and palate (CLP), and a comparison group of unimpaired infants (COMP). Method Twenty-two CP infants, 24 CLP infants, and 61 matched COMP infants were assessed at 12 and 24 months of age in an urban children's hospital. At both visits, mothers and infants participated in the Strange Situation, which was videotaped and subsequently coded for patterns of attachment behavior. Results CP infants displayed a lower rate of 12-month attachment security than infants in the CLP or COMP groups. By 24 months, no diagnostic group differences in attachment classification were found. Stable 12- to 24-month attachment classifications were less likely in the CP group (36.3%) than in the COMP (62.3%) group. CP infants who were insecure at 12 months were more likely to become secure by 24 months than were CLP or COMP group infants. Conclusions In contrast to previous theory and clinical speculation, the facial appearance of infants with CLP does not appear to affect the early mother-infant relationship adversely. The infancy period is marked by attachment instability for infants with CP, who demonstrated lower-than-expected rates of security at 12 months. However, these problems resolved in nearly all cases by 24 months of age. Most infants with clefts emerged from the first 2 years of life with secure maternal attachments.
Age-Related Changes in Intracranial Pressure in Rabbits with Uncorrected Familial Coronal Suture Synostosis
Authors: Fellows-Mayle Wendy K. , Mooney Mark P. , Losken H. Wolfgang , Dechant Jason , Cooper Gregory M. , Burrows Annie M. , Smith Timothy D. , Pollack Ian F. , Siegel Michael I. 
Published: October 2018

Objective Chronic, elevated intracranial pressure (ICP) in craniosynostotic infants may result in ocular and neurocapsular problems; however, not all infants exhibit elevated ICP. Clinical ICP studies are further confounded by small and heterogeneic samples, multiple-suture involvement, and varying surgical management protocols. The present study was designed to describe longitudinal changes in ICP in a large, homogenous sample of rabbits with uncorrected familial, nonsyndromic coronal suture synostosis. Methods Ninety-one rabbits were divided into four groups: (1) normal rabbits (n = 28), (2) rabbits with delayed-onset coronal suture synostosis (DOCS; n = 25), (3) rabbits with unilateral coronal suture synostosis (UCS; n = 12), and (4) rabbits with bilateral coronal suture synostosis (BCS; n = 26). ICP was measured at 24 and 42 days of age using a Codman epidural microtransducer. Results Rabbits with BCS had a significantly (p < .05) higher mean ICP at 25 days of age than rabbits in the other three groups by approximately 146%. However, by 42 days of age, mean ICP in normal control rabbits and rabbits with DOCS was significantly (p < .01) increased compared with their mean ICP values seen at 25 days of age, while mean ICP in BCS rabbits significantly (p < .01) decreased (by 32%) over the same time period. ICP in rabbits with UCS was between that seen in normal control rabbits and rabbits with BCS and did not significantly (p > .05) change over time. Conclusions These findings suggest that the degree of suture involvement may be related to early increases in ICP. Possible multifactorial explanations for intracranial decompression and compensation in the craniosynostotic rabbit model are discussed.
Dental Arch Relationships in Yorkshire Children with Unilateral Cleft Lip and Palate
Authors: Morris David O. , Roberts-Harry Dai , Mars Michael 
Published: October 2018

Objective To assess the dental arch relationships of children with a complete unilateral cleft lip and palate (UCLP), born consecutively between 1983 and 1987, who had undergone primary cleft repair in the West Yorkshire region of the United Kingdom. The treatment outcome of this UCLP sample was then compared with the results of a previously published intercenter European study. Design A retrospective study with standardized record collection and blind assessment. Setting Regional dental hospital providing secondary and tertiary health care to the local population. Patients 35 UCLP patients whose primary repair had been performed within West Yorkshire. Interventions Dental casts obtained for each subject within 12 months of their 10th birthday. Main outcome Measures The West Yorkshire models were randomly mixed with an anonymous sample of 115 UCLP cases from other cleft centers in the U.K. The dental arch relationships of the 10-year-old models were assessed by applying the Goslon Yardstick. Results One-third of the West Yorkshire cleft sample were rated as belonging to Goslon group 2 (good result), another third to group 3 (fair result), and the remaining third to groups 4 and 5 (poor/very poor result). Numerically, the results were of a slightly higher standard than that previously published for other U.K. and European cleft centers but were inferior to the treatment outcome of two European centers. No statistically significant differences were found between the outcome results of the West Yorkshire group and the other cleft centers. Conclusions These results provide useful baseline data against which progress in achieving improved treatment outcome for West Yorkshire UCLP children can be determined by future research.
Lipoma of the Cleft Soft Palate: A Case Report of a Rare Congenital Anomaly
Authors: Mahabir Raman C. , Mohammad Jamal A. , Courtemanche Douglas J. 
Published: October 2018

Objective Congenital tumors of the oral cavity are extremely uncommon. The teratoid tumors (epiganthi, dermoid, and hairy polyps) account for almost all of the reported cases and are not infrequently associated with cleft of the soft palate. Of the remaining tumors in the pediatric cleft palate population, infantile lipoma of the oral cavity is exceedingly rare. A case of a congenital lipoma associated with a cleft of the soft palate is presented. The review of the literature, the description of the lesion, the diagnosis, and the management of this finding are outlined.