OBJECTIVE: To assess modelled facial development of infants with unilateral cleft lip (CL) and cleft lip and palate (UCLP) compared to controls up to two years of age. DESIGN AND PARTICIPANTS: A total of 209 facial images of children (CL: n = 37; UCLP: n = 39; controls: n = 137) were obtained in four age categories (T0 = 0.2-0.5; T1 = 0.6-1.0; T2 = 1.1-1.5; T3 = 1.6-2.0 years) and were evaluated using stereophotogrammetry and geometric morphometry. All patients underwent lip surgery before T0, patients with UCLP underwent palatoplasty (T0, T1 before palatoplasty; T2, T3 after palatoplasty). RESULTS: In patients with CL, the forehead was significantly retracted (p ≤ 0.001), while the supraorbital and ocular regions were prominent (p ≤ 0.001). The oronasal region appeared convex (p ≤ 0.001). The lower lip and chin were non-significantly protruded. In patients with UCLP, a significantly retracted forehead and prominent supraorbital region were apparent (p ≤ 0.001). A retrusive oronasal region (p ≤ 0.001) was observed in the middle face. The chin was anteriorly protruded (p ≤ 0.01). No progression of deviations was found with increasing age. After the first year, a slight improvement in the morphological features became apparent. The shape variability of the clefts and controls overlapped, suggesting a comparable modelled facial development. CONCLUSIONS: The facial morphology of individuals with cleft was comparable to the norm. Shape deviation was apparent in the oronasal region, forehead, and chin, which minimised with increasing age even in complete clefts.
- Klíčová slova
- 3D facial morphology, controls., geometric morphometrics, infants, neonatal cheiloplasty, unilateral cleft lip, unilateral cleft lip and palate,
- MeSH
- fotogrammetrie * metody MeSH
- kefalometrie MeSH
- kojenec MeSH
- lidé MeSH
- maxilofaciální vývoj MeSH
- obličej anatomie a histologie abnormality MeSH
- předškolní dítě MeSH
- průřezové studie MeSH
- rozštěp patra * chirurgie diagnostické zobrazování patologie MeSH
- rozštěp rtu * chirurgie patologie MeSH
- studie případů a kontrol MeSH
- zobrazování trojrozměrné * MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: There are minimal data available on nutrition after early repair of cleft lip and the factors influencing initiation of breastfeeding. This study assessed the impact of the length of surgery, length of ventilation support, and duration of hospital stay on breastfeeding rates after early cleft lip surgery. DESIGN: This is a prospective observational cohort study comparing 2 hospitals providing early surgical repair of facial clefts from January 2014 to December 2016. Both hospitals are designated as Baby-Friendly Hospitals. Demographic and anthropometric data from mothers and newborns were recorded. SETTING: Tertiary neonatal and pediatric surgery center. PATIENTS: Hospital A: 61 newborns, Hospital B: 157 newborns. INTERVENTIONS: Early (day 5 to 14) cheiloplasty in newborns with cleft lip or cleft lip and palate. MAIN OUTCOME MEASURES: Influence of duration of hospital stay, length of operation, and artificial ventilation on the rate of breastfeeding. RESULTS: Significantly, more newborns were breastfed following early surgical repair of an isolated cleft lip compared to those with both cleft lip and palate, in both hospitals (hospital A 82% vs 0%, P = .0001, hospital B 66% vs 5%, P = .0001). Duration of hospital stay, length of operation, and duration of artificial ventilation did not significantly affect the rate of breastfeeding. CONCLUSIONS: The factors associated with early cleft lip repair (length of operation, length of ventilation support, and duration of hospital stay) do not affect breastfeeding rate.
- Klíčová slova
- breastfeeding, cleft lip, early surgery, nutrition,
- MeSH
- délka pobytu MeSH
- dítě MeSH
- kojenec MeSH
- kojení MeSH
- lidé MeSH
- novorozenec MeSH
- prospektivní studie MeSH
- rozštěp patra * chirurgie MeSH
- rozštěp rtu * chirurgie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
OBJECTIVE: To evaluate the effect of the timing of secondary alveolar bone graft (SABG) on craniofacial morphology in patients with complete unilateral cleft lip and palate (UCLP). DESIGN: Single-center retrospective assessment of consecutively treated nonsyndromic patients with complete UCLP. PARTICIPANTS: One hundred sixty-seven patients (108 males, 59 females) with complete UCLP in whom the cleft was repaired with 1-stage method at approximately 8 months of age. The age of 128 patients at SABG varied from 1.4 to 11.5 years (SABG group), while 39 patients still awaited SABG at the moment of cephalometric evaluation (no-SABG group). METHODS: Craniofacial morphology was assessed on lateral cephalograms taken at 10 years of age (standard deviation = 0.8; range: 7.5-12.3) using linear and angular measurements. T tests and regression models were made to analyze data. RESULTS: Regression models demonstrated that the effect of SABG on the craniofacial morphology was limited-cephalometric variables which were statistically significantly different between SABG and no-SABG groups showed no association with the timing of SABG when (1) age of primary repair of the cleft, (2) age of cephalometric evaluation, (3) cleft side, (4) gender, and (5) operator were controlled for. Only the length of the maxilla (Condylion-point A) was affected-1-year delay of SABG corresponded with an increase in Co-point A distance by 0.52 mm. However, adjusted R2 of the model was 0.11. CONCLUSIONS: Our findings cautiously indicate that SABG performed before 8 years of age can have limited negative effect on craniofacial morphology. Nevertheless, our results should be confirmed by cleft centers practicing alternative surgical repairs of the cleft.
- Klíčová slova
- bone grafting, cephalometry, craniofacial growth, craniofacial morphology, maxilla,
- MeSH
- alveolární kostní štěp * MeSH
- dítě MeSH
- kefalometrie MeSH
- lidé MeSH
- maxila MeSH
- retrospektivní studie MeSH
- rozštěp patra * MeSH
- rozštěp rtu * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: To compare the influence of 3 different time protocols of cleft lip and palate operations on the growth of the dentoalveolar arch in patients with unilateral cleft lip and palate (UCLP). MATERIALS AND METHODS: We evaluated 64 plaster casts of 8-year-old boys with UCLP operated on according to 3 different time protocols: lip repair at the age of 6 months and palate repair at 4 years, lip repair at 3 months and palate repair at 9 months, and neonatal lip repair and palate repair at 9 months. The control group contained 13 plaster casts of 8-year-old boys. The dentoalveolar arch width was measured between deciduous canines and between the second deciduous molars; the length was measured between incisive papilla and the line connecting both tuber maxillae. RESULTS: All measured distances were statistically significantly smaller in boys with UCLP than in the control group. Intercanine width was not statistically significantly different between the patients operated on according to the different time protocols. In comparison to the lip repair at 6 months and palate repair at 4 years, the intermolar width was statistically significantly smaller in the group with neonatal lip repair; the alveolar arch length was statistically significantly shorter in both groups with lip repair performed neonatally or at 3 months. CONCLUSIONS: The length of the dentoalveolar arch is shorter after surgical repair of cleft lip neonatally or at the age of 3 months. Cleft palate repair at 9 months can contribute to a reduction in the width of the dentoalveolar arch.
- Klíčová slova
- cleft lip, cleft palate, dimension, hypoplasia, maxilla, operation timing,
- MeSH
- dítě MeSH
- lidé MeSH
- maxila MeSH
- novorozenec MeSH
- ret * chirurgie MeSH
- rozštěp patra * chirurgie MeSH
- rozštěp rtu * chirurgie MeSH
- zubní oblouk anatomie a histologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVE: Three-dimensional analysis of palate size and shape in 30 patients with complete bilateral cleft lip and palate (BCLPc) at the stage of permanent dentition. DESIGN: Cross-sectional study based on laser scanning. SUBJECTS: Thirty dental casts of boys approximately 15 years old with BCLPc and 28 dental casts of healthy boys of the same age. INTERVENTIONS: Arched-lip suture with periosteoplasty and push-back of the palate with pharyngeal-flap surgery. MAIN OUTCOME MEASURES: Data on palate height in the 210 defined locations and on palate widths and profile area in 10 transverse sections. RESULTS: The palate in patients with BCLPc was conical and narrower than in control study subjects, much more anteriorly than posteriorly. From the canines posteriorly, the palate was of almost constant height of 10 mm in the midline, being higher than in control study subjects at this location and lower more posteriorly (by 24% to 29% between molars). The area of transverse sections was reduced as compared with control study subjects from the first premolars posteriorly and reached more than 40% between molars. The length of the palate up to the first molars was not changed. CONCLUSION: BCLPc subjects exhibited narrow, low, and flat palate. Palate size and shape differences indicate a substantial reduction of the space for the tongue.
- MeSH
- asymetrie obličeje patologie MeSH
- dentice trvalá MeSH
- dítě MeSH
- Fourierova analýza MeSH
- lidé MeSH
- maxilofaciální vývoj MeSH
- mladiství MeSH
- moire topografie MeSH
- neparametrická statistika MeSH
- počítačové zpracování obrazu MeSH
- průřezové studie MeSH
- rozštěp patra patologie chirurgie MeSH
- rozštěp rtu patologie chirurgie MeSH
- šicí techniky MeSH
- zubní modely * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVE: Three-dimensional analysis of palate size and shape in patients with complete unilateral cleft lip and palate (UCLP) at the stage of permanent dentition. SUBJECTS: Thirty randomly selected dental casts of boys approximately 15 years old with complete UCLP and 28 dental casts of normal boys of the same age. INTERVENTIONS: All patients underwent lip repair according to Tennison with primary periosteoplasty (mean age 8.5 months) and palate repair by pushback and pharyngeal flap surgery (mean age 4.9 years). MAIN OUTCOME MEASURES: Data on the palate height in 210 defined locations. RESULTS: The palate in patients with UCLP was narrower throughout its whole extent, more anteriorly than posteriorly. From the canines posteriorly, it was also lower, and the difference as compared with controls increased in a posterior direction up to the level of second premolars (up to 30%) and then slightly diminished (to 21% between the first molars). The reduction of area of transverse sections reached 45% between premolars and 39% between first molars. The palate in the anterior portion was highest on the cleft side and in a posterior direction the maximum height of the palate shifted toward the midline and even beyond that line toward the noncleft side. Palatal height did not depend on dentoalveolar arch width. CONCLUSION: The smaller width and height of the palate confirm the substantially reduced space for the tongue in patients with UCLP. The reduction is only slightly larger than in previously examined patients with isolated cleft palate. Palatal vault is asymmetrical, highest anteriorly on the cleft side and posteriorly on the noncleft side.
- MeSH
- asymetrie obličeje patologie MeSH
- dentice trvalá MeSH
- dítě MeSH
- Fourierova analýza MeSH
- kefalometrie MeSH
- lidé MeSH
- maxilofaciální vývoj * MeSH
- mladiství MeSH
- moire topografie MeSH
- počítačové zpracování obrazu MeSH
- referenční hodnoty MeSH
- rozštěp patra patologie MeSH
- rozštěp rtu patologie MeSH
- studie případů a kontrol MeSH
- tvrdé patro patologie MeSH
- zubní modely MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVE: Fourier transform profilometry was used for the three-dimensional measurement of maxillary dental casts to analyze the size and shape of the palate. The objective of this study was to test the accuracy of the measuring system and determine the precision and reliability of the measurement METHODS: Images of dental casts were analyzed using newly developed measuring software. Based on five landmarks located on the alveolar ridge, the measuring software constructed 10 transversal sections of the palate. In each section profile, the width, area, and 23 height variables were assessed. SUBJECTS: Maxillary dental stone casts of 25 healthy girls, 14.1 to 15.3 years of age, were studied. RESULTS: The technical error of measurement exceeded 5% of the size of the measurement only in variables with means less than approximately 3 mm. In fact, such small absolute dimensions were exhibited only by the palate height in anterior profile 2 and the palate height at the margins of other profiles. Reliability of the measurements was found to be very high for the width and area of the profiles. For height measurements, the coefficient of reliability was slightly lower at the profile margins than near the midline. Nevertheless, only three height variables showed a coefficient of reliability lower than 0.90. The coefficients of reliability of other height measurements of profiles 3 through 10 were only sporadically lower than 0.97. CONCLUSION: With regard to the accuracy of the measuring system as well as the precision and reliability of the measurement, this method proved to be a suitable tool for studying palatal morphology.
- MeSH
- Fourierova analýza MeSH
- kefalometrie metody MeSH
- lidé MeSH
- maxila MeSH
- mladiství MeSH
- patro anatomie a histologie MeSH
- reprodukovatelnost výsledků MeSH
- zobrazování trojrozměrné metody MeSH
- zubní modely * MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- práce podpořená grantem MeSH
OBJECTIVE: Three-dimensional analysis of palate size and shape in patients with isolated cleft palate at the stage of permanent dentition. DESIGN: Cross-sectional study using Fourier transform profilometry. SUBJECTS: Twenty-nine randomly selected dental casts of approximately 15-year-old boys with isolated cleft palate and 28 dental casts of normal boys of the same age. INTERVENTIONS: All patients were operated on by the same method (pushback and pharyngeal flap surgery) at a mean age of 4.5 years. MAIN OUTCOME MEASURES: Data on the palate height in 210 defined locations (pixels). RESULTS: The palate in isolated clefts is narrower throughout its whole extent and lower from the level of the first premolars. The difference, as compared with controls, increases in a posterior direction. At the level of the first molars, palatal height is reduced by one-quarter, the area of the transversal section by more than one-third. The shaping of the palate vault is, on average, symmetrical with a marked interindividual variability. Palatal height does not depend on the width of the dentoalveolar arch, and the height of the primary palate is not reduced. CONCLUSION: The smaller width and reduced height from the level of the first premolars posteriorly confirm the substantially reduced space available for the tongue in patients with isolated cleft palate. Deviations are on the average symmetrical, and the anterior part of the palate is not shallower.
- MeSH
- dentice trvalá MeSH
- Fourierova analýza MeSH
- kefalometrie MeSH
- lidé MeSH
- mladiství MeSH
- moláry patologie MeSH
- patro patologie MeSH
- počítačové zpracování obrazu MeSH
- premolár patologie MeSH
- processus alveolaris patologie MeSH
- průřezové studie MeSH
- rozštěp patra patologie chirurgie MeSH
- špičák patologie MeSH
- zobrazování trojrozměrné MeSH
- zubní modely MeSH
- zubní oblouk patologie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
OBJECTIVE: The objective of this study is to evaluate whether manipulation of the nasal septum, its release, and changing of its abnormal position in infancy has an impact on maxillary growth and facial development in patients with unilateral cleft lip and palate. DESIGN: Roentgencephalometric investigation. SETTING: Cleft Centre at the Clinic of Plastic Surgery, Prague. PATIENTS: Two consecutive groups of male patients (n = 32 and 30) with complete unilateral cleft lip and palate without associated malformations at 15 years of age. INTERVENTIONS: The patients were operated on by the same team of surgeons and by the same method (lip: Tennison and primary periosteoplasty; palate: pushback with pharyngeal flap surgery), with the exception of complete primary repositioning of the nasal septum performed only in one group. MAIN OUTCOME MEASURES: Roentgencephalometric data of both series of patients were compared with a t-test. All measurements were performed by one investigator. RESULTS: Patients with primary repositioning of the nasal septum had a more favorable nasal prominence and better vertical growth of the upper and whole face in posterior height. Better growth in anterior height was only suggested; maxillary retrusion was equal in both groups. CONCLUSIONS: Primary repositioning of the nasal septum has a favorable effect on nasal development, and it neither deteriorates nor markedly improves maxillary growth in patients with unilateral cleft lip and palate.
- MeSH
- kefalometrie statistika a číselné údaje MeSH
- lidé MeSH
- maxilofaciální vývoj * MeSH
- mladiství MeSH
- nosní přepážka chirurgie MeSH
- radiografie MeSH
- rozštěp patra diagnostické zobrazování patofyziologie chirurgie MeSH
- rozštěp rtu diagnostické zobrazování patofyziologie chirurgie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
