INTRODUCTION: The aim of this study was to assess speech outcomes and dental arch relationship of 5-year-old Czech patients with unilateral cleft lip and palate (UCLP) who have undergone neonatal cleft lip repair and one-stage palatal closure. METHODS AND MATERIALS: Twenty-three patients with UCLP, born between 2009 and 2010, were included in the study. Three universal speech parameters (hypernasality, articulation and speech intelligibility) have been devised for speech recordings evaluation. Outcomes of dental arch relationship were evaluated by applying the GOSLON Yardstick and subsequently compared with the GOSLON outcome of other cleft centers. RESULTS: Moderate hypernasality was present in most cases, the mean value for articulation and speech intelligibility was 2.07 and 1.93, respectively. The Kappa values for inter-examiner agreement for all the three speech outcomes ranged from 0.786 to 0.808. Sixty-three percent of patients were scored GOSLON 1 and 2, 26% GOSLON 3, and 10% GOSLON 4. GOSLON mean score was 2.35. Interrater agreement was very good, represented by kappa value of 0.867. CONCLUSION: The treatment protocol, involving neonatal cleft lip repair and one-stage palatal repair performed up to the first year of UCLP patient's life, has shown good speech outcomes and produced very good treatment results in regard to maxillary growth, comparable with other cleft centers.

• Klíčová slova
• Neonatal cleft lip surgery, One-stage palatal repair, Speech outcomes measurements, The GOSLON Yardstick, Unilateral cleft lip and palate,
• MeSH
• dítě MeSH
• klinické protokoly MeSH
• kvalita hlasu MeSH
• lidé MeSH
• maxila růst a vývoj   MeSH
• předškolní dítě MeSH
• řeč MeSH
• rozštěp patra chirurgie   MeSH
• rozštěp rtu chirurgie   MeSH
• věkové faktory MeSH
• výsledek terapie MeSH
• zubní oblouk MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVES: This study evaluated maxillary growth and dental arch relationships at 5 and 10 years of age in patients with unilateral cleft lip and palate (UCLP) who underwent early cleft lip and palate surgery. METHODS: 28 patients with UCLP who underwent cleft lip surgery in neonatal age and cleft palate surgery at average age of 7 months without orthodontic treatment (intervention group) were measured for intercanine and intermolar distances and for dental arch length. These measurements were compared with those of 30 healthy participants in a control group. Dental arch relationships in the intervention group were evaluated by 5-YO index at 5 years and the GOSLON Yardstick score at 10 years of patients' age. RESULTS: Patients in the intervention group had significantly shorter mean intercanine distance and arch length than control patients at both 5 and 10 years of age (p<.001 for all). There were no significant differences in intermolar distance at both 5 (p = .945) and 10 years (p = .105) of patients' age. The average 5YO index increased from 2.46 to an average GOSLON 10-year score of 2.89 in intervention group. CONCLUSION: Intercanine distance and dental arch length of patients with UCLP are significantly reduced at 5 and 10 years after early cleft lip and palate surgeries compared to the healthy population. Dental arch relationships at 5 and 10 years of patients with UCLP show comparable outcomes to those reported by other cleft centers. CLINICAL SIGNIFICANCE: This study evaluates maxillary growth in UCLP patients 5 and 10 years of age who underwent early primary lip and palate surgery.

• Klíčová slova
• 5YO index, Cleft lip and palate, Dental arch relationship, GOSLON, Neonatal cleft lip surgery,
• MeSH
• dítě MeSH
• lidé MeSH
• maxila * chirurgie   růst a vývoj   MeSH
• maxilofaciální vývoj MeSH
• předškolní dítě MeSH
• průřezové studie MeSH
• rozštěp patra * chirurgie   MeSH
• rozštěp rtu * chirurgie   MeSH
• studie případů a kontrol MeSH
• zubní oblouk * růst a vývoj   patologie   chirurgie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The aim of this study was to compare facial development in subjects with complete unilateral cleft lip and palate (CUCLP) treated with two different surgical protocols. Lateral cephalometric radiographs of 61 patients (42 boys, 19 girls; mean age, 10.9 years; SD, 1) treated consecutively in Warsaw with one-stage repair and 61 age-matched and sex-matched patients treated in Oslo with two-stage surgery were selected to evaluate craniofacial morphology. On each radiograph 13 angular and two ratio variables were measured in order to describe hard and soft tissues of the facial region. The analysis showed that differences between the groups were limited to hard tissues – the maxillary prominence in subjects from the Warsaw group was decreased by almost 4° in comparison with the Oslo group (sella-nasion-A-point (SNA) = 75.3° and 79.1°, respectively) and maxillo-mandibular morphology was less favorable in the Warsaw group than the Oslo group (ANB angle = 0.8° and 2.8°, respectively). The soft tissue contour was comparable in both groups. In conclusion, inter-group differences suggest a more favorable outcome in the Oslo group. However, the distinctiveness of facial morphology in background populations (ie, in Poles and Norwegians) could have contributed to the observed results.

• Klíčová slova
• Cephalometrics, Cleft lip, Cleft palate, Morphology, Treatment,
• MeSH
• dítě MeSH
• kefalometrie metody   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• rozštěp patra chirurgie   MeSH
• rozštěp rtu chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem 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

The study aimed at comparing maxillofacial morphology and burden of surgical treatment in post-pubertal patients with unilateral cleft lip and palate (UCLP) following early vs. late secondary alveolar bone grafting (SABG). In this retrospective study maxillofacial morphology was assessed on lateral cephalograms of skeletally matured patients with UCLP operated on consecutively in one center by the same method of one-stage primary cleft repair followed by SABG. Cephalometric analysis comprised 8 angular and 7 linear measurements. Maxillary growth restriction was evaluated by measuring SNA angle and Co-A and PNS-A distances. Five linear regression models with SNA, SNB, ANB, Co-A, and MP/SN as dependent variables and age at primary cleft repair, age at SABG, age at taking cephalogram, surgeon, and total number of surgical interventions as independent variables were also created. 135 patients were included in the study - 70 patients (47 males and 23 females) had early SABG (E-SABG group) and 65 patients (40 males and 25 females) had late SABG (L-SABG group). Mean age at bone grafting procedure was 2.7 years (range 1.5-5.9, SD 1.1) and 10.3 years (range 6.1-18.8, SD 3.2) in E-SABG and LSABG group respectively. The variables describing the degree of maxillary growth restriction - SNA, Co-A, and PNS-A - were comparable in both groups (p = 0.707, 0.116, and 0.932, respectively). Regression models demonstrated that independent variables were not associated with the values of SNA angle, SNB angle, ANB angle, MP/SN angle, and Co-A distance (p = 0.761, 0.088, 0.249, 0.380, and 0.363, respectively). The percentages of oronasal fistula repair, VPI repair, repeated SABG, upper lip correction, rhinoplasty, orthognathic surgery were 22.9, 7.1, 15.7, 24.3, 42.9, 2.9 in E-SABG group and 27.7, 7.7, 9.2, 36.9, 47.7, 3.1 in L-SABG group respectively. Mean number of all surgical interventions was 3.2 in E-SABG and 3.4 in L-SABG group, respectively (p = 0.271). Considering the comparable maxillofacial morphology and burden of surgical care in matured patients after early and late SABG, the choice of timing of bone grafting surgery could be left to the discretion of the surgeon.

• Klíčová slova
• Bone grafting, Cephalometric analysis, Maxillofacial morphology, Unilateral cleft lip and palate,
• MeSH
• alveolární kostní štěp * MeSH
• kefalometrie MeSH
• kojenec MeSH
• lidé MeSH
• předškolní dítě MeSH
• retrospektivní studie MeSH
• rozštěp patra * diagnostické zobrazování   chirurgie   MeSH
• rozštěp rtu * chirurgie   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Facial development of patients with unilateral complete cleft lip and palate (UCLP) is associated with many problems including deformity of the palate. The aim of this study was to evaluate palatal morphology and variability in patients with UCLP compared with Czech norms using methods of geometric morphometrics. The study was based on virtual dental cast analysis of 29 UCLP patients and 29 control individuals at the age of 15 years. The variability of palatal shape in UCLP patients was greater than that in nonclefted palates. Only 24% of clefted palates fell within the variability of controls. The palatal form of UCLP patients (range from 11.8 to 17.2 years) was not correlated with age. Compared with control palates, palates of UCLP patients were narrower, more anteriorly than posteriorly. Apart from the praemaxilla region, they were also shallower, and the difference increased posteriorly. The UCLP palate was characterised by the asymmetry of its vault. The maximum height of the palatal vault was anterior on the clefted side, whereas it was posterior on the nonclefted side. The slope of the UCLP palate was more inclined compared with the control group. The praemaxilla was therefore situated more inferiorly.

• Klíčová slova
• 3-D geometric morphometrics, Dense correspondence analysis, Palatal shape, Surface scanning, Unilateral cleft of lip and palate,
• MeSH
• anatomická variace MeSH
• anatomická značka patologie   MeSH
• dítě MeSH
• kefalometrie metody   MeSH
• lidé MeSH
• maxila patologie   MeSH
• mladiství MeSH
• patro patologie   MeSH
• počítačové zpracování obrazu metody   MeSH
• rozštěp patra patologie   MeSH
• rozštěp rtu patologie   MeSH
• uživatelské rozhraní počítače MeSH
• věkové faktory MeSH
• zákroky plastické chirurgie metody   MeSH
• zobrazování trojrozměrné metody   MeSH
• zubní modely MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

X-ray measurements were used for studies of craniofacial morphology in unilateral (right-sided) cleft lip and palate in 58 adult males operated upon with the same technique. The results obtained showed a slightly smaller neurocranium without marked changes of the cranial base. Basic facial skeletal deviations included a shortening of maxillary depth, reduction of the upper face height, widening of some maxillary dimensions (interorbital and of nasal cavity), retroinclination of upper incisors and alveolar process and mandibular changes resulting from growth deficiency (they consisted of shortening of the body and ramus, elongation of anterior mandibular height, obtuse gonial angle, acute chin angle, steeper slope of the body, retroinclination of incisors and retrognathia). Described changes caused an impairment of sagittal and vertical jaw relations, anterior crossbite, flattening of the face and a limitation of its anterior growth rotation. There was also a displacement of the whole maxilla backwards and a reduction of the height and of the thickness of the upper lip (increasing retrocheilia). The elongation of the lower face and thus of the whole face was produced by the increase of the anterior height of the mandible, impaired overjet and by maxillary dentoalveolar retroinclination. A slight transversal flattening of the face (greater retrusion in the centre than in the zygomatic regions) was present as well.

• MeSH
• čelní kost patologie   MeSH
• dospělí MeSH
• kefalometrie MeSH
• lebka patologie   MeSH
• lidé MeSH
• mandibula patologie   MeSH
• maxila patologie   MeSH
• obličej * MeSH
• rozštěp patra patologie   MeSH
• rozštěp rtu patologie   MeSH
• sella turcica patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: A new method of early neonatal cheiloplasty has recently been employed on patients having complete unilateral cleft lip and palate (cUCLP). We aimed to investigate (1) their detailed palatal morphology before surgery and growth during the 10 months after neonatal cheiloplasty, (2) the growth of eight dimensions of the maxilla in these patients, (3) the development of these dimensions compared with published data on noncleft controls and on cUCLP patients operated using later operation protocol (LOP; 6 months of age). METHODS: Sixty-six virtual dental models of 33 longitudinally evaluated cUCLP patients were analysed using metric analysis, a dense correspondence model, and multivariate statistics. We compared the palatal surfaces before neonatal cheiloplasty (mean age, 4 days) and before palatoplasty (mean age, 10 months). RESULTS: The palatal form variability of 10-month-old children was considerably reduced during the observed period thanks to their undisturbed growth, that is, the palate underwent the same growth changes following neonatal cheiloplasty. A detailed colour-coded map identified the most marked growth at the anterior and posterior ends of both segments. The maxilla of cUCLP patients after neonatal cheiloplasty had a growth tendency similar to noncleft controls (unlike LOP). CONCLUSIONS: Both methodological approaches showed that early neonatal cheiloplasty in cUCLP patients did not prevent forward growth of the upper jaw segments and did not reduce either the length or width of the maxilla during the first 10 months of life.

• Klíčová slova
• 3-D geometric morphometry, Early neonatal cheiloplasty, Palatal growth, Traditional morphometry, Unilateral cleft lip and palate,
• MeSH
• algoritmy MeSH
• antropometrie metody   MeSH
• kojenec MeSH
• lidé MeSH
• maxila růst a vývoj   MeSH
• novorozenec MeSH
• patro růst a vývoj   MeSH
• rozštěp patra chirurgie   MeSH
• rozštěp rtu chirurgie   MeSH
• velikost orgánu MeSH
• zákroky plastické chirurgie MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: To compare palatal growth changes in infants with complete unilateral (UCLP) or bilateral (BCLP) cleft lip and palate during the first year of life. MATERIALS AND METHODS: Upper dental arches of 68 neonates with UCLP and BCLP were evaluated using 2D and 3D morphometry based on dental casts obtained in two age categories (T0 before early neonatal cheiloplasty-UCLP 4 ± 3 days, BCLP 6 ± 5 days; T1 before palatoplasty-UCLP 10 ± 2 months, BCLP 12 ± 3 months). RESULTS: Intensive palatal growth was manifested in both directions of the palate. Palatal growth in the anterior direction was not restricted, despite the intercanine (CC´) and anterior (LL´) widths being significantly narrowed in the BCLP group (CC´ p = 0.019, LL´ p = 0.009). The posterior dental arches were significantly enlarged (UCLP p ≤ 0.001; BCLP p ≤ 0.001). The negative effect of cleft severity on palatal length was not confirmed (p = 0.802). Variability of the palate was immense mainly in BCLP infants (T0); however, it decreased in both cleft types, confirming the formative effect of palatal growth leading to alveolar cleft closure (UCLP p ≤ 0.001; BCLP p = 0.006 on the right, 0.005 on the left). CONCLUSIONS: Both analyzed cleft groups (UCLP, BCLP) grew favorably during the first year of life, and the palatal growth was not limited in any direction. CLINICAL RELEVANCE: Geometric morphometry allowed a comprehensive analysis of the palate, which can contribute to the improvement of surgical methods.

• Klíčová slova
• Bilateral cleft lip and palate, Classic morphometry, Early neonatal cheiloplasty, Geometric morphometry, Unilateral cleft lip and palate, Upper dental arches,
• MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• rozštěp patra * chirurgie   MeSH
• rozštěp rtu * chirurgie   MeSH
• zákroky plastické chirurgie * MeSH
• zubní oblouk chirurgie   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH

Retrospective studies into the effects of some aspects of treatment on facial development were based on x-ray films obtained in 58 men with unilateral cleft lip and palate operated on by palatal pushback. Because of mandibular retroposition, individuals subjected to systematic orthodontic treatment had better sagittal jaw relations and occlusion of incisors than insufficiently treated patients. The retroposition was attained with orthodontic proclination of upper incisors leading to a positive overjet and retraining the anterior development of the mandible. In patients with complete clefts operated on at about 6 years of age, sagittal jaw relations were more favorable than in those who had surgical repair at 4 years of age. The superior results in the group operated at a later age were due, in part, to the slighter retrusion of the maxilla. These differences were not apparent in incomplete clefts nor in patients with isolated cleft palate reported earlier. On the basis of these observations, a differentiated approach was proposed for determining the most convenient age for palatoplasty, according to individual types of clefts and their extent. The findings provided evidence of the essential role of orthodontic therapy for the configuration of the lower face in clefts.

• MeSH
• chirurgické laloky metody   MeSH
• dítě MeSH
• dospělí MeSH
• farynx chirurgie   MeSH
• kefalometrie MeSH
• lidé MeSH
• malokluze patologie   patofyziologie   terapie   MeSH
• mandibula růst a vývoj   patologie   MeSH
• maxila růst a vývoj   patologie   MeSH
• maxilofaciální vývoj * MeSH
• ortodoncie korekční MeSH
• předškolní dítě MeSH
• radiografie MeSH
• retrospektivní studie MeSH
• řezáky patologie   MeSH
• rozštěp patra diagnostické zobrazování   patologie   patofyziologie   chirurgie   MeSH
• rozštěp rtu diagnostické zobrazování   patologie   patofyziologie   chirurgie   MeSH
• techniky palatinální expanze MeSH
• věkové faktory MeSH
• zubní okluze MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH