Treatment Outcome after Two-Stage Palatal Closure in Unilateral Cleft Lip and Palate: A Comparison with Eurocleft

2005 ◽  
Vol 42 (5) ◽  
pp. 512-516 ◽  
Author(s):  
Pieter J. P. M. Nollet ◽  
Christos Katsaros ◽  
Martin A. van't Hof ◽  
Gunvor Semb ◽  
William C. Shaw ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Repeated Measures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Treatment Protocol ◽  
Dental Arch ◽  
Treatment Results ◽  
Two Stage ◽  
Treatment Protocols

Objective To evaluate dental arch relationships of patients with unilateral cleft lip and palate (UCLP) treated with a two-stage palatal closure and to compare them with the six centers from the Eurocleft study that used various treatment protocols. Design Repeated-measures study. Setting Cleft Palate Craniofacial Unit of Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands. Patients Records of 9-year-old children with complete unilateral cleft lip and palate (n = 43) were included. Interventions The dental arch relationships of these patients were assessed by applying the Goslon Yardstick and subsequently compared with the Goslon outcome of the six-center Eurocleft study. Mean Outcome Measures Statistics of intra- and interexaminer agreement. Results For the Nijmegen UCLP group, 9% of dental arch relationships had a Goslon score of 1, 52% had a score of 2, 30% has a score of 3, 9% had a score of 4, and none had a score of 5. The mean Nijmegen Goslon score showed no significant differences with Eurocleft centers A, B, and E, which achieved the best treatment results, but did significantly differ from Goslon outcomes of Eurocleft centers D (p < .001), C, and F (p < .01), which had relatively poor treatment outcome. Conclusions Treatment outcome of the patients in the Nijmegen UCLP group treated with two-stage palatal closure was comparable with the results of the Eurocleft centers with the best outcome. Treatment protocol could not explain differences in the quality of treatment results.

Early Two-Stage Palatoplasty Using Modified Furlow's Veloplasty

2010 ◽  
Vol 47 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Nishio Juntaro ◽  
Yamanishi Tadashi ◽  
Hiroshi Kohara ◽  
Yoshiko Hirano ◽  
Michiyo Sako ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Protocol ◽  
Dental Occlusion ◽  
Central Incisor ◽  
Two Stage ◽  
Treatment Protocols ◽  
Normal Occlusion ◽  
New Treatment ◽  
Velopharyngeal Function

Objective To achieve sufficient velopharyngeal function and maxillary growth for patients with unilateral cleft lip and palate (UCLP), the authors have designed a new treatment protocol for palate closure involving early two-stage palatoplasty with modified Furlow veloplasty. Details of the surgical protocol and the outcomes of the dental occlusion of patients at 4 years of age are presented. Design and Setting This was an institutional retrospective study. Patients Seventy-two UCLP patients were divided into two groups based on their treatment protocols: patients treated using the early two-stage palatoplasty protocol (ETS group; n = 30) and patients treated using Wardill-Kilner push-back palatoplasty performed at 1 year of age (PB group; n = 42). Interventions The features of the ETS protocol are as follows: The soft palate is repaired at 12 months of age using a modified Furlow technique. The residual cleft in the hard palate is closed at 18 months of age. Lip repair is carried out at 3 months of age with a modified Millard technique for all subjects. Results The ETS group showed a significantly better occlusal condition than the PB group. The incidence of normal occlusion at the noncleft side central incisor was 7.1% in the PB group; whereas, it was 66.7% in the ETS group. Conclusion The results indicate that the early two-stage protocol is advantageous for UCLP children in attaining better dental occlusion at 4 years of age.

Photographs of Study Casts: An Alternative Medium for Rating Dental Arch Relationships in Unilateral Cleft Lip and Palate

2004 ◽  
Vol 41 (6) ◽  
pp. 646-650 ◽  
Author(s):  
Pieter J. P. M. Nollet ◽  
Christos Katsaros ◽  
Martin A. van 't Hof ◽  
Catharina A. M. Bongaarts ◽  
Gunvor Semb ◽  
...  
Keyword(s):  
The Netherlands ◽  
Repeated Measures ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Dental Arch ◽  
Reproducible Method ◽  
The University ◽  
Dental Casts

Objective To investigate the reliability of using photographs of study casts as an alternative to casts for rating dental arch relationships. Design Repeated-measures study. Setting Cleft Palate Center of the University Medical Center Nijmegen, Nijmegen, The Netherlands. Patients Records of children with complete unilateral cleft lip and palate (UCLP) (n = 49) at the age of 9 years were included. Mean Outcome Measure(s) Statistics of intra- and interexaminer agreement. Results No significant differences were found between the rating of dental casts and photographs of dental casts, using the Goslon Yardstick. Conclusions Photographs of dental casts provide a consistent, reproducible method for rating dental arch relationships in patients with UCLP at the age of 9 years and provide a reliable alternative to the application of the Goslon Yardstick on dental casts.

Comparison of two treatment protocols in children with unilateral complete cleft lip and palate: Tridimensional evaluation of the maxillary dental arch

2016 ◽  
Vol 44 (9) ◽  
pp. 1117-1122 ◽  
Author(s):  
Paula Karine Jorge ◽  
Wanda Gnoinski ◽  
Karine Vaz Laskos ◽  
Cleide Felício Carvalho Carrara ◽  
Daniela Gamba Garib ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Dental Arch ◽  
Treatment Protocols

Speech and Hearing Outcomes of the Patients with Cleft Lip and Palate: Comparison between One-Stage Simultaneous and Two-Stage Surgical Repairs

2020 ◽  
Vol 103 (11) ◽  
pp. 1171-1177
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Common Belief ◽  
Two Stage ◽  
Treatment Protocols ◽  
Palatal Fistula ◽  
One Stage ◽  
Significant Difference ◽  
Cleft Lip Palate ◽  
Palate Repair

Background: Conventional treatment for cleft lip and palate patients is lip repair at three to four months and then palatal repair at nine to 12 months of age. However, for the patients who delay seeing a doctor especially in a developing area such as Northern Thailand, simultaneous lip and palate repair is performed at 12 to 18 months of age or later, depending on the age at the first visit. It is a common belief that patients with cleft lip and palate will be behind non-cleft patients in early development phonemes because of the open palate. This delay persists until the palate is repaired and on into the postoperative period. This proposition has not been proven with long-term clinical outcomes in one-stage repairs. Objective: To investigate the effects of one-stage repair on speech assessment, hearing, and incidence of palatal fistula. The results were compared with conventional two-stage surgical repairs. Materials and Methods: The present study was designed two groups. Group 1 consisted of 25 children (mean age 11.28±1.93 years) treated with a one-stage repair. Cleft lip, palate, and alveolus were repaired at a single surgical session in the first 18 months of life (mean age at the time of surgery 13.52±4.51 months). Group 2 consisted of 17 children (mean age 11.02±2.23 years) treated in two-stage surgical repairs. Lip repair was performed at a median age of 4.01 months (IQR 3.62 to 5.46), and palate repair was performed at a mean age of 13.54±4.14 months. Both groups underwent cleft lip and palate repairs at the Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University between January 1, 2004 and December 31, 2010. Speech and hearing for all patients were evaluated by experienced ENT doctors. The palatal fistula was evaluated by the same plastic surgeons. Results: One-stage repair showed significant normal articulation and less articulation disorder when compared with two-stage surgical repairs. However, no significant difference was determined for other speech assessments, hearing, and incidence of palatal fistula. Conclusion: Because one-stage repair seems to have a more positive influence on articulation, and both surgical treatment protocols give similar results on speech assessments, hearing, and incidence of palatal fistula, regardless of the timing of the surgery, the one-stage repair is not inferior to conventional two-stage surgical repairs for patients in developing areas. This is due to several important advantages, such as less hospitalization, lower cost, and less chance of nosocomial infection. Keywords: One-stage repair, Speech, Hearing, Palatal fistula, Cleft lip, Palate

scholarly journals The Assessment of Treatment Outcome by Evaluation of Dental Arch Relationships in Unilateral Cleft Lip and Palate Children using mHB Scoring System

2017 ◽  
Vol 26 (2) ◽  
pp. 195-202
Author(s):  
Mazida Najwa Md. Zin ◽  
Mohammad Khursheed Alam ◽  
Sanjida Haque ◽  
Tohru Imanishi ◽  
Jin Toriya ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Scoring System ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Dental Arch

scholarly journals Treatment Outcome in Bilateral Cleft lip and Palate Patients Evaluated With the Huddart-Bodenham Scoring System and the Bilateral Cleft lip and Palate Yardstick: A Systematic Review

2021 ◽  
pp. 105566562110418
Author(s):  
Wenying Kuang ◽  
Miranda Aarts ◽  
Anne Marie Kuijpers-Jagtman ◽  
Hong He ◽  
Edwin M. Ongkosuwito
Keyword(s):  
Treatment Outcome ◽  
High Risk ◽  
Scoring System ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Risk Of Bias ◽  
Dental Arch ◽  
Quality Of Evidence ◽  
Bilateral Cleft Lip

Objectives To assess treatment outcome (transversal and sagittal dental arch relationships) and its determinants in complete bilateral cleft lip and palate (BCLP) evaluated with the modified Huddart-Bodenham scoring system and the BCLP Yardstick. Materials and methods Multiple electronic databases were searched without time limitation. Randomized clinical trials, cohort and case control studies using BCLP Yardstick and/or modified Huddart-Bodenham system to judge treatment outcome of patients with BCLP were included. The Risk of Bias in Nonrandomized Studies of Interventions tool and Grading of Recommendations, Assessment, Development, and Evaluation was used. Results Of the 528 studies identified by the electronic search, only eight retrospective studies met the inclusion criteria and were included. A total of 12 cleft centers were represented. All treatment protocols differed and background information was underreported. The results for the BCLP yardstick showed that all except the centers in New Zealand had a mean score lower than 3, indicating good treatment results. However, these studies had a moderate to high risk of bias. The modified Huddart-Bodenham scores were negative in all studies. No further meta-analysis was done due to heterogeneity and high risk of bias. The quality of evidence was graded as very low. Conclusion Results for the dental arch relationship of studies in complete BCLP and possible determinants were not synthesized due to very low quality of evidence. Clinical research for patients with BCLP should focus on sound methodological designs to enable evidence-based decision making to improve treatment for patients with BCLP and thereby hopefully their quality of life.

scholarly journals Maxillary Growth and Speech Outcome in Patient with Cleft Lip and Palate after Two-Stage Palate Repair: A Systematic Review

1970 ◽  
Vol 1 (4) ◽  
Author(s):  
Mulyadi Mulyadi ◽  
Prasetyanugraheni Kreshanti ◽  
Siti Handayani ◽  
Kristaninta Bangun
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Literature Search ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Protocol ◽  
Two Stage ◽  
Language Studies ◽  
Palate Repair ◽  
Maxillary Growth

Background: The management of patients with cleft lip and palate is complex, where the treatment outcome is judged on the balance between aesthetics, speech, and maxillary growth. Up to now, there is no generally accepted treatment protocol. Every center must find the best-suited protocol treatment for their population. Methods: A systematic review through literature search was conducted for English-language studies in PubMed. This search was conducted in September 2011 using EndNote X3 with keywords: Two-stage Palate Repair and Maxillary Growth and Two-stage Palate Repair and Speech Outcome. Both retrospective and prospective studies on maxillary growth and speech outcome in patient with cleft lip and palate after two-stage palate repair published from 2001 to 2012 were included. Result: From the reviewed of 37 articles, only 14 articles fit the inclusions criteria, three articles discussed the outcome of maxillary growth and speech outcome, eight articles only discussed the maxillary growth and the rest of articles only discussed the speech outcome. Conclusion:From this review we found that most of the two-stage palate repair results in better maxillary growth, but only few of them results in good speech outcome. We will perform further study based on this review to discover a new protocol for the management of palate repair in our center.

scholarly journals Maxillary distraction osteogenesis for correction of maxillary retrognathia in cleft lip and palate patients: a case series

2019 ◽  
Vol 5 (6) ◽  
pp. 154
Author(s):  
Burçak Kaya ◽  
Secil Cubuk ◽  
Sıdıka Akdeniz ◽  
Burak Bayram
Keyword(s):  
Distraction Osteogenesis ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Protocol ◽  
Case Series ◽  
Dental Arch ◽  
Maxillary Expansion ◽  
Oronasal Fistula ◽  
Alveolar Bone Grafting ◽  
Maxillary Distraction

<p class="abstract">The treatment protocol of patients having maxillary retrognatia is presented in this case series. Maxillary expansion, secondary alveolar bone grafting and/or oronasal fistula closure were performed in 6 cleft lip and palate patients. Preoperative simulation of Le Fort I osteotomy and adaptation of maxillary distractors were realized with stereolytographic cranium models. Intraoral maxillary distraction was applied under general anesthesia. A single unit acrylic occlusal splint was ligated to maxillary dental arch and worked as a guide during entire activation and consolidation period of distraction osteogenesis. Rigid internal fixation plates were placed in the osteotomy sites at the end of consolidation period. The amount of maxillary advancement was between 5-14 mm.  Satisfying occlusal and skeletal relationships were obtained in all patients. Advancement of maxilla by distraction osteogenesis resulted in gradual formation of bone at the osteotomy line and enhanced treatment outcome in patients with cleft lip and palate.</p>

scholarly journals Primary surgery effect on dental arch relationships of patients born with unilateral cleft lip and palate using the GOSLON yardstick index

2021 ◽  
Vol 76 (5) ◽  
pp. 245-249
Author(s):  
Emad Ghabrial ◽  
Hester JS Van den Berg ◽  
Susanna M Du Plessis
Keyword(s):  
Treatment Outcome ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Weighted Kappa ◽  
Good Treatment ◽  
Observer Agreement ◽  
Dental Arch ◽  
Facial Cleft ◽  
Primary Surgery ◽  
Good Treatment Outcome

To score dental arch development using the Great Ormond Street, London, and Oslo (GOSLON) yardstick index, following primary surgery in patients with a complete unilateral cleft lip and palate (UCLP), and to compare the outcome score with the GOSLON score of Cleft Care UK (CCUK) as well as with the Clinical Standards Advisory Group (CSAG), United Kingdom.Study models of patients (average age 12 years) with a non-syndromic complete UCLP, who had been surgically treated at the University of Pretoria Facial Cleft Deformity (UPFCD) clinic. They were assessed using the GOSLON yardstick index by certified raters from the Dental School in Dundee, Scotland. The mean outcome ratings were calculated from the scoring of 27 sets of plaster models. The other scoring rounds were used to calculate intraand inter-observer agreement using Cohen's weighted kappa and Fleiss's multi-rater kappa. There were strong intra- and inter-observer agreement, with a weighted kappa of 0.92. The Facial Cleft Deformity (FCD) clinic data showed a good treatment outcome with a mean GOSLON rating of 2.85 compared to a rating of 3.2 for the CSAG and 2.62 for the CCUK cohort studies. The UPFCD clinic primary surgical protocol displayed a good treatment outcome rating, in line with that of the CCUK cohort and better than the CSAG results.

scholarly journals Treatment Outcome and Factors Affecting Dental Arch Relationship in Malay Children with Unilateral Cleft Lip and Palate (UCLP)

2016 ◽  
Vol 25 (4) ◽  
pp. 371-376 ◽  
Author(s):  
Jawaad Ahmed Asif ◽  
Mohammad Khursheed Alam ◽  
Tohru Imanishi ◽  
Ayako Mukai ◽  
Tatsunori Yusa ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Dental Arch ◽  
Factors Affecting ◽  
Dental Arch Relationship
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