Infant Orthopedics Has No Effect on Maxillary Arch Dimensions in the Deciduous Dentition of Children with Complete Unilateral Cleft Lip and Palate (Dutchcleft)

2006 ◽  
Vol 43 (6) ◽  
pp. 665-672 ◽  
Author(s):  
Catharina A. M. Bongaarts ◽  
Martin A. van't Hof ◽  
Birte Prahl-Andersen ◽  
Iris V. Dirks ◽  
Anne M. Kuijpers-Jagtman
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Vertical Position ◽  
Controlled Clinical Trial ◽  
Deciduous Dentition ◽  
Surgical Closure ◽  
Infant Orthopedics ◽  
Maxillary Arch

Objective: Evaluation of the effect of infant orthopedics on maxillary arch dimensions in the deciduous dentition in patients with unilateral cleft lip and palate. Design: Prospective two-arm randomized controlled clinical trial with three participating cleft palate centers. Setting: Cleft palate centers of the Radboud University Nijmegen Medical Center, Academic Center of Dentistry Amsterdam, and University Medical Center Rotterdam, the Netherlands. Patients: Children with complete unilateral cleft lip and palate (n = 54) were included. Interventions: Patients were randomly divided into two groups. Half of the patients (IO+) had a presurgical orthopedic plate until surgical closure of the soft palate at the age of 52 weeks; the other half (IO−) did not undergo presurgical orthopedics. Mean outcome measures: Maxillary arch dimensions were assessed on dental casts at 4 and 6 years of age with measurements for arch width, arch depth, arch length, arch form, and the vertical position of the lesser segment. Contact and collapse were assessed also. Results: There were no clinically significant differences found between IO+ and IO− for any of the variables. Conclusions: Infant orthopedics had no observable effect on the maxillary arch dimensions or on the contact and collapse scores in the deciduous dentition at the ages of 4 and 6 years. Considering the Dutchcleft results to date, there is no need to perform infant orthopedics for unilateral cleft lip and palate patients.

The Effect of Infant Orthopedics on the Occlusion of the Deciduous Dentition in Children with Complete Unilateral Cleft Lip and Palate (Dutchcleft)

2004 ◽  
Vol 41 (6) ◽  
pp. 633-641 ◽  
Author(s):  
Catharina A. M. Bongaarts ◽  
Anne M. Kuijpers-Jagtman ◽  
Martin A. van't Hof ◽  
Birte Prahl-Andersen
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
University Hospital ◽  
Controlled Clinical Trial ◽  
Dental Arch ◽  
Deciduous Dentition ◽  
Surgical Closure ◽  
Infant Orthopedics

Objective Evaluation of the effect of infant orthopedics (IO) on the occlusion of the deciduous dentition in patients with unilateral cleft lip and palate (UCLP). Design Prospective, two-arm, randomized, controlled clinical trial with three participating cleft palate centers (Dutchcleft). Setting Cleft Palate Centers of the University Medical Center Nijmegen, Academic Center of Dentistry Amsterdam, and Dijkzigt University Hospital Rotterdam, The Netherlands. Patients Children with complete UCLP (n = 54) were included. Interventions In a concealed allocation procedure, half of the patients was randomized to wear a plate till surgical closure of the soft palate (IO+), and the other half (IO−) did not have a plate. Mean Outcome Measures Dental arch relationships were assessed at 4 and 6 years of age with the 5-year-old index; the Huddart-score; and measurements of overjet, overbite, and sagittal occlusion. Results There were no significant differences found between the IO+ and IO− groups for the 5-year-old index; the Huddart-score; and overjet, overbite, and sagittal occlusion. Conclusions IO had no observable effect on the occlusion in the deciduous dentition at 4 and 6 years of age. Considering the occlusion only, there is no need to perform IO in children with UCLP.

Effect of Infant Orthopedics on Facial Appearance of Toddlers with Complete Unilateral Cleft Lip and Palate (Dutchcleft)

2008 ◽  
Vol 45 (4) ◽  
pp. 407-413 ◽  
Author(s):  
Catharina A. M. Bongaarts ◽  
Birte Prahl-Andersen ◽  
Ewald M. Bronkhorst ◽  
Paul H. M. Spauwen ◽  
Jan W. Mulder ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Controlled Clinical Trial ◽  
Minor Effect ◽  
Facial Appearance ◽  
Surgical Closure ◽  
Significant Difference ◽  
Full Face ◽  
Infant Orthopedics ◽  
Positive Effect

Objective: To evaluate the effect of infant orthopedics (IO) on facial appearance of 54 patients with unilateral cleft lip and palate (UCLP), aged 4 and 6 years. Design: Prospective two-arm randomized controlled clinical trial in three Cleft Palate Centers in the Netherlands (Dutchcleft-trial). Interventions: Patients were divided randomly into two groups. Half of the patients (IO+) had a plate until surgical closure of the soft palate at the age of ± 52 weeks; the other half (IO−) received no intervention. Main Outcome Measures: Facial appearance at 4 and 6 years of age assessed on full face photographs and photographs showing only nose and mouth. Ratings were performed on a VAS-scale by professionals and laymen. Results: At 4 years of age the full face pictures of IO+ children were scored to be more attractive than those of IO− children. However, this difference had disappeared at 6 years of age. At the age of 6, only professionals saw a significant difference on nasolabial photographs between IO+ and IO−. Regression analysis showed a minor effect of occlusion, lip revision, or type of nose reconstruction on the esthetic results. Conclusions: IO had a positive effect on full facial appearance of UCLP children at the age of 4 years, but at the age of 6, only professionals saw a positive effect of IO on the nasolabial photographs. This is irrelevant for UCLP patients since they deal with laymen in their daily life.

Infant Orthopedics and Facial Growth in Complete Unilateral Cleft Lip and Palate until Six Years of Age (Dutchcleft)

2009 ◽  
Vol 46 (6) ◽  
pp. 654-663 ◽  
Author(s):  
Catharina A. M. Bongaarts ◽  
Birte Prahl-Andersen ◽  
Ewald M. Bronkhorst ◽  
C. Prahl ◽  
Edwin M. Ongkosuwito ◽  
...  
Keyword(s):  
Soft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Controlled Clinical Trial ◽  
Facial Growth ◽  
Hard Tissue ◽  
Surgical Closure ◽  
Randomized Controlled ◽  
Palate Repair ◽  
Infant Orthopedics

Objective: To evaluate longitudinally the effect of infant orthopedics (IO) on dentofacial cephalometric variables in unilateral cleft lip and palate (UCLP) patients from 4 to 6 years of age. Design: Prospective two-arm randomized controlled clinical trial in three cleft palate centers in The Netherlands (Dutchcleft trial). Patients: Fifty-four children with complete UCLP. Interventions: Patients were divided randomly into two groups. Half of the patients (IO+) had IO until surgical closure of the soft palate at the age of ±52 weeks; the other half (IO−) received no intervention. Mean Outcome Measures: Cephalometric values representing soft tissue, hard tissue, and dental structures, measured on lateral headfilms made at 4 and 6 years of age. Results: In the IO+ group, 21 patients were analyzed; in the IO− group, 20 patients were analyzed at age 4 and 22 at age 6. No differences were found between IO+ and IO−, except for two measurements: The interincisal angle was larger and the mentolabial angle was smaller in the IO+ group. Conclusions: For infants with UCLP whose surgical management included soft palate repair at 12 months and delayed hard palate closure, cephalometric outcomes at ages 4 and 6 provide no indication for the type of IO used in this study.

A Randomized Prospective Clinical Trial of the Effect of Infant Orthopedics in Unilateral Cleft Lip and Palate: Prevention of Collapse of the Alveolar Segments (Dutchcleft)

2003 ◽  
Vol 40 (4) ◽  
pp. 337-342 ◽  
Author(s):  
Charlotte Prahl ◽  
Anne M. Kuijpers-Jagtman ◽  
Martin A. van't Hof ◽  
Birte Prahl-Andersen
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Controlled Trial ◽  
Significant Group ◽  
Arch Form ◽  
Arch Forms ◽  
First Year Of Life ◽  
Infant Orthopedics ◽  
Maxillary Arch

Objective To study the effect of infant orthopedics (IO) on maxillary arch form and position of the alveolar segments. Design Prospective two-arm randomized, controlled trial in parallel with three participating academic cleft palate centers. Treatment was assigned by means of a computerized balanced allocation method. Setting Cleft palate centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. Patients, Participants Infants with complete unilateral cleft lip and palate and no other malformations. Interventions One group (IO+) wore passive maxillary plates during the first year of life; the other group (IO−) did not. All other interventions were the same. Main Outcome Measure(s) The presence of contact and/or overlap (collapse) between the maxillary segments at maxillary casts made shortly after birth, at 15, 24, 48, 58, and 78 weeks. Survival experience of contact and collapse with time as well as the frequencies of different arch forms and severity of collapse were evaluated. Results Comparable arch forms with no contact or overlap of the maxillary segments were seen at birth in both groups. With time the frequency of collapse increased, with no significant differences between groups. No significant group differences were found with respect to the survival experience of contact and collapse or for the severity of collapse at the end of the observational period. Conclusions Infant orthopedics does not prevent collapse and can be abandoned as a tool to improve maxillary arch form.

Presurgical Orthopedics and Satisfaction in Motherhood: A Randomized Clinical Trial (dutchcleft)

2008 ◽  
Vol 45 (3) ◽  
pp. 284-288 ◽  
Author(s):  
Charlotte Prahl ◽  
Birte Prahl-Andersen ◽  
Martin A. Van't Hof ◽  
Anne M. Kuijpers-Jagtman
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Controlled Trial ◽  
First Year ◽  
Balanced Allocation ◽  
The Individual ◽  
First Year Of Life ◽  
Presurgical Orthopedics ◽  
Infant Orthopedics

Objective: To study the effect of infant orthopedics on satisfaction in motherhood. Design: Prospective two-arm randomized controlled trial in parallel with three participating academic cleft palate centers. Treatment allocation was concealed and was performed by means of a computerized balanced allocation method. Setting: Cleft palate centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. Patients: Two groups of infants with complete unilateral cleft lip and palate and no other malformations. Interventions: Group IO+ (n  =  27) wore passive maxillary plates during the first year of life, group IO− (n  =  27) did not. Main Outcome Measure(s): Mean satisfaction scores were obtained from completed questionnaires at 6, 24, and 58 weeks of age. A 4-point scale was used (1  =  very satisfactory to 4  =  very unsatisfactory). Results: The range of the mean scores for the individual items on the questionnaires for both groups ranged between 1.1 and 2.4. No differences were found between groups. Mothers appear to be satisfied in motherhood, least satisfied with the available time for themselves, and very satisfied with hugging and walking their babies. No differences were found between groups. Conclusions: Results from the present study show that infant orthopedics, with a passive plate during the first year of life, in children with a unilateral cleft lip and palate has no influence on the mothers’ satisfaction in motherhood.

Long-Term Otologic and Audiometric Outcomes in Patients with Cleft Palate

2017 ◽  
Vol 157 (4) ◽  
pp. 676-682 ◽  
Author(s):  
Terence E. Imbery ◽  
Lindsay B. Sobin ◽  
Emily Commesso ◽  
Lindsey Koester ◽  
Sherard A. Tatum ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Closure Rate ◽  
Pressure Equalization

Objective Describe longitudinal audiometric and otologic outcomes in patients with cleft palates. Study Design Case series with chart review. Setting Single academic medical center. Methods Charts of 564 patients with a diagnosis of cleft palate (59% syndromic etiology, 41% nonsyndromic) from 1998 to 2014 were reviewed. Patients without at least 1 audiometric follow-up were excluded from analysis. Patient demographics, surgeries, audiometric tests, and otologic data were recorded for 352 patients. Results Forty-five percent had isolated cleft palates, 34% had unilateral cleft lip and palate, and 21% had bilateral cleft lip and palate. Patients were followed for a mean of 50.3 months with a mean of 3.2 separate audiograms performed. Patients received a mean of 2.93 pressure equalization tubes. Increased number of pressure equalization tubes was not associated with incidence of cholesteatoma, which was identified in only 4 patients. Nine patients underwent eventual tympanoplasty with an 89% closure rate. Analysis of mean air-bone gap by cleft type did not reveal significant differences ( P = .08), but conductive losses and abnormal tympanometry persisted into teenage years. Conclusions Patients with cleft palates have eustachian tube dysfunction, which, in our cohort, resulted in persistent conductive hearing loss, highlighting the importance of long-term follow-up. Cholesteatoma incidence was low and not associated with number of tubes, which at our institution were placed prophylactically. Tympanoplasty was successful in those with persistent perforations.

Infant Orthopedics in UCLP: Effect on Feeding, Weight, and Length: A Randomized Clinical Trial (Dutchcleft)

2005 ◽  
Vol 42 (2) ◽  
pp. 171-177 ◽  
Author(s):  
Charlotte Prahl ◽  
Anne M. Kuijpers-Jagtman ◽  
Martin A. Van't Hof ◽  
Birte Prahl-Andersen
Keyword(s):  
The Netherlands ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Controlled Trial ◽  
Bottle Feeding ◽  
Mean Values ◽  
Z Scores ◽  
Infant Orthopedics ◽  
Weight For Age

Objective To study the effects of infant orthopedics (IO) on feeding, weight, and length. Design Prospective two-arm randomized controlled trial in three academic Cleft Palate Centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation method. Setting Cleft Palate Centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. Patients Infants with complete unilateral cleft lip and palate (UCLP), no other malformations. Interventions One group (IO+) wore passive maxillary plates during the first year of life, but the other group (IO−) did not. All other interventions were the same for both groups. Main Outcome Measures Bottle feeding velocity (mL/min) at intake, 3, 6, 15, and 24 weeks (T0 to T24); weight-for-age, length-for-age, and weight-for-length using z scores; reference values from the Netherlands’ third nationwide survey on growth. Results Feeding velocity increased with time from 2.9 to 13.2 mL/min in the IO− group and from 2.6 to 13.8 mL/min in the IO+ group; no significant differences were found between groups. Weight-for-age, length-for-age, and weight-for-length (z scores) did not differ significantly between groups, but overall the infants with unilateral cleft lip and palate in both groups had significantly lower mean z scores for weight-for-age and height-for-age than the reference during the first 14 months, and had lower mean values for weight-for-length after soft palate closure. Conclusion Infant orthopedics with the aim of improving feeding and consequent nutritional status in infants with unilateral cleft lip and palate can be abandoned.

Infant Orthopedics and Facial Appearance: A Randomized Clinical Trial (Dutchcleft)

2006 ◽  
Vol 43 (6) ◽  
pp. 659-664 ◽  
Author(s):  
Charlotte Prahl ◽  
Birte Prahl-Andersen ◽  
Martin A. van't Hof ◽  
Anne M. Kuijpers-Jagtman
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Controlled Trial ◽  
First Year ◽  
Facial Appearance ◽  
Visual Analog Scales ◽  
Z Scores ◽  
Full Face ◽  
Infant Orthopedics

Objective: To study the effect of infant orthopedics on facial appearance. Design: Prospective two-arm randomized controlled trial in parallel with three participating academic cleft palate centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation method. Setting: Cleft Palate Centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. Patients: Infants with complete unilateral cleft lip and palate, no other malformations. Interventions: One group (IO+) wore passive maxillary plates during the first year, the other group (IO−) did not. Main Outcome Measure(s): Two metrical response modalities were used (i.e., visual analog scales and reference scores) to score facial appearance. Full face and cropped photographs were compared with reference photographs and were judged. The photographs were judged by 45 judges, 24 laypeople, and 21 professionals. Transformation of the scores into z scores was applied to compare and to pool both response modalities. The validity of each individual judge was evaluated, as was the reliability of the scales. Differences between the treatment groups were evaluated by means of t tests. Results: Photographs were available of 41 subjects, 21 with and 20 without infant orthopedics. No significant differences were found between groups. Mean z-score values for the full-face photographs were: group IO+ = 0.10 (SD = 0.73) and group IO− = −0.03 (SD = 0.48); for the cropped photographs were: group IO+ = 0.12 (SD = 0.71) and group IO− = −0.06 (SD = 0.55). Conclusions: Infant orthopedics have no effect on facial appearance.

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