December 2011. A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Introduction: The nasoalveolar molding appliance is used pre-surgically in cleft lip and palate patients as a method of bringing together the lip and alveolus by applying force to direct desired growth.1 It is used in the infant to reduce the pre-surgical severity of the initial cleft and to improve alignment of the base of the nose and lip segments.1 The purpose of this study was to examine the long-term effect of nasoalveolar molding on facial growth and nasolabial esthetics in complete unilateral cleft lip and palate patients. Methods: Sixteen (N=16) post-surgical cleft lip and palate patients who had undergone nasoalveolar molding as infants and twelve (N=12) control patients, treated surgically without nasoalveolar molding, were recalled for a clinical examination including impressions, photographs, and a lateral cephalogram. Dental models were analyzed using the Goslon Yardstick, developed by Mars et al. in 1987.2¬ Photographs were analyzed using the Asher-McDade method for rating the nasolabial appearance in patients with cleft lip and palate.3 Finally, lateral cephalograms were digitized and analyzed using Dolphin Imaging software. Results: Separate ordinal logistic regression models indicated no significant difference between the molding and non-molding groups in Goslon score, nasal form, nose symmetry, vermilion border or nasolabial profile assessments. Generalized linear models revealed one cephalometric variable to be statistically significant between the two groups. The ANB angle was decreased by 2.34 degrees on average in the group who underwent nasoalveolar molding prior to cheiloplasty. Intra-rater and inter-rater weighted kappa statistics were calculated for each variable. Conclusion: Short-term benefits of nasoalveolar molding have been documented in the literature. However, more long-term studies are needed in order to demonstrate the longitudinal effects of the appliance on esthetics and midfacial growth. Due to the limitations of cleft lip and palate studies, it is often difficult to accurately assess treatment effects. Through inter-center studies such as the Eurocleft and Americleft projects, some limitations and biases can be overcome in order to compare various protocols and outcomes.4 In the future, it is the desire of the investigators to include the current sample of nasoalveolar molding patients in the future efforts and expansion of the Americleft study.

Indiana University-Purdue University Indianapolis (IUPUI) / The Riley Children's Hospital Craniofacial Anomalies Team rigorously follows a treatment protocol developed by Dr. Sheldon Rosenstein for the treatment of cleft lip and palate patients. Rosenstein's protocol incorporates primary bone grafting and alveolar molding appliances for cleft lip and palate patients. While other cleft lip and palate treatment centers utilize alveolar molding appliances, there remains debate concerning the efficacy of primary bone grafting. The principal detraction of primary bone grafting is the concern that such early surgical treatment affects maxillary and craniofacial growth and development. The purpose of this retrospective study was to analyze post-treatment lateral head plates and dental casts of cleft lip and palate circumpubertal patients treated in infancy at Riley Hospital in Indianapolis by the Craniofacial Team following Rosenstein's protocol. The hypothesis was that primary alveolar bone grafting in conjunction with the use of alveolar molding appliances contributes to the early stabilization of the alveolar segments, and produces no statistically significant difference in craniofacial development among primary bone grafted patients and nongrafted patients. The dental arch dimensions of the nongrafted patients (control group) consisted of the same data utilized by Moorrees in his study of the dentition of the growing child. The dental arch dimensions of nongrafted cleft patients consisted of the same data utilized by Athanasiou in his study of the dentition of cleft patients treated surgically without bone grafting. Of the eight measurements made by the three examiners, six demonstrated excellent interexaminer agreement, one demonstrated moderate interexaminer agreement, and one demonstrated poor interexaminer agreement. The arch width and length for the grafted group was significantly smaller (p < .05, Student's t-test) than the normal group in all measures except for the mandibular canine width. The arch width and length for the grafted group was not significantly different (p < .05, Student's t-test) than the nongrafted group, except for the maxillary molar width where the grafted group was smaller than the nongrafted group. The cephalometric values of the Riley group were compared against a nongrafted group, an early primary grafted group, and the Bolton standard values cited in Rosenstein's study. The Bolton standard values were used as the control group. This study found the cephalometric values of the Riley experimental group (treated following Rosenstein's protocol) to be of no statistically significant difference (p < .05, Students t-test) when compared with cephalometric values of the nongrafted and primary alveolar grafted groups cited in Rosenstein's 1982 study. The cephalometric values of the Riley experimental group were less than the cephalometric values of the nonclefted patients (Bolton standard control group) cited in Rosenstein's 1982 study. Interexaminer agreement ranged from poor to good with the poorest agreement among the linear values of ANS/PNS and GO/ME. The intraclass correlation coefficient values for SNA,m ANB, and SNB ranged from fair to moderate. The Riley cephalometric values were equal or slightly better than Rosenstein's grafted and nongrafted groups. Though smaller than the control group, the Riley cephalometric values were of no statistical significance (p < .05, Students t-test) when compared with the same parameters cited in Rosenstein's study. Although these findings infer that the patients treated following Rosenstein's protocol demonstrate some degree of craniofacial growth attenuation when compared with nonclefted patients (Bolton standard control group), the Riley patients showed no worse growth attenuation than similar patients treated without Rosenstein's protocol for primary alveolar grafting. The hypothesis of this thesis was that Rosenstein's protocol was viable and non-detrimental when compared with other treatment regimens. The results of this study support the hypothesis that Rosenstein's surgical protocol is not a contributing factor in craniofacial growth attenuation among cleft lip and palate patients.

No description available.

Objective: The multidisciplinary follow-up of patients with cleft lip with or without palate (CL/P) is organized differently in specialized centers worldwide. The aim of this study was to evaluate the different treatment needs of patients with different manifestations of CL/P and to potentially adapt the frequency and timing of checkup examinations accordingly. Design:We retrospectively analyzed the data of all patients attending the CL/P consultation hour at a tertiary care center between June 2005 and August 2020 (n=1126). We defined 3 groups of cleft entities: (1) isolated clefts of lip or lip and alveolus (CL/A), (2) isolated clefts of the hard and/or soft palate, and (3) complete clefts of lip, alveolus and palate (CLP). Timing and type of therapy recommendations given by the specialists of different disciplines were analyzed for statistical differences. Results: Patients with CLP made up the largest group (n=537), followed by patients with cleft of the soft palate (n=371) and CL ±A (n=218). There were significant differences between the groups with regard to type and frequency of treatment recommendations. A therapy was recommended in a high proportion of examinations in all groups at all ages. Conclusion: Although there are differences between cleft entities, the treatment need of patients with orofacial clefts is generally high during the growth period. Patients with CL/A showed a similarly high treatment demand and should be monitored closely. A close follow-up for patients with diagnosis of CL/P is crucial and measures should be taken to increase participation in followup appointments.

No description available.

Syfte: Syftet med den här studien var att kartlägga upplevelsen av omhändertagandet bland föräldrar till LKG-patienter och unga vuxna LKG-patienter i södra Sverige. Material och metod: Samtliga av de artiklar som presenteras i den här rapporten har erhållits genom litteratursökning på PubMed. Främst användes artiklar som berör upplevelsen av omhändertagandet, men även litteratur och hemsidor från svenska sjukhus och LKG-föreningar bidrog med information. För djupare förståelse av och för att erhålla ytterligare information om omhändertagandet i södra Sverige utfördes även en intervju med Ingemar Swanholm, ortodontist vid SUS. I denna enkätstudie tillfrågades 55 personer, varav 24 var föräldrar till barn med LKG och 31 var unga vuxna LKG-patienter. Detta gjordes för att få en helhetsbild av hur patienter och föräldrar upplevt omhändertagandet genom behandlingsgången.Resultat: Totalt deltog 30 patienter, varav 13 föräldrar till barn med LKG och 17 unga vuxna LKG-patienter. Resultatet redovisades var för sig, föräldrars upplevelse respektive patientens egen.Konklusion: Konklusion var att LKG-patienter och föräldrar till barn med LKG generellt var nöjda med omhändertagandet av dem och deras familj, vilket bekräftade hypotesen. För att kunna dra en slutgiltig slutsats om detta krävs dock vidare undersökningar med fler deltagande och validerade enkäter.

Background. The treatment of patients born with cleft lip and palate has been gradually modified over the years as the surgical procedures have developed and improved. Multidisciplinary team care has evolved and provided improved care with enhanced results. Clefts in the alveolus can be reconstructed by alveolar bone grafting or by periosteoplasty. The main goal is to repair and close the alveolar cleft and create a continuous alveolar processes so that the teeth can erupt. Aims. This thesis has several aims: to investigate the impact of dental status and initial cleft width on the outcome of Secondary alveolar bone grafting (SABG) in patients born with unilateral cleft lip and palate (UCLP) at the 10-year follow-up (Studies I and II); to compare the outcomes of primary periosteoplasty (PPP) with those of SABG in patients born with unilateral cleft lip and alveolus (CLA) (Study III); to evaluate clinical and radiographic conditions and identify factors important for the final treatment outcomes after SABG ( Study IV); to evaluate two radiographic methods, i.e. occlusal radiographs and cone beam tomography (CBCT)) for assessing alveolar bone height ( study IV). Results. In UCLP patients, SABG achieved excellent results in terms of bone height; tended to reduce with time, correlated with dental status and dental restoration factors. Occlusal radiographs correspond well with the CBCT, for evaluating alveolar bone height in cleft area. The width of the initial cleft does not seem to affect the success of SABG. Finally, patients with CLA treated with PPP at the time of lip repair have inferior bone formation outcomes in the cleft area compared with patients treated with SABG at the time of mixed dentition. Conclusion.  Poor dental status and malpositioning negatively affect the long-term survival of bone in the alveolar cleft. The initial cleft width affects certain dental status factors. In adults with UCLP, the alveolar bone height in the cleft was correlated to the presence of gingival inflammation and restorations at 20 years follow-up. Specially designed maintenance therapy is beneficial, after complex dental restorations in the cleft area. SABG is preferred to PPP for the reconstruction of alveolar clefts.

published_or_final_version / Dentistry / Master / Master of Dental Surgery

Darbe nagrinėjamas kompleksinės pagalbos vaikams su įgimtais lūpos ir / ar gomurio nesuaugimais vertinimas tėvų požiūriu. Atlikta teorinė vaikų, turinčių įgimtą lūpos, alveolinės ataugos, gomurio nesuaugimus pagrindinių aspektų analizė. Tyrimo tikslas - ištirti tėvų požiūrį apie medicininės ir logopedinės pagalbos teikimą vaikams, turintiems įgimtų lūpos, alveolinės ataugos ir/ar gomurio nesuaugimų. Darbe aprašytos kompleksinės pagalbos vaikams su įgimtais lūpos ir / ar gomurio nesuaugimais strategijos, išnagrinėti logopedinės pagalbos ypatumai dirbant su tokiais vaikais. Panaudotas anketinės apklausos metodas, interviu ir atlikta statistinė duomenų analizė. Tyrime dalyvavo 105 tėvai, auginantys vaikus su įgimtais lūpos ir / ar gomurio nesuaugimais: 97 šeimos dalyvavo anketinėje apklausoje ir 8 – interviu. Svarbiausios empirinio tyrimo išvados: 1. Vaikams, turintiems lūpos, alveolinės ataugos ir gomurio nesuaugimų, reikalinga kompleksinė įvairių sričių specialistų pagalba. Tokiems vaikams pagalba teikiama iki 18 m. amžiaus. Visame šiame procese labai svarbu komandinis specialistų darbas ir aktyvus bendradarbiavimas su vaiko šeima. 2. Tėvų, auginančių vaikus su įgimtais lūpos, alveolinės ataugos ir/ar gomurio nesuaugimais, nuomonė apie teikiamą pagalbą jų vaikams yra skirtinga ir prieštaringa. Pagalbos suteikimo informacijos sklaida šeimoms, auginančioms vaikus su lūpos ir/ar gomurio nesuaugimais nėra tiek pakankama mažuose Lietuvos miesteliuose, kiek didžiuosiuose miestuose... [toliau žr. visą tekstą] / In this work, the approach to professional help for children with congenital cleft lip and / or palate was evaluated from the parents’ perspective. There was carried out the theoretical analysis of the main aspects related to children with congenital cleft lip, alveolus and palate. Aim of the study – to research parents’ opinion about the treatment and logopedic help support for children with congenital cleft lip, alveolus and palate. In the work, the strategies of professional help for children with congenital cleft lip and / or palate are described, and the peculiarities of logopedic help in work with such children are researched. It was used the method of questionnaire, interview, and it was performed the analysis of statistical data. In the study, there were involved 105 parents having children with congenital cleft lip and / or palate: 97 questionnaire respondents and 8 interview participants. The main conclusions of the empirical study: 1. For children with congenital cleft lip and / or palate, the complex course for rehabilitation of functions is applied until the age of 18 years. In order to achieve good results, the teamwork of surgeon, orthodontist, speech therapist with other specialists in cooperation together with children parents is useful. 2. The opinion of parents, having children with congenital cleft lip and / or palate, is different and contradictory in terms of the professional help for their children; it was revealed that there is a lack of information... [to full text]

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