Orofacial clefts are extremely common birth defects. Orofacial clefts affect a multitude of different areas including feeding, speech, proper tooth development, as well as personality. There are many causes associated with the many different presentations of the birth defect. There have been a multitude of different surgical procedures over time that have dealt with the complications associated with repairing the various clefts. There is no current accepted standard for orofacial cleft repair. In more recent times the focus of the various orofacial clefts procedures have gone from a major procedure where survival was the objective to a more streamline procedure with a man goal of restoring normal human anatomy. Presurgical nasoalveolar molding (PNAM) is more recent procedure that takes advantage of the malleability and rapid growth of facial tissue during the first months of life. This procedure uses a custom acrylic plate that brings the right and left halves of the cleft closer together. This procedure is currently not accepted by all because the long-term effects are unclear. The aim of this study is to point out the short term successes of the PNAM procedure, compare our results to current published studies, and suggest further study that should be completed. A case report was completed on the first five months of treatment on a bilateral cleft lip/ cleft palate case. The case report followed the patient from birth through the first cleft lip closure surgery. The notes taken at weekly appliance adjustment appointments will be reviewed for information on progress as well as behavior and parent involvement. Pictures were also reviewed in order to review progress as well as surgical procedure. After review of the appointment notes and various pictures from throughout the process it was deemed that this PNAM procedure was a success. It was found that there was an overall increase in symmetry in facial structure as well and an increase in facial tissue. After reviewing pictures of the surgical procedure it can be concluded that the overall process was made easier by the PNAM procedure. It is concluded that the PNAM procedure is extremely successful in the short term but in order to receive more concrete results more cases must be reviewed with future follow-ups in order to see consistent long-term results.

published_or_final_version / Dentistry / Master / Master of Dental Surgery

BACKGROUND AND SIGNIFICANCE: Almost 15% of newborns have congenital anomalies that involve the oral and craniofacial regions, but of these congenital anomalies, cleft lip and palate and craniosynostosis are the most common. It is estimated that the incidence of cleft lip and palate is 0.664 in 1000 live births. These patients commonly have skeletal imbalances of the maxillae and mandible that require surgical and orthodontic correction. Orthodontists and oral surgeons play a critical role in identifying the necessary care and ensuring that the patient receives the best quality of care possible. OBJECTIVES: The objective of the current study is to examine the prevalence of adverse effects of medical care and infectious complications in patients with cleft lip/palate undergoing facial bone repairs/orthognathic surgeries in the United States during the years 2012 to 2014. It will also examine the association between patient/hospital related factors and surgical outcomes (including adverse affects of surgery, incidence of infection, etc.) and how these surgical outcomes impact the hospital costs and length of stay in the hospital. MATERIALS AND METHODS: The Nationwide Inpatient Sample (NIS) is a 20% stratified probability sample of hospitalizations occurring in all acute care hospitals in the United States. It is part of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ) [12]. Each hospital in this sample provides information on 20% of hospitalizations occurring during the select years. Hospital stratification is based on multiple hospital-associated variables including: hospital location, geographic region, bed size, teaching status, and ownership/control. Each hospitalization is assigned a sampling weight. Patient-related variables are also provided by the hospitals. In this study, this information is used to provide a nationally representative estimate of all hospitalizations and associated outcomes in the United States from 2012-2014. RESULTS: This study includes all 1,785 patients with cleft lip/palate undergoing facial bone repair/orthognathic surgical procedures in the United States during the study period (2012-2014). These results confirm the hypothesis that there are a combination of patient and hospital related factors that contribute to the occurrence of adverse events and that the occurrence of these events is associated with substantial increases in hospital charges and length of hospital stay. CONCLUSION: These study results are a national representative sample of patients with cleft lip/palate undergoing bony facial repair and orthognathic surgery. They reflect the practice patterns and hospitalization outcomes across the United States. These results can serve as a platform for future prospective controlled studies to examine the risk factors associated with adverse effects of medical care for a wide range of surgical procedures. This information is useful for clinicians, health policy makers, and patients so that they can make informed treatment and policy decisions as well as continue to improve surgical procedures and outcomes.

Thesis(M.A.)--Case Western Reserve University, 2010 / Title from PDF (viewed on 2010-01-28) Department of Communication Sciences Includes abstract Includes bibliographical references and appendices Available online via the OhioLINK ETD Center

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No description available.

This retrospective cohort study of 336 lateral cephalometric radiographs from 62 children (34 males and 28 females) with non-syndromic complete unilateral cleft lip and palate from the Hospital for Sick Children and 50 non-cleft children (25 females and 25 males) from the Burlington Growth Centre. Cervical vertebral maturation stages at age 10, 12 and 14 were determined. The cervical vertebral maturation (CVM) was established using the 6-stage method described by Baccetti and coworkers. The reproducibility of classifying CVM stages was high, with an inter-rater reliability (ICC) with the standard (Baccetti et al, 2005) of 80% and intra-rater reliability of 85%. The Cervical vertebral maturation stage for both males and females with UCLP was significantly later than children without a cleft at age 10, 12 and 14. The results suggest that patients with UCLP show delayed skeletal maturation in comparison to non-cleft patients.

This retrospective cohort study of 336 lateral cephalometric radiographs from 62 children (34 males and 28 females) with non-syndromic complete unilateral cleft lip and palate from the Hospital for Sick Children and 50 non-cleft children (25 females and 25 males) from the Burlington Growth Centre. Cervical vertebral maturation stages at age 10, 12 and 14 were determined. The cervical vertebral maturation (CVM) was established using the 6-stage method described by Baccetti and coworkers. The reproducibility of classifying CVM stages was high, with an inter-rater reliability (ICC) with the standard (Baccetti et al, 2005) of 80% and intra-rater reliability of 85%. The Cervical vertebral maturation stage for both males and females with UCLP was significantly later than children without a cleft at age 10, 12 and 14. The results suggest that patients with UCLP show delayed skeletal maturation in comparison to non-cleft patients.

Thesis (M.S.)--University of Wisconsin--Madison, 1965. / eContent provider-neutral record in process. Description based on print version record. Bibliography: l. 116-129.

Thesis (MA)--University of Chicago. / Includes bibliographical references.