Pub Date : 2022-01-21DOI: 10.5772/intechopen.101065
Badr M.I. Abdulrauf
Nasal deformity in association with a cleft lip is quite characteristic and remains to be a stigma for the individual with this deformity. As a newborn, a cleft lip is the most obvious deformity viewed by average individuals and parents, but in the long-term it is the nose. Most of the previously described corrective techniques for addressing the nasal deformity associated with a cleft lip have focused on the dermal approximation of the adjacent lip by securing the freed cartilages to the skin temporarily and repositioning the nasal tip cartilages. We developed a corrective technique in which the nose is effectively lifted and suspended internally to the radix in a semi-closed manner. Secondary corrections to the nose or lip in childhood should be avoided unless problems in these areas are causing psychological disturbances. In such situations, minimal incisions and/or old lip scars should be used for access. Introduction of scars to the columella must be avoided in children, as this procedure hinders future formal cleft rhinoplasty. Unilateral cleft-associated nasal deformity has been more challenging due to the relative asymmetry compared to the bi-lateral counterpart. Secondary cleft septo-rhinoplasty is considered a challenging operation requiring significant surgical expertise. In adults, an open tip approach is required in addition to the use of sturdy cartilage grafts to augment the columella, tip, and dorsum, and to address functional nasal issues. In cases of severe and or poorly treated bilateral cleft lips and nasal deformities in adults, the nose and columella are first to be reconstructed with prolabial flap followed by an Abbe flap to the lip.
{"title":"Nasal Deformity in Association with Cleft Lip - Management from Infancy to Adulthood","authors":"Badr M.I. Abdulrauf","doi":"10.5772/intechopen.101065","DOIUrl":"https://doi.org/10.5772/intechopen.101065","url":null,"abstract":"Nasal deformity in association with a cleft lip is quite characteristic and remains to be a stigma for the individual with this deformity. As a newborn, a cleft lip is the most obvious deformity viewed by average individuals and parents, but in the long-term it is the nose. Most of the previously described corrective techniques for addressing the nasal deformity associated with a cleft lip have focused on the dermal approximation of the adjacent lip by securing the freed cartilages to the skin temporarily and repositioning the nasal tip cartilages. We developed a corrective technique in which the nose is effectively lifted and suspended internally to the radix in a semi-closed manner. Secondary corrections to the nose or lip in childhood should be avoided unless problems in these areas are causing psychological disturbances. In such situations, minimal incisions and/or old lip scars should be used for access. Introduction of scars to the columella must be avoided in children, as this procedure hinders future formal cleft rhinoplasty. Unilateral cleft-associated nasal deformity has been more challenging due to the relative asymmetry compared to the bi-lateral counterpart. Secondary cleft septo-rhinoplasty is considered a challenging operation requiring significant surgical expertise. In adults, an open tip approach is required in addition to the use of sturdy cartilage grafts to augment the columella, tip, and dorsum, and to address functional nasal issues. In cases of severe and or poorly treated bilateral cleft lips and nasal deformities in adults, the nose and columella are first to be reconstructed with prolabial flap followed by an Abbe flap to the lip.","PeriodicalId":340147,"journal":{"name":"Recent Advances in the Treatment of Orofacial Clefts [Working Title]","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130330987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-16DOI: 10.5772/intechopen.101205
Manal Abdalla Ali Eltahir
Oronasal fistula is one of the disappointing expected outcomes of cleft palate surgery. It may follow palatoplasty for palatal clefting patients, which is defined as an abnormal communication between the oral and nasal cavities. More than one system has attempted its classification. It may be a small and a symptomatic or symptomatic fistula that requires correction. Its rate differs widely according to many factors. Both surgical and non-surgical methods (the pros and cons of each should be considered) are available for its correction, and there are adjunctive therapies to assist in improving the surgical outcome.
{"title":"Oronasal Fistula: A Complication of Cleft Palate Surgery","authors":"Manal Abdalla Ali Eltahir","doi":"10.5772/intechopen.101205","DOIUrl":"https://doi.org/10.5772/intechopen.101205","url":null,"abstract":"Oronasal fistula is one of the disappointing expected outcomes of cleft palate surgery. It may follow palatoplasty for palatal clefting patients, which is defined as an abnormal communication between the oral and nasal cavities. More than one system has attempted its classification. It may be a small and a symptomatic or symptomatic fistula that requires correction. Its rate differs widely according to many factors. Both surgical and non-surgical methods (the pros and cons of each should be considered) are available for its correction, and there are adjunctive therapies to assist in improving the surgical outcome.","PeriodicalId":340147,"journal":{"name":"Recent Advances in the Treatment of Orofacial Clefts [Working Title]","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126849114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-28DOI: 10.5772/intechopen.98633
David F. Gómez-Gil
The treatment of patients with cleft lip with/without cleft palate is still a challenge for its correct team management. The fact that not all clefts are alike, based on anatomical findings and ortho/surgical alternatives used in their correction, requires that clinicians -working in interdisciplinary or multidisciplinary teams- direct efforts not only to repair the facial and oral characteristics of the cleft, but also to work in the context of the patient’s craniofacial growth and development, tri-dimensionally affected by this type of craniofacial difference. The first part of this chapter is focused on the diagnostic approach for patients with unilateral cleft lip and palate (UCLP), using a modified version of the GOSLON yardstick (GOSLON+) that considers not only dental components but also 3D facial aspects of a complex malocclusion originated from this congenital malformation. Second, current treatment alternatives based on patient’s stages of dental development and cleft width, using either straight-wire or passive self-ligation appliances are presented, directed to avoid dental prosthetic replacements if possible. Finally, our treatment algorithms summarized in a step-by-step fashion the treatment of such differences with approaches that will focus on these two key aspects, essential for a successful, patient-based, interdisciplinary treatment protocol.
{"title":"Alternative Craniofacial Orthodontics Treatment Approaches for Differential Severity in Patients with Unilateral Cleft Lip with/without Palate","authors":"David F. Gómez-Gil","doi":"10.5772/intechopen.98633","DOIUrl":"https://doi.org/10.5772/intechopen.98633","url":null,"abstract":"The treatment of patients with cleft lip with/without cleft palate is still a challenge for its correct team management. The fact that not all clefts are alike, based on anatomical findings and ortho/surgical alternatives used in their correction, requires that clinicians -working in interdisciplinary or multidisciplinary teams- direct efforts not only to repair the facial and oral characteristics of the cleft, but also to work in the context of the patient’s craniofacial growth and development, tri-dimensionally affected by this type of craniofacial difference. The first part of this chapter is focused on the diagnostic approach for patients with unilateral cleft lip and palate (UCLP), using a modified version of the GOSLON yardstick (GOSLON+) that considers not only dental components but also 3D facial aspects of a complex malocclusion originated from this congenital malformation. Second, current treatment alternatives based on patient’s stages of dental development and cleft width, using either straight-wire or passive self-ligation appliances are presented, directed to avoid dental prosthetic replacements if possible. Finally, our treatment algorithms summarized in a step-by-step fashion the treatment of such differences with approaches that will focus on these two key aspects, essential for a successful, patient-based, interdisciplinary treatment protocol.","PeriodicalId":340147,"journal":{"name":"Recent Advances in the Treatment of Orofacial Clefts [Working Title]","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115320576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-07DOI: 10.5772/intechopen.99109
N. Vo, N. Pham, Chien Dac Ho, Son Van Le, Ha Manh Nguyen
Alveolar cleft bone graft in the second stage of surgery was a crucial part of the cleft palate treatment protocol with many advantages: reconstructing bone for tooth eruption, supporting the periodontal structure for the teeth adjacent to the cleft, supporting and lifting the arch and preventing from collapsing of maxillary arch. Grafting technique and material are selected based on the treatment purpose that for orthodontic moving tooth into the arch or for dental implant rehabilitation. Cancellous material provides rapid vascularization and healing facilitating for tooth moving into the cleft site but easy to resorb that unsuitable for dental implant placement. While dense material is difficult to move teeth into the cleft but increase initial stability. Therefore, we offered a method that limit bone resorption, easily obtain the implant initial stability, quick osseointegration called two iliac cortical bone blocks sandwich technique for a purposes of dental implant rehabilitation. Treatment protocol started with orthodontic treatment prior alveolar bone grafting to create proper space for implant restoration. Our clinical experience with 32 cleft sites using two iliac cortical bone blocks sandwich had shown potential clinical application in follow-up time up to 96 months. Evaluation criteria of bone grafting for alveolar cleft included soft tissue condition of graft area, nasal fistula closure, bone grafting outcome, success in osseointegration and implant prosthesis. This chapter described in detail treatment procedure and outcomes of a new technique of two iliac cortical bone blocks sandwich for alveolar cleft in patients with unilateral cleft palate.
{"title":"A New Technique of Two Iliac Cortical Bone Blocks Sandwich Technique for Secondary Alveolar Bone Grafting in Cleft Lip and Palate Patients","authors":"N. Vo, N. Pham, Chien Dac Ho, Son Van Le, Ha Manh Nguyen","doi":"10.5772/intechopen.99109","DOIUrl":"https://doi.org/10.5772/intechopen.99109","url":null,"abstract":"Alveolar cleft bone graft in the second stage of surgery was a crucial part of the cleft palate treatment protocol with many advantages: reconstructing bone for tooth eruption, supporting the periodontal structure for the teeth adjacent to the cleft, supporting and lifting the arch and preventing from collapsing of maxillary arch. Grafting technique and material are selected based on the treatment purpose that for orthodontic moving tooth into the arch or for dental implant rehabilitation. Cancellous material provides rapid vascularization and healing facilitating for tooth moving into the cleft site but easy to resorb that unsuitable for dental implant placement. While dense material is difficult to move teeth into the cleft but increase initial stability. Therefore, we offered a method that limit bone resorption, easily obtain the implant initial stability, quick osseointegration called two iliac cortical bone blocks sandwich technique for a purposes of dental implant rehabilitation. Treatment protocol started with orthodontic treatment prior alveolar bone grafting to create proper space for implant restoration. Our clinical experience with 32 cleft sites using two iliac cortical bone blocks sandwich had shown potential clinical application in follow-up time up to 96 months. Evaluation criteria of bone grafting for alveolar cleft included soft tissue condition of graft area, nasal fistula closure, bone grafting outcome, success in osseointegration and implant prosthesis. This chapter described in detail treatment procedure and outcomes of a new technique of two iliac cortical bone blocks sandwich for alveolar cleft in patients with unilateral cleft palate.","PeriodicalId":340147,"journal":{"name":"Recent Advances in the Treatment of Orofacial Clefts [Working Title]","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132398005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-04DOI: 10.5772/intechopen.99166
Rahma ElNaghy, Sara A. Amin, Majd Hasanin
Digital workflow in the dental is on the brink of completely replacing the traditional workflow. This opened the frontier for the introduction of intraoral scanners (IOS). In the craniofacial field, IOS has proven its applicability in various procedures with highly promising results. This includes comprehensive diagnosis of patients with orofacial clefts and custom-made treatment planning of challenging cases as well as its use in nasoalveolar molding (NAM) therapy. IOS also opened the horizon to the advanced digital workflow required for appliances design, manufacturing, and virtual surgical planning. IOS offer various advantages that decrease the time, effort for both the patients, their families and care providers. IOS adopt different optical technologies what aim for precise recording of a three-dimensional (3D) object. This chapter aims to provide a comprehensive review of the use of intraoral scanners in the craniofacial field.
{"title":"Concepts and Clinical Applications of Intraoral 3D Scanning in the Management of Patients with Orofacial Clefts","authors":"Rahma ElNaghy, Sara A. Amin, Majd Hasanin","doi":"10.5772/intechopen.99166","DOIUrl":"https://doi.org/10.5772/intechopen.99166","url":null,"abstract":"Digital workflow in the dental is on the brink of completely replacing the traditional workflow. This opened the frontier for the introduction of intraoral scanners (IOS). In the craniofacial field, IOS has proven its applicability in various procedures with highly promising results. This includes comprehensive diagnosis of patients with orofacial clefts and custom-made treatment planning of challenging cases as well as its use in nasoalveolar molding (NAM) therapy. IOS also opened the horizon to the advanced digital workflow required for appliances design, manufacturing, and virtual surgical planning. IOS offer various advantages that decrease the time, effort for both the patients, their families and care providers. IOS adopt different optical technologies what aim for precise recording of a three-dimensional (3D) object. This chapter aims to provide a comprehensive review of the use of intraoral scanners in the craniofacial field.","PeriodicalId":340147,"journal":{"name":"Recent Advances in the Treatment of Orofacial Clefts [Working Title]","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127042629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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