Cleft Palate-Craniofacial Journal最新文献

Zygomatic implant (ZI) is considered a predictable alternative for patients with atrophic maxilla. However, regarding the case of patients with cleft lip and palate (CLP), the evidence of ZI rehabilitation remains unclear. This study aimed to evaluate the indications and clinical outcomes of rehabilitation using ZI in CLP patients. The focus question was: "What are the indications and clinical outcomes of ZI rehabilitation in patients with CLP?" Electronic and manual literature searches were performed from January 2000 to May 2024 in five databases. Clinical studies and case reports were selected. The primary outcome was the ZI survival rates. The secondary outcomes were indications, loading protocols, and complications. The extracted data were subjected to descriptive analysis. In total, 16 studies were included, 24 patients with CLP received 48 ZIs, with an average of 4.2 years of follow-up. The survival rate of ZIs was 97.9% and was mainly indicated for those with Cawood and Howell classification V and VI, with insufficient bone in the maxilla with bilateral CLP. The immediate loading was performed in 33.3% of the cases, and the prosthesis was designed according to case complexity and necessity. ZI rehabilitation appears to be a reliable and predictable solution for the patient with CLP. The immediate loading solution can be beneficial to CLP patients as it helps avoid additional treatments. However, with the inconsistently limited data, the indications cannot be only based on the existing CLP classification.

Objective: The purpose of this study was to evaluate maxillary sinus (MS) pathologies in children and adolescents with cleft lip and palate (CLP) in comparison to a sex- and age-matched control group using cone beam computed tomography (CBCT), retrospectively.

Method: CBCT images obtained between the years 2014 and 2022 from a total of 130 patients aged between 7 and 18 were considered eligible for this study. Age, sex, and the type of MS pathologies in each sinus were recorded in CLP (n = 65) and control (n = 65) groups. The MS pathologies were categorized and recorded for both right and left sinuses separately as: (1) healthy; (2) mucosal thickening >3 mm; (3) polypoidal mucosal thickening; (4) partial opacification; and (5) complete opacification. In the CLP group, the cleft type and side were also recorded. Variations of polypoidal mucosal thickenings were subcategorized as small, large, and multiple.

Results: The mean age of the 130 patients (58 female, 72 male) was calculated as 12.43 ± 3.13. Among the patients in the study and control groups, polypoidal mucosal thickening was found to be the most frequent sinus pathology (25.4%), while total opacification was found to be the least frequent (1.6%). Overall, only the number of sinuses with mucosal thickening greater than 3 mm was statistically significantly higher in the CLP than that of the control group (P < .05). In terms of cleft type and side, the frequency of the pathology based on the sinuses showed no significant difference in any of the pathology groups (P > .05).

Conclusion: Incidental findings in the oral and maxillofacial region that are detected on CBCT images of CLP patients may play an important role in the early diagnosis of MS diseases and aid in the referral for further evaluation.

To identify cephalometric parameters that could predict future need for orthognathic surgery (OGS) in patients with unilateral cleft lip and palate (UCLP).

Final search was conducted on July 7, 2024, across PubMed, Scopus, Embase, Web of Science, Cochrane, Ovid Medline, EBSCO, and LILACS, without any language and publication time restriction. Studies comparing surgical versus nonsurgical UCLP patients were included. Two independent reviewers screened studies, and those included were evaluated using Quality in Prognostic Studies (QUIPS) tool. Random-effects meta-analysis of various sagittal and vertical cephalometric parameters (SNA, SNB, ANB, mandibular plane angle [MPA], and lower anterior face height [%LFH]) was performed.

Ten studies were included in systematic review and 5 in meta-analysis. Quality in Prognostic Studies tool assessment indicated moderate risk in 6 studies, with 2 demonstrating high and low risks of bias. Meta-analysis revealed that in the 5- to 8-year age group, significant differences were observed in SNA and ANB angles between surgical and nonsurgical groups, with mean differences of 2.25° (95% confidence interval [CI] = 1.12, 3.39) and 3° (95% CI = 1.86, 4.15), respectively. In 9- to 14-year age group, significant differences were found in all 3 sagittal parameters: SNA angle difference of 2.65° (95% CI = 1.44, 3.86), SNB angle difference of 3.23° (95% CI = -4.69, -1.77), and ANB angle difference of 5.54° (95% CI = 3.66, 7.42). Vertical parameters (MPA and %LFH) were not statistically significant between groups in any age group.

Cephalometric parameters could be a valuable predictive factor for determining the future need for OGS in patients with UCLP. ANB angle has been shown to be a significant predictor for distinguishing between surgical and nonsurgical patients.

Background: Conventionally, vector guidance for internal distractor placement during cleft maxillary distraction osteogenesis (DO) is done using vector guidance splint. Vector guidance splint cannot be fabricated if occlusion is not decompensated for model surgery.

Solution: Using mandibular occlusal plane as anatomical reference, vector guidance oral prosthesis is fabricated to guide distractor placement and vector determination, in cases where model surgery is not possible.

What we do that is new: Vector guidance oral prosthesis is a new prototype produced to guide maxillary DO without the need of model surgery.

This study aims to explore the characteristics of microtia in Indonesia and examine whether family traits influence its severity, focusing on other congenital anomalies in patients categorized as either isolated or syndromic microtia.

This study is a descriptive-analytical study with a cross-sectional design.

Questionnaires were distributed via the WhatsApp group "Indonesian Microtia Family," established by the Airlangga University Hospital Microtia Team.

A total of 354 respondents completed the questionnaire, comprising patients with microtia and their family members and relatives.

There is no intervention in this study.

The data on the characteristics of patients with microtia are presented in a descriptive form. An analysis was conducted to determine the influence of family characteristics on the presence of other congenital anomalies in patients.

Familial microtia, defined as microtia occurring in patients with a family history of microtia or related anomalies such as preauricular tags and preauricular fistulas, significantly influences the presence of additional congenital malformations (syndromic microtia), as indicated by a P value of .018. An odds ratio of 3.191 was obtained, indicating that the risk of isolated microtia occurrence is 3 times higher in familial microtia compared to sporadic microtia.

In Indonesia, the majority of patients with microtia are male (78%), unilateral right (55.9%), third-degree Hunter (64.4%), solitary (72%), and sporadic (88.1%). Compared to sporadic microtia, familial microtia will increase the probability of isolated microtia occurrence by 3-fold.

Objective: To establish the effect of cleft palate repair on hearing outcomes in children with glue ear and conductive hearing loss undergoing elective primary palatoplasty.

Methods: A retrospective chart review of all patients who underwent cleft palate repair (isolated cleft palate [CPO], unilateral cleft lip and palate [UCLP], and bilateral CLP [BCLP]) between 2020 and 2022 in a single institution. Patient demographic data and cleft type were recorded. Statistical analysis was performed on pre and postoperative audiology reports.

Results: A total of 42 children (20 males, 22 females) had cleft palate repair within the study period. The mean age at primary repair was 15.2 months (range: 8-33 months). Seven of the 42 children were syndromic and 4 had Pierre Robin sequence. Preoperatively, 36 patients (86%) were diagnosed with conductive hearing loss. A single patient had hearing aids preoperatively due to severe hearing loss. One patient had grommets inserted at the time of palatoplasty. Postoperatively, all 42 patients attended their follow-up audiology appointments (100%); 20 patients (48%) had improved hearing levels, 18 (43%) had similar hearing levels, and 4 (9%) had worse hearing levels. When stratified by cleft type (25 CPO, 9 BCLP, and 8 UCLP) no difference was noted. Four patients required hearing aids postoperatively.

Conclusions: This study confirms that primary cleft palate repair has a positive impact on audiology outcomes in patients with cleft. These findings suggest that primary cleft palate repair may improve hearing at an early stage, possibly by contributing proactively to restoring eustachian tube function and normalizing middle ear ventilation before glue ear and associated conductive hearing loss improve with patient maturity.

Objective: To evaluate the effectiveness and parental satisfaction of an at-home weight reporting system for the maintenance of weight stability in infants with cleft lip and/or palate (CLP).

Design: A prospective cohort of infants with CLP was provided an at-home scale to track weekly weights compared to a retrospective cohort of infants with CLP that underwent standard weight checks at routine healthcare appointments.

Setting: Tertiary care pediatric hospital.

Patients/participants: Infants from 0 to 3 months of age who presented to a large midwestern Cleft Clinic with a diagnosis of CLP without a secondary major birth difference.

Interventions: "Weigh Easy" at-home scale and reporting system.

Main outcome measure(s): Weight loss or plateau.

Results: Infants enrolled in the prospective cohort (n = 25) were significantly less likely to have a destabilizing weight loss compared to the retrospective cohort (n = 131) (OR = 0.09, 95% CI = 0.01-0.60, P = .001 at 30 g/day; OR = 0.15, 95% CI = 0.04-0.60, P = .001 at 25 g/day; OR = 0.24, 95% CI = 0.09-0.61, P = .002 at 20 g/day). Over at least 90 days of data collection, the prospective group had a median of 12 weight changes compared to 4 in the retrospective cohort (P < .001). The Parent Satisfaction Survey (n = 17) revealed 94.1% preferred to weigh their child at home with the Weigh Easy Scale compared to commuting to a publicly available scale and 88.2% would recommend the "Weigh Easy" scale to their friends and family.

Conclusions: Providing parents of infants with CLP with the "Weigh Easy" scale identifies feeding and nutritional needs more quickly than standard weight checks.

Objective: To compare the reliability of different digitizing methods not only among themselves but also with direct measurements from facial plaster models of unoperated cleft babies.

Design: Single-center retrospective study.

Setting: The study consisted facial models of babies with unilateral (UCLP, n = 65) and bilateral (BCLP, n = 65) cleft lip and palate from the archives of the Department of Orthodontics, Marmara University, Istanbul, Turkey. Those models were digitized using Medit i600, iTero Element 2 (Align Technology), and E3 3Shape scanning devices. A digital caliper with a 0.03 precision (INSIZE Digital Caliper) was used for manual measurements on plaster models. 3Shape Ortho Analyzer software was used for digital measurements.

Results: All scanning methods were reliable and compatible with a rate of 90% or more compared to manual measurements. The E3 3Shape device showed the lowest deviations (UCLP, between 0.04 and 0.11 mm; BCLP, between 0.04 and 0.25 mm) from manual measurements. In the UCLP group, Medit i600 presented the highest deviation (0.15-0.58 mm) whereas Itero Element 2 showed the highest deviation in the BCLP group (0.16-0.46 mm). Although there were statistically significant differences in the deviations of digital measurements, the values were still within clinically acceptable limits.

Conclusion: Intraoral scanners were less reliable in topographic measurements, especially in cases with increased depth. Although the highest compatible results were found with E3 3Shape model scanner, iTero Element 2 and Medit i600 were promising and advisable for digitizing and archiving the plaster models of babies with cleft lip and palate.