Cleft Palate-Craniofacial Journal最新文献

ObjectivesThe study aimed to understand parents' reactions to cleft, the manner in which they learned about its presence, and the challenges they faced in caring for their child with a view to providing healthcare professionals insights toward enhancing care delivery.DesignQualitative in-depth interviews using the grounded theory approach were carried out with 11 mothers and fathers of children with cleft lip and palate (CLP) attending a cleft speciality hospital in Chennai city, in South India.ResultsAnalysis resulted in the discovery of 5 core categories, learning about CLP-when and how, reactions and attributions to CLP, learning about and expectations from treatment, caring for a child with CLP and support systems. Feelings of shock and bewilderment when they learned of the presence of cleft in their child was reported by most parents. Poor awareness of cleft, difficulties in feeding, and concerns for the child's future were major sources of disquiet. The presence of support from family and friends and interactions with other parents of children with cleft helped them to cope better.ConclusionsThe results highlight the need for enhancing understanding of cleft among parents and strengthening them emotionally, thereby empowering them to provide effective care for their child. There is an urgent need to develop standardized information materials for parents to ensure that they have clear, consistent, and reliable information on the care of their child.

ObjectiveTo develop an artificial intelligence (AI)-based algorithm for the assessment and comparison of skeletal maturation in patients with and without cleft lip and/or palate and to detect the presence of cervical vertebral anomalies (CVAs).DesignRetrospective cohort study.SettingA university orthodontic clinic and comprehensive cleft care centers.Patients/ParticipantsIn total, 1080 cephalograms of patients with and without unilateral cleft lip and palate (UCLP) aged 6 to 18 years, without any associated syndromes, congenital disorders, or history of trauma or illness, were collected. About 960 cephalograms were assessed in the study upon elimination of poor-quality lateral cephalograms.MethodsThe MobileNet architecture using TensorFlow framework was employed to develop 2 convolutional neural network (CNN)-based AI models for automated assessment of skeletal age and detection of CVAs. Inter-rater reliability for manual cervical vertebral maturation (CVM) staging was assessed using Cohen's kappa coefficient, and intraclass correlation coefficient (ICC) was calculated. The results of each model were separately analyzed using chi-square test, and the statistical significance was tested at 5% level.ResultsThe CNN-based AI model yielded an average accuracy rate of 74.5%, with an accuracy of up to 88% for detecting skeletal maturity and an accuracy rate of 83% for detecting CVAs.ConclusionsIt can be concluded that CVM methods help detect skeletal maturity objectively in patients with UCLP and have shown delayed skeletal growth compared to patients without UCLP. CVAs were found to be more prevalent in patients with UCLP than in their non-cleft counterparts, with these findings facilitated by utilizing a novel AI algorithm.

ObjectiveTo date, there are no published studies From the Sultanate of Oman on the incidence or characteristics of craniosynostosis (CS). This is a population-based epidemiological study of the incidence of CS.MethodsThe prospective registry of the craniofacial surgery unit in Khoula Hospital was used to retrieve data on all individuals with CS treated between 2004 and 2023. The cohort was divided into four 5-year groups based on year of birth: 2004 to 2008, 2009 to 2013, 2014 to 2018, and 2019 to 2023.ResultsWe identified 312 individuals with CS. The incidence increased significantly during the study period and was 2.5 per 10 000 live births in the last 5-year period. There was a male preponderance (male/female ratio 1.5:1). Our study findings reveal a notable diversity in the trend of suture involvement, we observed a higher frequency of complex CS within our study population 35.9%. Half of the study population was nonsyndromic, accounting for 51.6%. The nonsyndromic population exhibits a higher proportion of midline suture involvement.ConclusionsThe incidence of CS increased during the study period. The majority of cases were identified as nonsyndromic. We found that multiple sutures CS were the most prevalent overall in our population. It is imperative to intensify efforts aimed at raising awareness among the general population regarding these deformities.

Objective:This study aimed to identify the predictive role of cleft type, ethnicity, adoption status, spoken language at home and parental education level on the caries risk in the primary dentition of patients with cleft lip and/or palate (CL/P). This knowledge is used to make an estimate on increased caries risk in young patients with CL/P.Design:A retrospective analysis of data concerning dental caries and basic characteristics of patients with CL/P was done. Patients were born and registered in 2016, 2017, or 2018 at the cleft team of the Erasmus Medical Center, Rotterdam, the Netherlands.Results:After Chi-square tests, the cleft type (P = .02), country of birth father (P < .001), country of birth mother (P = .002), parental educational level (P = .006), and spoken language at home (P = .002) were significantly different between 144 patients with CL/P with and without caries. Items were used in binary logistic regressions and after stepwise backward elimination resulting in most important determinants for caries in the primary dentition in patients with CL/P being: father born in another country than the Netherlands (odds ratio [OR] = 4.87, P = .001), a cleft lip alveolus and palate phenotype (OR = 3.54, P = .002), and a lower parental educational level (OR = 2.30, P = .04).Conclusion:The recommendation for the dental care professional will be to use these 3 determinants as a first prediction on future dental caries. This helps the dental professional in clinical decisions as recall intervals, referral to specialized dental care and extensiveness of caries prevention strategies and thereby improves oral health of patients born with CL/P.

ObjectiveAssess the relationship between static and dynamic facial asymmetry in unilateral cleft lip and palate during maximum smile.DesignRetrospective cross-sectional study.SettingMultidisciplinary dentofacial planning clinic.ParticipantsThirty-one surgically managed non-syndromic unilateral cleft lip and palate patients between the ages of 13 to 17 years.Materials and MethodsDynamic three-dimensional (3D) facial images (four-dimensional [4D]) throughout the course of a maximum smile were captured using video stereophotogrammetry at a rate of 60 frames per second, which generated 180 3D images/expression. A generic facial mesh containing more than 7000 vertices was superimposed onto the 3D facial images to quantify and track facial asymmetry throughout the captured sequence. Partial ordinary Procrustes analysis was utilized to calculate an asymmetry score at the rest position, maximum smile, and at the point of maximum mathematical asymmetry. The relationships between the asymmetry at rest and the asymmetry at the point of maximum smile (static 3D), and the maximum mathematical asymmetry (dynamic 4D) were evaluated.ResultsAsymmetry scores were higher at maximum smile than at rest. Maximum mathematical asymmetry was observed in most cases during the relaxation phase. Static asymmetry at rest and maximum smile was strongly correlated with the maximum mathematical asymmetry (r = 0.941, P < .001).ConclusionsStatic 3D asymmetry at both rest and maximum smile are strongly correlated with dynamic 4D facial asymmetry. The use of 4D imaging, combined with generic mesh conformation and dense correspondence analysis, provides a valid objective measure of facial asymmetry.

ObjectiveTo evaluate the posterior superior alveolar canal (PSAC) in individuals with cleft lip and palate (CLP) by comparing them with individuals with no cleft lip and palate (NC) using cone beam computed tomography (CBCT).SettingThis is a cross-sectional, analytical study with a prospective sample.Patients, ParticipantsCBCT scans of 29 individuals with no cleft and palate (Group I) and 29 individuals with cleft lip and palate (Group II) were used.InterventionsPSAC was evaluated and compared for its position, diameter, and distance between the individuals with CLP and NC using CBCT scans.ResultsThe mean age of individuals in Group I and II were 12.93 and 11.82 years, respectively. The distribution of individuals based on gender comprised of 51.7% males and 48.3% females in both the study groups. PSAC was present in both right and left maxillary sinus in 100% of the study subjects of Group I and Group II. The most prevalent position of PSAC in Group I and Group II was on the lower third and middle third of lateral wall of maxillary sinus, respectively. The mean diameter was higher in Group II (1.2962 mm) when compared to Group I (1.0897 mm) which showed statistically significant value (P = .008).ConclusionThe promising results obtained from the present study demonstrates the importance of knowing the precise anatomical location of the PSAC in individuals with cleft lip and palate by using CBCT which is reliable, less time consuming and cost effective imaging tool.

ObjectiveThis study aimed to investigate the prevalent pattern of congenital tooth agenesis and the development of crown width in patients with alveolar clefts in Guizhou, China.MethodsThe imaging data and complete medical record information of 222 patients who met the criteria were studied. The rate of tooth agenesis, tooth agenesis patterns, type of cleft, gender, and crown width in patients with alveolar cleft were counted.ResultsTwenty-two congenital tooth agenesis patterns were statistically identified in patients with alveolar clefts by the tooth agenesis code method. The rate of congenital tooth agenesis in patients with alveolar cleft was 72.5%, and the most common missing teeth were lateral incisors. The rate of tooth agenesis was higher in bilateral alveolar cleft (87.1%) than in unilateral alveolar cleft (67.4%). No correlation was found between gender and tooth agenesis patterns, tooth agenesis rate, or number of missing teeth. Crown width in patients with alveolar clefts is less than normal. No correlation was found between the number of missing teeth and crown width.ConclusionsThe congenital tooth agenesis patterns and tooth agenesis rates in patients with alveolar clefts in Guizhou, China, were related to the type of cleft, independent of gender. The crown widths in patients with alveolar clefts were smaller than normal, irrespective of the number of tooth agenesis.

ObjectiveTo develop, implement, and evaluate a standardized perioperative care pathway for pediatric patients undergoing alveolar bone grafting from the anterior iliac crest.DesignA historical control group of 40 patients was reviewed retrospectively and compared to a prospectively collected treatment group of 40 patients who were treated with the new pathway.SettingTertiary-level academic pediatric hospital between 2018 and 2021.PatientsPediatric patients with nonsyndromic cleft lip and palate undergoing alveolar bone grafting.InterventionA perioperative clinical care pathway was specifically designed for patients undergoing alveolar bone grafting from the anterior iliac crest. The pathway involved standardization of perioperative care, ultrasound-guided regional anesthesia for both surgical sites, and scheduled postoperative analgesia.Main outcome measures(1) Length of hospital stay; (2) opioid consumption postoperatively; and (3) volume of oral intake in the first 24 h postoperatively. Data was analyzed via comparison of means (Student's t-test for continuous data and Chi-square test for categorical data) and control chart analysis.ResultsCompared to the control group, patients in the treatment group had lower mean length of stay (26.8 vs 37.8 h, p < .001), lower mean morphine consumption postoperatively (8 vs 34 mcg/kg, p = .008), and a higher proportion of patients not requiring any postoperative opioid use (80% vs 50%, p = .005).ConclusionsImplementation of a standardized clinical care pathway for pediatric patients undergoing alveolar bone grafting from the anterior iliac crest is feasible and was associated with significant reductions in postoperative length of stay and postoperative opioid requirements.

BackgroundCommon congenital malformations known as orofacial clefts include cleft lip, cleft lip and palate, and cleft palate. They present significant public health challenges globally due to their medical, psychological, and socioeconomic impacts. Genetic and environmental factors mostly influence the genesis of nonsyndromic cleft lip with or without cleft palate.MethodsA meta-analysis was carried out to evaluate the association between IRF6 polymorphisms (rs2235371, rs2235373, and rs2235375) and NSCL/P. PubMed, Google Scholar, Scopus, and Embase were systematically searched for relevant articles. Studies meeting predefined inclusion criteria included case-control designs, genotype data, and statistical measures (odds ratios, 95% confidence intervals). Seventeen research papers were chosen based on the Newcastle-Ottawa Scale criteria for worth evaluation.ResultsThe meta-analysis included 1809 NSCL/P cases and 3164 controls from diverse populations, including Chinese Han, Brazilian, South Indian, Northeast Chinese, Uyghur, Indonesian, Vietnamese, Mesoamerican, and Iranian groups. However, in our analysis, only specific IRF6 SNPs-rs2235371 and rs2235373-showed significant associations in the allelic and dominant models, respectively, while other SNPs, including rs2235375, showed no significant association. These findings underscore the genetic heterogeneity of NSCL/P across various ethnic groups.ConclusionThis meta-analysis emphasizes the complex role of IRF6 polymorphisms in the genetic susceptibility to NSCL/P. While significant associations were identified in several populations, the lack of association in others suggests that genetic factors contributing to NSCL/P vary widely. Further research is needed to elucidate additional genetic determinants and their interfaces with environmental factors in the pathogenesis of NSCL/P.

ObjectivesCharacterize the upper airways (UAW) in individuals with syndromic craniosynostosis (SCS) using computed tomography scans and correlate with the airflow dynamics and craniofacial pattern.DesignObservational, cross-sectional study.SettingTertiary craniofacial center.IndividualsTwenty-nine individuals were included, divided in 2 groups: CON (n = 19; 21.2 ± 3.7 y), individuals with no craniofacial anomalies and no UAW morphological alterations, and SCS (n = 10; 22.1 ± 5.1 y) individuals with SCS prior to maxillomandibular surgery.InterventionsVolume (V, cm³) and minimal cross-sectional area (mCSA, mm²) was calculated (Mimics, Belgium). Computational fluid dynamics (ANSYS, EUA) was performed and flow (F, L/min), pressure (P, Pa), and resistance (R, Pa/[L/min]) were calculated. Cephalometric analysis (SNA[^o]), ANB[^o], Ba-S-N[^o]) was also assessed (Dolphin Imaging, USA).Main OutcomeThe morphophysiology of the UAW in SCS individuals was severely impaired compared with the CON group.ResultsThe SCS group exhibited significant volumetric reduction in the total UAW (-29%), nasal cavity (-21%), and pharynx (-37%) compared with the CON group. The mCSA was 57% smaller in the SCS group. CFD simulations demonstrated decreased flow (-9%), increased pressure (136%), and resistance (156%) in the SCS group. UAW resistance presented a strong positive correlation with mCSA (CON: r = 0.77 / SCS: r = 0.88). Cephalometric findings revealed significant differences between CON and SCS, with the SCS group exhibiting values outside the normal range.ConclusionThe UAW of individuals with SCS was anatomically and functionally impaired, suggesting a significant risk for obstructive sleep apnea.