Cleft Palate-Craniofacial Journal最新文献

It's interesting to note that despite clinical improvements in upper airway dimensions, the maxillary, mandibular, and mandibular body lengths remained smaller than those of controls. This finding may represent an underlying neurocristopathy, which represents a deficiency in the population of neural crest cells available in the embryonic maxillary and mandibular processes de novo. Indeed, it is known that craniofacial dimensions in infants with malformations, such as cleft palate, are often smaller when compared to non-cleft counterparts. The post-treatment decrease in the SNA angle and increase in angle SNB, which resulted in a decreased ANB angle may be associated with a "headgear effect" whereby the maxilla is dragged postero-inferiorly by the mandible, aided by gravity. To avoid this effect, proactive maxillary development might be beneficial. In fact, the concept of "catch-up growth" is also noteworthy since a developmental mechanism would need to be invoked. The authors referred to the old Functional matrix hypothesis, but the treatment effect was primarily a change in jaw position, which evoked a positive functional outcome. Thus, according to the Spatial matrix hypothesis, clinical decompensation of a dysfunctional spatial matrix leads to a cascade of events since a change in mandibular position is associated with changes in gene expression. Recently, genetic expression of Sdf1 and Foxc1 associated with histologic changes following mandibular advancement in rats has been reported as well as the effects of the PINK1/Parkin pathway on the genioglossus muscle through mandibular advancement device use in rabbits with obstructive sleep apnea. Clinically, therapeutic epigenetic changes using an orthodontic mandibular advancement device have also been reported in children.

ObjectiveThe 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.MethodCBCT 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.ResultsThe 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).ConclusionIncidental 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.

ObjectiveThis study synthesized and described the prevalence and incidence of cleft lip and/or palate (CL/P) reported by different studies in Europe.DesignA scoping review was designed according to the Joanna Briggs Institute methodology and an advanced search was conducted using MedLine, Science Direct, and Semantic Scholar without time or language restrictions. Two reviewers extracted data from the articles included.ParticipantsThe extracted data included specific details on the type of orofacial cleft, the European regions (Northern Europe, Western Europe, Eastern Europe, and Southern Europe).Main Outcome Measure(s)A meta-analysis was conducted with the data reported for the incidence and prevalence of CL/P.ResultsA total of 66 studies were obtained reporting from 29 European countries. According to what was obtained from the meta-analysis, a prevalence of cleft lip and palate (CLP) of 0.7/1000 95% CI: (0.6-0.7) births is reported in Europe, followed by cleft palate (CP) and cleft lip (CL) with 0.5/1000 95% CI: (0.4-0.5) and 0.3/1000 95% CI: (0.3-0.4), respectively. A total prevalence of CL/P in Europe is estimated at 1.1/1000 95% CI: (1.0-1.2) between 1950 and 2014. The incidence of CLP is reported to be 0.7/1000 95% CI: (0.6 to 0.8) followed by CP and CL with 0.5/1000 95% CI: (0.5-0.6) and 0.4/1000 95% CI: (0.3-0.4), respectively. The total incidence of CL/P in Europe is estimated at 1.6/1000 95% CI: (1.5-1.7) between 1948 and 2018.ConclusionThis review provides a description of the status of the prevalence and incidence of CL/P in Europe and its regions, and can be considered as a guide for the development of promotion and prevention programs.

ObjectiveThis study aimed to analyze the stress distribution and displacement generated by bone-borne maxillary expansion in a late adolescent with unilateral cleft lip and palate (UCLP) using finite element analysis.DesignA 3-dimensional finite element model (3DFEM) was obtained from craniofacial bones and maxillary teeth. Seven 3DFEM maxillary expanders were adapted on the palatal slope with a displacement of 0.25 mm per turn.SettingThe study used a computational model based on a patient's craniofacial anatomy.Patients, ParticipantsThis study included one late adolescent with UCLP.InterventionsSeven different bone-borne maxillary expanders were tested, each with a displacement of 0.25 mm per turn on each side of the maxilla.Main Outcome Measure(s)The primary outcomes measured were stress distribution and displacement within the craniofacial structure.ResultsThe highest stress and displacement were generated by devices with Temporary Anchorage Devices and occurred at the cleft side. Maximum stress was observed in the zygomatic-maxilla interface of all analyzed devices. The displacement on the transverse plane was greater in the anterior region for most devices, forward on the anteroposterior plane, and downward on the vertical plane.ConclusionsUsing bone-borne devices in late adolescents with UCLP might be useful for correcting transverse maxillary deficiency.

ObjectiveDescribe surgical decision making and outcomes in a series of patients with persistent VPI after pharyngeal flap placement that were all treated with revision palatoplasty.DesignRetrospective, case series.ParticipantsFive patients with nonsyndromic cleft palate and persistent hypernasality following a pharyngeal flap. On MRI, 3 patients presented with an incohesive levator veli palatini muscle, and 4 patients had a pharyngeal flap that was below the palatal plane.InterventionsOne patient underwent straight-line intravelar veloplasty (IVVP), 2 patients underwent pharyngeal flap take-down and IVVP, and 2 patients underwent pharyngeal flap take-down and palate lengthening with buccal myomucosal flaps.Main Outcome MeasurePre- and postoperative resonance.ResultsFour of five patients (80%) achieved normal resonance 12 months postoperation.ConclusionsRevision palatoplasty may be an effective approach for treating patients with persistent hypernasality following a pharyngeal flap. MRI may aid in surgical selection based on patient-specific anatomical findings.

BackgroundPrior studies have linked the timing of craniosynostosis surgeries to several postoperative outcomes. However, less is known regarding the influence of sociodemographic factors on surgical timing for this population. This study investigates the influence of social vulnerability index (SVI), race, and urbanicity on the timing of craniosynostosis surgery.MethodsRetrospective data from 2013 to 2023 were queried from Cosmos, a national deidentified database from Epic electronic health record. Patients were stratified into sociodemographic cohorts, and chi-square tests were used to compare the proportion of each cohort undergoing craniosynostosis surgeries before and after 6 months of age.ResultsMore than 3000 patients were identified for each predetermined metric for sociodemographic analysis (SVI n = 3369, race n = 3541, urbanicity n = 3375). The proportion of patients undergoing surgery at 5 months or less decreased and those undergoing any surgery at 6 months or more increased (P < .0001) with increasing SVI. There was also a significant association of surgical timing and patient race (P < .0001) but not urbanicity.ConclusionSVI and patient race are associated with the timing of craniosynostosis surgery. Specifically, higher social vulnerability and certain racial groups are correlated with delayed surgical intervention. This delay in presentation may result in the inability to take advantage of more minimally invasive options, such as strip craniectomy with or without cranial spring placement. These findings highlight the need for targeted, patient-specific, interventions to address disparities in access to timely craniosynostosis surgery.

Witteveen-Kolk syndrome (WITKOS) is an exceptionally uncommon genetic and neurodevelopmental disorder, characterized by developmental delay, mild intellectual disability, and craniofacial dysmorphic features. Although cleft palate (CP) has rarely been reported in WITKOS, CP in this condition has not been assessed in detail. Here, we present a case of WITKOS with a CP. The patient was a 2-year-old male and he was referred to our clinic with CP and dysmorphic clinical findings. Screening for CP should be considered when a diagnosis of WITKOS is made. CP repair can be performed successfully after neurodevelopmental maturation is complete.

IntroductionSocial media has played a pivotal role in relaying healthcare-related information, especially in efforts to improve cleft management. Cleft management involves a multidisciplinary team throughout the years of comprehensive intervention, from birth to adulthood.ObjectiveTo investigate the behaviors of parents and patients with clefts regarding social media use in improving cleft-related outcomes, knowledge, and awareness.DesignThis questionnaire-based descriptive study was conducted online and involved both closed- and short-ended questions.ParticipantsParents and patients with cleft lip and palate provided consent to participate in the study.Main Outcome Measures:Patient demographics, history, and timing of cleft treatment, barriers to care, and social media use were explored.ResultsFifty-six participants were enrolled in this study. The mean ages of the mothers and fathers of children with cleft were 34 (range, 24-57) and 36 (range, 26-59) years, respectively, and more than one-half were university graduates. WhatsApp, Instagram, and YouTube were used by 100%, 89%, and 89% of parents, respectively, 82% of whom were part of a cleft community group. Seventy-two percent underwent labioplasty, and 75% underwent palatoplasty at the ideal time. Parents exhibited low perceived barriers to care, with 33% and 37% reporting limitations on knowledge and accommodation, respectively.ConclusionSocial media is the key to bridging the gap between the large number of cases and facility limitations and specialized human resources. Cleft centers should integrate combined platforms (WhatsApp, YouTube, and Instagram) for marketing and education purposes. Social media and community groups facilitate sharing, engagement, and empowerment of patients and caregivers to improve cleft-related outcomes.

BackgroundCranial orthosis is a widely accepted treatment approach for moderate to severe deformational plagiocephaly. Custom-fit helmets molded tightly to the head are worn for 23 hours a day for several months2. This poses a challenge for children with concurrent conductive hearing loss who benefit from hearing devices, specifically bone anchored hearing aids (baha), that are intended to contact the skull directly1. We theorized the bone conducted signals could be transferred through the helmet to the baha device given its tight fit to the cranium.MethodsThis is a pilot study in which we present a case report of three patients in whom baha with headbands were used over their helmet therapy. Feedback management settings were adjusted to account for this. Given the age and development of the children, aided testing was performed.ResultsGood aided benefit was seen with using baha placement over the helmet. Optimal results were achieved with placement of the processor on the flat section of the helmet near the ear pinna. One patient, however, did not tolerate stimulus well and the baha was discontinued. For the other two patients, the baha over the helmet was utilized until they completed helmet therapy. Baha program settings were re-measured/adjusted when the device was used without the helmet. Parents reported positive responses when their child was wearing the baha compared to without.ConclusionPlacement of the baha with headband over a molding helmet is an important alternative method for patients with concurrent deformational plagiocephaly and conductive hearing loss. This modification allows for earlier baha implementation to facilitate auditory and language development, and minimize communication delays, while permitting optimal head reshaping without compromising speech development or head shape.

Velopharyngeal insufficiency (VPI) predominantly affects children with cleft palate, undermining their ability to communicate. As a result, intelligible speech generation is one of the most important outcomes following cleft palate repair. In low- and middle-income countries (LMICs), the elevated incidence of cleft palate, unavailability of speech services, and suboptimal surgical outcomes has contributed to a substantial yet poorly defined global burden of VPI. Tracking speech outcomes in LMICs is essential to assessing VPI severity and identifying patients needing care. Artificial intelligence and machine learning are well-suited to accommodate this goal.