Cleft Palate-Craniofacial Journal最新文献

To describe the long-term treatment course of bone-anchored maxillary protraction (BAMP) and evaluate orthognathic surgical indications after BAMP.

Retrospective case series.

Craniofacial/Cleft Palate Program at the Orthopaedic Institute for Children in Los Angeles, CA.

Twelve male patients with cleft palate (CP), unilateral cleft lip and palate (UCLP), or bilateral cleft lip and palate (BCLP) and Class III malocclusion treated with BAMP (mean age: 11.4 ± 2.6 years) were included.

BAMP treatment was performed by placement of bone-anchored maxillary and mandibular plates connected with intraoral Class III dental elastics or maxillary plates connected to a facemask.

We retrospectively assessed BAMP treatment variables, including age at surgery, revision surgeries, and treatment duration. The primary goal was correction to class I occlusion.

Twelve patients underwent BAMP treatment for an average of 4.4 ± 2.4 years. Two patients were corrected to class I occlusion at the time of this report. Le Fort I advancement was no longer required in two patients (16.7%), it was required for nine patients (75.0%) and was completed for one patient following BAMP treatment (8.3%).

This preliminary report demonstrated that BAMP treatment may be associated with a minimal reduction in the requirement for Le Fort I advancement at skeletal maturity. Future studies with larger sample sizes are necessary to confirm this association.

Objective: This study aims to systematically review and meta-analyze the electromyographic activity of masticatory muscles in cleft palate and non-cleft patients, and identify influencing factors.

Design: Systematic Review and Meta-analysis.

Patients and exposures: Patients with cleft lip/ palate.

Comparison: Patients without CL/P.

Main outcome measures: Electrical activity of masseter and temporalis muscles at rest and during peak activation.

Results: After a comprehensive search in MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL up to December 2022, without language or date restrictions. Eligible trials were selected based on the PECO question and assessed for bias using Cochrane's ROBINS-E tool. Eight clinical trials with 474 participants were included in the review. Then relevant data was extracted from included studies using customized forms. A random-effects meta-analysis was performed to combine the results of the studies, meta-analyses showed that CL/P patients have elevated electrical activity in the masseter (P = .01) and temporalis (P = <.01) muscles at rest compared to non-cleft control patients. During maximum bite force, cleft patients exhibited a statistically significant decrease in electrical activity in both the masseter (P = .03) and temporalis (P = <.01) muscles.

Conclusions: According to our meta-analysis, cleft patients exhibited increased resting muscle activity but decreased activity during maximum bite force, indicating reduced efficiency of masticatory muscles compared to non-cleft patients. These differences can be attributed to anatomical variations, compensatory mechanisms, and previous treatments.

Objective: To define "high osteotomy" and determine the feasibility of performing this procedure.

Design: Single institution, retrospective review.

Setting: Academic tertiary referral hospital.

Patients, participants: 34 skeletally mature, nonsyndromic patients with unilateral CLP who underwent Le Fort I osteotomy between 2013 and 2020. Patients with cone-beam computed tomography (CBCT) scans completed both pre- (T1) and post-operatively (T2) were included. Patients with bilateral clefts and rhinoplasty prior to post-operative imaging were excluded.

Interventions: Single jaw one-piece Le Fort I advancement surgery.

Main outcome measures: Measurements of the superior ala and inferior turbinates were taken from the post-operative CBCT.

Results: The sample included 26 males and 8 females, 12 right- and 22 left-sided clefts. The inferior turbinates are above the superior alar crease at a rate of 73.53% and 76.48% on the cleft and non-cleft sides, respectively. One (2.9%) osteotomy cut was above the level of the cleft superior alar crease, and no cuts were above the level of the non-cleft superior ala. On average, the superior ala was 2.63 mm below the inferior turbinates. The average vertical distances from the superior alar crease and the inferior turbinates to the base of the non-cleft side pyriform aperture were 12.17 mm (95% CI 4.00-20.34) and 14.80 mm (95% CI 4.61-24.98), respectively. To complete a "high osteotomy," with 95% confidence, the cut should be 20.36 mm from the base of the pyriform aperture.

Conclusions: A "high" osteotomy is not consistently possible due to the relationship between the superior alar crease and the inferior turbinate.

Sotos syndrome is a genetic disorder characterized by distinct craniofacial features, overgrowth in childhood, and impaired intellectual development. We herein report the successful orthodontic treatment of a 14-year-old boy with Sotos syndrome caused by a heterozygous mutation in the NSD1 gene. He showed severe hypodontia, impaction of the maxillary second molars and a skeletal Class III jaw-base relationship. Orthodontic management, including space control by protraction of the maxillary first molars and traction of the impacted molars, was performed using fixed appliances and miniscrews. As a result, acceptable occlusion was obtained without any discernible relapse 18 months postretention.

Introduction: The levator veli palatini (LVP) muscle has two segments with distinct roles in velopharyngeal function. Previous research suggests longer extravelar segments with shorter intravelar segments may lead to a more advantageous mechanism for velopharyngeal closure. The purpose of this study was to examine whether the distribution of the LVP intravelar and extravelar segments differs between children with cleft palate with and without VPI and controls.

Methods: The study included 97 children: 37 with cleft palate +/- lip with VPI, 37 controls, and 19 with cleft palate with normal resonance. Measures included mean LVP length, mean extravelar LVP length, and intravelar LVP length.

Results: Overall mean LVP length was similar (P = .267) between controls and children with cleft palate (with and without VPI). However, there was a significant difference (P < .001) between group for both intravelar and extravelar LVP lengths: the intravelar segment was significantly longer in those with VPI compared to controls and children with cleft palate and normal resonance; and the extravelar segment was significantly shorter in those with VPI compared to controls and children with cleft palate and normal resonance.

Conclusions: Results from this study demonstrate a significant difference between the distribution of the functional segments of the LVP among children with VPI, with a more disadvantageous distribution of the muscle segments among those with VPI.

A case series of early postoperative complications due to trauma following primary cleft lip repair has been presented. Out of 193 primary cleft lip repair performed over the past 4 years, 5 patients had trauma related complications, 2 had complete wound dehiscence, 2 had partial dehiscence, and 1 presented with bleeding. This is the first report on complications following trauma after cleft lip repair. Such complications can be prevented with due vigilance during the early postoperative period. All children presented with wound dehiscence were managed with immediate suturing with good outcome. A protocol for the management of complications following trauma after cleft lip repair is being presented.

Prior 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.

Retrospective 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.

More 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.

SVI 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.

To analyze the content and sources of TikTok posts regarding cleft conditions; to examine the quality and reliability of educational content related to cleft conditions.

Cross-sectional, observational study of cleft-related TikTok content.

N/A.

N/A.

N/A .

Frequencies of TikTok post likes, views, comments, shares, and saves; engagement rate; post themes; and post educational content accuracy, quality, and reliability (assessed with the Patient Education Materials Assessment Tool and modified DISCERN [mDISCERN] rating scales).

A total of 252 cleft-related TikTok posts were reviewed. Most posts were created by family members of patients (n = 193, 76.59%), while posts from plastic surgeons were underrepresented (n = 11, 4.37%). Positive Messages were the most common video theme (n = 80; 31.75%), and 24 (9.52%) of the TikTok posts were classified as providing educational content. Plastic surgeons had the highest mDISCERN score (2.75) among all content creator categories, indicating more accurate and reliable educational content. When content creator categories were stratified by physician versus nonphysician creators, physician posts had significantly higher mDISCERN scores (P = .001). Despite objectively better educational content, plastic surgeons had the lowest engagement rate (1.82%), while family members had the highest engagement rate (7.04%).

Cleft teams should anticipate that patients and their caregivers will most likely access social media to learn more about cleft conditions and seek support. Patients and caregivers should be urged to stay cautious of the information they find online and ideally be offered reputable sources of information and support.

Objective: To 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.

Methods: The 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.

Results: We 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.

Conclusions: The 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: To assess craniofacial and upper airway growth in infants with Robin sequence (RS) during the 1^st year of life when their severe upper airway obstruction was treated non-surgically with the Stanford orthodontic airway plate treatment program (SOAP).

Design: Retrospective longitudinal cohort study comparing SOAP-treated infants with RS (treatment group) with age-matched healthy controls (HC) using computed tomography (CT).

Setting: Single tertiary referral hospital.

Patients: Twelve SOAP-treated infants with RS.

Interventions: SOAP.

Main outcome measures: Craniofacial skeletal cephalometric parameters and three-dimensional airway metrics.

Results: No infants required mandibular distraction or tracheostomy surgery after SOAP. The pre-treatment CT was acquired at the mean age (±SD) of 1.3 months (±0.7). The treatment lasted for 4.8 months (±0.9). Post-treatment CT was acquired at 12.9 months (±2.3) of age. The pre-treatment obstructive apnea hypopnea index decreased from 29.21 events/hour (±14.80) to 4.11 events/hour (±2.21) at post-treatment. The total mandibular length increased from 40.58 mm (±2.98) to 62.15 mm (±2.77) at post-treatment (p < 0.001) resulting in the growth velocity of 51.02% (±11.20) or 20.52 mm (±3.95) per year. The maxillary and mandibular lengths of the treatment group at post-treatment were shorter than those of HC although the maxillomandibular relationship was not different (p = 0.618). The upper airway volume and minimal cross-sectional area were also not different (p = 0.083, p = 0.254, respectively).

Conclusions: The maxillomandibular relationship and upper airway of the SOAP-treated infants with RS were near-normalized at post-treatment, comparable to age-matched healthy infants.