An optimized imaging protocol for orofacial cleft patients

Abstract

The objective was to present an optimized imaging protocol for orofacial cleft (OFC) patients, which might be used as an international recommendation for OFC care programs. The present radiological protocol has been structured by the OFC team of the University Hospitals Leuven based on a combined approach of clinical experience and scientific evidence. The development was based on careful monitoring of the existing needs for radiological diagnosis by the involved disciplines. Needs were revised by expert consensus and radiological optimization. Effective doses were converted to panoramic equivalents (professional conversion) and background radiation (patient conversion). At the age of 6, a panoramic radiograph is taken for the evaluation of dental anomalies. For the preoperative planning of secondary alveolar bone, grafting a low‐resolution cone beam computer tomography (CBCT) of a limited field of the maxilla is taken at the age of 7 to 9. At the age of 10, 15, and 20, a low‐resolution CBCT of both jaws with the smallest possible field is taken serving as conventional, presurgical, and end of treatment records, respectively. Two‐dimensional images are reconstructed out of 3D ones. There are currently no international guidelines concerning the imaging protocol for OFC patients. It is clear that a multidisciplinary approach plays a key role in radiation hygiene. In this article, we presented an optimized imaging protocol for OFC patients based on European guidelines to accomplish the concepts of justification and optimization, which might be used as an international recommendation for OFC care programs.

Dental development in cleft lip and palate patients: A systematic review

“…De Mulder et al 2018 presented an optimized imaging protocol for CLP patients based on European guidelines to accomplish the concepts of justification and optimization, which can be used as an international recommendation for CLP care programs. [66] In this protocol, the former policy of excessive uncoordinated radiological exposures (both 2D and 3D) by different disciplines leading to high cumulative doses [67] was restructured. One carefully selected CBCT image is able to yield all requested information for several disciplines, replacing a cascade of 2D images.…”

“…Prospective, longitudinal cohort studies are preferred; with assessment of tooth development using radiographs taken at fixed time points. A well-established imaging protocol, as suggested by De Mulder et al 2018, is useful for the availability of radiographs at these time points.…”

Impact of COVID-19 on Cleft Surgical Care

“…Surgeries conducted after 4 months of age, 12 months of age, and 108 months of age (9 years) were classified as late procedures for primary CL repair, primary CP repair, and ABG, respectively. [3][4][5]7,9 ABG augmentations (ABG subgroup), revisional surgeries, and secondary repairs were excluded from this analysis as they do not follow explicit timelines. Untimely surgeries were classified based on their causality and included acute illnesses, difficulties with coordinating patient care, complex pre-existing conditions, COVID-19, dental immaturity (ABG subgroup only), and unspecified.…”

“…7,8 The optimal time to repair alveolar clefts is based on the skeletal maturity of the maxilla which varies patient-to-patient; however, craniofacial surgeons generally aim to correct alveolar cleft deformities before 9 years of age to increase the odds of the lateral incisors erupting normally. 7-9…”

“…7,8 The optimal time to repair alveolar clefts is based on the skeletal maturity of the maxilla which varies patient-to-patient; however, craniofacial surgeons generally aim to correct alveolar cleft deformities before 9 years of age to increase the odds of the lateral incisors erupting normally. [7][8][9] Coronavirus disease 2019 (COVID-19) has greatly impacted healthcare facilities throughout the United States. Despite children exhibiting a milder clinical course than adults, pediatric healthcare facilities saw significant reductions in surgical volume.…”