Continuous circular closure in unilateral cleft lip and plate repair in one surgery

Benitez, Benito K.; Brudnicki, Andrzej; Surowiec, Zbigniew; Singh, Rasnik; Nalabothu, Prasad; Schumann, D.; Mueller, Andreas

doi:10.1016/j.jcms.2021.07.002

Cited by 9 publications

(13 citation statements)

References 59 publications

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“…Primary alveolar bone grafting [ 10 ] and one-stage two-flap palatoplasty with secondary healing of lateral releasing incisions were abandoned. Following passive presurgical therapy, a one-stage protocol with bipedicled palatal flaps was implemented and modified for a continuous two-layer closure and primary healing [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…To limit growth inhibition by cleft repair, staged protocols have been developed to postpone surgical interventions to time periods with less of an impact on growth [ 3 ]. In contrast, one-stage protocols, combining lip and palate closure, focus on reducing patient and parent burden, early normal function, shortening anesthesia time and lowering overall healthcare costs [ 4 , 5 , 6 , 7 ]. Technical differences among one-stage protocols might have an influence on craniofacial growth and should therefore be investigated.…”

Section: Introductionmentioning

confidence: 99%

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Craniofacial Growth at Age 6–11 Years after One-Stage Cleft Lip and Palate Repair: A Retrospective Comparative Study with Historical Controls

et al. 2022

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Background: Primary alveolar bone grafting inhibits craniofacial growth. However, its effect on craniofacial growth in one-stage cleft lip and palate protocols is unknown. This study investigated whether primary alveolar bone grafting performed during one-stage unilateral cleft lip and palate repair negatively affects growth up to 6–11 years old. Methods: The craniofacial growth, dental arch relationship and palatal morphology at 6–11 years old in children with unilateral cleft lip and palate were compared retrospectively. Two cohorts after a one-stage protocol without (Group A) and with (Group B) primary bone grafting at the same center were compared. Further, cephalometric measurements for growth were compared with an external cohort of a one-stage protocol and a heathy control. Results: Group A comprised 16 patients assessed at 6.8 years (SD 0.83), and Group B comprised 15 patients assessed at 9 years (SD 2.0). Cephalometric measurements indicated similar sagittal maxillary growth deficits and a significant deviation in maxillary inclination in both groups compared to the healthy group. Moderate to severe changes in palatal morphology were observed in 70% of the members in both groups. Conclusion: Omitting primary alveolar bone grafting under the one-stage protocol with two-flap palatoplasty studied did not improve growth at 6–11 years. The results implicate two-flap palatoplasty with secondary healing as having greater adverse effects on growth than primary alveolar bone grafting. Dental and palatal morphology was considerably compromised regardless of primary alveolar bone grafting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Craniofacial Growth at Age 6–11 Years after One-Stage Cleft Lip and Palate Repair: A Retrospective Comparative Study with Historical Controls

et al. 2022

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“…This is due to the continuous reduction of the cleft by approximation of the greater and lesser segment observed under presurgical treatment [ 22 ], compensating for the growth of the segments. The second plate is worn until combined cleft nose, lip, and palate repair in one single surgical intervention is performed after eight months of age [ 6 , 23 ]. Early secondary alveolar bone grafting is then performed around five to six years of age before the permanent teeth adjacent to the cleft erupt.…”

Section: Discussionmentioning

confidence: 99%

“…Presurgical orthopedics has a long history of development and application in patients with cleft lip and palate [ 1 , 2 , 3 , 4 ]. More than half a century after McNeil’s introduction, presurgical orthopedic therapy aims to narrow the cleft, align the alveolar cleft segments, and improve nasal symmetry to allow for surgical repair under minimum tension and tissue shift [ 1 , 5 , 6 ]. Various appliances exist with pin retained active plates on one end of the spectrum and passive plates on the other [ 2 , 3 , 4 , 5 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

A Point-of-Care Digital Workflow for 3D Printed Passive Presurgical Orthopedic Plates in Cleft Care

Zarean

Thieringer

et al. 2022

Children

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Cleft lip and palate are one of the most common congenital craniofacial malformations. As an initial treatment, presurgical orthopedics is considered standard treatment at many cleft centers. Digital impressions are becoming feasible in cleft care. Computer-aided design (CAD) and three-dimensional (3D) printing are manufacturing standards in dentistry. The assimilation of these technologies has the potential to alter the traditional workflow for the fabrication of customized presurgical orthopedic plates. We present a digital workflow comprising three steps: 3D digital image acquisition with an intraoral scanner, open-source CAD modeling, and point-of-care 3D printing for the fabrication of personalized passive presurgical plates for newborns with cleft lip and palate. The digital workflow resulted in patient-related benefits, such as no risk of airway obstruction with quicker data acquisition (range 1–2.5 min). Throughput time was higher in the digital workflow 260–350 min compared to 135 min in the conventional workflow. The manual and personal intervention time was reduced from 135 min to 60 min. We show a clinically useful digital workflow for presurgical plates in cleft treatment. Once care providers overcome procurement costs, digital impressions, and point-of-care 3D printing will simplify these workflows and have the potential to become standard for cleft care.

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“…Presurgical orthopedics using a passive palatal plate were started during the first days after birth and were continued until cleft surgery was performed. The surgical technique consisted of simultaneously repairing the cleft nose, lip, and palate in one single surgical intervention at the age of 8 months ( Benitez et al, 2021 ).…”

Section: Methodsmentioning

confidence: 99%

Histologic Aspect of the Curved Vomerine Mucosa in Cleft Lip and Palate

Benitez

Brudnicki²,

Nalabothu

et al. 2021

The Cleft Palate-Craniofacial Journal

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Background: Common surgical techniques aim to turn the entire vomerine mucosa with vomer flaps either to the oral side or to the nasal side. The latter approach is widely performed due to the similarity in color to the nasal mucosa. However, we lack a histologic description of the curved vomerine mucosa in cleft lip and palate malformations. Methods: We histologically examined an excess of curved vomerine mucosa in 8 patients using hematoxylin–eosin, periodic acid–Schiff, Elastin van Gieson, and Alcian blue stains. Tissue samples were obtained during surgery at 8 months of age. Results: Our histological analysis of the mucoperiosteum overlying the curved vomer revealed characteristics consistent with those of an oral mucosa or a squamous metaplasia of the nasal mucosa, as exhibited by a stratified squamous epithelium containing numerous seromucous glands. Some areas showed a palisaded arrangement of the basal cells compatible with metaplasia of respiratory epithelium, but no goblet cells or respiratory cilia were identified. Abundant fibrosis and rich vascularity were present. Conclusion: The vomer mucosa showed no specific signs of nasal mucosa. These findings should be considered in presurgical cleft orthopedics and palatal surgery for further refinement. Shifting the vomer mucosa according to a fixed physiologic belief should not overrule other important aspects of cleft repair such as primary healing and establishing optimal form and function of palatal roof and nasal floor.

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Continuous circular closure in unilateral cleft lip and plate repair in one surgery

Cited by 9 publications

References 59 publications

Craniofacial Growth at Age 6–11 Years after One-Stage Cleft Lip and Palate Repair: A Retrospective Comparative Study with Historical Controls

Craniofacial Growth at Age 6–11 Years after One-Stage Cleft Lip and Palate Repair: A Retrospective Comparative Study with Historical Controls

A Point-of-Care Digital Workflow for 3D Printed Passive Presurgical Orthopedic Plates in Cleft Care

Histologic Aspect of the Curved Vomerine Mucosa in Cleft Lip and Palate

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