From Birth to Maturity: A Group of Patients Who Have Completed Their Protocol Management. Part III. Bilateral Cleft Lip-Cleft Palate

Six-year-old children with bilateral cleft lip and palate (BCLP) were examined to evaluate the need for orthognathic surgery later in life and to cephalometrically compare the craniofacial morphology of those needing orthognathic surgery with those not needing surgery. Design Retrospective longitudinal study. Patients Thirty-eight consecutive nonsyndromic patients with BCLP (29 boys). Main Outcome Measures Children with BCLP were analyzed from lateral cephalograms taken at a mean age of 6.1 years (range 5.8 to 6.6 years). The need for orthognathic surgery in these patients was determined from hospital records at the mean age of 18.2 years (range 15.5 to 20.2 years). Student's t test and chi-square test were used in statistical analysis. Results The overall frequency of maxillary or bimaxillary osteotomy was 66% (25 of 38). The patients needing maxillary or bimaxillary osteotomies had flatter soft tissue profiles (n-sn-gn), shorter lower facial heights (ANS-ME), and smaller mean values of the ANB angle (sagittal maxillomandibular relationship) at the age of 6 years than those who did not. ANB angle was the most significant predictor for later osteotomy. Despite individual variation, all children (n = 13) whose ANB angle was less than 7°, needed later orthognathic surgery; whereas, none of those whose ANB angle was greater than 12.5° (n = 6) needed maxillary osteotomies. Conclusions Two thirds of children with BCLP needed orthognathic surgery later in life. Half of the children who needed later osteotomies could be identified at the age of 6 years by having an ANB angle less than 7°.

Section: Discussionsupporting

confidence: 72%

mentioning

confidence: 98%

Craniofacial Cephalometric Morphology and Later Need for Orthognathic Surgery in 6-Year-Old Children with Bilateral Cleft Lip and Palate

Heliövaara

Leikola

Hukki

2013

“…The homogeneity of cleft patients was not present in some studies (Meyer-Marcotty and Stellzig-Eisenhauer, 2009; Chung et al, 2013; Foo et al, 2013). It has been reported that facial growth is different in patients with bilateral cleft lip and palate than in those with unilateral cleft lip and palate (David et al, 2011). This may indicate that different cleft types could affect the result of the final outcome, and heterogeneity in case selection should be avoided (Anderson et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Facial Appearance in Patients with Cleft Lip and Palate by Laypeople and Professionals: A Systematic Literature Review

Zhu

Jayaraman

Khambay

2016

Objective To identify whether laypeople and professionals rate the facial appearance of patients with cleft lip and palate (CLP) similarly based on viewing full facial images. Design Several electronic databases were searched. A hand search was performed among reference lists and relevant journals. Studies that assessed the full facial appearance of patients with CLP based on two-dimensional (2D) photographs, 3D images, or clinical examination by laypeople and professionals using a visual analog scale (VAS) or a categorical rating scale were included. Two authors independently assessed articles using methodologic-quality scoring protocol. Results Eleven articles were included in qualitative synthesis, including four high-level and seven moderate-level papers. Three studies found that laypeople were more critical than professionals, three found there was no significant difference between laypeople and professionals, and five reported that professionals were more critical than laypeople when assessing facial appearance of patients with CLP. Conclusions It still remains unknown whether laypeople are more or less critical than professionals when rating facial appearance of patients with repaired CLP. Professionals are more familiar with the esthetic outcomes and difficulties of treating patients. The opposite maybe true for laypeople; this disparity between what is achievable by professionals and what is expected by laypeople may be a source of dissatisfaction in facial appearance outcome. Further well-designed studies should be carried out to address this question and the clinical significance of the difference in rating scores for patients with CLP.

“…The incidence of fistulae has also been reported to be higher in more extensive clefts (Sommerlad, 2003; Hardwicke et al, 2014; Khan et al, 2018). David et al's (2011) long-term study of individuals with BCLP indicated that they have worse speech outcomes than children with UCLP who had been cared for and assessed by the same team. He related this to tissue deficiency.…”

Section: Introductionmentioning

confidence: 99%

The Method of Surgical Lip Repair Affects Speech Outcomes in Children With Bilateral Cleft Lip and Palate

Peryer

Slator

Thomson

et al. 2020

Objective: It was hypothesized that lip repair protocols in children with bilateral cleft lip and palate (BCLP) would affect development of bilabial consonants /m/ /b/ /p/. This study compared speech outcomes in 2 surgical groups. Design: A retrospective case note investigation. Setting: UK Cleft Centre (2000-2009). Patients: Forty-nine children with complete BCLP, of whom 26 had a 1-stage and 23 a 2-stage bilateral cleft lip repair. Interventions: One-stage cleft lip repair versus a 2-staged cleft lip repair. Main Outcome Measures: Bilabial consonant production at 18 months, 3 and 5 years of age. Cleft Speech Characteristics (CSCs) at age 5. Results: At age 18 months, 81% of the 1-stage lip repair group and 4% of the 2-stage lip repair group produced bilabial consonants ( P <·0001, Fisher test). At age 3 years, 81% of the 1-stage and 26% of the 2-stage lip repair groups produced bilabial consonants ( P =·0133, Fisher test). At age 5 years, both groups had similar bilabial consonant production, but children in the 2-stage lip repair group had more frequent and severe CSCs ( P = ·0037, χ2). Conclusion: A 1-stage lip repair for children with complete BCLP resulted in better bilabial consonant production at 18 months and 3 years of age than a 2-stage lip repair. At age 5 years both groups had bilabial consonants but children in the 2-stage lip repair group had worse CSCs. The surgical protocol for bilateral cleft lip repair affected speech outcome in children with BCLP.