Dental Cast Study of Adult Patients with Untreated Unilateral Cleft Lip or Cleft Lip and Palate in Indonesia Compared with Surgically Treated Patients in The Netherlands

Abstract

To determine differences in maxillary and dentoalveolar relationships between untreated and treated patients having unilateral clefts of the lip and alveolus (UCLA) or lip and palate (UCLP), dental cast assessments were done on 70 untreated adult Indonesian patients (UCLA-I, UCLP-I) and 67 Dutch patients, surgically treated in infancy (UCLA-D, UCLP-D). The Indonesian group consisted of 44 UCLA-I and 26 UCLP-I patients, and the Dutch group of 24 UCLA-D and 43 UCLP-D patients. In the UCLA-I patients, deformities occurred in that part of the dentoalveolar complex that surrounds the cleft. Lip repair in the UCLA-D group more frequently caused deformities in the incisor and buccal areas on the cleft side. In the UCLP-I patients, deformities were present in the incisor and cuspid areas on the cleft side. The buccal segments showed collapse both on the cleft and noncleft sides. Lip and palate repair in the UCLP-D group caused significantly more deformities in the incisor, cuspid, and buccal areas up to the level of the first molars, both on the cleft and noncleft sides. Surgical treatment seems to cause maxillary and dentoalveolar deformities up to the first molars more frequently, but these are not as pronounced as one would expect: following the practiced surgical regimen, the deformities were usually mild. Negative effects of surgical intervention seem to be antagonized by the restored integrity of the lip and palate leading to orientation of maxillary parts and correction of tongue position, which in turn has a molding effect on the maxilla and mandible.

Tissue engineering strategies combining molecular targets against inflammation and fibrosis, and umbilical cord blood stem cells to improve hampered muscle and skin regeneration following cleft repair

“…The orbicularis oris normally functions as a sphincter but, in a cleft lip, it pulls the two portions of the lip laterally leading to an imbalance between lip and tongue pressure. When a cleft lip is not surgically corrected at a young age, the anterior teeth will often become malpositioned …”

“…When a cleft lip is not surgically corrected at a young age, the anterior teeth will often become malpositioned. 39 The superficial fibers of the orbicularis oris muscle are oriented parallel to the cleft, medial towards the columella and lateral to the alar base. The fibers at the medial side are deficient.…”

Avaliação dos arcos dentários com e sem fissuras labiopalatinas em crianças de 3 a 9 meses

“…Neste trabalho, foi possível coletar modelos de gesso para análise de pacientes com fissura pré-forame incisivo bilateral completa, no entanto, não foi possível encontrar trabalhos sobre as dimensões dos arcos dentários que tivessem amostra de pacientes com fissura pré-forame incisivo bilateral completa. A maioria das pesquisas em que as medidas dos arcos dentários foram avaliados utilizou-se a fissura transforame unilateral para análise ou a análise foi a comparação com outro tipo de fissura, sem confrontar os dados com um grupo sem fissura labiopalatina (Pruzansky e Friede 1975, Spauwen et al 1993, Suzuki et al 1993, Honda et al 1995, Han et al 1995, Peltomaki et al 2001, DiBiase et al 2002, Huang et al 2002, Braumann et al 2003, Simionato et al 2003, Faraj e André 2007, Carrara 2011, Chiu et al 2011. Além disso, pesquisas abordando o crescimento e desenvolvimento da maxila têm amostras inferiores a 50 pacientes (Pruzansky e Friede 1975, Suzuki et al 1993, Spauwen et al 1993, Han et al 1995, Heidbuchel e Kuijpers-Jagtman 1996, Peltomaki et al 2001, DiBiase et al 2002, Huang et al 2002, Braumann et al 2003, Faraj e André 2007, Krey et al 2009, Chiu et al 2011 2012) e poucos deles foram realizados com crianças na primeira infância (Peltomaki et al 2001, Huang et al 2002, Braumann et al 2003, Krey et al 2009, Carrara 2011, Chiu et al 2011.…”

“…A presença de comunicação entre as cavidades nasal e oral pode ser um fator de risco significativo para a aspiração do material de moldagem e de desconforto respiratório (Grayson e Maull 2006 (Spauwen et al 1993, Suzuki et al 1993, Simionato et al 2003, Thilander 2009, Ye et al 2012, o que poderia explicar o pequeno número de trabalhos existentes na área, especialmente com crianças na primeira infância.…”

“…negativo, em longo prazo, dos procedimentos cirúrgicos.SegundoSpauwen et al (1993), a análise de um indivíduo adulto com fissura labiopalatina não operado evidencia que há maior crescimento do complexo maxilo-mandibular em relação àqueles que tiveram a fissura operada. Comparando o crescimento da maxila de indivíduos adultos não operados e operados, os autores constataram que, após o tratamento cirúrgico,…”