Protocols in the management of cleft lip and palate: A systematic review

Wadde, Kavita; Chowdhar, Asha; Venkatakrishnan, L.; Ghodake, Dr. Monali; Sachdev, Sanpreet Singh; Chhapane, Dr. Ashwini

doi:10.1016/j.jormas.2022.11.014

Cited by 5 publications

(5 citation statements)

References 29 publications

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“…This fit well with the conclusions drawn from the original studies. One systematic review by Wadde et al evaluated several aspects of cleft care (42), with fistula formation and hypernasality being the outcomes relevant to this review. Only one study was included in the review with regard to these outcomes, the RCT performed by Reddy et al (37), which is also included in our systematic review.…”

Section: Comparison With Results From Systematic Reviewsmentioning

confidence: 99%

A systematic review of differences in outcome between one and two stage palate repair in cleft lip and palate

Cornefjord,

Arnebrant,

Guné

et al. 2023

JPHS

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The aim of this systematic review was to determine whether one-stage palatoplasty for children born with cleft lip and palate shows overall advantages in outcome compared with two-stage palatoplasty. The included studies were controlled studies of syndromic and non-syndromic children born with unilateral cleft lip and palate, bilateral cleft lip and palate, or isolated cleft palate. The interventions studied were one-stage palatoplasty and two-stage palatoplasty starting with the soft palate. The outcomes were facial growth, speech, hearing, presence of fistulae, other complications related to surgery, health-related quality of life, and health economics. In total, 14 original studies were included. Results were dichotomized into showing advantage for one- or two-stage palatoplasty for the respective outcome and compared with the results from six included systematic reviews. No overall advantage for either surgical strategy was found for any of the outcome measures. The certainty of evidence was highest for the presence of fistulae, followed by facial growth and speech. For several outcomes, the quality of the existing evidence was too low to allow for any conclusions to be drawn. Neither one- nor two-stage palatoplasty showed significant advantages in clinical outcomes compared with the other. Other aspects such as ethics, economics, or surgeon’s preference might hence be of more importance. Homogenous choices of outcome measures and defined minimal clinically important differences would facilitate further research.

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Section: Comparison With Results From Systematic Reviewsmentioning

confidence: 99%

A systematic review of differences in outcome between one and two stage palate repair in cleft lip and palate

Cornefjord,

Arnebrant,

Guné

et al. 2023

JPHS

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“…Therefore, despite years of research and different surgical techniques as well as non-surgical techniques using nasal conformers, a gold standard has not been found to date to achieve proper nasal conformation and symmetry. Throughout history, we have found numerous types of conservative techniques to achieve the optimal result, configured from various materials, from acrylics, silicones, and expansion screws; to spongy materials used at different stages of the patient's life 12 .…”

Section: Discussionmentioning

confidence: 99%

Efectividad de un Moldeador Alveolar para Corrección de Colapso Nasal en Pacientes con Labio Hendido.

González Macías,

Metlich Medlich,

García García

et al. 2024

j.maxilo

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Objective: To propose the use of a post-surgical alveolar molder in patients under 4 years of age who have undergone cheiloplasty, aiming for better aesthetic and functional outcomes, using nasal morphometric and photogrammetric studies as measurement references.Materials and methods: This is a before-and-after pilot study conducted at the Oral and Maxillofacial Surgery Service and the Plastic and Reconstructive Surgery Service of Dr.Ignacio Morones Prieto Central Hospital. Patients included in the study were those diagnosed with Cleft Lip and Palate (CLP), presenting clinical data of nasal asymmetry, and aged between 0 and 4 years. An alveolar molder was fabricated using orthodontic wire and self-polymerizing acrylic/monomer according to the size and shape of the patient's nose. The device consists of a wire device with double hooks and a double "V" that will be placed in the frontal region. The evaluation of nasal shape and symmetry was carried out through a photogrammetric study and clinical measurement of nasal height and width. Results:The study included 18 patients, aged between 4 and 39 months, of which 10 presented left-sided clefts, 5 right-sided, and 3 bilateral. The study demonstrated that the use of an alveolar molder in patients with cleft lip and palate resulted in significant improvements in nasal symmetry and morphology, evidenced by increases in vertical and angular dimensions; specifically, the PnC-SarSal distance increased from 18.61 ± 1.78 mm to 20.50 ± 1.64 mm and the height of the right nasal fossa from 6.97 ± 1.49 mm to 8.22 ± 1.68 mm, with notable angular improvements in the Nlr-Midline and Nll-Midline distances. Conclusions:The alveolar molder proposed in this study proved to be a useful tool for improving nasal symmetry and morphology in these types of patients.

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“…While the Grayson NAM appliance is a common PSIO treatment option, DynaCleft offers advantages such as ease of use and application, and it does not interfere with an infant’s feeding [ 3 ]. However, no randomized clinical trials have been published that compare the use of NAM with DynaCleft, as indicated by two recent systematic reviews [ 12 , 13 ]. Two cohort studies [ 9 , 10 ] have compared NAM to DynaCleft, and one retrospective study compared DynaCleft to no treatment [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to recent systematic reviews on PSIO treatment modalities, there are no randomized clinical trials that compare the effectiveness of NAM and DynaCleft in treating unilateral CLP (UCLP) [ 12 , 13 ]. The literature shows considerable variation in assessing the effectiveness of PSIO, lacking a unified consensus on the appropriate measures to use.…”

Section: Introductionmentioning

confidence: 99%

The nasoalveolar molding technique versus DynaCleft nasal elevator application in infants with unilateral cleft lip and palate

Bahaa,

El-Bagoury,

Khaled

et al. 2024

Arch Craniofac Surg

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Background: The introduction of presurgical nasoalveolar molding represented a significant departure from traditional molding methods. Developed by Grayson and colleagues in 1993, this technique combines an intraoral molding device with a nasal molding stent. This study aimed to compare the Grayson nasoalveolar molding appliance versus DynaCleft appliance as two methods of presurgical nasoalveolar molding.Methods: A single-blinded, randomized, parallel-arm clinical trial was conducted. Sixteen infants with complete unilateral cleft lip and palate were enrolled and divided into two groups of eight. Group 1 was treated with a modified Grayson nasoalveolar molding appliance that included a nasal stent, while group 2 was treated with DynaCleft elastic adhesive tape and an external nasal elevator. Standardized digital photographs of each infant were taken at baseline and post-treatment using a professional camera. Nine extraoral anthropometric measurements were obtained from each image using image measurement software.Results: The modified Grayson nasoalveolar appliance demonstrated a more significant improvement compared to DynaCleft in terms of alar length projection (on both sides), columella angle, and nasal tip projection. Symmetry ratios also showed enhancement, with significant improvements observed in nasal width, nasal basal width, and alar length projection (<i>p</i>< 0.05).Conclusion: Both the modified Grayson nasoalveolar appliance and DynaCleft appear to be effective presurgical infant orthopedics treatment options, demonstrating improvements in nasolabial aesthetics. The modified Grayson appliance, equipped with a nasal stent, improved nasal symmetry more effectively than DynaCleft, resulting in a straighter columella and a more medially positioned nasal tip.

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Protocols in the management of cleft lip and palate: A systematic review

Cited by 5 publications

References 29 publications

A systematic review of differences in outcome between one and two stage palate repair in cleft lip and palate

A systematic review of differences in outcome between one and two stage palate repair in cleft lip and palate

Efectividad de un Moldeador Alveolar para Corrección de Colapso Nasal en Pacientes con Labio Hendido.

The nasoalveolar molding technique versus DynaCleft nasal elevator application in infants with unilateral cleft lip and palate

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