Timing of Cleft Palate Closure Should Be Based on the Ratio of the Area of the Cleft to That of the Palatal Segments and Not on Age Alone

Berkowitz, Samuel; Duncan, Robert T.; Evans, Carla A.; Friede, Hans; Kuijpers-Jagtman, Anne Marie; Prahl-Anderson, Birte; Rosenstein, Sheldon W.

doi:10.1097/01.prs.0000161673.31770.23

Cited by 65 publications

(36 citation statements)

References 8 publications

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“…Current methods of treatment favor staged treatment , ie, closing the lip cleft in 2 stages: the first year and the palate at a later age usually between 18 and 24 months 8 or sometimes earlier, or even later, depending on the 15% to 20% ratio of cleft to palate size. Doing so offers a more encouraging prognosis than that of the surgeons who closed the palatal cleft before 1 year, a practice that has prevailed for the last 50 years.…”

Section: What We Learnedmentioning

confidence: 99%

The Facial Growth Pattern and the Amount of Palatal Bone Deficiency Relative to Cleft Size Should Be Considered in Treatment Planning

Berkowitz

2016

Plastic and Reconstructive Surgery - Global Open

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Background:The aim of this study is to determine the best surgical/orthodontic treatment plan for the complete bilateral and unilateral cleft lip and palate patient to achieve all treatment goals of facial aesthetics, speech, dental function, and psychosocial development.Methods:Review of 40 years of serial complete bilateral cleft lip and palate and complete unilateral cleft lip and palate dental casts and photographs from birth to adolescence, with serial cephs starting at 4 years. This was part of a multicenter international 3-dimensional palatal growth study of serial dental casts of patients who developed good speech, occlusion, and facial growth.Results:Nasoalveolar molding and gingivoperiosteoplasty were introduced without proven longitudinal benefits. The procedure bodily retruded the premaxilla, which “telescoped” backward causing synostosis at the premaxillary vomerine suture. The resulting midfacial recessiveness with an anterior dental crossbite can only be corrected by midfacial protraction or a Le Fort I surgery.Conclusions:Staged orthodontic/surgical treatment limiting premaxillary retraction forces to lip adhesion or forces that cause only premaxillary ventroflexion produce the best results. The palatal cleft should be closed between 18 and 24 months when the ratio of the cleft to the palatal size medial to the alveolar ridge is at least 10%. The protruding premaxilla should only be ventroflexed but never bodily retruded. The facial growth pattern and degree of palatal bone deficiency are the main items to be considered in treatment planning.

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Section: What We Learnedmentioning

confidence: 99%

The Facial Growth Pattern and the Amount of Palatal Bone Deficiency Relative to Cleft Size Should Be Considered in Treatment Planning

Berkowitz

2016

Plastic and Reconstructive Surgery - Global Open

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“…The dimensions and shape of the cleft alveolus and palate play an important role in the outcome of any primary surgery [18]. Different methods are used to measure the cleft dimensions, with some investigators only measuring the separation between two segments anteriorly, whereas others measure the cleft width at several palatal levels or measure the cleft area in relation to the total palatal area [2][3][4][5][6][7][10][11][12][13][18][19][20]. Aberrant anatomical structures on dental casts pose a major challenge to the clinician attempting to identify and determine the correct anatomical landmarks [20][21][22].…”

Section: Three-dimensional Analysismentioning

confidence: 99%

“…The projection of 3D points onto a 2D plane is affected by the orientation of the cast and the plaster-cast surface area. Most measurements in cleft lip and palate studies, such as of the inclination of the palatal shelves or the surface area of the palatal segments, are 3D in nature and therefore only strictly valid when evaluated in three dimensions [13,14].…”

Section: Introductionmentioning

confidence: 99%

Three-Dimensional Morphological Changes of the True Cleft under Passive Presurgical Orthopaedics in Unilateral Cleft Lip and Palate: A Retrospective Cohort Study

Nalabothu

Benitez

Dalstra³

et al. 2020

JCM

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The aim of this cohort study was to quantify the morphological changes in the palatal cleft and true cleft areas with passive plate therapy using a new analysis method based on three-dimensional standardized reproducible landmarks. Forty-five casts of 15 consecutive patients with complete unilateral cleft lip and palate were laser scanned and investigated retrospectively. The landmarks and the coordinate system were defined, and the interrater and intrarater measurement errors were within 1.0 mm. The morphological changes of the cleft palate area after a period of 8 months of passive plate therapy without prior lip surgery are presented graphically. The median decrease in cleft width was 38.0% for the palatal cleft, whereas it was 44.5% for the true cleft. The width of the true and palatal cleft decreased significantly over a period of 8 months. The true cleft area decreased by 34.7% from a median of 185.4 mm2 (interquartile range, IQR = 151.5–220.1) to 121.1 mm2 (IQR = 100.2–144.6). The palatal cleft area decreased by 31.5% from a median of 334 mm2 (IQR = 294.9–349.8) to 228.8 mm2. The most important clinical considerations are the reproducibility and reliability of the anatomical points, as well as the associated morphological changes. We propose using the vomer edge to establish a validated measuring method for the width, area, and height of the true cleft.

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“…Avec un bon contrôle de la croissance, on pérennise le résultat des interventions chirurgicales et on obtient un équilibre optimum des maxillaires. La comparaison des l'état initial et de l'état final permet d'évaluer l'efficacité du traitement [1][2][3][4][5][6].…”

Section: Objectifsunclassified

“…Par la suite, avec le traitement orthodontique, il complète le traitement des autres spécialistes du groupe multidisciplinaire participant à la prise en charge de ces patients. Pour les étapes tardives (patients n'ayant pas bénéficié d'une prise en charge précoce), il contribue à la réhabilitation et cherche à obtenir un état stable à long terme du patient et l'amène à un état de santé physique et mental optimal [1][2][3][4][5][6].…”

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Traitement orthodontique dans les fentes labio-palatines au Mexique

Beljour

Domínguez

Ramírez

et al. 2012

Med Buccale Chir Buccale

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Résumé -Les patients ayant une fente labio-palatine (FLP) présentent diverses anomalies maxillo-faciales, associées à un faible potentiel de croissance et de développement des structures. En fonction de leurs manifestations phénotypiques, les FLP sont classées en formes modérées ou sévères. Pendant toutes les étapes de la croissance, les patients doivent être intégrés dans un programme individualisé de contrôle et de stimulation. Abstract -Orthodontic care and treatment in cleft lip and palate patients. The cleft lip and palate patients present alterations accompanied by a low growth and development potential of the maxillofacial structures. Depending on the phenotypic manifestations, they can be mild or severe. That is why these patients need an integrated and individualized program of control and stimulation during the growing stage. On the other hand, it is well known that the secondary problems resulted by surgical procedures may increase these alterations, making the orthodontics therapy being a great importance to obtain the correct balance, harmony and satisfactory results. This article presents the general orthopedics and orthodontics indicated to achieve optimal results in different stages during development and evolution of the multidisciplinary treatment.L'orthodontiste joue un rôle fondamental dans le traitement intégré des patients ayant des malformations craniomaxillo-faciales. Il contribue très tôt à la réhabilitation des patients ayant une fente labio-palatine (FLP) ou une autre anomalie dento-faciale. Il stimule la croissance et le déve-loppement des structures formant cette région, en utilisant des appareils orthopédiques fonctionnels. Par la suite, avec le traitement orthodontique, il complète le traitement des autres spécialistes du groupe multidisciplinaire participant à la prise en charge de ces patients. Pour les étapes tardives (patients n'ayant pas bénéficié d'une prise en charge

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Timing of Cleft Palate Closure Should Be Based on the Ratio of the Area of the Cleft to That of the Palatal Segments and Not on Age Alone

Cited by 65 publications

References 8 publications

The Facial Growth Pattern and the Amount of Palatal Bone Deficiency Relative to Cleft Size Should Be Considered in Treatment Planning

The Facial Growth Pattern and the Amount of Palatal Bone Deficiency Relative to Cleft Size Should Be Considered in Treatment Planning

Three-Dimensional Morphological Changes of the True Cleft under Passive Presurgical Orthopaedics in Unilateral Cleft Lip and Palate: A Retrospective Cohort Study

Traitement orthodontique dans les fentes labio-palatines au Mexique

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